Health economic burden that wounds impose on the National Health Service in the UK

OBJECTIVE: To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.Ye

Perceptions of the policing and crime mapping ‘Trailblazers’, Home Office Research Report 67

The research involved interviews with key staff involved and focus groups with members of the public to explore their views and opinions on the initiatives. The research highlights considerable public curiosity, and to an extent an appetite, for crime and criminal justice information. However a key message from the research was that providing more information should not be an end in itself. Information needs to be relevant, useable, of high quality and tailored to suit its purpose, whether that is crime prevention or holding the police to account

Flexible New Deal evaluation: customer survey and qualitative research findings

by Sandra Vegeris, Lorna Adams, Katie Oldfield, Christine Bertram, Rosemary Davidson, Lucia Durante, Catherine Riley and Kim Vowden This report presents qualitative and quantitative research findings from an evaluation of the Flexible New Deal (FND), Phase 1 of which was introduced in October 2009 in 28 Jobcentre Plus districts in England, Scotland and Wales. The research consisted of qualitative research into customer and provider experiences of FND delivery and a quantitative survey of customer experiences of FND in Phase 1 areas compared with customers at the same point in their claims experiencing the former Jobseeker’s Allowance (JSA) regime and New Deals in Phase 2 areas. Comparisons between the two areas provide an indication of FND services in contrast to JSA/New Deal services but they do not constitute an impact assessment. This is the fourth in a series of evaluation reports aiming to understand experiences of the Jobseekers Regime and Flexible New Deal (JRFND) from the point of view of customers, Jobcentre Plus staff and provider staff, and establish the extent to which JRFND leads to additional customer employment outcomes

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

Approach to a rational rotation number in a piecewise isometric system

We study a parametric family of piecewise rotations of the torus, in the limit in which the rotation number approaches the rational value 1/4. There is a region of positive measure where the discontinuity set becomes dense in the limit; we prove that in this region the area occupied by stable periodic orbits remains positive. The main device is the construction of an induced map on a domain with vanishing measure; this map is the product of two involutions, and each involution preserves all its atoms. Dynamically, the composition of these involutions represents linking together two sector maps; this dynamical system features an orderly array of stable periodic orbits having a smooth parameter dependence, plus irregular contributions which become negligible in the limit.Comment: LaTeX, 57 pages with 13 figure