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Introduction The Royal College of Physicians have emphasised the need to provide good end of life care for patients in the acute care setting, with the publication of the Acute Care Resource (1) in February 2021. This follows on from their key recommendations in 2018, which proposed that 'all healthcare professionals reviewing patients with chronic conditions,...more than one serious medical problem, or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences' (2). Coordinate My Care (CMC) is an electronic urgent care plan accessible to all relevant health and social care professionals caring for patients residing in London Boroughs, enabling communication of wishes and preferences, including those of resuscitation status and advance care plans. Method Multiple PDSA Cycles, including requesting logins for CMC for emergency medicine, acute and general medical senior and junior doctors, and hosting CMC training sessions. Teaching sessions given to the above cohorts with regard to advance care planning and the use of CMC. Creation of live link to CMC via Trust's electronic patient record. Results An increase in average monthly CMC record views from 45 to 108 by clinicians at North Middlesex Hospital. An increase from an average of 18 CMC records created per month, compared to 27 records created per month after the QI project, with an estimated additional cost saving of almost £19,000 per month (3). Conclusion Successful QI project, with demonstrated increase in staff access to CMC and number of patient CMC records created in a busy acute hospital. Ongoing success will be reflected in sustainability of the current numbers of acute hospital staff accessing CMC and creation of records. [ABSTRACT FROM AUTHOR]

BackgroundThe prevalence of mental disorders among prisoners is considerably higher than in the general population. This is an important public health issue as the vast majority of prisoners stay in custody for less than 9 months and, when not in prison, offenders' lifestyles are frequently chaotic, characterized by social exclusion, instability and unemployment. Multi-disciplinary mental health inreach services were introduced to target care towards prisoners with severe mental illness (SMI) in a similar way to that provided by Community Mental Health Teams outside prison. The aim was to establish the proportion of prisoners with SMI who were assessed and managed by prison mental health inreach services.MethodA two-phase prevalence survey in six prisons in England measured SMI upon reception into custody. Case-note review established the proportion of those with SMI subsequently assessed and treated by inreach services.ResultsOf 3492 prisoners screened, 23% had SMI. Inreach teams assessed only 25% of these unwell prisoners, and accepted just 13% onto their caseloads.ConclusionsInreach teams identified and managed only a small proportion of prisoners with SMI. Prison-based services need to improve screening procedures and develop effective care pathways to ensure access to appropriate services. Improved identification of mental illness is needed in both the community and the Criminal Justice System to better engage with socially transient individuals who have chaotic lifestyles and complex needs. [ABSTRACT FROM PUBLISHER]

A laboratory exercise is described that introduces the engineering student to design to meet a customer specification. The student learns to appreciate the system-engineering nature of design, where multiple objectives need to be satisfied. The design vehicle is one of the most conceptually simple instruments, namely a voltmeter based on a moving-coil movement. The student finds out how to reduce cost by making maximum use of the tolerance-forming part of the customer specification. He or she learns how both deterministic and statistical methods may be brought to bear. The statistical method applied may also be of more general interest to instrument designers working in industry. [ABSTRACT FROM AUTHOR]

A cargo of approximately 1,500 tonnes of unbarked spruce pulpwood billets being imported from an area of windblow in West Germany was inspected by Forestry Commission staff in England. About 10 per cent of the logs were found to contain living adults of the bark beetle Ips typographus and imprints of their gallery systems were found on many of the remaining logs. Unlike native spruce-dwelling bark beetles, it is capable of attacking live trees as a primary pest and can have serious effects on spruce which are debilitated by some agent such as windthrow or which are growing in sub-optimal conditions.

Objective: Behavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services., Methods: We conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes., Results: We conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users., Conclusion: Overall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England., Objectives: The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care., Design: The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen., Setting: SH clinics in England., Participants: Young people (aged 16-25 years), and men who have sex with men., Intervention: A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients., Main Outcome Measures: The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial)., Results: We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%)., Limitations: Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT., Conclusion: We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area., Trial Registration: Current Controlled Trials ISRCTN16738765., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 23, No. 12. See the NIHR Journals Library website for further project information., Competing Interests: Fiona Burns reports personal fees from Gilead Sciences Europe Ltd outside the submitted work. Maryam Shahmanesh reports grants from the Bill and Melinda Gates Foundation, the National Institutes of Health, the Medical Research Council and from the Engineering and Physical Sciences Research Council outside the submitted work.

To understand whether people attending sexual health (SH) clinics are willing to participate in a brief behavioural change intervention (BBCI) to reduce the likelihood of future sexually transmitted infections (STIs) and to understand their preferences for different service designs, we conducted a discrete choice experiment (DCE) with young heterosexual adults (aged 16-25 years), and men who have sex with men (MSM) aged 16 or above, attending SH clinics in England. Data from 368 participants showed that people particularly valued BBCIs that involved talking (OR 1.45; 95%CI 1.35, 1.57 compared with an 'email or text'-based BBCIs), preferably with a health care professional rather than a peer. Findings also showed that 26% of respondents preferred 'email/texts' to all other options; the remaining 14% preferred not to participate in any of the offered BBCIs. These results suggest that most people attending SH clinics in England are likely to participate in a BBCI if offered, but the type/format of the BBCI is likely to be the single important determinant of uptake rather than characteristics such as the length and the number of sessions. Moreover, participants generally favoured 'talking'-based options rather than digital alternatives, which are likely to require the most resources to implement.

The elevated risk of suicide in prison and after release is a well-recognised and serious problem. Despite this, evidence concerning community-based offenders' suicide risk is sparse. We conducted a population-based nested case-control study of all people in a community justice pathway in England and Wales. Our data show 13% of general population suicides were in community justice pathways before death. Suicide risks were highest among individuals receiving police cautions, and those having recent, or impending prosecution for sexual offences. Findings have implications for the training and practice of clinicians identifying and assessing suicidality, and offering support to those at elevated risk., (© The Royal College of Psychiatrists 2015.)

Background: Multiple national and local data sources collected by healthcare systems across Europe contain information regarding coronary artery bypass grafts (CABG). Currently surveillance for surgical site infections (SSIs) in this patient group is voluntary in the UK., Aim: To investigate and compare the currently available data sources in England for SSI surveillance in CABG patients., Methods: Data were extracted from the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) Adult Cardiac Surgery Registry, the Health Protection Agency SSI surveillance, and the Patient Administration System (PAS) from a single large National Health Service Trust. These data were deterministically linked using patient identifiers, anonymized, and then underwent descriptive analysis., Findings: From 1 January 2011 to 30 June 2011, 306 patients were recorded in at least one dataset as having undergone CABG. Of these, 76% were recorded by all three data sources being investigated. Of the discordant patients, 5% were recorded by both the local cardiac registry and PAS, and 18% by both the HPA surveillance and PAS. A total of 28 surgical site infections were recorded, of which 21% were identified by all the data sources., Conclusion: Currently, the databases which collect and store data relating to CABG patients suffer from duplications and discrepancies. Integration of the discordant systems is recommended to create a streamlined, sustainable electronic surveillance system., (Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Objective: This study examined associations between clinical, demographic, and criminological characteristics of inmates with mental illness and level of mental health intervention received during early custody., Methods: In a prospective study, 3,079 participants entering five English jails were recruited and screened for mental illness with a standardized tool. Individuals who screened positive were assessed for mental illness and symptom severity within one week of arrival. Clinical records of those who received a diagnosis of mental illness (N=409) were reviewed for one month (or until discharge, if sooner) to determine mental health care interventions received. Main outcomes were the level of mental health intervention received (none, primary, or secondary) and whether an intervention was received from substance misuse services., Results: Compared with individuals who did not receive services, those who received primary mental health care were more likely to have a diagnosis of major depressive disorder than another mental illness (OR=2.01, CI=1.20–3.36). Compared with those who received primary care services, those who received secondary mental health care were more likely to have a diagnosis of psychosis (OR=3.34, CI=1.81–6.17). However, 23% of the sample received no intervention. Offenders with mental illness who misused drugs were more likely than those who misused alcohol alone to receive an intervention from substance misuse services (OR=3.67, CI=1.91–7.05)., Conclusions: Level of intervention was not consistently linked with diagnoses or symptom severity among inmates with mental illness. Triage processes should be improved to ensure that mental health care resources in jails are appropriately matched to clinical need.

Aims: Prisoners with mental illness on release from prison often face complex challenges with little support, leading to poor clinical and social outcomes. This feasibility study aimed to see whether a Critical Time Intervention (CTI) in the first weeks post-release effectively connects mentally ill prisoners with social, clinical, housing, and welfare services on leaving prison. The study took place in 2007 and involved local prisons in London and Manchester., Methods: A pilot randomised controlled trial in which CTI was compared to Treatment as Usual (TAU)., Results: Sixty prisoners were randomised in the trial, with outcome measures completed on 23. A higher proportion of prisoners in CTI group were in contact with services at follow-up than those receiving TAU. CTI prisoners were significantly more likely to be receiving medication, and be registered with a General Practitioner (GP) than those in the TAU group., Conclusions: Continuity of care for prisoners with severe mental illness can be improved by working with them to identify their needs prior to release, and by assisting them to engage effectively to the necessary agencies in the community.

The spatial, temporal, and spatio-temporal features of the 2001 British foot-and-mouth disease epidemic in selected areas within the counties of Cumbria and Devon, which experienced the greatest incidence of disease, are described using hazard functions, extraction mapping and the space-time K-function. In Cumbria, the hazard of foot-and-mouth disease infection peaked at 2.8% in the week commencing 8 March 2001 and farm holdings in this area continued to be identified with disease to 12 September 2001. In contrast, peak infection hazard in Devon was 0.7% in the week commencing 15 March 2001 and eradication of the disease was achieved in this area by 31 May 2001. Persistence of the disease in Cumbria was consistent with: (1) many cattle holdings infected early in the epidemic (creating a high environmental viral load), and (2) a relatively large amount of medium-to-long-distance spread of the virus associated with seasonal farming activities-compounded to some extent by the movement of people and vehicles between disaggregated farm land parcels. The interaction of disease risk in Cumbria showed that premises remained infectious for longer throughout May, June and July, consistent with delays in disease detection during this period.