Improving the quality of mental health services using patient outcome data: Making the most of HoNOS

Efforts to assess and improve the quality of mental health services are often hampered by a lack of information on patient outcomes. Most mental health services in England have been routinely collecting Health of the Nation Outcome Scales (HoNOS) data for some time. In this article we illustrate how clinical teams have used HoNOS data to identify areas where performance could be improved. HoNOS data have the potential to give clinical teams the information they need to assess the quality of care they deliver, as well as develop and test initiatives aimed at improving the services they provide

Ultra-high-resolution observations of circumstellar K I and C2 around the post-AGB star HD 56126

We have used the Ultra-High-Resolution Facility (UHRF) at the AAT, operating at a resolution of 0.35 km s−1 (FWHM), to observe K I and C2 absorption lines arising in the circumstellar environment of the post-AGB star HD 56126. We find three narrow circumstellar absorption components in K I, two of which are also present in C2. We attribute this velocity structure to discrete shells resulting from multiple mass-loss events from the star. The very high spectral resolution has enabled us to resolve the intrinsic linewidths of these narrow lines for the first time, and we obtain velocity dispersions (b-values) of 0.2–0.3 km s−1 for the K I components, and 0.54 ± 0.03 km s−1 for the strongest (and best defined) C2 component. These correspond to rigorous kinetic temperature upper limits of 211 K for K I and 420 K for C2, although the b-value ratio implies that these two species do not co-exist spatially. The observed degree of rotational excitation of C2 implies low kinetic temperatures (Tk ≈10 K) and high densities (n ≈ 106 to 107 cm−3) within the shell responsible for the main C2 component. Given this low temperature, the line profiles then imply either mildly supersonic turbulence or an unresolved velocity gradient through the shell

Ultra-high-resolution measurements of the intrinsic line profiles of interstellar C-2 towards zeta Ophiuchi and HD 169454

We have used the Ultra-High-Resolution Facility at the Anglo-Australian Telescope (AAT), operating at a resolution of 0.35 km s−1 (FWHM), to measure the intrinsic profiles of the Q(2) and Q(4) lines of the (2-0) Phillips band of interstellar C2 towards ζ Oph and HD 169454. The C2 lines were found to be very narrow, with intrinsic velocity dispersions (b-values) in the range 0.25−0.71 km s−1. In the case of ζ Oph, two velocity components (separation 1.10 ± 0.17 km s−1) have been resolved, and found to have rather different linewidths and rotational excitation temperatures. In the case of HD 169454, the data are consistent with a single velocity component, but the well-defined b-value (0.59 + 0.04 km s−1) and low kinetic temperature would then imply supersonic turbulent velocities. One way to avoid this conclusion is to postulate the existence of unresolved velocity structure (or a velocity gradient) within the cloud

Detection of a variable interstellar absorption component towards δ Orionis A

Observations of δ Ori A made with the UHRF in its highest resolution mode (R≈900 000) have revealed the presence of a cool (Tk⩽350 K) variable absorption component at a heliocentric velocity of +21.3 km s−1. The component is detected in Na I D1, where clear hyperfine splitting is seen, and Ca II K. Comparison of our data with existing spectra suggests that the component has consistently increased in strength from 1966 to 1994, and subsequently reduced in intensity by 1999. Following a discussion of the possible origins of this component it is concluded that an interstellar, rather than circumstellar, origin is most likely. This is one of very few detections of variable interstellar absorption reported in the literature, and we suggest an origin within filamentary material associated with the expanding H I shell surrounding the Orion-Eridanus superbubble

High-Resolution Observations of Interstellar NA i and CA II Absorption Lines toward the Scorpius OB1 Association

Observations of Na I and Ca II in absorption toward 22 stars in the Sco OB1 region, obtained at resolution R = 100,000 with a coude echelle spectrograph and 3.3-m camera on the 1.9-m telescope at Mt. Stromlo Observatory during 1986, are reported. The data are presented in extensive tables and graphs and analyzed in detail. Features discussed include (1) strong absorption at heliocentric velocities between 0 and -20 km/sec, (2) sharp discrete components with blueshifted velocities of up to -50 km/sec, and (3) some absorption at positive heliocentric velocities up to +20 km/sec. The (Na I)/(Ca II) ratios are found to be 4-200 for component (1), near 1 for component (2), and 0.4 or less for component (3)

An ultra-high-resolution study of the interstellar medium towards Orion

We report ultra-high-resolution observations graphic of Na I, Ca II, K I, CH and CH+ for interstellar sightlines towards 12 bright stars in Orion. These data enable the detection of many more absorption components than previously recognized, providing a more accurate perspective on the absorbing medium. This is especially so for the line of sight to the Orion nebula, a region not previously studied at very high resolution. Model fits have been constructed for the absorption-line profiles, providing estimates for the column density, velocity dispersion and central velocity for each constituent velocity component. A comparison between the absorption occurring in sightlines with small angular separations has been used, along with comparisons with other studies, to estimate the line-of-sight velocity structures. Comparisons with earlier studies have also revealed temporal variability in the absorption-line profile of ζ Ori, highlighting the presence of small-scale spatial structure in the interstellar medium on scales of ≈10 au. Where absorption from both Na0 and K0 is observed for a particular cloud, a comparison of the velocity dispersions measured for each of these species provides rigorous limits on both the kinetic temperature and turbulent velocity prevailing in each cloud. Our results indicate the turbulent motions to be subsonic in each case. graphic abundance ratios are derived for individual clouds, providing an indication of their physical state

An audit of the quality of inpatient care for adults with learning disability in the UK

OBJECTIVES: To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. SETTING: Nine acute general hospital Trusts and six mental health services. PARTICIPANTS: Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. RESULTS: Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. CONCLUSIONS: Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group

Religious discrimination and common mental disorders in England: a nationally representative population-based study

PURPOSE: Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England. METHODS: We used data from the Adult Psychiatric Morbidity Survey 2007 that represents all adults age 16 years and over living in private households in England. Common mental disorders were ascertained using the Revised Clinical Interview Schedule. Experience of discrimination was assessed by a computer-assisted self-report questionnaire and potential paranoid traits by the Psychosis Screening Questionnaire. RESULTS: From the total of 7318 participants, 3873 (52.4 %) reported adhering to religion. 108 subjects (1.5 %) reported being unfairly treated in the past 12 months due to their religion. Non-Christian religious groups were more likely to report perceived religious discrimination compared to Christians (OR 11.44; 95 % CI 7.36–17.79). People who experienced religious discrimination had increased prevalence of all common mental disorders. There was a two-fold increase in the risk of common mental disorders among people who reported experience of religious discrimination independent of their ethnicity, skin colour or suspected paranoid traits. CONCLUSIONS: The impact of perceived religious discrimination on mental health should be given more consideration in treatment and future preventative policies

Micelle-Promoted Reductive Amination of DNA-Conjugated Amines for DNA-Encoded Library Synthesis

DNA-encoded libraries (DELs) have become a leading technology for hit identification in drug discovery projects as large, diverse libraries can be generated. DELs are commonly synthesised via split-and-pool methodology; thus, chemical transformations utilised must be highly efficient, proceeding with high conversions. Reactions performed in DEL synthesis also require a broad substrate scope to produce diverse, drug-like libraries. Many pharmaceutical compounds incorporate multiple C-N bonds, over a quarter of which are synthesised via reductive aminations. However, few on-DNA reductive amination procedures have been developed. Herein is reported the application of the micelle-forming surfactant, TPGS-750-M, to the on-DNA reductive amination of DNA-conjugated amines, yielding highly efficient conversions with a broad range of aldehydes, including medicinally relevant heterocyclic and aliphatic substrates. The procedure is compatible with DNA amplification and sequencing, demonstrating its applicability to DEL synthesis

Delirium screening and mortality in patients with dementia admitted to acute hospitals

Objectives: Delirium is associated with increased mortality in older adults. National guidance recommends that all people with dementia who are admitted to hospital are screened for delirium. However, the impact of screening for delirium among inpatients with dementia has not been examined. This study aims to examine this relationship.Methods: Secondary analysis of data from 10,047 patients admitted to 199 hospitals in England and Wales that took part in the third round of the National Audit of Dementia. Data on patients with dementia who died during their admission were compared with those who survived. We calculated odds of mortality among those who were screened for delirium, received cognitive testing, and, in those with delirium, an expert clinical review.Results: The mean age of study patients was 84 years (SD = 7.9), 40.1% were male and 82.1% white British. 1,285 patients (12.8%) died during their admission to hospital. Overall, 4,466 (44.5%) patients were screened for delirium, of whom 2,603 (58.6%) screened positive. The odds of mortality were lower in patients who underwent delirium screening (OR: 0.79, 95% confidence interval (CI): 0.69-0.90) and in those receiving cognitive testing (OR: 0.71, 95%CI: 0.61-0.82).Conclusion: These results demonstrate that, among people with dementia who are admitted to hospital, screening for delirium and assessment of cognitive functioning are associated with lower mortality. While we cannot be certain that these associations are causal, the findings support efforts that are being made to increase levels of screening for delirium among people with dementia who are admitted to hospital