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Durham, United Kingdom

Ahmed S.,Tees | Leurent B.,University College London | Sampson E.L.,University College London
Age and Ageing | Year: 2014

Background: delirium affects up to 40% of older hospitalised patients, but there has been no systematic review focussing on risk factors for incident delirium in older medical inpatients. We aimed to synthesise data on risk factors for incident delirium and where possible conduct meta-analysis of these. Methods: PubMed and Web of Science databases were searched (January 1987-August 2013). Studies were quality rated using the Newcastle-Ottawa Scale. We used the Mantel-Haenszel and inverse variance method to estimate the pooled odds ratio (OR) or mean difference for individual risk factors. Results: eleven articles met inclusion criteria and were included for review. Total study population 2338 (411 patients with delirium/1927 controls). The commonest factors significantly associated with delirium were dementia, older age, co-morbid illness, severity of medical illness, infection, 'high-risk' medication use, diminished activities of daily living, immobility, sensory impairment, urinary catheterisation, urea and electrolyte imbalance and malnutrition. In pooled analyses, dementia (OR 6.62; 95% CI (confidence interval) 4.30, 10.19), illness severity (APACHE II) (MD (mean difference) 3.91; 95% CI 2.22, 5.59), visual impairment (OR 1.89; 95% CI 1.03, 3.47), urinary catheterisation (OR 3.16; 95% CI 1.26, 7.92), low albumin level (MD -3.14; 95% CI -5.99, -0.29) and length of hospital stay (OR 4.85; 95% CI 2.20, 7.50) were statistically significantly associated with delirium. Conclusion: we identified risk factors consistently associated with incident delirium following admission. These factors help to highlight older acute medical inpatients at risk of developing delirium during their hospital stay. © The Author 2014.

Bainbridge C.L.,Tees
Journal of Forensic Psychiatry and Psychology | Year: 2016

Psychologically informed planned environments (PIPEs) are specifically designed environments where staff members have additional training to increase their psychological understanding of their work. This understanding enables them to create a safe and supportive environment which can help facilitate the development and improvement of those who live there. They aim to maximise ordinary situations in order to support development and to approach this in a psychologically informed way, and by paying particular attention to issues relating to personality disorder. Since PIPEs have been introduced into the Criminal Justice System in 2011, significant improvements in institutional behaviour have been observed. This paper considers the development of the therapeutic environment of a PIPE Unit and in particular its translation for women in custody. Reflecting upon narratives taken from focus groups within a female PIPE Unit in England, it will theorise why, for many women, the environment plays a significant part in their recovery and progression in prison. Although this paper focuses on a PIPE environment, it is suggested that observations can also be transferred to other forensic environments, including therapeutic communities, enabling environments, treatment services, hospital wards, normal wing locations and so forth. © 2016 Informa UK Limited, trading as Taylor & Francis Group

de Silva P.N.,Tees
Progress in Neurology and Psychiatry | Year: 2013

The SBARD communication system is recommended by the NHS Institute for Innovation and Improvement for use in electronic documentation, letters and reports. Here, Dr de Silva describes how his Old Age Psychiatry team in Whitby applied SBARD and the resulting effect on quality of documentation. © 2013 John Wiley & Sons, Ltd.

Srikanth R.,Tees | Cassidy G.,Coventry and Warwickshire Partnership Trust | Joiner C.,Coventry and Warwickshire Partnership Trust | Teeluckdharry S.,Birmingham and Solihull Mental Health Foundation Trust
Journal of Intellectual Disability Research | Year: 2011

Background: The population of people with intellectual disabilities (ID) is increasing and their health needs impact on primary and secondary healthcare specialities. One important aspect of their physical health is bone health as people with ID have increased risk factors associated with osteoporosis. It has been identified that this population has an increased prevalence of low bone mineral density (BMD), osteoporosis and osteopenia. The main contributory factors for low BMD are age, use of antiepileptics, immobility and diagnosis of Down's syndrome. Methods: A literature search of electronic databases was undertaken. Studies that included people with ID were reviewed for the prevalence of osteoporosis and osteopenia. A cross sectional survey was conducted in a community sample (n = 149) to screen for risk factors for osteoporosis. Results: The majority of studies identified increased prevalence of osteoporosis and osteopenia with associated low BMD. In most studies individuals with ID presented with more than two risk factors. In our survey, we identified an increased prevalence of risk factors associated with osteoporosis, namely use of antiepileptics (64%), immobility (23%), history of falls (20%) and fractures (11%). We found that 54% of our sample fulfilled the criteria for screening. Of those who went on to have scans, 55% had osteoporosis and 33% had osteopenia.Conclusion We conclude that we should be screening for the risk factors associated with low BMD in adults with ID. If these are present further investigations should take place and those found to have osteoporosis and osteopenia should have treatment at an early stage to prevent morbidity and improve their quality of life. 2010 The Authors. Journal of Intellectual Disability Research © 2010 Blackwell Publishing Ltd.

Miltsiou E.,Tees | Tiffin P.A.,Durham University
Journal of Intellectual and Developmental Disability | Year: 2010

Background Pervasive developmental disorders (PDDs) were originally conceptualised as a form of ("infantile") psychosis. Recently, the disorders have been viewed as separate constructs. However, there is evidence of overlapping psychopathology, pathophysiology, and occurrence of the two syndromes. Methods A historical overview is provided. A systematic search strategy was then used to identify literature relating to the co-occurrence of PDD and nonaffective psychosis. Results The methodology and estimated rates of psychosis occurring in PDD varied dramatically, and few conclusions could be drawn due to the level of heterogeneity and selection bias in the populations studied. However, there were indications from the literature that rates of comorbid PDD were elevated in adolescents affected by juvenile-onset psychosis but the methodology was insufficiently robust to estimate a pooled prevalence. Conclusions There is some evidence for elevated rates of comorbid PDD in individuals with childhood-onset psychosis. Further work is needed in order to understand the potential mechanisms underlying such co-occurrence and how such affected individuals can be best supported. © 2010 Australasian Society for the Study of Intellectual Disability, Inc.

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