Costs of regulating residential care services for children. Funded/commissioned by: Department of Health and Welsh Office

There are a number of important planned changes in the way that the regulatory function is to be conducted in Englandand Wales in the future (Department of Health, 1998). These include the setting up of independent regional authoritiesresponsible for regulating care services, the extension of regulatory requirements to services not currently covered byregulatory legislation and the setting of standards at a national level. An important issue to consider in this context is thesetting of fees to those who are being regulated. A key recommendation of the Burgner report on regulation and inspectionof social services was that the cost of regulation should be independently reviewed with a view to relating fee levels moreclosely to the actual costs of regulation (Burgner, 1996; p8). This report describes the results of an extension to a Department of Health and Wales Office funded study of health andlocal authority inspection units in England which had investigated the costs of regulating care homes for adults (Netten,Forder and Knight, 1999a). The principal aim of this study was to establish the costs of regulating residential care servicesfor children, in a way that could be used to identify cost-based fees to establishments. Residential care services forchildren were taken to include residential homes, family centres, boarding schools, foster care agencies, and adoptionagencies. Of these services Units currently have statutory responsibility for inspecting homes registered under the Children’s Act1989 and independent boarding schools. The Social Services Inspectorates of the Department of Health and Wales Officeinspect voluntary homes and voluntary adoption agencies. There are no statutory requirements to regulate the otherservices. Under the Children Act 1989 local authorities have the power to charge a “reasonable” fee for registration andinspection of private children’s homes, but voluntary homes, local authority homes and boarding schools do not pay fees. The main data collection was a survey of local authority and joint inspection units undertaken during the autumn of 1999.The data collection built on data collected in the previous survey (Netten, Forder and Knight, 1999a). For this studysupplementary data were collected about unit policies and practice with respect to services for which they had no statutoryresponsibilities, children’s services’ inspector characteristics and a sample week’s time use; and a sample of recentlyundertaken inspections and registrations. Information was also collected about enforcement actions undertaken during theprevious year. SSI inspectors involved also provided equivalent information on the amount of time spent on inspecting andregistering voluntary homes

The economic evidence for advance care planning: systematic review of evidence

Background: Advance care planning (ACP), a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of controlling health spending at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of academic literature. Data sources: We searched for English language peer-reviewed journal articles, 1990 to 2014, using relevant research databases; PubMed; ProQuest; CINAHL Plus with Full Text; EconLit; PsycINFO; SocINDEX with Full Text and International Bibliography of the Social Sciences. Empirical studies using statistical methods in which ACP and costs are analytic variables were included. Results: There are no published cost-effectiveness studies. Included studies focus on health care savings, usually associated with reduced hospital care. ACP may be associated with healthcare savings for some people, in some circumstances, such as people living with dementia in the community, in nursing homes or in areas with high end of life care spending. Conclusions: There is need for clearer articulation of the likely mechanisms by which ACP can lead to reduced care costs or improved cost-effectiveness, particularly for people who retain capacity. There is a need to consider wider costs, including intervention costs and the costs of substitute health, social and informal care. There is no evidence that ACP is more expensive. Economic outcomes should be considered in the context of quality benefits

Role of echocardiography in stress cardiomyopathy diagnosis after tracheal extubation

Stress cardiomyopathy or Takotsubo cardiomyopathy is a new syndrome and still insufficiently recognized among emergency patients, hospitalized patients. Many different physical and emotional stressors are triggers, but individual susceptibility to Takotsubo cardiomyopathy can not be predicted. Takotsubo cardiomyopathy in surgical and critical care population is a huge diagnostic challenge. Apart that these patients are treated in stressful environment and conditions. Postoperatively due to change of consciousness and inability to speak we can not rely on verbal symptoms to make differential diagnosis. Although essential sometimes they can not be submitted to coronary angiography to exclude obstructive coronary disease due many risk factors. So, then we follow clinical course, electrocardiographic, radiologic and echocardiographic dynamic changes, laboratory findings and consiliar opinion to make diagnosis. We represent a case of Takotsubo cardiomyopathy in a 59-years old postmenopausal Caucasian woman after tracheal extubation. She was submitted to surgery of intraabdominal collection evacuation in short general endotracheal anesthesia

Adenosinergic Signaling Alters Natural Killer Cell Functional Responses

Adenosine is a potent immunosuppressive purine metabolite contributing to the pathogenesis of solid tumors. Extracellular adenosine signals on tumor-infiltrating NK cells to inhibit their proliferation, maturation, and cytotoxic function. Cytokine priming imparts upon NK cells distinct activation statuses, which modulate NK anti-tumor immunity and responses to purinergic metabolism. Here, for the first time, we investigated human NK cell responses to adenosinergic signaling in the context of distinct cytokine priming programs. NK cells were shown to be hyper-responsive to adenosine when primed with IL-12 and IL-15 compared to IL-2, exhibiting enhanced IFN-γ expression from CD56bright and CD56dim subsets while modulating the expression of activation marker NKG2D. These responses resulted in signaling that was dependent on mTOR. Adenosine induced upregulation of transcriptional signatures for genes involved in immune responses while downregulating cellular metabolism and other protein synthesis functions that correlate to inhibited oxidative phosphorylation and glycolysis. Overall, our findings show that adenosine acts on specific cellular pathways rather than inducing a broad inhibition of NK cell functions. These responses are dependent on cytokine priming signatures and are important in designing therapeutic interventions that can reprogram NK cell immunometabolism for improved immunotherapies of solid tumors

Phenotypical variability of post-partum reversible cerebral vasoconstriction syndrome

Reversible cerebral vasoconstriction syndrome is recognized increasingly as a complication of the postpartum period. Our series of four cases illustrates its phenotypical variability, summarizes the diagnostic work-up, and outlines potential treatment strategies for this usually benign but sometimes disabling and life-threatening disease

A wide-angle international review of evidence and developments in mental health policy and practice. Evidence review to inform the parameters for a refresh of A Vision for Change (AVFC).

This report presents the results of an evidence review to inform the parameters of the planned refresh of mental health policy in Ireland ten years after the publication of the existing policy framework set out in A Vision for Change (AVFC). The approach encompassed a stock-take of mental health developments in Ireland and a review of international developments, innovation, evidence and good practice. The review had a broad brief covering the various dimensions of the mental health terrain that might have relevance for informing the parameters of a refresh of mental health policy in Ireland. As the timeframe for the exercise was short (approximately 12 weeks) the review took a structured, but pragmatic, broad sweep or ‘wide-angle’ perspective and approach