Silos and rigid processes: Barriers to the successful implementation of the Older prisoner Health and Social Care Assessment and Plan.

Older adults are the fastest growing sub-group in prisons. They have complex health, social care and custodial needs and often the support they receive is sub-optimal. The Older prisoner Health and Social Care Assessment and Plan (OHSCAP) aimed to better meet these inter-related needs. As part of a wider study, a randomised controlled trial was conducted to evaluate the OHSCAPs effectiveness in meeting older prisoners' health, social care and custodial needs in comparison to treatment as usual. This article describes the nested qualitative study which aimed to explore the barriers and facilitators to the effective implementation of the OHSCAP. Semi-structured interviews were conducted with older adults (n = 14) and staff members t (n = 12). Data was analysed using the framework method. Three overarching key themes were identified. These were: (1) balancing care and custodial requirements; (2) prison, health and social care silos; and (3) rigid prison processes. Prison is an important opportunity to engage residents and improve public health. Cultural and strategic change is required for health, social care and custodial interventions, such as the OHSCAP, to be successfully implemented into prison settings.

Identification and management of prisoners with severe psychiatric illness by specialist mental health services.

BACKGROUND: The prevalence of mental disorders among prisoners is considerably higher than in the general population. This is an important public health issue as the vast majority of prisoners stay in custody for less than 9 months and, when not in prison, offenders' lifestyles are frequently chaotic, characterized by social exclusion, instability and unemployment. Multi-disciplinary mental health inreach services were introduced to target care towards prisoners with severe mental illness (SMI) in a similar way to that provided by Community Mental Health Teams outside prison. The aim was to establish the proportion of prisoners with SMI who were assessed and managed by prison mental health inreach services. Method A two-phase prevalence survey in six prisons in England measured SMI upon reception into custody. Case-note review established the proportion of those with SMI subsequently assessed and treated by inreach services. RESULTS: Of 3492 prisoners screened, 23% had SMI. Inreach teams assessed only 25% of these unwell prisoners, and accepted just 13% onto their caseloads. CONCLUSIONS: Inreach teams identified and managed only a small proportion of prisoners with SMI. Prison-based services need to improve screening procedures and develop effective care pathways to ensure access to appropriate services. Improved identification of mental illness is needed in both the community and the Criminal Justice System to better engage with socially transient individuals who have chaotic lifestyles and complex needs.

Capillary electrophoresis in the pharmaceutical industry: applications in discovery and chemical development.

Over the last 10 to 15 years capillary electrophoresis (CE) has become an extensively used separation technique in the pharmaceutical industry. The attraction of the various modes of operation of CE to analysts is their complementarity to other more established methodology, in particular high-performance liquid chromatography. CE methods have been developed not only for the resolution of drug substances that vary widely in their structure, size and stereochemistry, but also for the determination of the physico-chemical constants of analytes, such as pKa and isoelectric point (pI) values, binding and complexation constants, and octanol-water partition coefficients.

The Domiciliary Rehabilitation and Support Program. Rationale, organisation and outcome.

OBJECTIVE: To describe the Domiciliary Rehabilitation and Support Program (whose principles are early surgery, rapid mobilisation, avoidance of sedation, and early discharge with physiotherapy and nursing support provided in the home) for elderly patients with proximal femoral fractures (PFF), and to compare its costs with those of a conventional approach to the problem. DESIGN AND SETTING: Prospective data accumulation on all patients admitted to a major metropolitan teaching hospital (Sir Charles Gairdner Hospital). PATIENTS: Six hundred and fifteen patients, 60 years or more, 76% female (mean age 82.6 +/- 8.1 years), 24% male (mean age 79.9 +/- 7.6 years). RESULTS: The mean length of hospital stay of patients on the program was 18.9 (+/- 27.3) days compared with 28 days for elderly PFF patients in the preceding year. The morbidity and mortality figures were comparable with or better than other published series. There was a 15% financial saving following introduction of the scheme. CONCLUSION: The Domiciliary Rehabilitation and Support Program is a safe and cost effective method of dealing with elderly patients suffering from a proximal femoral fracture.