The impact of co-located NHS walk-in centres on emergency departments

Objectives: To determine the impact of establishing walk-in centres alongside emergency departments on attendance rates, visit duration, process, costs and outcome of care. Methods: Eight hospitals with co-located emergency departments and walk-in centres were compared with eight matched emergency departments without walk-in centres. Site visits were conducted. Routine data about attendance numbers and use of resources were analysed. A random sample of records of patients attending before and after walk-in centres opened were also assessed. Patients who had not been admitted to hospital were sent a postal questionnaire. Results: In most sites, the walk-in centres did not have a distinct identity and there were few differences in the way services were provided compared with control sites. Overall, there was no evidence of an increase in attendance at sites with walk-in centres, but considerable variability across sites. The proportion of patients managed within the four-hour NHS target improved at sites both with and without walk-in centres. There was no evidence of any difference in re-consultation rates, costs of care or patient outcomes at sites with or without walk-in centres. Conclusions: Most hospitals in this study implemented the walk-in centre concept to a very limited extent. Consequently there was no evidence of any impact on attendance rates, process, costs or outcome of care

The role of self-esteem and locus-of-control in determining confession outcomes

Previous research suggests that self-esteem and locus-of-control are inversely related to compliance. There is also research to suggest that low self-esteem and external locus-of-control are associated with interrogative suggestibility. While it is believed that compliance and interrogative suggestibility are risk factors for falsely confessing, previous research has not directly examined the relationship between these personality variables and confession decisions made in an experimental paradigm where ground truth is known. The present study used the Russano paradigm and involved 104 participants recruited through the Glasgow Science Centre. Participants filled out personality questionnaires and a set of cognitive exercises with a confederate. As is standard for the paradigm, they were then accused of cheating. The researcher was not aware of whether participants were guilty or innocent. During the subsequent interview, which was based on conversation management, signed confession statements were sought, with these coded as true or false based on the participant’s condition. Results indicated that having an external locus-of-control was predictive of falsely confessing, rather than denying guilt. Self-esteem and time at which a confession was made did not affect the results. This paper discusses the implications of these findings and the study's limitations. Keywords: Self-esteem, Locus-of-control, Confessions, Individual Differences, Russano Paradig

Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction

Objectives: To explore the impact of establishing walk-in centres alongside emergency departments on patient choice, preference and satisfaction. Methods: A controlled, mixed-method study comparing eight emergency departments with co-located walk-in centres with the same number of ‘traditional’ emergency departments. This paper focuses on the results of a cross-sectional questionnaire survey of users. Results: Survey data demonstrated that patients were frequently unable to distinguish between being treated at a walk-in centre or an A&E department, and even where this was the case, opportunities to exercise choice about their preferred care provider were often limited. Few made an active choice to attend a co-located walk-in centre. Patients attending walk-in centres were just as likely to be satisfied overall with the care they received as their counterparts who were treated in the co-located A&E facility, although a small proportion of walk-in centre users did report greater satisfaction with some specific aspects of their care and consultation. Conclusions: Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an A&E department was to provide patients with more options for accessing healthcare and greater choice, leading in turn to increased satisfaction, this evaluation was able to provide little evidence to support this. The high percentage of patients expressing a preference for care in an established emergency department compared to a new walk-in centre facility raises questions for future policy development. Further consideration should therefore be given to the role that A&E focused walk-in centres play in the Department of Health’s current policy agenda, as far as patient choice is concerned

Variation in detainee risk assessment within police custody across England and Wales

Every time a person is booked into police custody in England and Wales, they are assessed for risk of harm to themselves or others. National guidance is provided on what questions should be asked as part of this process; however, each year there are still instances of serious adverse incidents, self-harm and deaths in custody. The purpose of this study is to look at the extent to which the national guidance is being followed and the extent to which the risk assessment process varies between police forces. A Freedom of Information request was sent to all 43 police forces in England and Wales asking for information on their risk assessment process. This data was then analysed alongside findings from police custody inspection visits conducted by Her Majesty’s Inspectorate of Constabulary. This study provides evidence that the risk assessment process is not consistent across police forces in England and Wales. Not only does the process vary from the national guidance, the content and delivery differs considerably between police forces. The findings highlight a practical problem for police forces in ensuring that risk assessment processes are conducted to a consistent standard and reflect national guidance. The study is, to the authors’ knowledge, the first time that this data has been collated and compare

Investigating the decision-making approach to risk assessment in police custody

When a person is booked into police custody in England and Wales they are assessed for risk of harm to themselves or to others. This risk assessment informs the decision as to what observation level they are placed on, ranging from hourly visits to constant observation for the highest risk detainees. In comparison to the international standard for risk management, there are gaps in the risk assessment process in police custody. Currently, the analysis and evaluation of identified risk is down to the experience and judgement of the Custody Officer, rather than a more structured method. This paper questions whether the process should be more formalized, using a statistical tool rather than relying on expert judgement. This paper uses a mixed methods approach investigating custody record data from three English police forces to identify key risk factors that lead to variances in observation levels, and interviewing sixteen Custody Officers from a further two forces investigating their perspective of the risk assessment process The findings suggest that whilst there are key factors affecting observation level, an entirely statistically based risk assessment process would lack the flexibility to account for the individual and would need to include additional information custody officers consider. It is concluded that further investigation should be conducted into a process which combines an actuarial approach with the intuitive insights gained from expert decision-making

How do NHS organisations plan research capacity development? Strategies, strengths, and opportunities for improvement

Research that is integral into a 'learning healthcare system' can promote cost effective services and knowledge creation. As such, research is defined as a 'core function' in UK health service organisations, and is often planned through research and development (R&D) strategies that aim to promote research activity and research capacity development (RCD). The discussion focuses around the content of ten R&D strategies for healthcare organisations in England and Scotland, with respect to RCD. These organisations were engaged with a research interest network called ACORN (Addressing Organisational Capacity to do Research Network) that included two Scottish Health Boards, four community and mental health trusts, two provincial district hospitals, and two teaching hospitals. We undertook a thematic documentary analysis of the R&D strategies which identified 11 'core activities' of RCD. The potential for building research capacity in these 'core activities' was established by reviewing them through the lens of a RCD framework. Core activities aimed to 'hard wire' RCD into health organisations. They demonstrated a complex interplay between developing a strong internal organisational infrastructure, and supporting individual career planning and skills development, in turn enabled by organisational processes. They also included activities to build stronger inter-organisational relationships and networks. Practitioner, manager and patient involvement was a cross cutting theme. The potential to demonstrate progress was included in plans through monitoring activity across all RCD principles. Strategies were primarily aimed at research production rather than research use. Developing 'actionable dissemination' was poorly addressed in the strategies, and represents an area for improvement. We describe strengths of RCD planning activities, and opportunities for improvement. We explore how national policy and research funders can influence health systems' engagement in research

What do people search for in stuttering therapy: personal goal-setting as a gold standard?

Purpose Stuttering affects people in individual ways, and there are multiple factors which may influence a person’s goals when seeking therapy. Even though there is a common consensus that speech-language pathologists should discuss the individual’s goals and expectations for stuttering therapy and outcomes, few studies have systematically investigated this issue. The aims of the present study were to investigate individual motivations and goal-setting related factors in stuttering therapy. The associations between self-reported impact of stuttering and the participants’ perceptions of stuttering interference in communication, speaking abilities, and relationships with other people were also investigated. Method This study is part of a wider-ranging treatment study of individualized stuttering management tailored to the participants’ personal goals and preferences. A mixed method, multiple single-case design was used to address the research questions. Twenty-one adults, age 21-61 years, took part in a pretherapy interview, which also included two quantitative measures: the Client Preferences for Stuttering Therapy-Extended version (CPST-E) and the Overall Assessment of Speakers’ Experience of Stuttering-Adult version (OASES-A). Findings from the study sample was compared with a Norwegian reference group, in order to check for the representativeness of the study sample. Results Quantitative data showed that most participants wanted to focus on both physical and psychological aspects of therapy, and that 95% considered ‘to gain a sense of control over the stuttering’ as important. Participants’ perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. These outcomes aligned well with the finding of avoidance behaviors, such as avoiding words and speaking situations. Qualitative data identified four main areas that the participants wanted to improve: speech fluency, emotional functioning, activity and participation, and understanding of their stuttering. Conclusion The study confirms that multiple and individual factors may influence the person’s goals for therapy. Goals were mainly anchored in participants’ wish of better coping in real world settings. A high degree of avoidance behavior was reported, suggesting that anxiety, and in particular linguistic-related anxiety needs to be taken into account when addressing social anxiety in fluency disorders

Pretransplant CSF-1 therapy expands recipient macrophages and ameliorates GVHD after allogeneic hematopoietic cell transplantation

Host macrophages protect against graft-versus-host disease in part by engulfing donor T cells and inhibiting their proliferation