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Rose Anne Kenny - One of the best experts on this subject based on the ideXlab platform.
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impact of a Specialist Service in the emergency department on admission length of stay and readmission of patients presenting with falls syncope and dizziness
QJM: An International Journal of Medicine, 2021Co-Authors: Kristina Jusmanova, Ciara Rice, Robbie Bourke, Amanda Lavan, Conal Cunningham, Rose Anne Kenny, Geraldine C McmahonAbstract:BACKGROUND Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. AIM To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated Specialist Service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. DESIGN Pre- and post-cohort study. METHODS Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). RESULTS There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4-24.0] days compared to 18.2 (95% CI 14.6-21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). CONCLUSION This study highlights the significant potential benefits of embedding dedicated multidisciplinary Services at the hospital front door in terms of early Specialist assessment and directing appropriate patients to effective ambulatory care pathways.
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Impact of a Specialist Service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness.
QJM : monthly journal of the Association of Physicians, 2020Co-Authors: Kristina Jusmanova, Ciara Rice, Robbie Bourke, Amanda Lavan, C. Geraldine Mcmahon, Conal Cunningham, Rose Anne Kenny, Robert BriggsAbstract:BACKGROUND Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. AIM To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated Specialist Service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. DESIGN Pre- and post-cohort study. METHODS Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). RESULTS There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P
Andrew P Baranowski - One of the best experts on this subject based on the ideXlab platform.
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military veterans with and without post traumatic stress disorder results from a chronic pain management programme
Scandinavian Journal of Pain, 2020Co-Authors: Jannie Van Der Merwe, Suzanne Brook, Claire Fear, Maxwell J Benjamin, Gerald Libby, Amanda C De C Williams, Andrew P BaranowskiAbstract:Background and aims There is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical Services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: Services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one Specialist Service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation. Methods The PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use. Results One hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use. Conclusions Veterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care. Implications Military veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.
Walter Busuttil - One of the best experts on this subject based on the ideXlab platform.
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mental health and functional impairment outcomes following a 6 week intensive treatment programme for uk military veterans with post traumatic stress disorder ptsd a naturalistic study to explore dropout and health outcomes at follow up
BMJ Open, 2015Co-Authors: Dominic Murphy, Georgina Hodgman, Carron Carson, Lucy Spencerharper, Mark Hinton, Simon Wessely, Walter BusuttilAbstract:Objective Combat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national Specialist Service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6 months follow-up. Design A within subject design. Setting UK veterans with a diagnosis of PTSD who accessed Combat Stress. Participants 246 veterans who received treatment between late 2012 and early 2014. Intervention An intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation. Main outcome measures Clinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment. Results We observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: −13.0, 95% CI −14.5 to −11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): −16.5, 95% CI −19.0 to −14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): −6.85, 95% CI −7.98 to −5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6 months and those lost to follow-up. Conclusions In a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6 month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual trauma-focused cognitive behaviour therapy and group sessions when treating veterans with PTSD. This is the first UK study of its kind, but requires further evaluation.
Jannie Van Der Merwe - One of the best experts on this subject based on the ideXlab platform.
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military veterans with and without post traumatic stress disorder results from a chronic pain management programme
Scandinavian Journal of Pain, 2020Co-Authors: Jannie Van Der Merwe, Suzanne Brook, Claire Fear, Maxwell J Benjamin, Gerald Libby, Amanda C De C Williams, Andrew P BaranowskiAbstract:Background and aims There is very little published evaluation of the treatment of military veterans with chronic pain, with or without post-traumatic stress disorder. Few clinical Services offer integrated treatment for veterans with chronic pain and PTSD. Such veterans experience difficulty in accessing treatment for either condition: Services may consider each condition as a contraindication to treatment of the other. Veterans are therefore often passed from one Specialist Service to another without adequate treatment. The veteran pain management programme (PMP) in the UK was established to meet the needs of veterans suffering from chronic pain with or without PTSD; this is the first evaluation. Methods The PMP was advertised online via veteran charities. Veterans self-referred with accompanying information from General Practitioners. Veterans were then invited for an inter-disciplinary assessment and if appropriate invited onto the next PMP. Exclusion criteria included; current severe PTSD, severe depression with active suicidal ideation, moderate to severe personality disorder, or who were unable to self-care in the accommodation available. Treatment was by a team of experienced pain management clinicians: clinical psychologist, physiotherapist, nurse, medical consultant and psychiatrist. The PMP was delivered over 10 days: five residential days then five single days over the subsequent 6 months. The PMP combines cognitive behavioural treatment, which has the strongest evidence base, with more recent developments from mindfulness-based CBT for pain and compassion-focused therapy. Standard pain management strategies were adapted to meet the specific needs of the population, recognising the tendency to use demanding activity to manage post-traumatic stress symptoms. Domains of outcome were pain, mood, function, confidence and changes in medication use. Results One hundred and sixty four military veterans started treatment in 19 programmes, and 158 completed. Results from those with high and low PTSD were compared; overall improvements in all domains were statistically significant: mood, self-efficacy and confidence, and those with PTSD showed a reduction (4.3/24 points on the IES-6). At the end of the programme the data showed that 17% reduced opioid medication and 25% stopped all opioid use. Conclusions Veterans made clinically and statistically significant improvements, including those with co-existing PTSD, who also reduced their symptom level. This serves to demonstrate the feasibility of treating veterans with both chronic pain and PTSD using a PMP model of care. Implications Military veterans experiencing both chronic pain and PTSD can be treated in a PMP adapted for their specific needs by an experienced clinical team.
Jonathan Frost - One of the best experts on this subject based on the ideXlab platform.
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what shape do uk trainees want their training to be results of a cross sectional study
BMJ Open, 2016Co-Authors: Rhiannon L Harries, Mustafa Rashid, P Smitham, Alex Vesey, Richard Mcgregor, Karl Scheeres, Jon Bailey, Syed Mohammed Afzal Sohaib, Matthew Prior, Jonathan FrostAbstract:Objectives The British Government is acting on recommendations to overhaul postgraduate training to meet the needs of the changing population, to produce generalist doctors undergoing shorter broad-based training (Greenaway Review). Only 45 doctors in training were involved in the consultation process. This study aims to obtain a focused perspective on the proposed reforms by doctors in training from across specialities. Design Prospective, questionnaire-based cross-sectional study. Setting/participants Following validation, a 31-item electronic questionnaire was distributed via trainee organisations and Postgraduate Local Education and Training Board (LETB) mailing lists. Throughout the 10-week study period, the survey was publicised on several social media platforms. Results Of the 3603 demographically representative respondents, 69% knew about proposed changes. Of the respondents, 73% expressed a desire to specialise, with 54% keen to provide general emergency cover. A small proportion (12%) stated that current training pathway length is too long, although 86% felt that it is impossible to achieve independent practitioner-level proficiency in a shorter period of time than is currently required. Opinions regarding credentialing were mixed, but tended towards disagreement. The vast majority (97%) felt credentialing should not be funded by doctors in training. Respondents preferred longer placement lengths with increasing career progression. Doctors in training value early generalised training (65%), with suggestions for further improvement. Conclusions This is the first large-scale cross-specialty study regarding the Shape of Training Review. Although there are recommendations which trainees support, it is clear that one size does not fit all. Most trainees are keen to provide a Specialist Service on an emergency generalist background. Credentialing is a contentious issue; however, we believe removing aspects from curricula into post-Certificate of Completion of Training (CCT) credentialing programmes with shortened specialty training routes only degrades the current consultant expertise, and does not serve the population. Educational needs, not political winds, should drive changes in postgraduate medical education and all stakeholders should be involved.
