Assessment Unit Research Articles

Female fertility preservation for family planning: a position statement of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR).

This position statement by the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) aims to establish an optimal framework for fertility preservation outside the standard before oncological therapies. Key topics include the role of fertility units in comprehensive fertility assessment, factors impacting ovarian potential, available preservation methods, and appropriate criteria for offering such interventions. The SIFES-MR writing group comprises Italian reproductive physicians, embryologists, and scientists. The consensus emerged after a six-month period of meetings, including extensive literature review, dialogue among authors and input from society members. Final approval was granted by the SIFES-MR governing council. Fertility counselling transitions from urgent to long-term care, emphasizing family planning. Age, along with ovarian reserve markers, is the primary predictor of female fertility. Various factors, including gynecological conditions, autoimmune disorders, and prior gonadotoxic therapies, may impact ovarian reserve. Oocyte cryopreservation should be the preferred method. Women 30-34 years old and 35-39 years old, without known pathologies impacting the ovarian reserve, should cryopreserve at least 12-13 and 15-20 oocytes to achieve the same chance of a spontaneous live birth they would have if they tried to conceive at the age of cryopreservation (63% and 52%, respectively in the two age groups). Optimal fertility counselling necessitates a long-term approach, that nurtures an understanding of fertility, facilitates timely evaluation of factors that may affect fertility, and explores fertility preservation choices at opportune intervals.

Concordance among lacustrine communities are low and inconsistent in the conterminous United States.

Concordance occurs when two or more biological groups are correlated to each other. Examining the degree of concordance between communities has been a central goal in ecology. However, few studies have assessed the levels of community concordance at large spatial scales. We used a dataset obtained by the National Lakes Assessment (United States Environmental Protection Agency) to evaluate whether (i) the levels of concordance between aquatic communities were higher at the continental scale than within individual ecoregions of the United States and (ii) whether the levels of concordance between phytoplankton and zooplankton were higher than those between the plankton and macroinvertebrates communities. At the continental scale, the levels of concordance between different pairs of aquatic communities were low and did not exceed those within the ecoregions. Furthermore, levels of concordance varied considerably among ecoregions. Our results suggest that interactions between aquatic communities likely determined concordance patterns; however, the expectation of higher levels of concordance between the phytoplankton and zooplankton communities than between them and the macroinvertebrates community was not supported. The consistently low and variable levels of concordance suggest that using surrogate groups is not recommendable for monitoring lakes in the United States, both at the continental and regional scales. According to our results, the prospect of using the surrogacy approach was low even for aquatic communities that are highly interactive or driven by similar environmental factors.

Validating nutrient selection for product-group-specific nutrient indices for use as functional units in life cycle assessment of foods.

The ability to provide adequate nutrition is considered a key factor in evaluating the sustainability of foods and diets. Nutrient indices are used as functional units (FU) in life cycle assessment of foods to include nutritional performance in the environmental assessment of a product. Several general and food-group-specific nutrient indices exist but many lack validation, particularly when used as FU. In addition, the nutrient selection strategies and reference units for nutrient intake can vary considerably among studies. To validate intake-based product-group-specific nutrient indices previously developed for protein (NR-FIprot) and carbohydrate (NR-FIcarb) foods and for fruits and vegetables (NR-FIveg), we applied principal component analysis to investigate correlations between nutrients in foods and dishes representing a typical Finnish diet. The reference amounts for meal components were based on a plate model that reflected Finnish dietary recommendations. The portion sizes for the different food groups were anchored at 100 g, 135 g and 350 g for proteins, carbohydrates and fruits/vegetables, respectively. Statistical modelling largely validated the NR-FI indices, highlighting protein foods as sources of niacin, vitamin B12 and Se, carbohydrate foods as sources of Mg, Fe and phosphorous, and fruits/vegetables as sources of potassium, vitamin K, vitamin C, fibre and thiamine. However, in contrast to the intake-based approach applied in NR-FIprot, the dietary recommendation-based validation process suggested that fruits and vegetables should be favoured as sources of riboflavin and vitamin B6.

Which international co‐authorships produce higher quality journal articles?

AbstractInternational collaboration is sometimes encouraged in the belief that it generates higher quality research or is more capable of addressing societal problems. Nevertheless, while there is evidence that the journal articles of international teams tend to be more cited than average, perhaps from increased international audiences, there is no science‐wide direct academic evidence of a connection between international collaboration and research quality. This article empirically investigates the connection between international collaboration and research quality for the first time, with 148,977 UK‐based journal articles with post publication expert review scores from the 2021 Research Excellence Framework (REF). Using an ordinal regression model controlling for collaboration, international partners increased the odds of higher quality scores in 27 out of 34 Units of Assessment (UoAs) and all Main Panels. The results therefore give the first large scale evidence of the fields in which international co‐authorship for articles is usually apparently beneficial. At the country level, the results suggests that UK collaboration with other high research‐expenditure economies generates higher quality research, even when the countries produce lower citation impact journal articles than the United Kingdom. Worryingly, collaborations with lower research‐expenditure economies tend to be judged lower quality, possibly through misunderstanding Global South research goals.

Rehabilitation for adults with an intellectual disability and mental health and behavioural complexities: A scoping review

AbstractBackgroundThere has been significant focus in the past decade on reducing admissions to assessment and treatment units for people with intellectual disabilities experiencing mental health or behavioural concerns. This has included the development of intensive support functions of National Health Service Learning Disability services to bolster community support and treatment for people at risk of admission. However, in recent years, there has been increased consideration of service development to include rehabilitation functions which would aim to proactively provide medium‐term additional input to individuals with a complexity of need. This input would aim to improve future trajectories and support the individuals to remain living a good life in their own community. This review focuses on community and in‐patient approaches to meeting a complexity of need.MethodA scoping review was carried out according to established best practice guidelines. Papers returned from the search were screened by the following inclusion criteria (a) Models or Outcomes of Rehabilitation; (b) Intellectual Disability Population; (c) Sample being 18 or above and (d) longer than short‐term stay/treatment, defined as 6 months or longer; and (e) Mental health and/or behaviour complexities. The search was conducted in electronic databases CINAHL, PsycInfo, Medline, Embase and Social Policy & Practice. Here, 3790 articles were initially identified and 27 were ultimately included in the review.FindingsThere are few studies evaluating rehabilitation for people with intellectual disabilities and mental health or behavioural concerns. There was some evidence that accessing assessment and treatment inpatient provision resulted in clinical improvements. Some studies demonstrated initial evidence that longer term rehabilitation was beneficial as a step‐down from inpatient care. Some key principles were identified in terms of rehabilitation approaches: the need for person‐centred creative approaches, suitable staff training, focus on building skills, and a focus on increasing quality of life.ConclusionThere are some indicators of what good rehabilitation services might comprise for people with an intellectual disability, who have rehabilitation needs. However, far more research and guidance are required in this area. In particular, it is unclear whether rehabilitation is best provided within an inpatient or community model, and further detail is required about optimal components of such rehabilitation.

What is a high-quality research environment? Evidence from the UK’s research excellence framework

Abstract As part of the UK university sector’s performance-related research funding model, the ‘REF’ (Research Excellence Framework), each discipline-derived ‘Unit of Assessment’ must submit a statement to provide information about their environment, culture, and strategy for enabling research and impact. Our aim in this paper is to identify the topics on which these statements focus, and how topic variation predicts funding-relevant research environment quality profiles. Using latent Dirichlet allocation topic modelling, we analysed all 1888 disciplinary ‘unit-level’ environment statements from REF2021. Our model identified eight topics which collectively predicted a surprisingly large proportion—58.9%—of the variance in units’ environment scores, indicating that the way in which statements were written contributed substantially to the perceived quality of a unit’s research environment. Assessing research environments will increase in importance in the next REF exercise and the insights found through our analysis may support reflection and discussion about what it means to have a high-quality research environment.

Weight suppression at lowest weight as an indicator of eating disorder clinical severity: A retrospective cohort study

ObjectivesWeight suppression (WS) defines the difference between the highest weight in adulthood and the current weight. WS at lowest weight is the difference between the highest and the lowest ever weight. Weight rebound is the difference between the past lowest weight and current weight. The distinction in the capacities of WS, weight rebound, and WS at the lowest weight remains unclear regarding their efficacy in forecasting clinical endpoints. This study assessed the relationship between WS, WS at lowest weight and/or weight rebound and eating disorder (ED) clinical severity. MethodsIn this retrospective cohort study, adult participants were selected at the Outpatient Unit for multidisciplinary assessment of ED, Montpellier, France, between February 2012 and October 2014 and May 2017 and January 2020. ED clinical severity was evaluated using the Eating Disorder Examination Questionnaire (EDE-Q). ResultsThe sample included 303 patients: 204 with anorexia nervosa (AN) and 99 with bulimia nervosa (BN). The EDE-Q total score was positively correlated with WS at lowest weight in patients with AN (Spearman's rho = 0.181, p = 0.015) and with BN (Spearman's rho = 0.377; p < 0.001). It was also positively correlated with weight rebound (Spearman's rho = 0.319; p = 0.003) in patients with BN. In the multivariate analysis, EDE-Q total score was associated with WS at lowest weight only in patients with BN (β = 0.265; p = 0.03). ConclusionWS at lowest weight seems to be a good measure of ED clinical severity. More research is needed for better understanding WS at lowest weight in assessment and treatment of patients with ED.

Assessing pragmatic language difficulties using the Revised Children's Communication Checklist-2. Exploratory structural equation modeling and associations with restricted and repetitive behaviors.

In this paper, we investigated the psychometric properties of the Child Communication Checklist-Revised (CCC-R) for the first time with an English-speaking sample. We used a confirmatory application of exploratory structural equation modeling (ESEM) to re-evaluate the CCC-R's psychometric properties. We found strong support for its use as an assessment for pragmatic and structural language. Our second main aim was to explore associations between pragmatic and structural language and restricted and repetitive behaviors (RRBs), two hallmark characteristics of autism. We used the CCC-R and Repetitive Behavior Questionnaire (RBQ-2) to investigate these associations in a diverse non-clinical sample of children, taking a transdiagnostic approach. We intentionally excluded autism and other neurodevelopmental diagnoses to test, (1) the CCC-R in a broad sample and (2) the association between pragmatic language and RRB in children not already selected for that association. The sample comprised two groups of children, one was community sampled (n = 123) and the other (n = 143) included children with non-specific behavioral, emotional and/or cognitive difficulties referred to an assessment unit by schools. We found clear associations between pragmatic language difficulties and RRBs in both groups. Regression analysis showed that pragmatic language was the only significant contributor to RRBs even after Grammatical-Semantic score, age, sex, and socioeconomic status were controlled. The pattern was the same for both recruitment groups. However, the effects were stronger for the school-referred group which also had more pragmatic difficulties, grammatical-semantic difficulties and RRBs. A robust link between pragmatic language and RRBs, established in autism, has continuity across the broader non-clinical population.

Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study.

Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. A total of 30/210 (14.0%, 95% CI 9.9-19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P = 0.003), with an odds ratio of 3.65 (95% CI 1.49-8.89, P = 0.004). A hCG/C <4.0 was associated with a 1.9% risk of intervention, which accounted for 25.7% of the study population. A similar result was obtained by substituting hCG/C <4.0 with an initial hCG level <100 IU/l, which was associated with 2.0% risk of intervention, and accounted for 23.8% of the study population (P > 0.05). A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. No external funding was required for this study. No conflicts of interest are required to be declared. N/A.

1710 Using the Visual Assessment Tool (VAT) on all patients at risk of falls in the day assessment unit (DAU)

Abstract Objective To conduct a QIP to ensure that &amp;gt;80% of DAU patients’ vision was assessed via the VAT as per National Audit of Falls Prevention Guidance. Background Patients with visual impairment are twice as likely to fall than those without. The NAIF 2015 report identified &amp;lt;50% of elderly patients had their vision assessed in hospital; also evident at Southend Hospital. Methods Data collection from 56 patients over 8 weeks following weekly interventions helped us analyse their impact on VAT use. Control data (week 1) was pre-intervention. Intervention Six interventions were applied over 7 weeks: teaching to nurses, HCAs and doctors about VAT; email to Geriatrics team; reminder email to DAU nursing team and a feedback questionnaire. Results and Discussion Mean age was 82 and 38% of patients attending DAU had an ophthalmic history. Pre-intervention (week 1) identified 0% VAT use. In week 2, there was a 75% increase in VAT use after teaching nursing and HCA staff. In week 3, there was only 12.5% VAT use after the poster intervention. In week 4, there was a 25% uptake on VAT use with no intervention. Week 5’s intervention witnessed 100% in VAT use, which remained high in week 6 (85.7%), 7 (100%) and 8 (100%). The final intervention questionnaire highlighted that 100% of staff were (i) previously unaware of VAT, (ii) agreed on its importance in assessment of elderly patients, (iii) found teaching adequate, (iv) thought there was enough awareness on VAT use via the QIP, (v) agreed that an incomplete VAT was due to inability to undertake section 4 and 5. Conclusion VAT use identified 3 ophthalmic problems that would have otherwise not been managed. While the QIP did not meet the target of &amp;gt;80% VAT use, it successfully informed DAU staff in proper conduct of VAT in falls patients.

1705 Geriatrician involvement with community multi-disciplinary teams to support people living with frailty and reduce readmissions

Abstract Introduction Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach. Method Patients, residing in Benfleet and Leigh-on-sea, discharged from Geriatric wards at Southend Hospital were identified during ward MDT meetings. Inclusion criteria: • Recurrent admissions • Prolonged hospital stay • Clinical Frailty Score &amp;gt; 5 • Social support Using this criteria, 216 patients were included. 7-day readmission and 30 day readmission data was collected and compared to readmission rate prior to intervention. Intervention On discharge patients were linked with Frailty Nurses within their Primary Care Network and were reviewed within 48-72 hours of discharge. Community support was provided via MDT, with involvement from consultant geriatrician. Concerns that could result in readmission were highlighted during these meeting, with patients being seen in Day Assessment Unit for review of sub-acute frailty syndrome if appropriate. Results Following intervention of utilising community MDT there was a reduction in rate of readmission. 9 patients (4.1%) were readmitted within 7 days of discharge and 14 patients (6.4%) were readmitted within 30 days, in comparison to 7.6% and 19.3%, respectively, prior to commencement of MDT. Conclusion This concludes that utilising community MDT with review following discharge has positive impact in reducing readmission rates. Highlighting potential risks of readmissions allows the MDT to address issues within the community and use bridging services appropriately.

1908 Documentation in Clinical Frailty scores in patients aged &amp;gt;65 admitted to surgical assessment unit

Abstract Introduction According to the latest NELA report, frailty doubles the risk of mortality in patients &amp;gt;65 and above, but review by a geriatrician can significantly reduce this risk. To identify patients at risk, the report recommended that a formal frailty assessment for all patients&amp;gt;65 should be performed. The aim of this audit was to check compliance with this recommendation. Methods Data were collected retrospectively from a prospectively maintained electronic hospital records. Patients &amp;gt; 65 years admitted acutely under general surgery were identified from handover lists spanning a period of two weeks. The admission documents were reviewed to check for a formal assessment of clinical frailty score (CFS) had been completed. Following initial results, posters were put up in the SAU doctors’ office and all clerking doctors made aware via e-mails, WhatsApp groups and teaching to complete a CFS for patients &amp;gt;65 years. Results In the first cycle, 50 patients were identified and compliance rate was 18%. Following intervention, 51 patients were identified in the subsequent cycle with a compliance rate of 47%. After a second intervention, 99 patients were identified with a compliance rate of 61%. Discussion The NELA report highlighted only 23% of patients had a CFS documented and this was similar to the results of the initial audit. The main reason was lack of awareness, which was addressed by creating an awareness among the colleagues via poster, group chats and emails. This brought compliance up to 47%. Another reason was doctors being unable to locate the CFS on the electronic clerking document. A second round of intervention by poster, group chat, email communication and teaching achieved a 61% completion rate. The recommendation is to continue to improve the documentation of CFS further and utilize this to get input from geriatricians.

1775 Delirium education and documentation - Quality improvement project in geriatric assessment unit

Abstract Introduction Delirium is a common presentation in older people (&amp;gt;65 Years age) and associated with falls risk, longer inpatient stay, post-discharge institutionalization, accelerated cognitive decline and higher mortality. While median duration of delirium is reported as 1 week but for one third patients, symptoms may persist 3 months or more, even a proportion of patients will never fully recover to their pre-delirium cognitive baseline. It is essential to educate patient and family that staying in the hospital can only make delirium worse and they will need extra support on discharge for usual daily activities to avoid falls and readmissions. Physicians should be aware that delirium sufferers often have an awareness of their experience and for affected person and their family, delirium can be a cause of significant distress. Identification of risk factors, education, and a systematic approach to management can improve the outcome and experience of the syndrome. Aim To provide delirium education and Improve documentation up to 95 % in GAU. Method • Prospective data collection • Jan 2023 to March 2023 • Monthly data analysis of 20 patients in GAU with the confirm diagnosis of delirium. • PDSA 1 Departmental teaching and delirium leaflet awareness and availability • PDSA 2 Poster as Visual prompt Results After 2 PDSA cycles, we noticed significant improvement in delirium education and documentation up to 95%. Another QIP is ongoing to incorporate delirium time bundle in our practice to timely identify diagnosis, manage potential triggers and provide education to better understand its nature. Conclusion Along with prompt diagnosis and management, good educational approach and clear documentation will lead to improve understanding about delirium, reduce distress and facilitate safe early discharge. References https://www.sign.ac.uk/sign-157-delirium.

Environmental Impact Assessment United States of India Using GRA Method

An environmental impact assessment examines a project's potential effects on the environment while taking into consideration natural, social, and economic factors. More than half of the nations in the world require EIA in some capacity. EIAs had much less of an impact than their initial supporters anticipated. This study institutionalizes the difference, offers methodological justifications, and suggests approaches for future EIA use that will be more successful. Extensive knowledge of environmental impact assessments (EIA) as a tool for management of the ecosystem in the future Its goals and level of success have sparked a lot of discussion. It is evaluated based on the "Performance" of EIA. In particular, the debate shifts away from issues of actual implementation and toward the most crucial EIA objectives and their placement in broader decision-making contexts. EIA's implementation of planning choices is generally weak. Empirical research has supported the effect. The goal of this paper is to address Scale weights concern COPRAS interval-valued integers. The COPRAS method is extended to MCDM issues with unknowable knowledge. It essentially establishes some optimization models based on the traditional COPRAS method's fundamental concept, the determination of scale weights. This alternative in this method has been adopted by Delhi, Ladakh, Jammu and Kashmir, Andaman and Nicobar, Chandigarh, Lakshadweep, and the assessment criteria are Terrestrial, Aquatic, Economic, Social, and Cultural, as well as Air, Water, Soil, Noise, and Solid Waste pollution. As a result of this research Principles of the GRA technique uses the short-range and negative-best solutions to calculate the long-range answer, but the comparison of these distances is not thought to be important. Delhi has therefore been given the top ranking; Ladakh has received a poor ranking. This study demonstrates Delhi's elevated levels of air pollution.

Women’s experiences of early pregnancy loss services during the pandemic: A qualitative investigation

ProblemEarly pregnancy losses [EPL] are common, varied, and require different courses of management and care. BackgroundIn the UK, women who suspect or suffer a pregnancy loss are usually provided specialist care in early pregnancy assessment units [EPAUs]. Their configuration has recently been evaluated, but recommendations for change in-line with best practice for optimum outcomes were unable to be implemented due to the COVID-19 pandemic health system shock. AimTo compare women’s experiences of EPAUs during the pandemic to themes previously found in qualitative work undertaken with women who utilised EPAUs before the pandemic. MethodsWe conducted semi-structured virtual interviews, with women (N = 32) who suffered an early pregnancy loss during the pandemic; analysing transcripts using Template Analysis, based on findings about women’s (pre-pandemic) experiences of EPAU from The VESPA Study. FindingsWe report on seven key themes: Barriers to Accessing Services; Communication & Information; Retention of Relational Care; Involvement in Care Decisions; Staffs’ Attitude or Approach; Efficiency of Service Delivery; Sensitive Patient Management. DiscussionSensitive patient management and woman-staff interactions in EPAU settings remain a fundamental issue. Women also reported their experiences of EPAUs were comparatively worse during the pandemic. ConclusionsWomen valued the care provided by EPAUs and found services to be efficient, despite pandemic-related restrictions. However, psychological recognition surrounding EPL and appropriate, sensitive, relational care and support continue to be areas in need of improvement. Our recommendation is to implement the improvements suggested by VESPA as a priority to ameliorate present sub-optimal experiences and prevent further deterioration.

Implementation and impact of rapid SARS-CoV-2 point of care test on patient flow in the frailty pathway; A quality improvement approach.

To maintain patient flow during the COVID-19 pandemic, rapid and accurate decisions for the safe triage of geriatrics patients was essential as turnaround times for laboratory testing was ineffective at supporting rapid clinical decision-making for transfer of care. Thus, to mitigate and inform these clinical decisions, a quality improvement collaborative project with the geriatrics and virology department was conducted at the Frailty Assessment Unit (FAU) at Aberdeen Royal Infirmary. The goal was to facilitate patient triage during transfer of care with the introduction of Point of Care testing (POCT). The interventions which resulted in significant improvements were based on the fishbone problem solving approach and the driver diagram with change ideas informing the five Plan, Do, Study and Act (PDSA) cycles. The QI intervention was crucial in supporting clinical staff decision making during transfers for 95% of patients who had been clinically judged as asymptomatic for COVID-19 infection. High staff engagement was observed with 83% of staff suggesting the process map was easy to follow and 92% of clinical staff agreed it contained sufficient information to support the testing process. With POCT introduction, the proportion of patients who were transferred with an early POCT result increased by 20% in the Rosewell House group and by 65% in the community Hospitals group, once governance arrangements were in place. Finally, the considerable uptake of POCT by the ward consequently led to a decrease of up to 86% in the number of samples sent to the laboratory for rapid SARS-CoV-2 testing. The quality improvement project provided a rapid and reliable SARS-CoV-2 triage tool and was effectively integrated into the geriatrics triage algorithm to facilitate patient placement and flow.

Exploring the synergistic effects of warm and cold standby units in availability modelling and assessment of complex series-parallel systems

Exploring the synergistic effects of warm and cold standby units in availability modelling and assessment of complex series-parallel systems

Optimising Same Day Emergency Care (SDEC) Delivery Within a Leading Tertiary Cancer Centre in Southeast Wales

Expansion and enhancement of Same Day Emergency Care at Velindre Cancer Centre during 2022 compromises of Ambulatory Care Unit, Assessment Unit, Patient Support Unit and Immunotherapy toxicities service.&#x0D; To provide better value-based healthcare we have introduced an Immunotherapy Toxicities service plus expanded the existing Ambulatory Care Unit and Patient Support Unit providing 12-hour weekday working including a weekend service. &#x0D; The need for a dedicated Immunotherapy service was highlighted following NHS data which anticipated a growth of 240% in Immunotherapy treatments over the next 5 years with Immunotherapy treatments having already increased by 49% from 2018/19 to 2020/21. &#x0D; Without investment this would have led to increasing admissions in South East Wales Health Boards by over 320 patients per annum. This increase would perpetuate the strain on the Ambulatory Unit within VCC and Local Health Boards emergency departments due to the need to admit the patients experiencing toxic side-effects with no viable alternative.&#x0D; The development of the Immunotherapy service has allowed for a clear alternative to emergency/unscheduled admission by ensuring robust pathways are in place, 24/7 resilience and support of toxicities, increased patient and staff education in managing toxicities and rapid treatment and management of patients. &#x0D; The Ambulatory Care provision has expanded working hours as well as supporting a weekend service to ensure more timely interventions for patients on a same day basis, enhancing care and clinical outcomes plus removing additional demand on Local Health Boards by preventing admission. &#x0D; Since 2019 the Patient Support Unit has seen a 51% reduction for inpatient admissions for head and neck cancer with the average monthly bed days for patients reduced by 45%. Through service expansion it has been predicted that admissions and length of stay are likely to reduce by a further 10-15%. This will further decrease the burden on external services such as acute hospitals with an ever growing demand on the services.&#x0D; The expansion has improved access to a skilled multidisciplinary team including specialist nurses, dieticians, speech and language therapists, physiotherapists and occupational therapists who will all work together to ensure all patients are cared for through robust interventions with timely follow ups.&#x0D; The model of delivery is innovative and forward thinking and endorsed by patients and staff alike. The joint MDT allows professionals to anticipate, ameliorate and treat complex and rapidly changing symptoms as an outpatient. &#x0D; The services discussed are essential in reducing the burden on internal and external services whilst ensuring the patient has the best possible outcome. Through clear robust pathways and an upskilled workforce, the service will be sustainable for years to come whilst patients are dealt with in the best way possible in an Ambulatory manner.&#x0D; The outcome is a sustainably funded, evidence-based patient-centred service offered in a day case setting, that anticipates and manages complex toxicities and challenging symptoms that develop at different points during the treatment pathway. With these side effects managed on an ambulatory basis, it prevents patients requiring prolonged inpatient admission, a wider benefit for our partners in Local Health Boards.&#x0D;

Stuck in Hospital: how can we make integrated care a reality for people with a learning disability and / or autism who experience long stays in assessment &amp;amp; treatment settings?

Introduction: Integrating care so that people with learning disabilities and/or autistic people can receive support at home rather than in institutional assessment and treatment units is a priority in the UK and many other countries. Despite the recognition of its importance, progress on timely and coordinated discharge has been slow. Surprisingly little previous research has engaged directly with people with learning disabilities and/or autistic people, their families or front-line care staff to understand the issues from their perspectives. This project has sought to address this gap.&#x0D; Community of Interest: Professionals, policy makers, researchers, people with a learning disability and / or autism, and family carers connected with this area of integrated care policy and practice.&#x0D; Engagement: We worked with a Reference Group of people with learning disabilities and/or autistic people and their families to co-design our approach, sense check findings and support dissemination. Reference Group members were reimbursed for any expenses, paid for their time, and received appropriate support and training for the tasks in which they are involved. The project was also designed and delivered in collaboration with a self-advocacy group.&#x0D; Overview: We initially conducted a formal review of the research and grey literature, identifying rates of delayed discharge for people with learning disabilities and/or autistic people in long-stay hospital settings, the methods used to identify such rates and the solutions proposed. &#x0D; Next, we worked with three long-stay hospital sites from across the UK in order to conduct: &#x0D; In-depth work with ten people with learning disabilities and/or autistic people per site, and with a family member, to understand their journey through services over time, their experience of long-stay hospital provision, how care was co-ordinated to meet their aspirations, the kinds of lives they would like to be living, and the barriers that are preventing them from leaving hospital&#x0D; Focus groups with front-line staff and interviews with a commissioners for each of the 30 people with learning disabilities and/or autistic people.&#x0D; The perspectives of social workers supporting our 30 participants, as well as of advocates and social care providers working with people leaving long-stay hospital settings&#x0D; Results: The data from the study is currently being analysed with the final report due by the end of December 2022.&#x0D; &#x0D; Insights: From our analysis to date, we have identified the following recommendations for policy &amp; practice: see the person behind the labels; don’t make people jump through more hoops than is really needed; help hospital staff know what’s available in the community; give people the chance to try life outside; help people with the trauma they’ve experienced; and. don’t let people fall through the cracks between services.&#x0D; Next steps: Alongside completing the report, the research team have a practice guide in publication, a film highlighting main implications, and an accessible practice guide. The team are planning a follow up study with our lived experience reference group which will explore people’s quality of life post-discharge in relation to different approaches to facilitating more co-ordinated and person-centred care.&#x0D;

Research Assessment Exercise 2023: A Report

In 2023, the University of Jyväskylä conducted a comprehensive assessment of its research activities over the period from 2018 to 2022, with the faculties acting as the units of assessment. Independent institutes were included as a part of a faculty according to their discipline. The subjects of the assessment were the research environment, doctoral training and the societal impact of research conducted at the University of Jyväskylä. The primary goal of the assessment was to facilitate the development of the key preconditions for high-quality, high-impact research and doctoral training. One way to achieve this goal is to use the outcome of the assessment for the planning and strategy work of the units as well as that of the University. The assessment consisted of a self-assessment as well as an external assessment by an 11-person international multidisciplinary panel. To support the assessment, the units of assessment and the assessment panel were provided with background material that consisted of statistics on funding, research personnel, mobility, doctoral training, and publishing. In addition to statistical data on the units, the panel received the units’ self-assessment reports and research development plans. Development plans describe the actions each unit is taking to develop the areas for improvement they have identified. In May 2023, the assessment panel visited the University, where it met members of the units of assessment, the rector and the vice rectors, interviewed the research personnel and leadership of each unit, and visited research facilities. After the visit, the panel authored a joint report on each unit of assessment, where it gave constructive feedback on the units’ research development plans and assessed the units without giving a numerical rating or ranking them. The units received recommendations and ideas on how to further strengthen the quality of their research environments and doctoral training, as well as the societal impact of their research. The units used the feedback to finalize their research development plans. In addition to the unit-level recommendations, the panel pointed out overall challenges the University should address and provided suggestions for overcoming them. It suggested, among other measures, that the University review its tenure track system, reconsider moving some key administrative services back to the faculties, strengthen post-award support, develop a research leave scheme, and continue the JYU Visiting Fellow Programme. The panel also identified challenges the University should address to develop its well-functioning doctoral training. These challenges included the structure of the Graduate School, the number of doctoral students, and the sense of isolation experienced by some doctoral students. The panel saw that the potential for societal impact of research conducted at JYU could be boosted through, for example, training, support, and encouragement. For detailed feedback and recommendations, see Section 4 of the panel report. The final report presents the principles, process, and results of the assessment. The report contains summaries of the research development plans but not the complete plans and the self-assessment reports, as these are intended for internal use only.showless