Harm-reduction approaches for self-cutting in inpatient mental health settings:development and preliminary validation of the Attitudes to Self-cutting Management (ASc-Me) Scale

IntroductionHarm-reduction approaches for self-harm in mental health settings have been under-researched.AimTo develop a measure of the acceptability of management approaches for self-cutting in mental health inpatient settings.MethodsStage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross-sectional survey and statistical methods from classical test theory informed scale development.Results/FindingsAt stage one N=27 staff and service users participated. At stage two N=215 people (n=175 current mental health practitioners and n=40 people with experience of self-cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity, and internal consistency were acceptable. The harm-reduction approaches 'advising on wound-care' and 'providing a first aid kit' were broadly endorsed; 'providing sterile razors' and 'maintaining a supportive nursing presence during cutting' were less acceptable but more so than seclusion and restraint.DiscussionThe Attitudes to Self-cutting Management scale is a reliable and valid measure that could inform service design and development.Implications for practiceNurses should discuss different options for management of self-cutting with service users. Harm reduction approaches may be more acceptable than coercive measures. This article is protected by copyright. All rights reserved.</p

Real world evaluation of three models of NHS smoking cessation service in England

<p>Abstract</p> <p>Background</p> <p>NHS Stop Smoking Services provide various options for support and counselling. Most services have evolved to suit local needs without any retrospective evaluation of their efficiency.</p> <p>Three local service evaluations were carried out at Bournemouth & Poole Teaching Primary Care Trust (PCT) (PCT1), NHS South East Essex (PCT2) and NHS Warwickshire (PCT3) to describe the structure and outcomes associated with different services.</p> <p>Result</p> <p>Standardised interviews with key personnel in addition to analysis of data from 400 clients accessing the service after 1^stApril 2008 in each PCT. The PCTs varied in geography, population size and quit rate (47%-63%). Services were delivered by PCT-led specialist teams (PCT1), community-based healthcare providers (PCT3) and a combination of the two (PCT2) with varying resources and interventions in each.</p> <p>Group support resulted in the highest quit rates (64.3% for closed groups v 42.6% for one-to-one support (PCT1)). Quit rates were higher for PCT (75.0%) v GP (62.0%) and pharmacist-delivered care (41.0%) where all existed in the same model (PCT2). The most-prescribed therapy was NRT (55.8%-65.0%), followed by varenicline (24.5%-34.3%), counselling alone (6.0%-7.8%) and bupropion (2.0%-4.0%).</p> <p>Conclusion</p> <p>The results suggest that service structure, method of support, healthcare professional involved and pharmacotherapy all play a role in a successful quit. Services must be tailored to support individual needs with patient choice and access to varied services being key factors.</p

Measuring change in health care equity using small-area administrative data - evidence from the English NHS 2001-2008

This study developed a method for measuring change in socio-economic equity in health care utilisation using small-area level administrative data. Our method provides more detailed information on utilisation than survey data but only examines socio-economic differences between neighbourhoods rather than individuals. The context was the English NHS from 2001 to 2008, a period of accelerated expenditure growth and pro-competition reform. Hospital records for all adults receiving non-emergency hospital care in the English NHS from 2001 to 2008 were aggregated to 32,482 English small areas with mean population about 1500 and combined with other small-area administrative data. Regression models of utilisation were used to examine year-on-year change in the small-area association between deprivation and utilisation, allowing for population size, age-sex composition and disease prevalence including (from 2003 to 2008) cancer, chronic kidney disease, coronary heart disease, diabetes, epilepsy, hypertension, hypothyroidism, stroke, transient ischaemic attack and (from 2006 to 2008) atrial fibrillation, chronic obstructive pulmonary disease, obesity and heart failure. There was no substantial change in small-area associations between deprivation and utilisation for outpatient visits, hip replacement, senile cataract, gastroscopy or coronary revascularisation, though overall non-emergency inpatient admissions rose slightly faster in more deprived areas than elsewhere. Associations between deprivation and disease prevalence changed little during the period, indicating that observed need did not grow faster in more deprived areas than elsewhere. We conclude that there was no substantial deterioration in socio-economic equity in health care utilisation in the English NHS from 2001 to 2008, and if anything, there may have been a slight improvement

What next for Shared Lives? Family-based support as a potential option for older people

With an ageing population and limited resources the challenge for policy makers and practitioners is how best to provide for the care and support needs of older people. This article draws on findings from two studies, a scoping study of the personalisation of care services and another which aimed to generate evidence about the potential use of family-based support schemes (Shared Lives, SL) for certain groups of older people. Forty-three schemes participated in a survey to gather information about services provided and the extent to which this included older people and their carers, and six staffs were interviewed across two schemes about issues for expanding provision for older people in their local areas. It was evident that SL schemes were already supporting a number of older people and there was support for expansion from both schemes and local authorities. Adequate resources, awareness raising, management commitment, and a pool of suitable carers would be needed to support any expansion effort. There is also still a need for SL to be more widely known and understood by care managers if it is to be considered part of mainstream provision for older people

Paying for the quantity and quality of hospital care : the foundations and evolution of payment policy in England

Prospective payment arrangements are now the main form of hospital funding in most developed countries. An essential component of such arrangements is the classification system used to differentiate patients according to their expected resource requirements. In this article we describe the evolution and structure of Healthcare Resource Groups (HRGs) in England and the way in which costs are calculated for patients allocated to each HRG. We then describe how payments are made, how policy has evolved to incentivise improvements in quality, and how prospective payment is being applied outside hospital settings

Younger women’s experiences of deciding against delayed breast reconstruction post-mastectomy following breast cancer: An interpretative phenomenological analysis

Most women do not reconstruct their breast(s) post-mastectomy. The experiences of younger women who maintain this decision, although important to understand, are largely absent in the research literature. This interview-based study uses interpretative phenomenological analysis to explore the experiences of six women, diagnosed with primary breast cancer in their 30s/40s, who decided against delayed reconstruction. Findings reported here focus on one superordinate theme (decision-making) from a larger analysis, illustrating that the women’s drive to survive clearly influenced their initial decision-making process. Their tenacity in maintaining their decision is highlighted, despite non-reconstruction sometimes being presented negatively by medical teams. Patient-centred support recommendations are made

When a workforce strategy won't work : critique on current policy direction in England, UK

“The final, definitive version of this article has been published in the Journal, Journal of Intellectual Disabilities: JOID, Vol.14 Issue 4, 2010, Copyright SAGE Publications Ltd on SAGE Journals Online: http://online.sagepub.com/ "This editorial is based on findings from a regional review of educational commissioning, and workforce issues for one Strategic Health Authority in England. Known as the ‘Valued People Project’ (VPP) it commenced in May 2008 and was undertaken in response to expressed concerns by regional key stakeholders regarding education commissioning specifically of pre-registration learning disability nursing, and the contribution of the specialist learning disability health workforce more generally (Gates, 2009). This work was also undertaken as a consequence of the scale and cumulative effect of changes to education, workforce, professional regulation and central health and social care policy that has affected people with learning disabilities, and the services and personnel that support them.Peer reviewedFinal Accepted Versio

Prevalence of severe childhood obesity in England:2006-2013

BACKGROUND: International evidence shows that severe paediatric obesity results in an increased risk of ill health and may require specialised weight management strategies, yet there remains a lack of data on the extent of the problem. OBJECTIVE: To examine the prevalence of severe obesity in children aged 4-5 and 10-11 years, attending English schools between 2006/2007 and 2012/2013. DESIGN: A retrospective analysis of National Child Measurement Programme (NCMP) data. SETTING: Maintained schools in England. PARTICIPANTS: All children aged 4-5 and 10-11 years included in the NCMP dataset. MAIN OUTCOME MEASURES: Prevalence of severe childhood obesity, defined using the 99.6th centile of the British 1990 (UK90) growth reference for body mass index (BMI), analysed by sex, geography, ethnic group and deprivation. RESULTS: The key findings show that in 2012/2013, severe obesity (BMI ≥UK90 99.6th centile) was found in 1.9% of girls and 2.3% of boys aged 4-5 years, and 2.9% of girls and 3.9% of boys aged 10-11 years. Severe obesity prevalence varies geographically and is more prevalent in children from deprived areas, and among those from black ethnic groups. CONCLUSIONS: The findings from this study should help to raise awareness of the prevalence of severe obesity and support the provision of adequate treatment and prevention services both to support children who are already severely obese and reduce the prevalence of extreme weight in the future

Effect of a health-improvement pilot programme for older adults delivered by a professional football club: the Burton Albion case study

Older adults are a priority within policy designed to facilitate healthy lifestyles through physical activities. Golden Goal is a pilot programme of physical activity-led health improvement for older adults, 55 years and older. Activities were delivered at Burton Albion Football Club. Sessions involved weekly moderate to vigorous intensity exercise sessions including exer-gaming (exercise-orientated video-games), indoor bowls, cricket, new age curling, walking football, and traditional board games and skittles. Secondary analysis of data collected through the original programme evaluation of Golden Goal investigated the impact of the intervention on participants. Older adults completed self-reports for demographics, health screening/complications and quality of life. Attendees, n = 23 males (42.6%) and n = 31 females (57.4%) with a mean age of 69.38 (±5.87) (n = 40), ranging from 55-85 years took part. The mean attendance was 7.73 (±3.12) sessions for all participants, (n = 51). Older adults with two or more health complications (n = 22, 42.3%) attended fewer sessions on average (6.91 ± 3.322) compared to those reporting less than two health complications (8.65 ± 2.694). Self-rated health was higher for women (87.32 ± 9.573) vs. men (80.16 ± 18.557), although this was not statistically significant (U = 223.500, p = 0.350). Results support the potential of football-led health interventions for recruiting older adults, including those reporting health problems. © 2014 © 2014 Taylor & Francis