Does gender matter? An analysis of men's and women's accounts of responding to symptoms of lung cancer

Peer reviewedPublisher PD

Evaluation of the Primary Care Mental Health Specialist role: Final Report

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis

The low-redshift circumgalactic medium in SIMBA

We examine the properties of the low-redshift circumgalactic medium (CGM) around star-forming and quenched galaxies in the Simba cosmological hydrodynamic simulations, focusing on comparing HI and metal line absorption to observations from the COS-Halos and COS-Dwarfs surveys. Halo baryon fractions are always well below the cosmic fraction due to stellar feedback at low masses, and jet-mode AGN feedback at high masses. Baryons and metals in the CGM of quenched galaxies are mostly in hot gas, while the CGM of star-forming galaxies is more multiphase. Hot CGM gas has low metallicity, while warm and cool CGM gas have metallicity close to that of galactic gas. Equivalent widths, covering fractions and total path absorption of HI and selected metal lines (MgII, SiIII, CIV and OVI) around a matched sample of Simba galaxies are broadly consistent with COS-Halos and COS-Dwarfs observations. Absorption is higher around star forming galaxies, and drops with radius. HI absorption around Simba star-forming galaxies is in good agreement with observations, however around quenched galaxies HI absorption is under-predicted. Metal-line absorption is sensitive to choice of photo-ionising background; assuming recent backgrounds, Simba matches OVI but under-predicts low ions, while an older background matches low ions but under-predicts OVI. Simba reproduces the observed dichotomy of OVI absorption around star forming and quenched galaxies. CGM metals primarily come from stellar feedback, while jet-mode AGN feedback reduces absorption particularly for lower ions.Comment: 23 pages, 12 figures, submitted to MNRAS. Comments welcom

Clinical Pathway for Comorbid ED and ASC

This is the peer reviewed version of the following article: Tchanturia, K., Dandil, Y., Li, Z., Smith, K., Leslie, M., & Byford, S. (2020). A Novel Approach for Autism Spectrum Condition patients with Eating Disorders: Analysis of Treatment Cost-savings. European Eating Disorders Review, 29(3), 514-518, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/erv.2760. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective: In the current economic context, it is critical to ensure that eating disorder (ED) treatments are both effective and cost-effective. We describe the impact of a novel clinical pathway developed to better meet the needs of autistic patients with EDs on the length and cost of hospital admissions. Method: The pathway was based on the Institute for Healthcare’s Model of Improvement methodology, using an iterative Plan, Do, Study, Act format to introduce change and to co-produce the work with people with lived experience and with healthcare professionals. We explored the change in length and cost of admissions before and after the pathway was introduced. Results: Preliminary results suggest that the treatment innovations associated with this pathway have led to reduced lengths of admission for patients with the comorbidity, which were not seen for patients without the comorbidity. Estimated cost-savings were approximately £22,837 per patient and approximately £275,000 per year for the service as a whole. Conclusion: Going forward, our aim is to continue to evaluate the effectiveness and cost-effectiveness of investment in the pathway to determine whether the pathway improves the quality of care for patients with a comorbid ED and autism and is good value for money

A novel approach to support the use of visual methods when researching with people living with dementia

Accepted methods of enquiry to address qualitative research questions are focus groups and interviews, enabling access to the experiences, opinions, and perspectives of participants. However use of these methods with people with dementia is problematic because this condition can impair verbal communication in addition to other domains. These challenges can have a significant impact when trying to obtain insight from an individual through conversation and discussion. As researchers, we should be creating alternative methods that place equal importance on behaviour that is non-verbal as well as verbal. This contribution highlights the need for the advancement of creative qualitative methods drawing on lessons learned of the benefits and challenges during the development of a novel approach to support the use of visual methods in dementia research. By focussing on all that is retained and done well, emphasising individual strengths and abilities, offers an increasingly prevalent alternative to existing loss-deficit models that have characterised dementia research in the past. This approach highlights the importance and appropriateness of visual methods in enabling meaning and transparency throughout the research process from ethical approval and consent procedures through to the collection, analysis, dissemination, and impact of the research data

Qualitatively exploring the suitability of tablet computers to encourage participation with activities by people with moderate stage dementia

INTRODUCTION: Opportunities to participate with enjoyable activities is one of the most frequently reported unmet needs by the person living with dementia. Enabling and intuitive technologies may offer accessible ways to engage with such activities. OBJECTIVES: To explore how tablet computers might encourage participation in enjoyable activities by people with moderate levels of dementia and to consider how such technologies might be incorporated into the repertoire of activities currently provided through day care settings. METHODS: A focused visual ethnographic approach was developed specifically to meet the research objectives. Twelve participants attending a community day care centre and nine supporters (both volunteers and paid staff) consented to take part in the research. Technology facilitated group activity sessions took place twice a week for a period of four weeks and all were video recorded. Findings: Video analysis demonstrated that the majority of people with dementia found the technology an effective means of participating in enjoyable activities. Analysis also revealed the extent to which participation relies on the existence of effective support. It showed how maintaining focus on retained strengths and abilities enabled the group overall to meet and often exceed their own and others perceived capacity to participate. Finally, analysis confirmed the importance of enjoyment of activities 'in the moment' and the need for those supporting people in the moderate stages of dementia to acknowledge and work with this. CONCLUSION: The use of tablet computers to enhance participation in sociable and enjoyable activities in day care settings is realistic and achievable if supported appropriately