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2 results

  • Using epidemiological evidence to forecast population need for early treatment programmes in mental health: a generalisable Bayesian prediction methodology applied to and validated for first-episode psychosis in England
  • Keltie McDonald, Tao Ding, Hannah Ker, Thandiwe Rebecca Dliwayo, David P.J. Osborn, Pia Wohland, Jeremy W. Coid, Paul French, Peter B. Jones, Gianluca Baio, James B. Kirkbride
  • Journal: The British Journal of Psychiatry / Volume 219 / Issue 1 / July 2021
  • Published online by Cambridge University Press: 08 March 2021, pp. 383-391
  • Print publication: July 2021
    • Article
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  • View abstract
    Background

    Mental health policy makers require evidence-based information to optimise effective care provision based on local need, but tools are unavailable.

    Aims

    To develop and validate a population-level prediction model for need for early intervention in psychosis (EIP) care for first-episode psychosis (FEP) in England up to 2025, based on epidemiological evidence and demographic projections.

    Method

    We used Bayesian Poisson regression to model small-area-level variation in FEP incidence for people aged 16–64 years. We compared six candidate models, validated against observed National Health Service FEP data in 2017. Our best-fitting model predicted annual incidence case-loads for EIP services in England up to 2025, for probable FEP, treatment in EIP services, initial assessment by EIP services and referral to EIP services for ‘suspected psychosis’. Forecasts were stratified by gender, age and ethnicity, at national and Clinical Commissioning Group levels.

    Results

    A model with age, gender, ethnicity, small-area-level deprivation, social fragmentation and regional cannabis use provided best fit to observed new FEP cases at national and Clinical Commissioning Group levels in 2017 (predicted 8112, 95% CI 7623–8597; observed 8038, difference of 74 [0.92%]). By 2025, the model forecasted 11 067 new treated cases per annum (95% CI 10 383–11 740). For every 10 new treated cases, 21 and 23 people would be assessed by and referred to EIP services for suspected psychosis, respectively.

    Conclusions

    Our evidence-based methodology provides an accurate, validated tool to inform clinical provision of EIP services about future population need for care, based on local variation of major social determinants of psychosis.

  • 25 - Basic outline of solid organ transplantation
  • Edited by Vish Bhattacharya, Gerard Stansby
  • Book: Postgraduate Vascular Surgery
  • Published online: 03 May 2011
  • Print publication: 20 January 2011, pp 298-316
  • View extract

    Summary

    Key points

    • Solid organ transplantation is now commonplace and is the standard of care for patients with end-stage organ failure

    • Indications have changed over time and there are few absolute contraindications

    • Equity of access to transplant waiting lists is paramount and selecting the correct recipient and donor pair will optimise the outcome

    • The surgical techniques for all organ transplantation are now well established and standardized and as a result there has been a year-on-year improvement in 1-year survival. Most recipeints die because of co-morbidity or poor organ function

    • Live donor transplantation for both kidney and liver recipients has become an extremely important source of donor organs

    • Complications are general to surgical patients but indeed each organ has its own specific risks

    • Immunosuppression has advanced hugely over the past 10 years and, as a result, the overall attrition rate due to acute rejection has reduced considerably

    • The biggest problem facing transplantation today is the donor shortage. In 2008, the organ donor taskforce set up by the Minister of Health has set out a plan to increase donation by 50%

    • Until this happens, transplantation will always have to deal with the ethical dilemmas of allocation, utilization and fairness

    Introduction

    Solid organ (liver, pancreas and kidney) transplantation is an important treatment modality for end-stage organ failure. Indeed if a vital organ such as the liver fails, transplantation is the only management option currently available.

    Organ transplantation increases life expectancy and quality of life (for the recipient and their family), but is not without risk.