It\u27s Worse Than We Think: Why It Matters That We Underestimate Depression

This paper will examine specific processes involved within the decision-making process of how to allocate limited health care resources. I will start by discussing how in order to compare and differentiate between health states, we have created ranking systems, based on the health state’s impact on people’s quality of life, which health states need more care, and which can be most effectively treated. We evaluate impact on quality of life by assigning quality weights to years of life lived with that health state, which we call quality-adjusted life years, or QALYs. Next, I will discuss the problems with assigning quality weights to health states; specifically, the disability paradox, meaning the distinct differences between quality weights assigned by non-patients versus patients. After that, I will explain how depression defies the trend of the disability paradox, and causes our prior arguments about why patients and non-patients rate health states different to contradict themselves., This leads me to suggest that we should consider a different way of deciding between different quality weights. I examine the arguments for choosing higher or lower quality weights, and conclude that because we have a moral imperative to provide health care resources to those in need, particularly those who are disadvantaged, we should take the lower quality weights and err on the side of overspending on health states. Ultimately, this will create the greatest change in funding for health states like depression that go against the disability paradox. Finally, I address the economic trade-offs we have to consider if we make the decision to spend more on treating health states

Overtreatment: Is a solution possible?

Screening is a useful tool for identifying potential health issues; however, it can also lead to overtreatment. Consequently, patients are sometimes harmed by unnecessary treatments and there are cost implications. Overtreatment can also occur in other areas of medicine besides screening and sometimes medical interventions are used to improve performance rather than to treat disease. In this paper, a distinction is made between the perspectives of the patient and the government. For patients, autonomy is important, and they can refuse life-saving treatments, assuming they have decision-making capacity. They can also choose to be treated to avoid a very small risk or to improve their performance. For a government with limited funds, it is important to focus on outcomes and fund those screening programmes and other medical interventions that can potentially save the most lives or prevent severe disability. Governments also have the power to legislate to enable a level playing field by prohibiting medications that improve performance, but there is no general consensus about this, and regulations can only be applied to specific, well-defined activities. The problem with overtreatment results from the different interests involved: autonomy is the guiding idea for patients and outcome is the guiding measure for societies. A general solution will not be possible because of these inherent conflicting interests. However, medical research may improve the identification and predictions surrounding any anomalies detected during scans and reduce the problem in practice for specific conditions

At home or in hospital: home treatment and mental health stigma

Background: Stigmatized attitudes towards people with mental illness may influence treatment choice for oneself and others. Aim: To gauge the attitudes of the UK general public towards treatment at home for mental illness and to assess the extent to which non-acceptability was related to stigmatized attitudes. Methods: Two hundred and two (101 female) people living in the UK completed an online (vignette) questionnaire in which we asked demographic details and personal experience of mental illness. To measure stigma, we used an adapted version of the Attitudes to Mental Illness Questionnaire (AMIQ) with vignettes asking about treatment at home and using scales for social distance and poor expectations; participants also filled in the Mental Health Knowledge Schedule (MAKS). Results: Participants did not evidence overall agreement with treatment at home for mental illness (i.e. >0; range = −16-to-+16, Mean (M) = 0.86, 95% confidence interval (CI) = −0.08, 1.80, p = .073), although they showed significant agreement with treatment at home should they experience mental illness themselves (range = −8-to-+8, M = 1.36, CI = 0.82, 1.89, p < .001). Acceptability for treatment at home differed according to specific mental illness considered (range = −4-to-+4); depression (M = 0.47, CI = 0.13, 0.81, p = .006) and alcohol abuse (M = 1.46, CI = 1.14,1.77, p < .001) were considered suitable for being treated at home but schizophrenia was not (M = −0.78, CI = −1.13,−0.43, p < .001). Multivariate analyses revealed that older age and attitudes indicating comfort with less social distance from people with mental illness were independently associated with treatment at home agreeability. Conclusions: Public acceptability of home treatment for mental illness remains ambivalent in the UK, most obviously when considering treatment approaches for individuals other than themselves and for people with schizophrenia. Disagreement with home treatment is particularly evident in younger people and those who prefer less social contact with people with mental illness

Length of stay in a home treatment team

AIMS: The aims were to establish the mean length of stay (LOS) in the Wandsworth home treatment team (HTT), and to identify which variables were associated with LOS. We hypothesised that the variables that are routinely collected via the electronic record system were associated with the LOS. BACKGROUND: Psychiatric HTT's have been set up in all NHS trusts in England. These 24-hour community health services exist to assess and manage patients during a crisis, who would otherwise be admitted to an acute psychiatric ward. HTT's also allow inpatients to be discharged sooner, as their treatment can continue in the community. Currently, research into predictors of LOS in HTT's is limited. Researchers have been exploring whether LOS in psychiatric inpatients can be predicted, but no consistent pattern has emerged. This suggests that LOS is mainly determined by the local service organisation, and the individual circumstances of the patients. METHOD: Routinely collected data about all patients under the care of the Wandsworth HTT during the financial year 2018/2019 were used. Only the first admission per individual was considered. Admissions lasting less than 2 days, or more than 42 days were excluded. This is on the basis that those with a very short LOS had not consented to being treated at home, and those with a very long LOS were due to administrative errors. This resulted in a total of 664 admissions being included in the study. The available data for analysis included age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type. The data were analysed in SPSS version 25 using ANOVA, independent samples T-test, and Pearson's correlation. RESULT: The mean LOS in the Wandsworth HTT was 14.28 days (standard deviation: 8.57). LOS was positively skewed, with a median LOS of 13 days, but 46.5% of admissions had a LOS longer than this. None of the variables (age, gender, diagnosis, HoNOS cluster, ethnicity, nationality, religion, marital status, referral source, employment status, accommodation status, and accommodation type) had a significant association with LOS, but there was a trend for referral source and accommodation type. CONCLUSION: The results from this study suggest that LOS cannot be consistently predicted in the Wandsworth HTT from the routinely collected variables, and that it is the specific circumstances of individual patients that determine their LOS. There was no external funding for this study

Facilitated early discharge in Wandsworth

OBJECTIVE: There is limited research surrounding facilitated early discharge (FD) and Home Treatment Teams (HTTs). This study aimed to compare patients who received FD with patients who were discharged without FD to identify whether there were significant differences in terms of social demographics, illness characteristics, health outcome and treatment duration. Using this data we furthermore aimed to provide proposals to help advance the effectiveness of FD, as well as suggesting concepts of where future research should lie. CASE REPORT: A randomised sample of patients who received FD and patients who were discharged without FD was obtained from a South London Hospital. This was manually narrowed down to patients specifically treated by the Wandsworth Home Treatment Team (WHTT). Socio-demographic and clinical data were then attained from the patients’ electronic records to compare and statistically analyse between the two groups. DISCUSSION: Patients who received FD from the WHTT were found to have significantly less previous psychiatric admissions compared to those who were discharged without FD (p = 0.032). All other variables were found to have no association with FD. CONCLUSION: Having a high number of previous psychiatric admissions seems to be an aspect that decreases the chance of being allocated FD. This variable can be seen as an indicator of severity of illness and a challenging social environment; it could therefore be valuable to take this variable into consideration when allocating FD. Furthermore, total treatment duration was found to not be significantly different for FD and non-FD patients, thus supporting the use of CRHTTs as an equivalent alternative for inpatient admission, however, national scale research should be conducted to strengthen and expand on these findings

Theology and cosmology beyond the Big Bang theory

Wetensch. publicati

The ethical desirability of moral bioenhancement: A review of reasons

Background: The debate on the ethical aspects of moral bioenhancement focuses on the desirability of using biomedical as opposed to traditional means to achieve moral betterment. The aim of this paper is to systematically review the ethical reasons presented in the literature for and against moral bioenhancement. Discussion: A review was performed and resulted in the inclusion of 85 articles. We classified the arguments used in those articles in the following six clusters: (1) why we (don't) need moral bioenhancement, (2) it will (not) be possible to reach consensus on what moral bioenhancement should involve, (3) the feasibility of moral bioenhancement and the status of current scientific research, (4) means and processes of arriving at moral improvement matter ethically, (5) arguments related to the freedom, identity and autonomy of the individual, and (6) arguments related to social/group effects and dynamics. We discuss each argument separately, and assess the debate as a whole. First, there is little discussion on what distinguishes moral bioenhancement from treatment of pathological deficiencies in morality. Furthermore, remarkably little attention has been paid so far to the safety, risks and side-effects of moral enhancement, including the risk of identity changes. Finally, many authors overestimate the scientific as well as the practical feasibility of the interventions they discuss, rendering the debate too speculative. Summary: Based on our discussion of the arguments used in the debate on moral enhancement, and our assessment of this debate, we advocate a shift in focus. Instead of speculating about non-realistic hypothetical scenarios such as the genetic engineering of morality, or morally enhancing 'the whole of humanity', we call for a more focused debate on realistic options of biomedical treatment of moral pathologies and the concrete moral questions these treatments raise