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Reports on the authors' experience with a patient safety quality improvement program, intended to reduce the incidence and severity of adverse outcomes for emergency department (ED) patients aged ≥75. The Identification of Seniors at Risk scale was used for screening, and those at high risk were referred for appropriate intervention. The plan‐do‐study‐act improvement cycle was followed, conducting process evaluation to diagnose and correct implementation difficulties. Reports that: implementing an ED screening and referral program is deceptively difficult; process evaluation multidisciplinary working group meetings are an essential improvement tool; screening inclusion criteria had to be adapted to the subject population in order to make efficient use of staff time; the screening questions and process required ongoing assessment, revision, and local adaptation in order to be useful; and high‐risk screening in the ED is critical to a hospital system's ability to anticipate clinical problems; the plan‐do‐study‐act improvement cycle is a practical and useful tool for improving quality and systems in a real care setting.

Resource constraints at all levels of the criminal justice system as well as the lack of a widely accepted, validated screening scale have made it difficult to screen adequately for serious mental illnesses (SMI) in offender populations. This study examined the use of the K6 scale, a recently developed and validated screening tool for SMI, using a sample of past-year arrestees. Among the main findings were that 18% of the sample screened positive for SMI. In contrast, commonly used screening questions misidentified a large proportion of arrestees with SMI. Based on these findings, we recommend the use of K6 scale to more accurately identify offenders with SMI.

The purpose of this paper is twofold. First to ascertain the efficacy of current police reception screening to detect detainees with intellectual disability (ID). Second to assess the validity of a short targeted screen for ID among police custody detainees.

The study comprised three stages. First, 248 police custody detainees were assessed for a range of health morbidities, including a pragmatic clinical evaluation of ID. For those with suspected ID, the police custody screens were scrutinised for evidence that this had been detected. Second, a new police health screen, incorporating a short screen for ID, was piloted. Totally, 351 detainees were assessed in the same way as in part 1 with the new screens being scrutinised for evidence that ID had been detected where relevant. Third, the new police screen for ID was validated among a sample of 64 inpatients, some with ID and some without, from forensic inpatient services. Parts 1 and 2 were carried out in the Metropolitan Police Service, London. Part 3 took place in one NHS Trust.

In parts 1 and 2, the rate of detainees with suspected ID was 2-3 per cent. The standard police screen detected 25 per cent of these detainees in part 1. When the new screen was introduced in part 2, the sensitivity for ID increased to 83 per cent. However, there was no requisite improvement in the proportion of detainees with ID receiving an Appropriate Adult. In the inpatient study, the new screen showed a good level of sensitivity (91 per cent) and reasonable specificity (63 per cent).

It is possible to improve the detection rate of detainees with suspected ID by introducing a short ID screen into the police custody officers’ reception health screen.

The Health Screening of People in Police Custody (HELP-PC) study is a project evaluating screening for health morbidity among police custody detainees. Other data from this study have been reported elsewhere, but this is the first time the data pertaining to ID screening has been reported in detail.

The purpose of this paper is to outline and report on the initial development of a screening tool for offenders with suspected intellectual disability (ID) known as the rapid assessment of potential intellectual disability (RAPID).

This paper summarises the wider literature in relation to screening tools and methodology, indicating that quick and easy screening measures for this population are sparse. It outlines the processes involved in the early stages of developing an evidence-based screening tool for ID offenders, and an overall pathway approach to the identification, assessment and diagnosis of ID.

It is possible to develop a tool that can be used to identify potential ID with relative ease. The RAPID screening tool provided practitioners with a simple and easy measure to identify such individuals so that they may be referred for further specialist assessment. It has also demonstrated that it is an effective measure in identifying offenders with a possible ID.

Formal statistical validation of this tool will serve to establish and measure its overall effectiveness and utility, further encouraging the timely identification of ID offenders.

This paper responds to current extensive literature about the variability of screening measures, and provides an effective solution to the identification of vulnerable offenders. Those who may benefit from an assessment of ID, and thereafter reasonable adjustments and alternatives to custodial sentencing are considered.

The purpose of this paper is to investigate the validity and accuracy of the Whooley questions for routine screening of maternal distress in Dutch antenatal care.

In this cohort design, the authors evaluated self-reported responses to the Whooley questions against the Edinburgh Depression Scale screening for antenatal depression, State-Trait Anxiety Inventory for general anxiety and the pregnancy-related anxiety questionnaire-revised screening for pregnancy-related anxiety, among Dutch pregnant women during the first and third trimester of pregnancy. The authors used standard diagnostic performance measures for the two case-finding items.

The Whooley items in this study showed a higher specificity than sensitivity. The Whooley results showed good evidence to identify women who are depressed or (trait)anxious in both trimesters of pregnancy, but the results showed weak to moderate evidence to identify pregnancy-related anxiety. The Whooley items had a low to moderate predictive ability for depression, trait-anxiety and pregnancy-related anxiety and a good ability for negative case-finding. The Whooley items proved to be more able to report how effective the case-finding questions are in identifying women without depression, trait-anxiety and pregnancy-related anxiety (ruling out) rather than how effective these are in identifying women with depression, trait-anxiety and pregnancy-related anxiety (ruling in). The Whooley items were accurate in identifying depression and trait-anxiety in both trimesters but were not very accurate to identify pregnancy-related anxiety.

Assessment of pregnancy-related anxiety using a case-finding tool requires further attention.

The two-item Whooley case-finding tool has shown good utility as a screening instrument for maternal distress. The continuous assessment of maternal emotional health during the childbearing period or, at least, revisiting the topic, would both support the woman and the midwife in regarding perinatal emotional wellbeing as an important remit of midwifery care.

A novel aspect of this paper is the proposition of applying the Whooley questions at later stages of pregnancy or presenting the Whooley questions in a written or digital form.

Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.

A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.

Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.

Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.

To the best of the authors’ knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

This paper presents the outcomes of a small qualitative study investigating the experience of mental health practitioners working with dual diagnosis in an early intervention in psychosis (EIP) team with a focus on the use of a specifically developed screening tool. Interviews were conducted with mental health professionals who were employed as care co‐ordinators within an EIP team. Grounded theory was adopted as a method for making sense of the data obtained. Six themes that emerged from the data are described: the importance of the cycle of change in treatment planning; service accountability and responsibility; the nature of psychotic illness; assumptions about substance use; confidence; and using the tool as part of the recovery process. These themes were discussed in relation to research surrounding psychosis, substance use and screening methods.Despite identifying the importance of a more integrated method of working with this complex service user group, gaps remain in practice. Modifications to the screening tool are recommended and a need for substance‐use‐specific interventions training for practitioners working within EIP services is identified.

Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness.

Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically.

Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced.

Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority.

To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.

Rather than businesses, individual end consumers may develop innovations for themselves. Innovating consumers generally do not protect their innovations with intellectual property rights and may be generally available – a phenomenon recently coined as “free innovation” (von Hippel, 2016). The purpose of this paper is to take stock of how innovation by individual consumers has been measured, and to propose a survey procedure for future studies of consumer innovation.

The author provides a literature review of how innovation by individual end consumers has been measured, and reports on a pilot study conducted in Finland to improve and standardize the measurement of consumer innovation.

The survey procedure includes up to six steps which can be tailored to specific research purposes.

The procedure will enable better international/cross-study comparisons and an efficient collection of data.

People with dementia in hospital are susceptible to delirium, pain and psychological symptoms. These diagnoses are associated with worse patient outcomes, yet are often underdiagnosed and undertreated. Distress is common in people experiencing delirium, pain and psychological symptoms. Screening for distress may therefore be a sensitive way of recognising unmet needs. The purpose of this paper is to describe the development and feasibility testing of the Distress Recognition Tool (DRT). The DRT is a single question screening tool that is incorporated into existing hospital systems. It encourages healthcare professionals to regularly look for distress and signposts them to relevant resources when distress is identified.

The authors tested the feasibility of using the DRT in people with dementia admitted on two general hospital wards. Mixed methods were used to assess uptake and potential mechanisms of impact, including frequency of use, observation of ward processes and semi-structured interviews with primary stakeholders.

Over a 52-day period, the DRT was used during routine care of 32 participants; a total of 346 bed days. The DRT was completed 312 times; an average of 0.9 times per participant per day. Where participants had an identified carer, 83 per cent contributed to the assessment at least once during the admission. Thematic analysis of stakeholder interviews, and observational data suggested that the DRT was quick and simple to complete, improved ward awareness of distress and had the potential to improve care for people with dementia admitted to hospital.

This is the first short screening tool for routinely detecting distress in dementia in any setting. Its uptake was positive, and if effective it could improve care and outcomes for people with dementia, however it was beyond the scope of the study test this.