An examination of service user satisfaction in forensic mental health settings

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the UK. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with the longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills

Interpretation of active-control randomised trials: the case for a new analytical perspective involving averted events

Active-control trials, where an experimental treatment is compared with an established treatment, are performed when the inclusion of a placebo control group is deemed to be unethical. For time-to-event outcomes, the primary estimand is usually the rate ratio, or the closely-related hazard ratio, comparing the experimental group with the control group. In this article we describe major problems in the interpretation of this estimand, using examples from COVID-19 vaccine and HIV pre-exposure prophylaxis trials. In particular, when the control treatment is highly effective, the rate ratio may indicate that the experimental treatment is clearly statistically inferior even when it is worthwhile from a public health perspective. We argue that it is crucially important to consider averted events as well as observed events in the interpretation of active-control trials. An alternative metric that incorporates this information, the averted events ratio, is proposed and exemplified. Its interpretation is simple and conceptually appealing, namely the proportion of events that would be averted by using the experimental treatment rather than the control treatment. The averted events ratio cannot be directly estimated from the active-control trial, and requires an additional assumption about either: (a) the incidence that would have been observed in a hypothetical placebo arm (the counterfactual incidence) or (b) the efficacy of the control treatment (relative to no treatment) that pertained in the active-control trial. Although estimation of these parameters is not straightforward, this must be attempted in order to draw rational inferences. To date, this method has been applied only within HIV prevention research, but has wider applicability to treatment trials and other disease areas

Developing and evaluating mental health lived experience practitioner (LXP) roles in an NHS trust

The value of establishing roles for people with lived experience of mental distress within mental health services is increasingly being recognised. However, there is limited information to guide the introduction of these roles into mental health services. This study details the development and evaluation of a new mental health peer worker role, the Lived Experience Practitioner (LXP), within an NHS Trust. A three-phase exploratory mixed-methods approach was used. Qualitative data were collected and analysed in the first phase. The qualitative findings were then translated into the formal procedures for introducing LXPs into the Trust, with the approach examined quantitatively in the third phase. The qualitative analysis identified five themes; role design, training, piloting, career pathways and communication. These formed the basis for working groups (workstreams) which developed policies and procedures for introducing the LXP role into the Trust. Twenty-eight applicants commenced a training programme with 10 successful completions. Seven LXPs were employed by the Trust and were still in their posts after 2 years. In this study, three areas were viewed as important when introducing LXP roles into mental health services; organisational support, the training programme and employment procedures

Diagnosis delays in the UK according to pre- or post-migration acquisition of HIV

Objectives: To evaluate whether infection occurred pre- or post-migration and the associated diagnosis delay in migrants diagnosed with HIV in the UK. Design: We analysed a cohort of individuals diagnosed with HIV in the UK in 2014–2016 born in Africa or elsewhere in Europe. Inclusion criteria were arrival within 15 years before diagnosis, availability of HIV pol sequence and viral subtype shared by at least 10 individuals. Methods: We examined phylogenies for evidence of infection after entry into the UK and incorporated this information into a Bayesian analysis of timing of infection using biomarkers of CD4+ cell count, avidity assays, proportion of ambiguous nucleotides in viral sequences and last negative test dates where available. Results: 1256 individuals were included. The final model indicated that HIV was acquired post-migration for most men who have sex with men (MSM) born in Europe (posterior expectation 65%, 95% credibility interval 64%-67%) or Africa (65%, 62%-69%), whereas a minority (20%-30%) of men and women with heterosexual transmission acquired HIV post-migration. Estimated diagnosis delays were lower for MSM than for those with heterosexual transmission, and were lower for those with post-migration infection across all subgroups. For MSM acquiring HIV post-migration the estimated mean time to diagnosis was 5 years for all subgroups. Conclusions: Acquisition of HIV post-migration is common, particularly among MSM calling for prevention efforts aimed at migrant communities. Delays in diagnosis reinforce the need for targeted testing initiatives

EMPOWERing older people and their communities to manage their own CARE (EMPOWERCARE): Evaluation study of a social innovation initiative across four European countries

This paper outlines the evaluation strategy of the EMPOWERCARE, an EU Interreg 2 Seas funded social innovation project, which involves a partnership of local authorities, universities and non-governmental organisations from four European countries: Belgium, France, the Netherlands and the United Kingdom. Partners are working in collaboration with local people aged 65+, and those aged 50+ with at least one chronic condition, to respond to current gaps in the care of older people. The project aims specifically to contribute to person-centred care and technology knowledge transfer whilst reducing isolation, loneliness and increasing solidarity amongst older people and their communities. During the project, partners are jointly developing a strategy for implementing good-practice models, a workforce transformation approach via shared training and a technology blueprint with emphasis on caring digital technologies to address the rising demand for health and social care services for older people. The project addresses this challenge by drawing on community assets, involving older people in decisions about their own health and wellbeing, enabling them to keep healthier and in their own homes and communities safely for longer. The project’s evaluation aims to measure the impact of the EMPOWERCARE initiative across 7 pilot sites in the 4 participating countries. Given the Covid-19 pandemic, the evaluation design has been developed with a view to being agile and able to respond to complex and shifting situations, and especially so in terms of what and how data are collected. A realist synthesis approach (Pawson & Tilley, 2004) guides the evaluation within a descriptive case study design (Yin 2003) to identify and contextualise the project strategies that are influential within and across the 7 different case study sites. The evaluation uses multiple interdisciplinary methods, such as surveys, Photovoice and Social Return on Investment, to capture a range of perspectives across three timepoints, baseline (T0), mid-point (T1) and end-point (T2). Online surveys are conducted with both end-users and the workforce in all pilot sites at T0 and T2. At T1, end-users are actively involved in creating visual data through Photovoice to capture their lived experiences with local initiatives in pilot sites. Visual data are going to be displayed at pilot site exhibitions targeted to key local stakeholders and members of the workforce. Focus groups will be conducted with all participants reflecting on the visual data exhibition to explore insights about the initiative from current and future perspectives. This aspect is informed by a Social Return on Investment approach. The sequential data collection of multiple sources and longitudinal study design identify patterns of change and impact. The evaluation design will deliver a theory-driven rich explanation of what works about EMPOWERCARE and for whom, why, how and in what circumstances it works. The analysis of the evaluation findings will contribute to a more empowered person-centred approach, with more inclusive and caring digital health solutions that will allow policy makers to develop localised, efficient and social-value driven services to meet the rising needs of older people in the European regions

Radionuclide Imaging of Viable Myocardium: Is it Underutilized?

Coronary artery disease is the major cause of heart failure in North America. Viability assessment is important as it aims to identify patients who stand to benefit from coronary revascularization. Radionuclide modalities currently used in the assessment of viability include 201Tl SPECT, 99mTc-based SPECT imaging, and 18F-fluorodexoyglucose (18F-FDG)-PET imaging. Different advances have been made in the last year to improve the sensitivity and specificity of these modalities. In addition, the optimum amount of viable (yet dysfunctional) myocardium is important to identify in patients, as a risk–benefit ratio must be considered. Patients with predominantly viable/hibernating myocardium can benefit from revascularization from a mortality and morbidity standpoint. However, in patients with minimal viability (predominantly scarred myocardium), revascularization risk may certainly be too high to justify revascularization without expected benefit. Understanding different radionuclide modalities and new developments in the assessment of viability in ischemic heart failure patients is the focus of this discussion

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome