A paediatric telecardiology service for district hospitals in south-east England: an observational study.

The attached article is a Publisher version of the final published version which may be accessed at the link below. Copyright © 2010 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reservedOBJECTIVES: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements. DESIGN: Prospective cohort study over 15 months. SETTING: Four district hospitals in south-east England and a London paediatric cardiology centre. PATIENTS: Babies and children. INTERVENTION: A telecardiology service introduced alongside outreach clinics. MEASUREMENTS: Clinical outcomes and mean NHS costs per patient. RESULTS: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days). CONCLUSION: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project

My Care, I Care: A study of what people with HIV value about NHS HIV services across London

Duration: January 2012 - March 2013 As part of a larger review of HIV services in London, the London Specialised Commissioning Group (SCG) commissioned Sigma Research to investigate the views of people with diagnosed HIV about the London NHS HIV services provided to them. The final report from the research, which included a large-scale self-completion survey and eight focus groups, is available to download here. It is also available in printed format, free to UK addresses here. Almost 1400 people with diagnosed HIV self-completion the survey which was available in HIV clinics and online from early February to the end of July 2012. The survey covered: demographics, current service use, motivations for service choice, aspirations for service development and broader social care needs. Sampling and recruitment were controlled in an attempt to ensure a sample broadly representative of the population of people using HIV clinical services in London and to ensure representation from all 28 London clinics. The survey was promoted online by HIV organisations and some HIV clinics. In addition paper copies of the survey were administered by dedicated fieldworkers in all the 28 specialist HIV out-patients clinics in Greater London. Eight focus groups with key groups of people with HIV were used to investigate in more detail motivations for service use, satisfaction with services and aspirations and suggestions for service development

What do you need? 2007-08 findings from a national survey of people with diagnosed HIV

Over the past twenty-five years, both the needs of people with diagnosed HIV and our understanding of them have changed dramatically. During this time there have been many assessments of need, usually within specific geographic boundaries (such as Primary Care Trusts) but no consistent approach to describing needs has been adopted. Most needs assessments have been shaped by a variety of local factors, including the profile of existing services. This study provides an insight into the needs of people with diagnosed HIV living in the UK, based on a final sample of 1777 people. The approach taken to measuring and describing need is the same as our previous national survey (Weatherburn et al. 2002). This approach was shaped by our earlier qualitative studies exploring the experience of people with diagnosed HIV in the early days of anti-HIV treatments (Anderson et al. 2000, Anderson & Weatherburn 1999, Anderson & Weatherburn 1998). While this study uses the same methods as our 2001-2002 survey we do not draw direct comparisons with our previous data or discuss change over time. The limitations of self-completion surveys using convenience samples make change comparisons hazardous. However, it is worth noting that in any comparison with our prior data (Weatherburn et al. 2002) current levels of need very rarely seem lower than we have previously reported. The range and extent of medical and social care, support and information needs we present here reveal significant challenges for service commissioners and providers. The first challenge is to avoid drawing quick conclusions about what the patterns of need mean for service commissioning and delivery. Needs have deliberately been separated from service use because the question of what services are ‘needed’ cannot be answered simply by identifying the extent of personal needs. The overall pattern of need is a useful starting point, but this pattern is complex

Collapsing Shells and the Isoperimetric Inequality for Black Holes

Recent results of Trudinger on Isoperimetric Inequalities for non-convex bodies are applied to the gravitational collapse of a lightlike shell of matter to form a black hole. Using some integral identities for co-dimension two surfaces in Minkowski spacetime, the area $A$ of the apparent horizon is shown to be bounded above in terms of the mass $M$ by the $16 \pi G^2 M^2$, which is consistent with the Cosmic Censorship Hypothesis. The results hold in four spacetime dimensions and above.Comment: 16 pages plain TE

Plus One: HIV diagnosis and disclosure

Plus One: HIV sero-discordant relationships among black African people in England (NAHIP) Duration: September 2010 - November 2011 Plus One involved in-depth, face-to-face interviews with black African people living in England who were in relationships where one person had diagnosed HIV and the other did not (ie. HIV serodiscordant)

Plus One: Sex and risk

Plus One: HIV sero-discordant relationships among black African people in England (NAHIP) Duration: September 2010 - November 2011 Plus One involved in-depth, face-to-face interviews with black African people living in England who were in relationships where one person had diagnosed HIV and the other did not (ie. HIV serodiscordant)

Plus One: Managing the relationship

Plus One: HIV sero-discordant relationships among black African people in England (NAHIP) Duration: September 2010 - November 2011 Plus One involved in-depth, face-to-face interviews with black African people living in England who were in relationships where one person had diagnosed HIV and the other did not (ie. HIV serodiscordant)

Plus One: Executive Summary

Plus One: HIV sero-discordant relationships among black African people in England (NAHIP) Duration: September 2010 - November 2011 Plus One involved in-depth, face-to-face interviews with black African people living in England who were in relationships where one person had diagnosed HIV and the other did not (ie. HIV serodiscordant)