The Effect of a Breath Alcohol Level Measurement on Length of Stay and Clinical Management of Acutely Intoxicated Patients in an Emergency Department

Background Alcohol use and misuse is a common occurrence in Australian society with one in seven Emergency Department Presentations being alcohol related. Despite substantial literature on the treatment and management of acute alcohol intoxication there is no consistency in the approach to treatment and diagnosis. With a lack of literature on the use of breath alcohol level measurement as a diagnostic tool and the focus of Australian Emergency Departments being length of stay, this study compares them alongside the additional interventions provided throughout the patient journey in the Emergency Department. Method A retrospective study of patient case notes from the calendar year 2016 was conducted. Five hundred and ninety episodes of care met the inclusion criteria and data was collected from the patient case notes and the Emergency Department computer system. This data included identifying treatment provided, breath alcohol levels, length of stay and demographic data. The data was analysed and then interpreted. Results Results revealed that having a breath alcohol level measurement affected length of stay and interventions in the Emergency Department but the value of that breath alcohol level did not influence length of stay or the interventions provided. This indicates that utilising a breath alcohol measurement for determining whether a person is intoxicated affects patient journey through the Emergency Department, however utilising it to determine how intoxicated a patient is, is unlikely to change their Emergency Department journey.Conclusion This study provides evidence on current practice in an Australian Emergency Department. It showed there was a lack of consistency in approach to treatment of acute alcohol intoxication and suggests some implications to clinical practice for Emergency Department clinicians, and examples of where future research would be beneficial.Thesis (MNSc.) -- University of Adelaide, School of Nursing, 201

Special educational needs and disability : Understanding local variation in prevalence, service provision and support

There is a growing recognition of the variation between local authorities in the proportions of children with SEN, the apparent composition of these groups, and the nature and quality of services provided to support them. Local area data collected on children with SEN, particularly the termly School Census and the annual SEN2 return by local authorities, show differences in the number of children with SEN, the nature of their recorded conditions and the Code of Practice level of support they are receiving. This variation was highlighted by the House of Commons Education and Skills Select Committee which commented on a ‘postcode lottery’ or a ‘lottery of provision’, and reports by the Audit Commission and Ofsted which also highlighted variation in provision and standards

Estimating benefits for economic evaluation, CHERE Discussion Paper No 2

This discussion paper provides an introduction to the estimation of benefits in economic evaluation. The concept of benefits, as something worth making a sacrifice to obtain, is explained. The issue of what the benefits of health care is discussed. Methods for the identification of benefits are described. Two approaches to valuing human life, human capital and willingness to pay are considered. A more recent development in health economics is the estimation of benefits using Quality Adjusted Life Years, or QALYs. QALY methodology is described. Finally a checklist of questions is provided to ask when setting up or reading an economic evaluation. The companion paper to this, Economic Evaluation of Health Care: Guidelines for Costing, has been published as CHERE Discussion Paper No. 1Economic evaluation, willingness to pay, QALYs

Iron Age and Romano-British Occupation at Craven Arms Enclosure B, Shropshire: Investigations in 2013

The investigations at Craven Arms B exposed the north-western corner and a length of the northern ditches for a square enclosure, associated with external activity which spanned approximately 200 years. A double-ditched enclosure, external oven and V-shaped ditch for a timber stockade are interpreted as representing the first phase of activity, dating to late prehistoric times. During the first century AD the outer enclosure ditch was recut, and subsequent activity during the first to second centuries was evidenced by infill of the enclosure ditch, two corn-drying ovens, two possible timber structures, a ditch and a pit. The alignment and regularity of these features indicate a planned element to the site. Activity continued in the second to third centuries with a remodelling of the outer enclosure ditch, gullies indicating a fence line (possibly a parallel enclosure) and compacted surfaces around the entrance, other ditch features and decommissioning of the ovens and structures. The site appears to have been abandoned in the third century, with evidence for possible flooding interspersed with archaeological features across much of the site. Post-medieval activity consisted of two different types of land drain, indicating that water management on the site has been a recurring theme over the centuries

Ariel - Volume 8 Number 2

Executive Editor James W. Lockard , Jr. Issue Editor Doug Hiller Business Manager Neeraj K. Kanwal University News Richard J. Perry World News Doug Hiller Opinions Elizabeth A. McGuire Features Patrick P. Sokas Sports Desk Shahab S. Minassian Managing Editor Edward H. Jasper Managing Associate Brenda Peterson Photography Editor Robert D. Lehman, Jr. Graphics Christine M. Kuhnl

A quasi-experimental effectiveness evaluation of the ’Incredible Years Toddler’ parenting programme on children’s development aged 5 : A study protocol

Child behavioural and mental health problems have become a public health crisis. The consequences of poor mental health in childhood have large economic costs and consequences for the individual, their families, and for society. Early intervention through parenting programmes can reduce the onset of poor mental health in childhood, hence evaluating the effectiveness of parenting programmes is critical. The ‘Incredible Years Toddler’ parent programme is an education and training intervention designed to enhance the social and emotional wellbeing of children aged 1–3 years. Whilst previous studies show Incredible Years Toddler to provide promising effects on child outcomes in the short term, the research samples have lacked ethnic diversity and representation from socioeconomically deprived families. This quasi-experimental study is registered on ISRCTN (ISRCTN49991769). We will investigate the effectiveness of Incredible Years Toddler being delivered in three neighbourhoods in inner city Bradford, England. These neighbourhoods contain a socially and ethnically diverse population with 84% living in the poorest decile for England and Wales. Parents with a child aged 1–3 years old who are enrolled in Born in Bradford’s Better Start interventional family cohort study are eligible for this study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. This study will use retrospective and prospective data from participants who attended Incredible Years groups between September 2018 and April 2024. The required minimum sample is n = 1336 (ratio 1:3) to detect a small effect (odds = 1.5, d = .20) on the Early Years Foundation Stage profile total score at age 5; a measure of early child development that is routinely collected by teachers. We will also establish whether these effects are moderated by child age at entry to intervention, programme delivery mode, socioeconomic status, and ethnicity. We will also estimate the cost of the intervention and conduct a cost-consequence analysis

Is it feasible to nest a Trial within a Cohort Study (TwiCS) to evaluate an early years parenting programme? : A Born in Bradford’s Better Start study protocol

Background Evaluating the effectiveness of early years parenting interventions provides evidence to improve the development and wellbeing of children. This protocol paper describes a study to explore the feasibility of evaluating the Incredible Years Toddler early life intervention programme, which is offered to parents of 1–3-year-olds via the Better Start Bradford programme. The study aims to use a Trial Within a Cohort Study (TwiCS) design that randomly selects individuals participating in a cohort to be offered an intervention. The TwiCS information and consent process is person-centred and aims to replicate real world practice whereby only those who are offered the intervention are given information about the intervention. The cohort is the Born in Bradford’s Better Start (BiBBS) cohort, an interventional birth cohort recruiting expectant parents in three areas of Bradford, UK. The study will assess the feasibility of TwiCS procedures, staged consent, and intervention take-up. Methods We will conduct a feasibility TwiCS to test study procedures. We aim to establish: (1) whether TWiCS methodology can be implemented to create control and intervention arms, while documenting any incidences of contamination within the cohort; (2) whether satisfactory rates of intervention uptake are achieved among participants allocated to the intervention; and (3) whether satisfactory rates of retention of participants in the intervention can be achieved. A RAG rating system has been applied to support the feasibility assessment of each objective: to be rated red (not achieved), amber (partly achieved) and green (achieved). Eligible participants in the BiBBS cohort will be individually randomised 1:1 to the intervention or control arms, with stratification by child age (1 or 2-years-old at the time of randomisation) and ethnicity (White British, South Asian, or other). BiBBS researchers will seek consent from participants randomised to the intervention to pass their contact details onto Incredible Years’ delivery agents. Discussion This feasibility study will inform the utility of the TwiCs approach within an experimental birth cohort to evaluate interventions for infants, toddlers, and their families. Trial registration The study was prospectively registered on ISRCTN (ISRCTN16150114)

Protocol for the effectiveness evaluation of an antenatal, universally offered, and remotely delivered parenting programme ‘Baby Steps’ on maternal outcomes : a Born in Bradford’s Better Start (BiBBS) study

BACKGROUND: Poor perinatal mental health and maternal sensitivity towards a child in the early years can carry a long-term cost to individuals and to society, and result in negative child outcomes such as poor mental health and social emotional issues. Despite the recognition of early intervention and prevention, there is mixed evidence regarding antenatal parenting interventions that aim to enhance perinatal mental health and maternal sensitivity to prevent negative child outcomes. ‘Baby Steps’ is a relationship-based antenatal and postnatal parenting programme. The service evaluated in this study is delivered in a low-income and ethnically diverse community via Better Start Bradford. This study aims to assess whether the universally, and remotely delivered Baby Steps programme is effective in improving postnatal maternal sensitivity (primary outcome) and postnatal maternal mental health (secondary outcome) when compared to services as usual 6–10 weeks post-birth. It will also assess differences in birth outcomes, and differences in the prevalence of poor perinatal mental ill health through routine data. The feasibility of collecting cost and health related resource use data for a future economic evaluation will be explored. METHODS: The study is a quasi-experimental evaluation in a single centre. All participants are drawn from Born in Bradford’s Better Start (BiBBS) interventional family cohort study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. The required minimum sample is n = 130 (ratio 1:1) to detect a medium effect (± 2.35, d = .50) on the primary outcome—maternal-child sensitivity, using the Mothers Object Relations Scale Short Form (MORS-SF). Secondary outcomes include the Patient Health Questionnaire (PHQ-8), Generalised Anxiety Disorder assessment 7 (GAD-7), identification of poor perinatal mental health through routine data, and birth outcomes (delivery method, gestation period, low birth weight). Service delivery costs and health resource use will be gathered from routine data. DISCUSSION: This study will evaluate the effectiveness of Baby Steps for enhancing maternal-child sensitivity and maternal mental health when delivered universally and remotely. The findings regarding programme effectiveness, process, and costs will be relevant for researchers, service commissioners, and service staff. TRIAL REGISTRATION: This study was prospectively registered with ISRCTN (22/04/2022, ISRCTN12196131). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-023-15111-1

Do-It-Yourself (DIY) Artificial Pancreas Systems for Type 1 Diabetes: Perspectives of Two Adult Users, Parent of a User and Healthcare Professionals

The artificial pancreas system or an automated insulin dosing system has been the ‘holy grail’ for patients with type 1 diabetes and their caregivers who have over the years wanted to ‘close the loop’ between monitoring of glucose and delivery of insulin. The launch of the Medtronic MiniMed 670G system in 2017 and the subsequent release of the Tandem t:slim with Control-IQ system, the DANA RS pump compatible-CamAPS FX app and the more recent announcement of the Medtronic MiniMed 780G system have come as answers to their prayers. However, in the time taken to develop and launch these commercial systems, creative and ebullient parents of young patients with type 1 diabetes, along with other patients, technologists and healthcare professionals have developed mathematical models as software solutions to determine insulin delivery that in conjunction with compatible hardware have helped ‘close the loop’. Under an umbrella movement #WeAreNotWaiting, they have, as a community, refined and disseminated technologies that are open source and ubiquitously available as do-it-yourself (DIY) closed-loop systems or DIY artificial pancreas systems (APS). There are presently three systems—OpenAPS, AndroidAPS and Loop. We present perspectives of two patients, parent of a patient, and their healthcare providers; the users spanning an age spectrum most likely to use this technology—a child, an adolescent in transitional care and a 31-yr old adult patient, highlighting how looping has helped them self-manage diabetes within the routine of their lives and the challenges they faced