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It takes on average 17 years to translate a promising laboratory development into better patient treatments or services. About 10 years of this innovation process lies within the National Institute for Health Research (NIHR) research pathway. Innovations developed through research have both national and global impact, so selecting the most promising studies to fund is crucial. Peer review of applications is part of the NIHR research funding process, but requires considerable resources. The NIHR is committed to improving efficiency and proportionality of this process. This study is part of a wider piece of work being undertaken by NIHR (1) to reduce the complexity of the funding pathway and thus make a real difference to patients lives.
This study elicited the views of various stakeholders concerning current and possible future methods for peer review of applications for research funding. Stakeholder groups included: members of boards with responsibility for making funding decisions; applicants (both successful and unsuccessful); peer reviewers and NIHR staff. Qualitative interviews were conducted with stakeholders selected from each group, and results were analyzed and integrated using a thematic template analytical method. The results were used to inform a larger online opinion survey which will be reported separately.
The views and insights of thirty stakeholders across the four groups about the peer review process of applications for funding will be presented. Findings generalizable to other funding programs outside the NIHR will be emphasized. The key themes which emerged included: strengths and weaknesses of applications, feedback, targeting and acknowledgement of peer reviewers.
The results of our study of peer review processes carried out by one national research funder has relevance for other funding organizations, both within our country and internationally.
Mental illness is common among prisoners, but little evidence exists regarding changes in symptoms in custody over time.
To investigate the prevalence and predictors of psychiatric symptoms among prisoners during early custody.
In a prospective cohort study, 3079 prisoners were screened for mental illness within 3 days of reception. To establish baseline diagnoses and symptoms, 980 prisoners were interviewed; all remaining in custody were followed up 1 month and 2 months later.
Symptom prevalence was highest during the first week of custody. Prevalence showed a linear decline among men and convicted prisoners, but not women or remand prisoners. It decreased among prisoners with depression, but not among prisoners with other mental illnesses.
Overall, imprisonment did not exacerbate psychiatric symptoms, although differences in group responses were observed. Continued discussion regarding non-custodial alternatives for vulnerable groups and increased support for all during early custody are recommended.
UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.
To determine the effectiveness and cost-effectiveness of this practice.
Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.
There were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule – Revised scores at 26 weeks compared with GP care were –1.4 (95% Cl –5.5 to 2.8) for generic nurse care, and 1.1 (–2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were £283 (95% Cl 154–411) for generic nurse care, and £315 (183–481) for nurse problem-solving treatment.
GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.
No existing instrument measures all or even most of the issues considered important by users of mental health services.
To develop and test a self-assessment instrument to enable users of mental health services to rate their experience across the range of domains that they consider to be important.
Relevant domains were identified and a new instrument was drafted and field tested to examine its psychometric properties.
The 17-item, self-rated Carers' and Users' Expectations of Services – User version (CUES–U) appears acceptable to most service users. Its items have reasonable test–retest reliability and a ‘total CUES–U score’ correlates significantly with a total score of the Health of the Nations Outcome Scales (Spearman's ρ=0.42; P<0.01).
The development and testing of CUES–U suggest that it might be feasible to apply a self-rated measure of the expectations and experience of users of mental health services.
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