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This paper aims to outline the process of undertaking the Confidential Inquiry (CI) into the deaths of people with learning disabilities and discusses three particular issues: engaging with professionals; maintaining confidentiality; and the tension between wanting to base the findings on a sufficiently large number of cases so that the findings are robust and reliable, but also wanting to make immediate changes to any potentially modifiable factors found to contribute to the deaths of people with learning disabilities.

The CI into the deaths of people with learning disabilities reviews the deaths of all people with learning disabilities living in the (former) Avon and Gloucestershire areas. It has been commissioned by the Department of Health to run until March 2013. One of the key drivers for a CI has been the work of Mencap in exposing the unequal health care that some people with learning disabilities received in the NHS.

The principal goal of the CI is to improve the standard and quality of care for people with learning disabilities and ultimately their health outcomes. The CI team aims to detect potentially modifiable contributory factors in the care of a person with learning disabilities who has subsequently died, share any examples of good practice in their care and provide information to guide the commissioning of services.

It is anticipated that the findings of the CI will provide a considerable amount of evidence on which to improve the standard and quality of care for people with learning disabilities and ultimately their health outcomes.

To develop and implement an educational programme to improve medical students’ attitudes towards intellectual disabilities. The purpose of this paper is to improve the healthcare outcomes for individuals with intellectual disability.

The development of an educational programme involving actors with an intellectual disability as simulated patients. Scenarios were developed involving basic healthcare interactions. The programme was piloted in three sessions with 45 students. A qualitative analysis of student feedback was then used to develop a student attitude questionnaire for completion pre- and post-educational intervention.

The student attitude questionnaire was completed by 23 different medical students. Two domains were analysed: affect and understanding domain scores, mean difference (95% CI) 3.17(2.41-3.94) p<0.001, knowledge and skills domain scores, mean difference (95% CI) 4.22(3.3-5.14) p<0.001.

Student feedback reveals significant positive changes in affect and understanding, and an improvement in knowledge and skill levels when interacting with people with an intellectual disability following the educational intervention. Some major institutions now offer comprehensive programmes involving people with intellectual disabilities as tutors, and in the role of simulated patients. However, more needs to be done to encourage the increased participation and good practice for all of tomorrow’s doctors to benefit.

Following the publication of recent enquiries into the deaths of people with intellectual disabilities. We know that many of these deaths are premature and potentially preventable. The main failing identified repeatedly is that healthcare staff lack of awareness of the needs of people with intellectual disabilities. This emanates from poor quality and limited curricula time dedicated to intellectual disabilities. There is a need to drastically change the approach to teaching about intellectual disabilities to medical students. All the evidence promotes the involvement of people with intellectual disabilities and their careers in designing and delivering this teaching.

The purpose of this paper is to estimate the mean life expectancy (LE) and the expected years of life lost (EYLL) for ischemic stroke and intracerebral hemorrhage.

This retrospective cohort study included 5,210 patients with a diagnosis of first ischemic stroke or intracerebral hemorrhage between 2005 and 2013 from Ramathibodi Hospital, Bangkok, Thailand. The survival of each case was followed until December 31, 2016. A semiparametric extrapolation method was applied to estimate the lifetime survival function relative to an age and sex-matched reference population.

Of 5,210 patients, 74.2 percent experienced ischemic stroke. About 54.3 percent were men. Mean age at diagnosis was 64.3 years. The mean LE was 12.5 years for ischemic stroke and 12.0 years for intracerebral hemorrhage. The EYLL among patients with intracerebral hemorrhage was significantly higher than among those with ischemic stroke (10.1 vs 5.7). Women were expected to lose more LE than men for both types of stroke (p-value<0.05), while younger aged patients were expected to lose more years of life than older ones.

This study fulfilled an identified need to estimate LE and EYLL among patients with ischemic stroke and intracerebral hemorrhage.

Faced with fierce competition, increasingly more organizations seek to audit demand in the marketplace. The same can be said for insurers. Empirical findings show that insurers are widely disliked by customers, and insurance agents talked to clients on average once every eight years. We found that approximately 44 per cent of the population does not own any form of insurance, for example life insurance and personal accidents insurance. What are the underlying reasons why the majority of people do not insure themselves against hazards? There is a need for insurers to undertake a demand audit in order to understand what the policyholder wants and needs. Information from customers plays a major role in the auditing process. Our audit checklist includes: demographic characteristics of policyholders and non‐policyholders; reasons for being insured and not insured; and critical purchasing factors. The demand audit that we surveyed will help the insurance industry design a good strategy to meet the demands of the market.

The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented.

This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions.

Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities.

Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities.

The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

Modern health care presents challenges for science and technology that go well beyond surgical procedures and physiological monitoring. But although technology is making a rod for policymakers’ backs, it may also be throwing them a lifeline. The research focus is increasingly on information and communications technologies, which are opening up new possibilities in preventive health, self‐diagnosis and even remote surgery. For a public accustomed to paternalistic medicine, the redistribution of R&D resources may come as a shock – but Europe’s overstretched health services need more than sticking plaster solutions.

The purpose of this paper is to improve the police, policy makers' and researchers' understanding of the likelihood of fatal outcomes befalling missing persons.

Data on the age, sex, duration missing and outcome (fatal or non‐fatal) of over 32,000 cancelled reports of missing persons were extracted from a police database of missing persons in the London metropolitan area. The analysis highlights the risk of a cancelled missing person report resulting in a fatal outcome by the same variables.

Shows that the risk of a cancelled missing person report resulting in a fatal outcome is overall very low, though it does increase with the age of the person reported missing and the duration they remain missing for. Males face a higher risk of being found dead than females.

The risk estimations use a base rate of all cancelled missing person reports, therefore excluding persons who have never being found. The estimations are based on missing person reports rather than individuals. Insufficient detail was available to analyse the fatal cases by type of death (e.g. suicide, homicide, accident, etc.).

This paper provides new empirical evidence on what happens to people reported missing. The findings provide an actuarial context in which clinical risk assessment by police officers can take place.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.

The purpose of this paper is to provide an estimate of the costs of premature mortality caused by the COVID-19 pandemic.

Using COVID-19 pandemic-derived mortality data for November 9, 2020 (globally 1,303,215 deaths) and applying a country-based value of statistical life (VSL), the worldwide cost of premature mortality was assessed. The cost was assessed based on income groups until November 9, 2020 and projected into the future until March 1, 2021 using three scenarios from the Institute for Health Metrics and Evaluation (IHME).

The global cost of premature mortality is currently estimated at Int$5.9 trillion. For the high-income group, the current estimated cost is Int$ $4.4 trillion or $3,700 per person. Using IHME projections until March 1, 2021, global premature mortality costs will increase to Int$13.7 trillion and reach Int$22.1 trillion if policies are relaxed, while the cost with 95% universal masks is Int$10.9 trillion. The richest nations will bear the largest burden of these costs, reaching $15,500 per person by March 1, 2021 if policies are relaxed.

The cost of human lives lost due to the pandemic is unprecedented. Preparedness in the future is the best policy to avoid many premature deaths and severe recessions in order to combat pandemics.