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To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible.
Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients’ individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic.
SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.
To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.
A retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
A quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.
The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.
Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.
Results identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
We are almost into the fifth decade of the acquired immunodeficiency syndrome (AIDS) pandemic, and in that time the illness has gone from being a highly unpredictable series of life-threatening illnesses that is consequent upon being immune compromised with a high mortality rate to being a highly treatable one-tablet-a-day infection. This represents an enormous revolution in medical treatment. AIDS was first recognized in 1981 after early cases of kaposi sarcoma and pneumocystis carinii were reported in the USA in young immunocompromised homosexual men (David et al., 2012; Rosca et al., 2012). However, the disease has been thought to have existed since the mid-1970s (Des Jarlais et al., 1989). There then followed the AIDS pandemic of the early 1980s when the spread of the virus grew exponentially throughout the world. Since then, several breakthroughs have taken place. In 1983, a retrovirus, now called human immunodeficiency virus (HIV), was identified as the causative agent (Sharp and Hahn, 2011). This led to the synthesis of antiviral medication aimed at inhibiting enzymes unique to the virus, such as reverse transcriptase inhibitors, protease inhibitors, and most recently, integrase inhibitors. In 1996 it was shown that taking a combination of these medications called combination antiretroviral therapy (cART) provided significantly effective treatment and basically stopped viral replication and the ensuing damage to the immune system (Ghosn et al., 2018). Since the introduction of cART and with further advances in research, HIV and AIDS have become a chronic illness. There has been a significant reduction in mortality and morbidity as a result of increased viral suppression that markedly halts the disease progression and reduces the rate of human transmission, resulting in people living longer and healthier lives (Ghosn et al., 2018; David et al., 2012).
The COVID-19 pandemic has put the UK's National Health Service under extreme pressure, and acute psychiatric services have had to rapidly adapt to a new way of working. This editorial describes the experience of a London psychiatric intensive care unit (PICU) where all nine in-patients ultimately tested COVID-19 positive.
Objectives: The aim of this study was to determine the prevalence and methods of expert knowledge elicitation (EKE) for specifying input parameters in health economic decision models (HEDM).
Methods: We created two samples using the National Health System Economic Evaluations Database: (1) 100 randomly selected HEDM studies to determine prevalence of EKE and (2) sixty studies using a formal EKE process to determine methods used.
Results: Fifty-seven (57 percent) of the random sample included at least one EKE-derived parameter. Of these, six (10 percent) used a formal expert process. Thirty-four studies from our second sample of sixty studies (57 percent) described at least one aspect of the process (e.g., elicitation method) with reasonable clarity. In approximately two-thirds of studies the external experts estimated parameters de novo; the remainder confirmed or modified initial estimates provided by authors, or the method was unclear. The majority of elicitations obtained point estimates only, although a few studies asked experts to estimate ranges of parameter values.
Conclusions: The use of EKE for parameter estimation is common in HEDMs, although there is room for improvement in the methods used.
In families in which parents conceived using donated sperm or donated eggs, only one parent will be the genetic parent of the child: the mother in the case of sperm donation and the father in the case of egg donation. Parents can choose to tell or not to tell their child about their donor conception. In families in which parents choose not to tell, children will grow up unaware that the person that they think of as their mother or father is not, in fact, their genetic parent. Furthermore, families in which children were conceived using an anonymous donor will likely never be able to know detailed or identifying information about their donor. In countries where donor anonymity has ended and donor-conceived adults are able to access information about their donor, it is still the case that if someone does not know they were donor conceived they will have no reason to access information about their donor. Therefore, is it in the child’s best interests to be told about their donor conception?
This chapter outlines empirical research and ethical reasoning to discuss whether disclosure of donor origins is in a child’s best interests. Our discussion considers deontological (duty-based) and consequentialist (outcome-based) ethics in relation to disclosure. We hold that the question of whether to disclose can best be answered by reviewing at least three types of considerations for each child: (1) medical welfare; (2) family welfare; and (3) rights. These considerations build on the established empirical evidence presented in the first half of this chapter. Our intention is to clarify reasons why telling or not telling may be the best decision.
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