UK Drug Situation: Focal Point annual report

Public Health England, Home Office, Welsh Government, The Scottish Government, Public Health Wales & Department of Health (Northern Ireland)| April 2018 | United Kingdom drug situation: Focal Point annual report 2017

Research and analysis into the drug situation in the UK reveals that prevalence in the general population is lower than a decade ago. Cannabis continues to be the most widely used, followed by powder cocaine and ecstasy/ MDMA. Data from the surveys in England and Scotland shows that prevalence in schoolchildren in has increased, which is in contrast to a previously reported steady decline among this age range.

• 

  Image source: assets.publishing.service.gov.uk

  There were almost 120,000 (119,973) treatment presentations in the UK in 2016. In England and Wales, 244,971 individuals were recorded as being in drug treatment during 2016. Of those in treatment in England and Wales, 138,422 were receiving prescribing treatment for opioid use.

• In the UK, two-fifths (42%) of treatment presentations in the UK were for primary heroin use, with  a quarter (25%) of all service users presenting for treatment of cannabis use. Among those who had never previously been in treatment, 45% of clients presented for primary cannabis use, whereas 16% presented for primary heroin use, representing a five per cent decrease in the proportion of first-time primary heroin clients from 2015. (Executive Summary)

The full analysis is available here

We see what we feel, suggests US research

Association for Psychological Science | April 2018 | The Emotions We Feel May Shape What We See

University of California psychological scientist Erika Siegel has previously studied the impact of influencing individuals emotional states to alter their impression of neutral faces which makes faces seem more or less likeable , and reliable. In this new research, the research team explored the consequence of changing participant’s emotional state would affect their perception of neutral faces.

The trial involved exposing the subjects to stimuli without them realising it, they showed the participants (n=43) a series of flashing images, which alternated between a pixelated image and a neutral face, presented to their dominant eye. At the same time, a low-contrast image of a smiling, scowling, or neutral face was presented to their nondominant eye. At the end of each trial, a set of five faces appeared and participants picked the one that best matched the face they saw during the trial.

They found that participants  tended to select faces that were smiling more as the best match if the image that was presented (without them realising) showed a person who was smiling rather than neutral or scowling.

For the second experiment, the researchers included an objective measure of awareness, asking participants to guess the orientation of the suppressed face. The results indicated that unseen positive faces changed participants’ perception of the visible neutral face.

For Siegel and colleagues, their findings could have broad, real-world implications that extend from everyday social interactions to situations with more severe consequences, such as when judges or jury members have to evaluate whether a defendant is remorseful (via American Psychological Association ).

Abstract

Affective realism, the phenomenon whereby affect is integrated into an individual’s experience of the world, is a normal consequence of how the brain processes sensory information from the external world in the context of sensations from the body. In the present investigation, we provided compelling empirical evidence that affective realism involves changes in visual perception (i.e., affect changes how participants see neutral stimuli). In two studies, we used an interocular suppression technique, continuous flash suppression, to present affective images outside of participants’ conscious awareness. We demonstrated that seen neutral faces are perceived as more smiling when paired with unseen affectively positive stimuli. Study 2 also demonstrated that seen neutral faces are perceived as more scowling when paired with unseen affectively negative stimuli. These findings have implications for real-world situations and challenge beliefs that affect is a distinct psychological phenomenon that can be separated from cognition and perception.

The full article is available for Rotherham NHS staff to request here

 

Centenarians children have a stronger sense of purpose in their lives, which may support their favorable health outcomes and long lifespan

Purpose of life (PIL) is a sense of purpose and direction in life and is linked to lower mortality, reduced cognitive impairment, disability and reduced risk of disease. A new study found that the children of centenarians had higher levels of PIL than those without any familial history of longevity.   These adult children displayed positive attitudes to life and as previous research shows that they have long lifespans, the researchers sought to discover if they also had higher levels of PIL than the general population (people with no familial precedent of longevity) (via Science Daily).

The study, co-authored by researchers from Boston University School of Public Health (BUSPH), examined the participant’s attitudes towards life.  As well as the centenarians offspring (average age 82), there were 3 referent groups. They comprised: the children’s spouses, those born the same time as the referents (but on average lived until their early 70s), and participants from a Health and Retirement Study (HRS), a nationally representative study of more than 30,000 individuals over the age of 50.

They used the  Ryff Scales of Psychological Well-Being as their methodological tool.  The Ryff Purpose of Life (PIL) uses a Likert scale with statements such as, “I enjoy making plans for the future and working to make them a reality” and, “My daily activities often seem trivial and unimportant to me,” with respondents selecting their response to a range of statements “strongly disagree” to “strongly agree.” A higher score is said to indicate a sense of greater well-being.

The investigators found 41 per cent of the children of centenarians had high levels of PIL, compared to just over a fifth of the HRS group (21 per cent) and less than one in five for the birth cohort of septuagenarian offspring (14 per cent). The centenarians children had  1.92 times the odds of high PIL as their spouses, 2.64 times the odds as the birth cohort participants, and 2.93 times the odds as the HRS participants.

“Aging well is not only escaping or delaying disease,” says co-author Paola Sebastiani,  “[but] feeling good about your life is important and should be considered an important aspect of healthy aging.”

The article appears in the The Journals of Gerontology: Series B. The abstract can be read here

Full reference

Marone, S. et al  |2018 |  Purpose in Life Among Centenarian Offspring, The Journals of Gerontology: Series B, ePub gby023, https://doi.org/10.1093/geronb/gby023
The article is available for Rotherham NHS staff to request here 

NIHR unveil new standards for involving the public in research

Chief Scientist Office, Health and Care Research Wales, Public Health Agency & NIHR |  March 2018  | National Standards for Public Involvement

A UK-wide partnership including members of the public and representatives from The National Institute for Health Research (NIHR) (England), the Chief Scientist Office (Scotland), Health and Care Research Wales and the Public Health Agency (Northern Ireland), and an independent expert have collaborated to develop standards for involving the public in research.

Image source: nihr.ac.uk

Their work has now been published as the National Standards for Public Involvement with the aim of providing people with clear, concise benchmarks for effective public involvement alongside indicators against which improvement can be monitored.

 

The 6 standards are:

Standard 1: Inclusive opportunities: We offer public involvement opportunities that are accessible and that reach people and groups according to research needs.

Standard 2: Working together : We work together in a way that values all contributions, and that builds and sustains mutually respectful and productive relationships.

Standard 3: Support & Learning: We offer and promote support and learning that builds confidence and skills for public involvement in research.

Standard 4: Communications: We use plain language for timely, two way and targeted communications, as part of involvement plans and activities.
Standard 5: Impact: To drive improvement, we capture and share the difference that public involvement makes to research.

Standard 6: Governance:  We involve the public in our governance and leadership so that our decisions  promote and protect the public interest

NIHR’s news piece, New national standards launched across the UK to improve public involvement in research announcing the standards is here

NIHR have created a video to promote the standards, it can be viewed here
The National Standards are available to download from the NIHR website 

Forward Thinking- NIHR research on support for people with severe mental illness (SMI)

NIHR | Forward Thinking- NIHR research on support for people with severe mental illness |

National Institute of Health Research (NIHR) has provided an overview of NIHR- funded recent research into support for individuals with a diagnosis of SMI. It supports early detection and intervention, crisis care, supporting recovery and managing physical and mental health.

Image source: dc.nihr.ac.uk

The overview includes 30 published studies and 19 ongoing research projects to address particular uncertainties and evidence gaps identified by those working in and using these services. It also highlights research currently taking place to inform the support and care of people with SMI; and provides questions to ask about support for people living with SMI.

Full details are at the NIHR website 

The full overview can be accessed here 

The clinical and cost effectiveness of shorter duration prescriptions vs. longer term prescriptions

The National Institute of Health Research (NIHR) has synthesised research from four recent papers looking at shorter duration prescriptions (28 days) and comparing these with three month prescriptions.

One of these papers, the Impact of issuing longer- versus shorter- duration prescriptions: a systematic review published today in the British Journal of General Practice, says 28-day prescriptions should be reconsidered in favour of longer- duration prescriptions.  The study examined the impact of longer-duration (2–4 months) versus shorter-duration (28-day) prescriptions. The systematic review found that UK recommendations to provide shorter prescriptions are not substantiated by the current evidence base. 

While other research  found that longer prescriptions were more cost-effective for the NHS, one of its authors, Dr Rupert Payne said that the evidence base for this was ‘poor’. Dr Payne also cautioned that “community pharmacies receive a fee for every prescription they dispense. So simply switching every repeat prescription item from, for example, one month to three months, could result in a large reduction in pharmacy income.” While this may reduce costs, a possible consequence could be loss of pharmacy services.  Therefore,  any “changes to policy around the length of repeat prescriptions should also consider how pharmacies are reimbursed.”

References:

 King, S.,  et al | Impact of issuing longer- versus shorter- duration prescriptions: a systematic review |British Journal of General  Practice | 2018 | bjgp18X695501. DOI: https://doi.org/10.3399/bjgp18X695501

The full article can be downloaded from British Journal of General Practice here

Doble, B. et al | 2018 |Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days)
prescription lengths in primary care for  common, chronic conditions in the UK |BMJ Open |Vol. 7| 12 | http://dx.doi.org/10.1136/bmjopen-2017-019382

This article can be downloaded from BMJ Open here 

Miani, C.et al. Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling. Health Technology Assessment |2017 | Vol. 21 |78| https://doi.org/10.3310/hta21780

This can be accessed from NIHR 

Martin, A., Payne, R., & Wilson, E., C., F., | 2018 | Long-Term Costs and Health Consequences of Issuing Shorter Duration Prescriptions for Patients with Chronic Health Conditions in the English NHS | Applied Health Economics and Health Policy |https://doi.org/10.1007/s40258-018-0383-9

This article can be requested by Rotherham NHS staff here

NHS Reality Check report

The Royal College of Practitioners (RCP) Reality Bites (2017)  was a key report that  provided a platform for doctors working  in the NHS to outline their experiences of delivering care. This year’s report enables over 1,500 doctors to describe their work in the UK health service. 

This year’s update concludes that conditions have got worse and NHS staff, who have benefited from some of the best medical education in the world, were not able to provide the standard of care they have been trained to deliver (RCP).

Image source: rcplondon.ac.uk

The report’s key findings show:

• 64% of doctors believe that patient safety has deteriorated over the past year – 10% higher than last year.
• 93% experienced staff shortages across the team – 9% higher than last year.
• 84% believe that the workforce is demoralised – 2% higher than last year.
• 85% cite rising demand for their service over the past year – 7% higher than last year.
• 47% cite lower-quality care over the past year – 10% higher than last year.
• 80% are worried about the ability of their service to deliver safe patient care in the next 12 months – 6% higher than last year.

It makes a number of recommendations for action to reduce the pressure on doctors:

•  In the short term, we need to make the UK more accessible
  and attractive to doctors from other countries.
• In the long term, government, NHS organisations, royal colleges,
  professions, trade unions, regulators, higher education institutions and think
  tanks need to work together to make sure the NHS has the workforce and
  resources it needs.
• Funding for health and social care must match growing patient need, and there
  must be more investment in public health initiatives that reduce that need.

The full report can be read here

You can read the Royal College of General Practitioners’ response:
RCGP welcomes solutions suggested in latest NHS Reality Check report 

The Royal College of Anaesthetists’ response is available here:
RCoA responds to NHS Reality Check report

In the media:

The Guardian: Patient safety getting worse, say two-thirds of NHS doctors