Postcode lottery? Hospital transfers from one London prison and responsible catchment area

Aims and method To consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin. Results Overall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays. Clinical implications There are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services

Investigating the impact of remote neuroanatomy education during the COVID-19 pandemic using online examination performance in a National Undergraduate Neuroanatomy Competition

Neuroanatomy is a notoriously challenging subject for medical students to learn. Due to the coronavirus disease-19 (COVID-19) pandemic, anatomical education transitioned to an online format. We assessed student performance in, and attitudes toward, an online neuroanatomy assessment compared to an in-person equivalent, as a marker of the efficacy of remote neuroanatomy education. Participants in the National Undergraduate Neuroanatomy Competition (NUNC) 2021 undertook two online examinations: a neuroanatomically themed multiple-choice question paper and anatomy spotter. Students completed pre- and post-examination questionnaires to gauge their attitudes toward the online competition and prior experience of online anatomical teaching/assessment. To evaluate performance, we compared scores of students who sat the online (2021) and in-person (2017) examinations, using 12 identical neuroradiology questions present in both years. Forty-six percent of NUNC 2021 participants had taken an online anatomy examination in the previous 12?months, but this did not impact examination performance significantly (p?>?0.05). There was no significant difference in examination scores between in-person and online examinations using the 12 neuroradiology questions (p?=?0.69). Fifty percent of participants found the online format less enjoyable, with 63% citing significantly fewer networking opportunities. The online competition was less stressful for 55% of participants. This study provides some evidence to suggest that student performance is not affected when undertaking online examinations and proposes that online neuroanatomy teaching methods, particularly for neuroradiology, may be equally as effective as in-person approaches within this context. Participants perceived online examinations as less stressful but raised concerns surrounding the networking potential and enjoyment of online events.Peer reviewe

A suitable waiting room? Hospital transfer outcomes and delays from two London prisons

Aims and Method To describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records. Results Overall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. the aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million. Clinical Implications Both prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged

An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain : A randomized trial (ATLAS)

OBJECTIVES: To assess the cost-effectiveness of acupuncture and usual care, and Alexander Technique lessons and usual care, compared with usual GP care alone for chronic neck pain patients. METHODS: An economic evaluation was undertaken alongside the ATLAS trial, taking both NHS and wider societal viewpoints. Participants were offered up to twelve acupuncture sessions or twenty Alexander lessons (equivalent overall contact time). Costs were in pounds sterling. Effectiveness was measured using the generic EQ-5D to calculate quality adjusted life years (QALYs), as well as using a specific neck pain measure-the Northwick Park Neck Pain Questionnaire (NPQ). RESULTS: In the base case analysis, incremental QALY gains were 0.032 and 0.025 in the acupuncture and Alexander groups, respectively, in comparison to usual GP care, indicating moderate health benefits for both interventions. Incremental costs were £451 for acupuncture and £667 for Alexander, mainly driven by intervention costs. Acupuncture was likely to be cost-effective (ICER = £18,767/QALY bootstrapped 95% CI £4,426 to £74,562) and was robust to most sensitivity analyses. Alexander lessons were not cost-effective at the lower NICE threshold of £20,000/QALY (£25,101/QALY bootstrapped 95% CI -£150,208 to £248,697) but may be at £30,000/QALY, however, there was considerable statistical uncertainty in all tested scenarios. CONCLUSIONS: In comparison with usual care, acupuncture is likely to be cost-effective for chronic neck pain, whereas, largely due to higher intervention costs, Alexander lessons are unlikely to be cost-effective. However, there were high levels of missing data and further research is needed to assess the long-term cost-effectiveness of these interventions

Prison health-care wings: psychiatry's forgotten frontier?

Background There is worldwide evidence of high rates of mental disorder among prisoners, with significant co‐morbidity. In England and Wales, mental health services have been introduced from the National Health Service to meet the need, but prison health‐care wings have hardly been evaluated. Aims/hypotheses To conduct a service evaluation of the health‐care wing of a busy London remand (pre‐trial) prison and examine the prevalence and range of mental health problems, including previously unrecognised psychosis. Methods Service‐use data were collected from prison medical records over a 20‐week period in 2006–2007, and basic descriptive statistics were generated. Results Eighty‐eight prisoners were admitted (4.4 per week). Most suffered from psychosis, a third of whom were not previously known to services. Eleven men were so ill that they required emergency compulsory treatment in the prison under Common Law before hospital tranfer could take place. Over a quarter of the men required hospital transfer. Problem behaviours while on the prison health‐care wing were common. Conclusions and implications Prison health‐care wings operate front‐line mental illness triaging and recognition functions and also provide care for complex individuals who display behavioural disturbance. Services are not equivalent to those in hospitals, nor the community, but instead reflect the needs of the prison in which they are situated. There is a recognised failure to divert at earlier points in the criminal justice pathway, which may be a consequence of national failure to fund services properly. Hosptial treatment is often delayed. Copyright © 2010 John Wiley & Sons, Ltd

Effect of a maximum permissible journey time (31 h) on physiological responses of fleeced and shorn sheep to transport, with observations on behaviour during a short (1 h) rest-stop

Concern for the welfare of export lambs during long-distance road transport has prompted much research and a recommended change in procedure. The latter envisages an absolute maximum journey time of 31 h and includes a rest-stop (minimum duration 1 h) for feeding and watering. In the present experiment, the physiological and behavioural responses to this new protocol have been investigated in fleeced and shorn lambs (no. = 10 per group) provided with venous catheters and heart rate monitors. The two groups were loaded on a vehicle into separate adjacent pens and driven for 14 h; then unloaded into a lairage, where their behaviour was recorded. After 1 h they were reloaded and driven for a further 15•5 h, finally arriving at a slaughterhouse where carcass condition was evaluated. Blood samples collected at 30- or 60-min intervals by experimenters travelling with the animals were analysed to determine haematocrit, plasma osmolality, plasma concentrations of glucose, creatinine phosphokinase (CPK), and the stress-responsive hormones, cortisol, prolactin, adrenaline and noradrenaline. The results showed that haematocrit increased after loading although the general trend during transport, as with osmolality, was a decline (P < 0•05). No significant changes in plasma glucose were detected but CPK increased in fleeced lambs after loading (P < 0•05). Cortisol release was stimulated by loading, especially in fleeced sheep (P < 0•001) but returned to home pen values within 6 h; heart rates changed in a similar manner. Transport did not markedly affect prolactin release although concentrations were consistently greater in fleeced sheep (P < 0•001). Noradrenaline, however, tended to be higher in shorn animals (P < 0•05). In lairage, both groups readily consumed hay, and especially concentrates, but the shorn lambs spent more time eating (P < 0•001). None of the shorn sheep, and only a few fleeced animals, drank water. There was no evidence for differences in weight loss between the two groups during the experiment and carcass quality at slaughter was within the normal expected range. The implications of these, and other related studies, for future transport policy are discussed, with particular reference to rest-stop duration and handling procedures