Future of health and healthcare provision in cities

This paper is concerned with the future of health and healthcare provision in cities in the UK. The primary data was collected at a facilitated workshop held at the Academy of Medical Sciences in September 2015. The workshop was designed to guide participants through a series of exercises in order to explore what the current, near future and far future trends in health and healthcare provision are likely to be for cities. The paper is organised into six sections. First, we describe the importance of understanding health and healthcare provision within cities and the intrinsic relationship between people and their built environment with regard both of these topics. Second, we examine the significant transformations within the sector of health and healthcare provision over the last fifty years. Third, we explore potential worst case scenarios for the future of such provision in cities. Fourth, we identify four possible future cities for healthy cities and effective healthcare provision. Fifth, we establish which policy developments would need to be designed and prioritised to facilitate delivery of these future cities. In conclusion, we establish a synthesis of the prevalent patterns and emergent relationships of themes raised during the workshop in order to draw together our findings and further understand how health and healthcare provision may impact the future of cities

Effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET)

Objective To compare the clinical effectiveness of doctors and nurses in undertaking upper and lower gastrointestinal endoscopy. Design Pragmatic trial with Zelen's randomisation before consent to minimise distortion of existing practice. Setting 23 hospitals in the United Kingdom. In six hospitals, nurses undertook both upper and lower gastrointestinal endoscopy, yielding a total of 29 centres. Participants 67 doctors and 30 nurses. Of 4964 potentially eligible patients, we randomised 4128 (83%) and recruited 1888 (38%) from July 2002 to June 2003. Interventions Diagnostic upper gastrointestinal endoscopy and flexible sigmoidoscopy, undertaken with or without sedation, with the standard preparation, techniques, and protocols of participating hospitals. After referral for either procedure, patients were randomised between doctors and nurses. Main outcome measures Gastrointestinal symptom rating questionnaire (primary outcome), gastrointestinal endoscopy satisfaction questionnaire and state-trait anxiety inventory (all analysed by intention to treat); immediate and delayed complications; quality of examination and corresponding report; patients' preferences for operator; and new diagnoses at one year (all analysed according to who carried out the procedure). Results There was no significant difference between groups in outcome at one day, one month, or one year after endoscopy, except that patients were more satisfied with nurses after one day. Nurses were also more thorough than doctors in examining the stomach and oesophagus. While quality of life scores were slightly better in patients the doctor group, this was not statistically significant. Conclusions Diagnostic endoscopy can be undertaken safely and effectively by nurses. Trial registration International standard RCT 8276570

Baryonic effects on the matter bispectrum

The large-scale clustering of matter is impacted by baryonic physics, particularly AGN feedback. Modelling or mitigating this impact will be essential for making full use of upcoming measurements of cosmic shear and other large-scale structure probes. We study baryonic effects on the matter bispectrum, using measurements from a selection of state-of-the-art hydrodynamical simulations: IllustrisTNG, Illustris, EAGLE, and BAHAMAS. We identify a low-redshift enhancement of the bispectrum, peaking at $k\sim 3h\,{\rm Mpc}^{-1}$, that is present in several simulations, and discuss how it can be associated to the evolving nature of AGN feedback at late times. This enhancement does not appear in the matter power spectrum, and therefore represents a new source of degeneracy breaking between two- and three-point statistics. In addition, we provide physical interpretations for other aspects of these measurements, and make initial comparisons to predictions from perturbation theory, empirical fitting formulas, and the response function formalism. We publicly release our measurements (including estimates of their uncertainty due to sample variance) and bispectrum measurement code as resources for the community.Comment: 29 pages, 24 figures. v2: MNRAS published version, with references and clarifications added (conclusions unchanged). See Fig. 13 for a summary of the main results. Simulation measurements are available at https://github.com/sjforeman/hydro_bispectrum , and bispectrum measurement code is available at https://github.com/sjforeman/bski

Evaluation Of Pilgrims Hospices Rapid Response Hospice At Home Service: Summary of findings March 2015

When faced with a life-limiting illness, most people say they would prefer to spend the end of their lives and die at home. However, we know that about half the people with cancer or long-term illnesses still die in hospital. Fewer than a quarter die in their own home. Patients are often admitted to hospital because of a crisis such as uncontrolled symptoms, carer fear or stress, or not having medication available when needed. Community based palliative care teams can help in such situations. In 2008 Pilgrims Hospices commissioned a review of the literature to understand what kinds of home care services provide the most benefit to patients at the end of their lives and their families. Though good quality evidence was scarce, the findings of the review suggested that successful services are able to respond rapidly, focus on supporting family carers at home and are available 24 hours a day seven days a week. Following these conclusions, Pilgrims Hospices developed the Rapid Response Hospice at Home service (Hospice at Home) to support people who are at the end of life and would like to die at home. The Hospice at Home service operates in addition to established hospice community services and is staffed by healthcare assistants (HCAs) who have been trained at the hospice. The HCAs are available day and night at four hours' notice to support patients in the last days of their lives or when they experience a crisis

Acute compartment syndrome of the lower limb following childbirth : a case report

Background: Acute compartment syndrome is a limb-threatening and occasionally life-threatening emergency that is rarely reported as a complication following childbirth. Prompt diagnosis is crucial to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors and signs and symptoms of acute compartment syndrome is necessary to prevent long-term complications and amputation. Case presentation: This paper presents a case of a 26-year-old primiparous Sri Lankan woman who developed acute compartment syndrome of the lower right limb following childbirth by cesarean section. Conclusion: Acute compartment syndrome is an important differential diagnosis in the setting of sudden onset of lower limb pain following childbirth. Predisposing factors for its manifestation within an obstetric environment are augmented labor, the lithotomy position, postpartum hemorrhage, hypotension following epidural analgesia, and the use of vasoconstrictive agents. If left undiagnosed and untreated, acute compartment syndrome may cause permanent neurovascular deficit, leading to a poor functional result, tissue ischemia, limb amputation, and rhabdomyolysis. If severe, and in large compartments, it can lead to renal failure and death. Alertness and a high index of clinical suspicion for the possibility of acute compartment syndrome are required to avoid a delay in diagnosis, and intracompartmental pressure measurement can be used to confirm the diagnosis

Finding the Right Assessment Measures for Young People with Intellectual Disabilities Who Display Harmful Sexual Behaviour

Background: Previous studies and national reports have all noted that a significant proportion of the young people who display harmful sexual behaviours have intellectual disabilities. However, research on the topic has been scarce. This study presents a systematic review of the literature relating to clinical instruments specifically developed or adapted for adolescents with intellectual disabilities who display harmful sexual behaviours. Method: An electronic search of databases was completed for published articles in English from the earliest possible date to the end of 2013. Results: No published articles met the full search criteria. This confirmed the lack of published clinical measures, apart from two risk assessment instruments. Conclusions: Given the lack of measures, it is recommended that the focus of future research needs to be on developing or adapting instruments that will offer researchers’ and clinicians’ empirical as well as clinical data on this all-too-often-overlooked population of vulnerable youth

Effectiveness and cost-effectiveness of community singing on the mental health related quality of life of the older population: a randomized controlled trial

Background: As the population ages, older people account for a greater proportion of the health and social care budget. While some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people. Aims: To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England. Method: A pilot pragmatic individual randomized controlled trial comparing group singing versus usual activities in those aged 60 years or more. Results: 258 participants were recruited across 5 centres in East Kent. At 6 months post-randomisation significant differences were observed in terms of mental health related quality of life measured using the SF12, mean difference 2.35 (95% CI 0.06 to 4.76) in favour of group singing. In addition the intervention was found to be marginally more cost-effective than usual activities. At 3 months significant differences were observed in terms of mental health components of quality of life (4.77; 2.53 to 7.01) anxiety (-1.78; -2.5; -1.06) and depression (-1.52; -2.13 to -0.92). Conclusions: Community group singing appears to have a significant effect on mental health related quality of life, anxiety and depression and may be a useful intervention to maintain and enhance the mental health of the older population