scholarly journals Services for self-harm: progress and promise?

2020 ◽  
Vol 217 (6) ◽  
pp. 663-664
Author(s):  
Nav Kapur
Keyword(s):  
Quality Of Care ◽  
Quality Assessment ◽  
Service Provision ◽  
Clinical Services ◽  
High Quality ◽  
Self Harm ◽  
The Uk ◽  
Improve Access ◽  
Made In

SummaryThis editorial considers whether the quality of care for people who present to clinical services in the UK following self-harm has improved or stagnated. Some real progress has been made in the areas of service provision and research, and self-harm has never had a higher priority in policy terms. However, major gaps remain. We need to enhance people's experience of services and improve access to high-quality assessment and aftercare.

scholarly journals Training to be a cleft surgeon in the UK

2021 ◽  
Vol 103 (3) ◽  
pp. 130-135
Author(s):  
M Fell ◽  
N Brierley ◽  
A Sadri ◽  
S Chummun ◽  
K Moar
Keyword(s):  
Quality Of Care ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
High Quality ◽  
Training Fellowship ◽  
Surgical Career ◽  
Higher Surgical Training ◽  
The Uk ◽  
Cleft Surgery

UK cleft services are centralised and involve working in a multidisciplinary team, offering patients a high quality of care and surgeons a potentially enormously rewarding career. Trainees wishing to specialise in cleft surgery should endeavour to gain targetted experience in cleft lip and palate from early in their surgical career as this will stand them in good stead for the cleft training fellowship applications towards the end of higher surgical training.

Relatives and Patients as Partners in the Management of Schizophrenia

1990 ◽  
Vol 156 (5) ◽  
pp. 654-660 ◽  
Author(s):  
Jo Smith ◽  
Max Birchwood
Keyword(s):  
Clinical Practice ◽  
Service Provision ◽  
Expressed Emotion ◽  
Family Management ◽  
Clinical Services ◽  
Clinical Context ◽  
The Family ◽  
Therapeutic Programme ◽  
Made In

Considerable advances have been made in the family management of schizophrenia but there remains a major challenge for the psychiatric services to integrate these innovations into clinical practice. A number of important issues need to be considered in developing routine clinical services: the problem of engaging families in a therapeutic programme; the utility of the concept of ‘expressed emotion’; and procedures for clinical practice. The latter include the needs of low-EE families; maintaining quality of intervention in a clinical context; responding to the multiplicity of needs of the patient and family; and integrating family interventions with ongoing rehabilitation practice. A model of service provision is described.

Improving Work Satisfaction amongst Nursing Staff and Quality of Care for Elderly Patients with Dementia: Some Policy Implications

1995 ◽  
Vol 15 (3) ◽  
pp. 375-391 ◽  
Author(s):  
Alan Gilloran ◽  
Alex Robertson ◽  
Tom McGlew ◽  
Kevin McKee
Keyword(s):  
Quality Of Service ◽  
Quality Of Care ◽  
Service Provision ◽  
Work Satisfaction ◽  
Policy Implications ◽  
High Quality ◽  
People With Dementia ◽  
Change In Practice ◽  
Audit Score

AbstractThis paper discusses the policy implications for encouraging a high quality of service provision in hospital for elderly people with dementia. Contemporary policy is examined and the continuing need for long-stay beds is highlighted, particularly in Scotland. The measurement of the quality of care in nursing is reviewed and concern is expressed over whether the patients or only the audit score will benefit from any change in practice. Ways of improving both work satisfaction and the quality of care are recommended on the basis of a study of psychogeriatric wards in NHS hospitals in Scotland.

scholarly journals Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Brenner ◽  
Caterina Favaretti ◽  
Julia Lohmann ◽  
Jobiba Chinkhumba ◽  
Adamson S. Muula ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Services ◽  
Antenatal Care ◽  
Service Provision ◽  
Child Health Services ◽  
Negative Externalities ◽  
Positive Externalities ◽  
Performance Based Financing ◽  
A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

scholarly journals Widespread gaps in the quality of care for primary biliary cholangitis in UK

2021 ◽  
pp. flgastro-2020-101713
Author(s):  
Mathuri Sivakumar ◽  
Akash Gandhi ◽  
Eathar Shakweh ◽  
Yu Meng Li ◽  
Niloufar Safinia ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Primary Biliary Cholangitis ◽  
Cholestatic Liver Disease ◽  
Patient Demographics ◽  
Risk Patients ◽  
Wide Scale ◽  
The Uk

ObjectivePrimary biliary cholangitis (PBC) is a progressive, autoimmune, cholestatic liver disease affecting approximately 15 000 individuals in the UK. Updated guidelines for the management of PBC were published by The European Association for the Study of the Liver (EASL) in 2017. We report on the first national, pilot audit that assesses the quality of care and adherence to guidelines.DesignData were collected from 11 National Health Service hospitals in England, Wales and Scotland between 2017 and 2020. Data on patient demographics, ursodeoxycholic acid (UDCA) dosing and key guideline recommendations were captured from medical records. Results from each hospital were evaluated for target achievement and underwent χ2 analysis for variation in performance between trusts.Results790 patients’ medical records were reviewed. The data demonstrated that the majority of hospitals did not meet all of the recommended EASL standards. Standards with the lowest likelihood of being met were identified as optimal UDCA dosing, assessment of bone density and assessment of clinical symptoms (pruritus and fatigue). Significant variations in meeting these three standards were observed across UK, in addition to assessment of biochemical response to UDCA (all p<0.0001) and assessment of transplant eligibility in high-risk patients (p=0.0297).ConclusionOur findings identify a broad-based deficiency in ‘real-world’ PBC care, suggesting the need for an intervention to improve guideline adherence, ultimately improving patient outcomes. We developed the PBC Review tool and recommend its incorporation into clinical practice. As the first audit of its kind, it will be used to inform a future wide-scale reaudit.

scholarly journals Impact of Adjustment for Quality on Results of Metaanalyses of Diagnostic Accuracy

2007 ◽  
Vol 53 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Mariska Leeflang ◽  
Johannes Reitsma ◽  
Rob Scholten ◽  
Anne Rutjes ◽  
Marcello Di Nisio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Quality Assessment ◽  
Confidence Intervals ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
High Quality ◽  
Poor Reporting

Abstract Background: We examined whether and to what extent different strategies of defining and incorporating quality of included studies affect the results of metaanalyses of diagnostic accuracy. Methods: We evaluated the methodological quality of 487 diagnostic-accuracy studies in 30 systematic reviews with the QUADAS (Quality Assessment of Diagnostic-Accuracy Studies) checklist. We applied 3 strategies that varied both in the definition of quality and in the statistical approach to incorporate the quality-assessment results into metaanalyses. We compared magnitudes of diagnostic odds ratios, widths of their confidence intervals, and changes in a hypothetical clinical decision between strategies. Results: Following 2 definitions of quality, we concluded that only 70 or 72 of 487 studies were of “high quality”. This small number was partly due to poor reporting of quality items. None of the strategies for accounting for differences in quality led systematically to accuracy estimates that were less optimistic than ignoring quality in metaanalyses. Limiting the review to high-quality studies considerably reduced the number of studies in all reviews, with wider confidence intervals as a result. In 18 reviews, the quality adjustment would have resulted in a different decision about the usefulness of the test. Conclusions: Although reporting the results of quality assessment of individual studies is necessary in systematic reviews, reader wariness is warranted regarding claims that differences in methodological quality have been accounted for. Obstacles for adjusting for quality in metaanalyses are poor reporting of design features and patient characteristics and the relatively low number of studies in most diagnostic reviews.

Gynaecology and genitourinary medicine

2018 ◽  
Author(s):  
Kevin Hayes
Keyword(s):  
Quality Of Life ◽  
Sexual Health ◽  
Teenage Pregnancy ◽  
Full Spectrum ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
The Government ◽  
The Uk ◽  
Improve Access

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in sub-specialization such as gynaecological oncology and urogynaecology. This chapter reflects these changes and covers the commonest areas in this interesting field. Sexual health is a specialty in its own right. The number of cases of sexually transmitted infections are rising in the UK, despite efforts to raise awareness of safe sex, so knowledge of their presentations is important. The UK also has the highest rate of teenage pregnancy in Europe, and the Government has set targets to improve access to contraceptive advice for women. In recent years, astounding advances have been made in the treatment of human immunodeficiency virus (HIV) infection, and people with HIV can now expect to have a much better quality of life. Although this chapter primarily focuses on diseases affecting women, we have included questions on the sexual health of men to represent the full spectrum of sexual health practice.

scholarly journals Protocol adjustment improves the extraction of high-quality total RNA from common bean stems infected by Sclerotinia sclerotiorum

2019 ◽  
Vol 43 ◽  
Author(s):  
Rafael Novais de Miranda ◽  
Caroline Marcela da Silva ◽  
Antonio Carlos da Mota Porto ◽  
Welison Andrade Pereira
Keyword(s):  
Gene Expression ◽  
Common Bean ◽  
Sclerotinia Sclerotiorum ◽  
Rna Extraction ◽  
White Mold ◽  
Basic Requirement ◽  
High Quality ◽  
Commercial Kits ◽  
Made In

ABSTRACT The Straw Test is an assay developed to evaluate the resistance of common bean to white mold, in which the plant stems are inoculated and the symptoms of the disease are monitored. It is plausible to admit that investigating gene expression in pathogen-infected tissues may be strategically interesting. However, obtaining a quality RNA is a basic requirement for this purpose. Therefore, the objective of this study was to evaluate adjustments in protocols of commercial kits in the expectation of improving the quality of RNA obtained from bean stems. For this, plants of two lines were inoculated and the stems pathogen-infected were collected 72 hours after. For RNA extraction, two commercial reagents were used following the manufacturer’s recommendations and then following adaptations in these protocols. In particular, the proposed modifications relate to volumes of supernatant recovered in purification steps, additional step of chloroform purification and extended time for nucleic acids precipitation. The obtained RNA was analyzed by spectrophotometer, electrophoresis and bioanalyzer, then converted into cDNA and subsequently submitted to PCR. From the obtained data, it was observed that the adaptations made in the protocols contributed to better results and that, when the indicative values of RNA quality are guaranteed, the subsequent reactions are more pure, precise and representative.

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