scholarly journals Risk, demand, capacity and outcomes in adult specialist eating disorder services in South-East of England before and since COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Agnes Ayton ◽  
David Viljoen ◽  
Sharon Ryan ◽  
Ali Ibrahim ◽  
Duncan Ford
Keyword(s):  
Eating Disorder ◽  
Length Of Stay ◽  
Waiting Times ◽  
Patient Treatment ◽  
Clinical Implications ◽  
Treatment Model ◽  
Improved Outcomes ◽  
Cognitive Behaviour ◽  
South East England ◽  
Effective Use

Aims and method This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021. Results There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment. Clinical implications Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.

scholarly journals Pathways to Recovery: development and evaluation of a cognitive–behavioural therapy in-patient treatment programme for adults with anorexia nervosa

2018 ◽  
Vol 42 (3) ◽  
pp. 95-101
Author(s):  
Andrea Brown ◽  
Richard Jenkinson ◽  
Julia Coakes ◽  
Annette Cockfield ◽  
Tish O'Brien ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anorexia Nervosa ◽  
Cognitive Behavioural Therapy ◽  
Previous Treatment ◽  
Behavioural Therapy ◽  
Patient Treatment ◽  
Clinical Implications ◽  
Treatment Model ◽  
Treatment Programme ◽  
Cognitive Behavioural

Aims and methodA cognitive–behavioural therapy in-patient treatment model for adults with severe anorexia nervosa was developed and evaluated, and outcomes were compared with the previous treatment model and other published outcomes from similar settings.ResultsThis study showed the Pathways to Recovery outcomes were positive in terms of improvements in body mass index and psychopathology.Clinical implicationsAdults with anorexia nervosa can achieve good outcomes despite longer illness duration and comorbidities.Declaration of interestA.B., A.C. and L.H. work at The Retreat where the Pathways to Recovery were developed.

scholarly journals Association of Emergency Department Waiting Times With Patient Experience in Admitted and Discharged Patients

2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Experience ◽  
Waiting Times ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Patient’S Experience ◽  
Discharged Patients ◽  
The Impact

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.

scholarly journals Clinical Implications of Polymicrobial Synergism Effects on Antimicrobial Susceptibility

Pathogens ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 144
Author(s):  
William Little ◽  
Caroline Black ◽  
Allie Clinton Smith
Keyword(s):  
Antimicrobial Susceptibility ◽  
Chronic Wounds ◽  
Clinical Laboratory ◽  
Patient Treatment ◽  
Clinical Implications ◽  
Clinical Environment ◽  
Tolerance Mechanisms ◽  
Sequencing Technologies ◽  
Generation Sequencing ◽  
Polymicrobial Infections

With the development of next generation sequencing technologies in recent years, it has been demonstrated that many human infectious processes, including chronic wounds, cystic fibrosis, and otitis media, are associated with a polymicrobial burden. Research has also demonstrated that polymicrobial infections tend to be associated with treatment failure and worse patient prognoses. Despite the importance of the polymicrobial nature of many infection states, the current clinical standard for determining antimicrobial susceptibility in the clinical laboratory is exclusively performed on unimicrobial suspensions. There is a growing body of research demonstrating that microorganisms in a polymicrobial environment can synergize their activities associated with a variety of outcomes, including changes to their antimicrobial susceptibility through both resistance and tolerance mechanisms. This review highlights the current body of work describing polymicrobial synergism, both inter- and intra-kingdom, impacting antimicrobial susceptibility. Given the importance of polymicrobial synergism in the clinical environment, a new system of determining antimicrobial susceptibility from polymicrobial infections may significantly impact patient treatment and outcomes.

scholarly journals Cognitive therapy training for psychiatrists: impact on individual clinical practice

2004 ◽  
Vol 28 (4) ◽  
pp. 117-119 ◽  
Author(s):  
G. Swift ◽  
I. Durkin ◽  
C. Beuster
Keyword(s):  
Clinical Practice ◽  
Cognitive Therapy ◽  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Previous Survey ◽  
Therapy Training ◽  
Training And Supervision ◽  
Improved Outcomes ◽  
Therapy Sessions

Aims and MethodWe aimed to survey how psychiatrists with in-depth training in cognitive therapy use these skills. A postal questionnaire based on a previous survey was sent to all psychiatrists who are accredited members of the British Association for Behavioural and Cognitive Psychotherapies.ResultsThere was a 94% response rate. Psychiatrists in non-psychotherapy posts used formal cognitive therapy, with an average of 20% of new patients compared with 65% for those in psychotherapy posts, and were less satisfied with the extent to which they were able to use their skills (20%v. 80%). A total of 85% of respondents described themselves as being involved in teaching, training and supervision of cognitive therapy.Clinical ImplicationsUnless psychiatrists are planning on working in specialised psychotherapy posts, they are unlikely to use cognitive therapy training in formal therapy sessions. Further research is needed to determine whether cognitive therapy training for psychiatrists translates into improved outcomes for patients.

Fluoxetine and Fluvoxamine Combined with Individual Cognitive-Behaviour Therapy in Binge Eating Disorder: A One-Year Follow-Up Study

2001 ◽  
Vol 70 (6) ◽  
pp. 298-306 ◽  
Author(s):  
Valdo Ricca ◽  
Edoardo Mannucci ◽  
Barbara Mezzani ◽  
Sandra Moretti ◽  
Milena Di Bernardo ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Cognitive Behaviour Therapy ◽  
Behaviour Therapy ◽  
Follow Up Study ◽  
Cognitive Behaviour ◽  
One Year

scholarly journals Attitudes of psychiatrists to evidence-based guidelines

2002 ◽  
Vol 26 (11) ◽  
pp. 421-424 ◽  
Author(s):  
Harvey Rees ◽  
Attila Sipos ◽  
Matthew Spence ◽  
Glynn Harrison
Keyword(s):  
Response Rate ◽  
Postal Questionnaire ◽  
Clinical Implications ◽  
Evidence Based ◽  
Previous Survey ◽  
Health Partnership ◽  
Improved Outcomes ◽  
Actual Use ◽  
Evidence Based Guidelines ◽  
Improving Patient Care

Aims and MethodWe aimed to survey clinicians' attitudes on using evidence-based guidelines. A postal questionnaire based on a previous survey of general practitioners was sent to 105 psychiatrists working within Avon and Western Wiltshire Mental Health Partnership NHS Trust.ResultsThere was a 91% response rate. Respondents were generally in favour of clinical guidelines, with scores indicating a positive attitude to guidelines in 13 of the 18 statements. The majority felt that guidelines were effective in improving patient care, could be used flexibly to suit individual patients and did not impinge on their clinical judgement.Clinical ImplicationsPsychiatrists welcomed the increasing use of guidelines. Further research is needed to determine whether this will translate into actual use and improved outcomes for patients.

Predictors of Outcome for Cognitive Behaviour Therapy in Binge Eating Disorder

2015 ◽  
Vol 23 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Mirjam W. Lammers ◽  
Maartje S. Vroling ◽  
Machteld A. Ouwens ◽  
Rutger C. M. E. Engels ◽  
Tatjana van Strien
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Cognitive Behaviour Therapy ◽  
Predictors Of Outcome ◽  
Behaviour Therapy ◽  
Cognitive Behaviour

Abstract 322: Optimizing Cardiac Catheterization Laboratory Utilization

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
William E Lawson ◽  
Lisa Wilbert ◽  
Lisa Sokoloff ◽  
Allen Jeremias ◽  
Anil Mani
Keyword(s):  
Length Of Stay ◽  
Limited Resource ◽  
Median Number ◽  
Skewed Distribution ◽  
Median Length ◽  
Case Volume ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Cardiac Catheterizations ◽  
Effective Use

Background: Optimizing efficient utilization of the catheterization lab is an important concern. Inefficient use of this limited resource increases costs and can compromise patient care. At times of high hospital and specialty care unit census, cath lab throughput is also limited by the availability of recovery beds which may further compromise efficient throughput. At SBUH the cardiac cath lab is staffed from 0630-2300 daily Monday-Friday with an on-call team to provide 7 x 24 hour coverage for STEMI’s. Lab usage was evaluated to determine if this was an efficient and effective use of this limited resource. Methods: All cardiac catheterizations during the period of 10/1/12-12/31/12 were reviewed. The distribution of daily cases, mean and median hours to catheterization by day of the week and median length of stay (ALOS) were determined. Elective outpatient, inpatient, and emergent cases were included. Results: There were a total of 997 cases during this quarter. Average weekday case volume ranged from 13-17 cases/day with the greatest average number of cases performed on Mondays (24% of the weeks cases). Median hours to the cath lab averaged 4.2 hours with the greatest delay on Mondays (5.4 hrs) and Fridays (5.7 hrs). The median number of hours to the cath lab was 31.3 hours with the greatest delay on Fridays (38.5 hrs) and gradually decreasing times from Monday through Thursday with the lowest time delay being on Thursdays (18.9 hrs). The median length of stay averaged 1.11 days, with Mondays patients averaging the longest stays at 1.26 days. There were 45 emergent STEMI cases (5% of the total) during the reviewed period. Conclusions: The marked disparity in mean and median hours reflects a skewed distribution, with many inpatients delayed in going to the CCL. Both median and mean hours were prolonged on Mondays and Fridays along with median length of stay. Further drill down suggested hand-offs, inter-hospital transfer delays, high bed occupancy, and high patient volume contributed to delays on these days. Operator availability, procedure variance, and case mix also contributed to distortions in scheduling and the effective use of lab time. Mid week, Wednesday, was the most efficient day. Block scheduling has since been implemented to better accomodate operators and procedure types within the current staffing constraints. Also as a result of this analysis fewer outpatients are being scheduled on Mondays, changes have been made in ACS protocols, hand-offs, rounding and transfers, and opening the cath lab on a weekend day for inpatients is planned.

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