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There are few reliable psychometric measures of the psychopathology of offenders with intellectual disabilities (ID). However, previous research has indicated that the emotional problems scale (EPS) is useful in identifying a range of treatment needs and in predicting risk to self and others. The purpose of this paper is to compare the severity of the emotional and behavioural problems of a small sample of offenders with ID in medium and low secure services, as assessed by EPS. Additionally, the data are tentatively compared with those reported in previous research to precipitate discussion regarding the changes in clinical populations in secure care over time.

The study collected demographic and EPS data for patients with ID (n=25) on medium secure and a low secure wards. Data were collected as part of routine clinical practice, with EPS forms being completed by nursing and other multi-disciplinary staff.

It was found that there was no statistically significant difference in EPS scores between medium and low secure patients with ID. The authors also highlight differences between the current sample and the normative data collected by previous research.

The data regarding the psychopathology of medium and low secure patients with ID provide insight into the ever changing resourcing needs and risk profiles of this complex patient group. In addition, there is a dearth of empirical research that comments on the clinical differences observed over time in forensic populations. As the current data differ from pre-existing normative data, the potential shift in populations and also implications for the accuracy of clinical decision making based on the assessment are discussed.

The prosthodontics sector is facing major challenges because of scientific and technological advances that imply a clearer definition of lines of action and decision making processes. Measuring quality of service in this sector is a complex decision problem since the perceptions of three main players need to be considered: patients, dentists and dental technicians. This study sought to develop an artificial-intelligence-based (AI-based) method for assessing service quality in the dental prosthesis sector.

Using strategic options development and analysis (SODA), which is grounded on cognitive mapping, and the measuring attractiveness by a categorical based evaluation technique (MACBETH), a constructivist decision support system was designed to facilitate the assessment of service quality in the dental prosthesis sector. The system was tested, and the results were validated both by the members of an expert panel and by the vice-president of the Portuguese association of dental prosthesis technicians.

The methodological process developed in this study is extremely versatile and its practical application facilitated the development of an empirically robust evaluation model in this study context. Specifically, the profile analyses carried out in actual clinics allowed the cases in which improvements are needed to be identified.

Although already applied in the fields of AI and decision making, no prior work reporting the use of SODA and MACBETH for assessing service quality in the prosthodontics sector has been found.

Individuals with dual diagnoses might experience significant clinical and social vulnerabilities during the pandemic and lockdown. This study aims to compare medication adherence, substance use, clinical stability and overall functioning before and during lockdown periods.

This was a cross-sectional survey among patients registered in dual diagnosis clinic of an addiction psychiatry center in Northern India between March 2019 and February 2020. This study approached 250 patients for telephonic interviews. This study assessed adherence to medications with the brief adherence rating scale (BARS). Global functioning was measured by global assessment of functioning. Clinical interviews assessed substance use and the clinical status of psychiatric disorders.

One hundred fifty patients were recruited. The mean age of the sample was 35.8 years. The sample had a slight preponderance of alcohol dependence. Depressive disorder was the largest category of psychiatric diagnosis. Compared to prelockdown period, during the lockdown, there were an increased number of days of nonadherence (X² 17.61, p <  0.05), proportion of patients underdosing (X² 8.96, p = 0.003) and lower BARS scores (t = 10.52, df = 144, p < 0.0001). More patients were abstinent from substances during the lockdown (X² 49.02, p < 0.0001). Clinical stability of psychiatric disorders did not differ during the two-time points, but overall functioning decreased during the lockdown (t = 2.118, p = 0.036). This study observed a small positive correlation (r = 0.2, p = 0.02) between functioning and adherence levels.

Lockdown was associated with poor medication adherence, change in substance use patterns and functional impairment. In the future, treatment programs and policies must take preemptive steps to minimize the effects of restrictions.

The medical consultation is one of the requirements in diseases diagnosis and patient treatment. In addition, a high-quality consultation is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to identify factors affecting the high-quality consultation in medical communications.

The following electronic databases were searched: MEDLINE (via PubMed), Web of Science, Cochrane, EMBASE, Scopus and ProQuest until December 2018. In addition, the authors searched Google Scholar. Qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme, Qualitative Checklist and the Center for Evidence-Based Management appraisal checklist, respectively. A stepwise approach was conducted for data synthesis.

Of 3,826 identified studies, 29 met the full inclusion criteria. Overall, after quality assessment of studies, 25 studies were included. The studies were conducted in the USA (n=6), the UK (n=6), the Netherlands (n=4), Canada (n=2), Belgium (n=2), Poland (n=2), Germany (n=1), Iran (n=1), Finland (n=1), Austria (n=1), Qatar (n=1), Denmark (n=1) and China (n=1), and five studies were excluded. Data synthesis showed that high-quality consultation consisted of three main categories: structural (4 main themes with 26 sub-themes), process (2 main themes with 33 sub-themes) and outcome (3 main themes with 12 sub-themes) quality.

Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Decision makers can use them to monitor and evaluate physicians’ performance. A high-quality consultation can be useful in social prescribing that helps patients to manage their disease.

The authors developed and validated an algorithm using health administrative data to identify patients who are attached or uncertainly attached to a primary care provider (PCP) using patient responses to a survey conducted in Ontario, Canada.

The authors conducted a validation study using as a reference standard respondents to a community-based survey who indicated they did or did not have a PCP. The authors developed and tested health administrative algorithms against this reference standard. The authors calculated the sensitivity, specificity positive predictive value (PPV) and negative predictive value (NPV) on the final patient attachment algorithm. The authors then applied the attachment algorithm to the 2017 Ontario population.

The patient attachment algorithm had an excellent sensitivity (90.5%) and PPV (96.8%), though modest specificity (46.1%) and a low NPV (21.3%). This means that the algorithm assigned survey respondents as being attached to a PCP and when in fact they said they had a PCP, yet a significant proportion of those found to be uncertainly attached had indicated they did have a PCP. In 2017, most people in Ontario, Canada (85.4%) were attached to a PCP but 14.6% were uncertainly attached.

Administrative data for nurse practitioner's encounters and other interprofessional care providers are not currently available. The authors also cannot separately identify primary care visits conducted in walk in clinics using our health administrative data. Finally, the definition of hospital-based healthcare use did not include outpatient specialty care.

Uncertain attachment to a primary health care provider is a recurrent problem that results in inequitable access in health services delivery. Providing annual reports on uncertainly attached patients can help evaluate primary care system changes developed to improve access. This algorithm can be used by health care planners and policy makers to examine the geographic variability and time trends of the uncertainly attached population to inform the development of programs to improve primary care access.

As primary care is an essential component of a person's medical home, identifying regions or high need populations that have higher levels of uncertainly attached patients will help target programs to support their primary care access and needs. Furthermore, this approach will be useful in future research to determine the health impacts of uncertain attachment to primary care, especially in view of a growing body of the literature highlighting the importance of primary care continuity.

This patient attachment algorithm is the first to use existing health administrative data validated with responses from a patient survey. Using patient surveys alone to assess attachment levels is expensive and time consuming to complete. They can also be subject to poor response rates and recall bias. Utilizing existing health administrative data provides more accurate, timely estimates of patient attachment for everyone in the population.

This study aims to compare public and private hospitals based on both cognitive and affective components of patients’ satisfaction.

A survey of 770 Italian patients from public and private hospitals was conducted. Then, hierarchical and non-hierarchical cluster analyses and a series of chi-squared tests were run with the aim of segmenting patients’ emotional response.

Respondents show different levels of satisfaction and a different emotional status based on the private or public nature of the service provider. The cluster analysis helped to identify two segments. Specifically, the cluster with the highest positive emotions is reported to have a higher level of satisfaction and a higher intention to return; this evidence is much stronger when a private service provider rather than a public one is considered. A series of chi-squared tests reveal that no significant differences exist among clusters based on socio-demographic characteristics.

This study uses a convenience sample and is highly context specific, and thus the authors are unable to make generalizations.

Hospital managers should develop a customer-oriented approach, for example, by paying greater attention to patients’ emotions and experience, via conducting systematic surveys on patients’ emotions and improving the servicescape.

The main contribution of this study resides in simultaneously considering the role of cognitive and affective components on patients’ satisfaction and behavioural intention, and segmenting patients based on their emotional responses. Moreover, only few studies provide a comparison of public and private hospitals in Italy.

The study aims to facilitate the medical tourists visiting emerging countries for various kinds of ailments by ranking the possible destinations to avail medical treatments.

A Fuzzy Analytical Hierarchical Process (FAHP) with a mixed-method approach is applied to analyze data collected from patients and substantiate it with medical tour operators in India to gain managerial insights on the choice-making patterns of the patients.

India is a preferred emerging market location due to the low cost and high medical staff quality. India offers value for money, whereas Singapore and Thailand are preferred destinations for quality and technology.

The study will facilitate the emerging markets' governments, hospitals and medical tourists to understand the importance of various determinants responsible for availing medical treatment outside their country.

The study recommends that cost and quality care are the patients' prime focus; government policies must provide clear guidelines on what the hospitals and country environment can offer and accordingly align the marketing strategies.

This study is the first attempt to rank various factors affecting medical tourism using the FAHP approach.

The purpose of this paper is to identify and report on the mental health needs of those attending substance misuse services (SMS) adhering to the diagnostic criteria as defined in DSM 5 with reference to common mental health disorders. It also examines differences in the numbers of appropriately trained cognitive behaviour therapy (CBT) therapists and highlights the lack of provision of CBT reflected in the much smaller number of accredited therapists in Wales compared to other parts of the UK.

This population was identified by way of an audit of data collected via the out-patient clinics conducted by the author.

The paper identifies a high proportion of patients who attended SMSs as having complex psychological need as a consequence of co-morbidity.

The results of the audit may have limitations but the implications from the findings suggest potential value in looking more at clinical outcomes following evidence-based psychological interventions.

A conclusion from the findings is suggested value in a more structured approach to looking at clinical outcomes.

This audit was undertaken in North Wales. There is no IAPT or matrix-structured Level II CBT training programmes available in Wales. The audit identifies the need for more evidence-based psychological interventions such as CBT linked to the development of such services. The apparent lack of political will to change the status quo is also highlighted as a problem.

The purpose of this paper is to better understand the influence of service quality and corporate image of Brazil’s National Cancer Institute (INCA) on the satisfaction of its outpatients.

The study is quantitative, with data collected from a self-administered structured questionnaire answered by a sample of 434 outpatients of Hospital do Câncer I, the largest and oldest hospital operated by the INCA. The data were treated with covariance-based structural equation modeling.

The results indicated that the corporate image of the INCA was the main factor having a positive influence on the patients’ satisfaction, followed by the quality of the services rendered by physicians and the quality of the hospital’s facilities.

The study shows that unlike indicated by the theory, quality does not have a direct impact on satisfaction with the nursing services, but rather an indirect impact via corporate image. Even though part of the explanation can be the fact that only outpatients were surveyed, who have less interaction with the nursing team than do inpatients, this result shows the strength of the hospital’s corporate image regarding patients’ satisfaction. Besides this, the study identified that hospitals with a strong corporate image transmit to patients the perception that they are being treated by technically qualified professionals, thus increasing the chances of cure and reduced suffering. This is fundamental for patients’ satisfaction, as most are unable to understand the technical attributes of the service. The study adds to the scarce Brazilian literature on the causal relation between the image of hospitals and their patients’ satisfaction.

Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. First, we discuss the concept of health care error and describe two approaches to analyze error proliferation and causation. Next, by applying transdisciplinary evidence and knowledge to health care, we detail the attributes fundamental to constructing safer health care systems as embedded components within the complex adaptive environment. Then, the Health Care Error Proliferation Model explains the sequence of events typically leading to adverse outcomes, emphasizing the role that organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction. Subsequently, we discuss the critical contribution health care leaders can make to address error as they strive to position their institution as a high reliability organization (HRO). Finally, we conclude that the future of patient safety depends on health care leaders adopting a system philosophy of error management, investigation, mitigation, and prevention. This change is accomplished when leaders apply the basic organizational accident and health care safety principles within their respective organizations.