Evidence-based Recovery Colleges: developing a typology based on organisational characteristics, fidelity and funding.

PURPOSE: Recovery Colleges (RCs) have been implemented across England with wide variation in organisational characteristics. The purpose of this study is to describe RCs across England in terms of organisational and student characteristics, fidelity and annual spending, to generate a RC typology based on characteristics and to explore the relationship between characteristics and fidelity. METHODS: All RC in England meeting criteria on recovery orientation, coproduction and adult learning were included. Managers completed a survey capturing characteristics, fidelity and budget. Hierarchical cluster analysis was conducted to identify common groupings and generate an RC typology. RESULTS: Participants comprised 63 (72%) of 88 RC in England. Fidelity scores were high (median 11, IQR 9-13). Both NHS and strengths-focussed RCs were associated with higher fidelity. The median annual budget was £200,000 (IQR £127,000-£300,000) per RC. The median cost per student was £518 (IQR £275-£840), cost per course designed was £5,556 (IQR £3,000-£9,416) and per course run was £1,510 (IQR £682-£3,030). The total annual budget across England for RCs is an estimated £17.6 m including £13.4 m from NHS budgets, with 11,000 courses delivered to 45,500 students. CONCLUSION: Although the majority of RCs had high levels of fidelity, there were sufficiently pronounced differences in other key characteristics to generate a typology of RCs. This typology might prove important for understanding student outcomes and how they are achieved and for commissioning decisions. Staffing and co-producing new courses are key drivers of spending. The estimated budget for RCs was less than 1% of NHS mental health spending.

Postoperative Complications Associated with External Skeletal Fixators in Dogs.

OBJECTIVES: To quantify and evaluate risks of complications attributable to external skeletal fixator (ESF) usage in dogs. METHODS: A retrospective review of medical records following ESF placement. RESULTS: Case records of 97 dogs were reviewed; fixator-associated complications occurred in 79/97 dogs. Region of ESF placement was significantly associated with complication development (p = 0.005), not complication type (p = 0.086). Complications developed most frequently in the tarsus (9/10), manus (8/9) and humerus (8/9). Superficial pin-tract infection and implant failure occurred in 38/97 and 17/97 dogs, respectively. Superficial pin-tract infection occurred frequently in the femur, humerus, radius and ulna and the pes, with implant failure frequent in the tarsus and deep pin-tract infection in the manus and tibia. Transarticular frames were significantly more likely to develop a complication (p = 0.028). Age was significantly associated with complication development (p = 0.029). No associations between breed, sex, weight, fracture type (open or closed), ESF classification and the incidence or type of complications were identified. No associations between, breed, age, sex, weight, fracture type (open or closed), ESF classification and the time to complication development were identified. CLINICAL SIGNIFICANCE: Fixator-associated complications are common in dogs, with the majority of complications related to implant infection. Region and placement of transarticular frames should be carefully considered when selecting stabilization method.

Postoperative complications associated with external skeletal fixators in cats.

OBJECTIVES: The objective of this study was to quantify complications associated with external skeletal fixators (ESFs) in cats and to identify potential risk factors. METHODS: A retrospective review of medical records and radiographs following ESF placement was performed. RESULTS: Case records of 140 cats were reviewed; fixator-associated complications (FACs) occurred in 19% of cats. The region of ESF placement was significantly associated with complication development. Complications developed most frequently in the femur (50%), tarsus (35%) and radius/ulna (33%). Superficial pin tract infection (SPTI) and implant failure accounted for 45% and 41% of all FACs, respectively. SPTI occurred more frequently in the femur, humerus and tibia, with implant failure more frequent in the tarsus. No association between breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, degree of fracture load sharing, and the incidence or type of FAC was identified. No association between region of placement, breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, fracture load sharing and the time to complication development was identified. CONCLUSIONS AND RELEVANCE: Complication development is not uncommon in cats following ESF placement. The higher complication rate in the femur, tarsus and radius/ulna should be considered when reviewing options for fracture management. However, cats appear to have a lower rate of pin tract infections than dogs.