Health needs of detainees in police custody in England and Wales. Literature review

The aim of this systematic is to review and analyse the literature concerned with the health needs of detainees in police custody in England and Wales.The healthcare of detainees in police custody is regulated by the England and Wales Police and Criminal Evidence Act 1984. The Faculty of Forensic and Legal Medicine of the Royal College of Physicians also sets quality standards for the provision of custodial healthcare. The provision of healthcare in custody presents a number of challenges including the patient group, the setting and the overlap between the legal and medical concerns that are addressed by the medical team. Currently, care to the detainees in custody is delivered by a mixture of private organisations, police-led forensic medical services and the NHS.A search of the PUBMED, EMBASE and PsycINFO databases undertaken using the search terms: (police custody) OR (detainees) OR (police detainees) yielded 830 publications. All of the titles were screened to identify potentially relevant publications concerned with the health needs of detainees in police custodies in England and Wales. There were no design specific criteria set for inclusion of the studies in this literature review. 77 articles were initially identified as relevant and obtained in full. After further analysis 28 publications were included in this literature review.A total sample of over 12,000 detainees was examined in this literature review. Approximately 20% of detainees seen by health care teams suffer from psychiatric conditions. On average, 50% of patients claim that they have problems with drugs and alcohol. Physical health conditions are also highly prevalent with up to 74% of detainees requiring regular medication. Forensic medical issues included the management of detainees who were restrained using handcuffs, irritant sprays and TASER. Detainees who are suspected of internal drug concealment also require intensive medical input. Injury documentation in custody is often requested for both the police officer and detainees.Current literature indicates that mental health problems including substance misuse and physical conditions are highly prevalent among the custody population and require both emergency and routine care. The current quality of the health-care services has been discussed and the need for improvement has been indicated by a number of agencies. Recent attempts have been made to incorporate the custodial services into the general structure of the NHS, aiming for more robust governance and standardization of services. Implementation of a routine health promotion service in custody has also been discussed which can be integrated into the general health care provision during detention.     

Provision of forensic medical services to police custody suites in England and Wales: Current practice

IntroductionPolice services within England and Wales are required under the Police and Criminal Evidence Act 1984 to ensure appropriate healthcare to those detained in police custody (forensic medical services). Traditionally doctors have been used by police services to provide an appropriate level of care. Changes within the Act allowed other healthcare professionals (nurses and paramedics and emergency care practitioners) to be included in the provision of such services. The aim of this appears at least in part to have been to reduce the costs of providing such a service. In recent years police services within England and Wales have been outsourced to assorted commercial providers. There are now several different modes of delivery of forensic medical services, which are determined locally by separate police services.AimsThis study aimed (a) to determine the different modes of delivery of forensic medical services in England and Wales; (b) to determine the healthcare workload caused by Police and Criminal Evidence Act 1984 Codes of Practice; (c) to determine the relative costs of different service models and (d) to determine availability of such information from the police services.MethodsThe study was undertaken in two parts – (a) a telephone survey of all police services, and (b) an application to each police service utilising the Freedom of Information Act 2000.ResultsAll police services (n = 43) in England and Wales were contacted. Of the 41forces that furnished detailed information; 13/41 had a doctor only service; 20/41 had a doctor/nurse service; 6/41 had a doctor/nurse/paramedic service; 1/41 had a doctor/emergency care practitioner service (who may be nurses or paramedic); 1/41 had a doctor/paramedic service. 23/43 services were outsourced to private commercial providers. Mean cost per patient contact (in 17/43 services which supplied data) was GBP 97.25. The cheapest cost per patient contact was the Metropolitan Police Service – a doctor only service (GBP 56.4), the highest Lincolnshire – a doctor only service (GBP 151.1). Mean cost for a doctor only service was GBP 97.1; for a doctor/nurse service – GBP 91.56 and for a doctor/nurse/paramedic service – GBP 115.76. There was no significant difference in costs per patient contact between a doctor only versus mixed HCP delivery of service. Relative costs and 95% confidence intervals expressed as a percentage show that a doctor only model was on average 3.4% lower than a mixed HCP provision, and that a non-outsourced service was on average 9.9% less than an outsourced service. No outsourced service in this study uses a doctor only model.ConclusionsThe study shows that there was a complete lack of consistency in the recording and availability of information regarding forensic medical services for police services in England and Wales. The information that was obtained suggested that usage of such services varied greatly between police services and that costs of forensic medical services appear to be increased by the use of mixed healthcare professional service delivery and by using external commercial providers.     

A qualitative analysis of radiography students' reflective essays regarding their experience of clinical placement during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic significantly impacted healthcare services and clinical placement for healthcare students. There is a paucity of qualitative research into radiography students’ experiences of clinical placement during the pandemic.MethodStudents in stages three and four of a 4-year BSc Radiography degree in Ireland wrote reflective essays regarding their experience of clinical placement during the COVID-19 healthcare crisis. Permission was granted by 108 radiography students and recent graduates for their reflections to be analysed as part of this study. A thematic approach to data analysis was used, allowing themes to emerge from the reflective essays. Two researchers independently coded each reflective essay using the Braun and Clarke model.ResultsFour themes were highlighted; 1) Challenges associated with undertaking clinical placement during the pandemic, such as reduced patient throughput and PPE-related communication barriers; 2) Benefits of clinical placement during the pandemic, in terms of personal and professional development and completing degree requirements to graduate without delay; 3) Emotional impact and 4) Supporting students in clinical practice. Students recognised their resilience and felt proud of their contribution during this healthcare crisis but feared transmitting COVID-19 to family. Educational and emotional support provided by tutors, clinical staff and the university was deemed essential by students during this placement.ConclusionsDespite the pressure hospitals were under during the pandemic, students had positive clinical placement experiences and perceived these experiences to have contributed to their professional and personal growth.Implications for practiceThis study supports the argument for clinical placements to continue throughout healthcare crisis periods, albeit with additional learning and emotional support in place.Clinical placement experiences during the pandemic prompted a deep sense of pride amongst radiography students in their profession and contributed to the development of professional identity.     

“There's definitely something wrong but we just don't know what it is”: A qualitative study exploring rowers' understanding of low back pain

ObjectivesLow back pain is highly prevalent in rowing and can be associated with significant disability and premature retirement. A previous qualitative study in rowers revealed a culture of concealment of pain and injury due to fear of judgement by coaches or teammates. The aim of this study was to explore rowers' perspectives in relation to diagnosis, contributory factors, and management of low back pain.DesignQualitative secondary analysis.MethodsWe conducted a secondary analysis of interview data previously collected from 25 rowers (12 in Australia and 13 in Ireland). A reflexive thematic analysis approach was used.ResultsWe identified three themes: 1) Rowers attribute low back pain to structural/physical factors. Most rowers referred to structural pathologies or physical impairments when asked about their diagnosis. Some participants were reassured if imaging results helped to explain their pain, but others were frustrated if findings on imaging did not correlate with their symptoms. 2) Rowing is viewed as a risky sport for low back pain. Risk factors proposed by the rowers were primarily physical and included ergometer training, individual technique, and repetitive loading. 3) Rowers focus on physical strategies for the management and prevention of low back pain. In particular, rowers considered stretching and core-strengthening exercise to be important components of treatment.ConclusionsRowers' understanding of low back pain was predominantly biomedical and focused on physical impairments. Further education of rowers, coaches and healthcare professionals in relation to the contribution of psychosocial factors may be helpful for rowers experiencing low back pain.     

A National Survey on Safety Management at MR Imaging Facilities in Japan

PurposeTo investigate safety management at Japanese facilities performing human MRI studies.MethodsAll Japanese facilities performing human MRI studies were invited to participate in a comprehensive survey that evaluated their MRI safety management. The survey used a questionnaire prepared with the cooperation of the Safety Committee of the Japanese Society for Magnetic Resonance in Medicine. The survey addressed items pertaining to the overall MRI safety management, questions on the occurrence of incidents, and questions specific to facility and MRI scanner or examination. The survey covered the period from October 2017 to September 2018. Automated machine learning was used to identify factors associated with major incidents.ResultsOf 5914 facilities, 2015 (34%) responded to the questionnaire. There was a wide variation in the rate of compliance with MRI safety management items among the participating facilities. Among the facilities responding to this questionnaire, 5% reported major incidents and 27% reported minor incidents related to MRI studies. Most major incidents involved the administration of contrast agents. The most influential factor in major incidents was the total number of MRI studies performed at the facility; this number was significantly correlated with the risk of major incidents (P < 0.0001).ConclusionThere were large variations in the safety standards applied at Japanese facilities performing clinical MRI studies. The total number of MRI studies performed at a facility affected the number of major incidents.     

The impact of a clinical team assisting the Coroner’s investigation of healthcare-related deaths: Reflections on six-years of service

AimThis study describes the short-term impacts of an on-site team of practising clinicians (Clinical Liaison Service, CLS), in enhancing the Coroner’s investigation for the prevention of healthcare-related deaths.MethodsAn internal observational program evaluation was conducted where objective and externally verifiable achievements of CLS over a six-year period were provided in relation to definable program components.ResultsFrom 2003–2008, the same conceptual model for CLS was in place.CLS developed and implemented for the death investigation process: (i) a working model for a comprehensive and standardised clinical review; (ii) a knowledge management strategy to enhance the healthcare sector access to information and coronial (iii) activities to improve communication channels between the Coroner’s Office and the healthcare sector.The short-term impact included improved appropriateness of cases that proceed to investigation; improvements in the nature and depth of the investigation, and self-reported changes to clinicians practice.CLS reflected that the clinically enhanced investigation improved the credibility of the Coroner’s death investigation, reduced apprehension in the healthcare sector about the purpose of the investigation and engendered co-operation between involved parties.DiscussionThis study suggests that a team of practising clinicians assisting the Coroner’s investigation of healthcare-related deaths contributes towards improving patient safety.     

Brachytherapy patient safety events in an academic radiation medicine program

PurposeTo describe the incidence and type of brachytherapy patient safety events over 10 years in an academic brachytherapy program.Methods and MaterialsBrachytherapy patient safety events reported between January 2007 and August 2016 were retrieved from the incident reporting system and reclassified using the recently developed National System for Incident Reporting in Radiation Treatment taxonomy. A multi-incident analysis was conducted to identify common themes and key learning points.ResultsDuring the study period, 3095 patients received 4967 brachytherapy fractions. An additional 179 patients had MR-guided prostate biopsies without treatment as part of an interventional research program. A total of 94 brachytherapy- or biopsy-related safety events (incidents, near misses, or programmatic hazards) were identified, corresponding to a rate of 2.8% of brachytherapy patients, 1.7% of brachytherapy fractions, and 3.4% of patients undergoing MR-guided prostate biopsy. Fifty-one (54%) events were classified as actual incidents, 29 (31%) as near misses, and 14 (15%) as programmatic hazards. Two events were associated with moderate acute medical harm or dosimetric severity, and two were associated with high dosimetric severity. Multi-incident analysis identified five high-risk activities or clinical scenarios as follows: (1) uncommon, low-volume or newly implemented brachytherapy procedures, (2) real-time MR-guided brachytherapy or biopsy procedures, (3) use of in-house devices or software, (4) manual data entry, and (5) patient scheduling and handoffs.ConclusionsBrachytherapy is a safe treatment and associated with a low rate of patient safety events. Effective incident management is a key element of continuous quality improvement and patient safety in brachytherapy.     

The experience of patients participating in a small randomised control trial that explored two different interventions to reduce anxiety prior to an MRI scan

IntroductionThis paper reports qualitative findings from within a larger randomised control trial where a video clip or telephone conversation with a radiographer was compared to routine appointment letter and information sheet to help alleviate anxiety prior to their MRI scan.MethodsQuestionnaires consisting of three free-text response questions were administered to all of the 74 patients recruited to the MRI anxiety clinical trial. The questionnaire was designed to establish patients' experiences of the intervention they had received. These questionnaires were administered post-scan. Two participants from each trial arm were also interviewed. A thematic approach was utilised for identifying recurrent categories emerging from the qualitative data which are supported by direct quotations.ResultsParticipants in the interventional groups commented positively about the provision of pre-MRI scan information they received and this was contrastable with the relatively indifferent responses observed among those who received the standard information letter. Many important themes were identified including the patients needs for clear and simplified information, the experience of anticipation when waiting for the scan, and also the informally acquired information about having an MRI scan i.e. the shared experiences of friends and family. All themes highlighted the need for an inclusive and individually tailored approach to pre-scan information provision.ConclusionQualitative data collected throughout the trial is supportive of the statistical findings, where it is asserted that the use of a short video clip or a radiographer having a short conversation with patients before their scan reduces pre-scan anxiety.     

A qualitative study of transgender individuals' experiences of healthcare including radiology

IntroductionTransgender and gender non-conforming people have historically been hidden in society. Increasing visibility has led to an awareness of the systematic discrimination experienced by this community. Transgender people experience factors that increase their need for healthcare while experiencing a lack of trans appropriate care.The aim of the research was to identify the lived experiences of transgender individuals in accessing radiologyMethodsA qualitative approach was used to determine the lived experiences of transgender individuals in accessing radiology for care unrelated to their transition process. In depth semi-structured interviews were used to collect data from six participants who identified as transgender or gender non-conforming. Participants were recruited by personal connection and subsequent snowball style sampling. Systematic thematic analysis was applied to the recorded interviews from each participantResultsThematic analysis identified a diverse range of individual lived experiences with 3 themes and a series of sub themes: (1) cultural competence (2) social stigma and (3) environmentConclusionThe study findings identify that negative healthcare experiences of transgender individuals are often the result of a lack of transgender knowledge demonstrated by healthcare professionals. Positive healthcare experiences were characterised by the use of inclusive language and the provision of an inclusive environment.Implications for practiceImproving the lived experience of healthcare for transgender individuals will require an improved inclusive curriculum within undergraduate education, as well as post qualification for all healthcare professionals. Healthcare professionals, including radiographers may make immediate improvements in the adoption of a more inclusive language and the display of signs and symbols which reflect a supportive environment. Longer term environmental improvements may include increasing access to gender neutral restrooms and changing facilities     

An evaluation of a therapeutic radiographer led “sexual care after radiotherapy” clinic

IntroductionChanges to sexuality and intimacy are a common consequence of a cancer diagnosis and treatment. Difficulties with sexual functioning and body image have been reported in over 50% of those treated for pelvic malignancies or breast cancer. The provision of sexual care support after radiotherapy is not adequately addressed by oncology professionals yet patients who have the opportunity to discuss sexual issues experience reduced sexual morbidity. This paper describes the evaluation and patient satisfaction of a novel and innovative clinic led by therapeutic radiographers for the management of sexual dysfunction.MethodQuantitative data was collected from NHS Friends and Family Test (FFT) patient questionnaires to assess how patients rated the service on a scale from not likely to extremely likely to recommend the service. A qualitative, thematic analysis of the comments provided insight into patient satisfaction and experience.ResultsOverall, 33 patients attended the clinic from 2019 to 2020. An 82% return rate of FFT questionnaire's showed 94% of patients were extremely likely and 6% were likely to recommend the service. Three emergent themes were the quality of information provision, the conduct of the staff member and the consultation experience. Patients stated that they were given a range of solutions and many cited a better understanding of their sexual issues.ConclusionSexual function is an important component of quality of life and sexual dysfunction can cause on-going distress, interfering with recovery. This clinic offers an opportunity to discuss issues and provides an important mechanism of support for patients to live with and beyond their cancer diagnosis.Implications for practiceOncology professionals should receive training and education to raise sexual issues with their patients and ensure relevant services are provided.     

Workflow and efficiency in MRI-based high-dose-rate brachytherapy for cervical cancer in a high-volume brachytherapy center

PurposeWe report the clinical workflow and time required for MRI-based image-guided brachytherapy (MR-IGBT) of cervical cancer patients in a high-volume brachytherapy center with 10 years of experiences to provide a practical guideline for implementing MR-IGBT into clinical use.Methods and MaterialsWe recorded the time and workflow of each procedure step within the 40 consecutive ring and tandem applicator fractions of MR-IGBT by our multidisciplinary team. We divided the entire procedure into four sections based on where the procedure was performed: (1) applicator insertion under sedation, (2) MR imaging, (3) planning, and (4) treatment delivery. In addition, we compared the current procedure time to the initial procedure time when first implementing MR-IGBT in 2007–2008 via a retrospective review.ResultsMean total procedure time was 149.3 min (SD 17.9, ranges 112–178). The multidisciplinary team included an anesthesia team, radiologist, radiation oncologist, nurses, radiation therapists, MRI technicians, dosimetrists, and physicists. The mean procedure time and ranges for each section (min) were as follows: (1) 56.2 (28.0–103.0), (2) 31.0 (19.0–70.0), (3) 44.3 (21.0–104.0), and (4) 17.8 (9.0–34.0). Under current setting, the combined mean procedure time for MR imaging and planning was 63.2 min. In comparison, the same procedure took 137.7 min in 2007–2008 period, which was significantly longer than the current workflow (p < 0.001).ConclusionsA skilled and dedicated multidisciplinary team is required for an efficient clinical workflow and delivery of MR-IGBT. Over the years, we have improved efficiency with clinical experience and continuous efforts in staff education.     

Use of High-fidelity simulation training for radiology healthcare professionals in the management of acute medical emergencies

Objectives:Life-threatening emergencies are relatively uncommon in the radiology department, but when encountered, require timely intervention. With an increasing number of critically unwell patients visiting the radiology department each year for both diagnostic and interventional procedures, it is vital that radiology staff are trained to provide basic resuscitation before further assistance arrives. Simulation training is a well-validated, effective method for rehearsing low-frequency, high-acuity events in a supportive and safe environment. The aim of our study was to investigate whether the introduction of a focussed, multidisciplinary simulation course would improve healthcare professional’s knowledge and confidence when managing common medical emergencies; including cardiac arrest, anaphylaxis and airway obstruction.Methods:A multidisciplinary group of radiology staff attended a dedicated simulation teaching course. Participants completed a pre- and post-test questionnaire which assessed a range of knowledge domains and their perceived confidence with dealing with the clinical scenarios. The delegates were then asked to repeat this questionnaire 6 months after taking part in the course to assess their retention of skills and knowledge.Results:Knowledge scores increased by a mean difference of 4 points (p < 0.001). The mean pre- and post-course perceived confidence scores were 4.4/10 and 8/10, respectively.Advances in knowledge:This study suggests that embedding simulation training into the radiology curriculum improves healthcare professional’s knowledge and perceived confidence when dealing with common medical emergencies. Although previous studies have looked at the use of simulation training for radiology trainees in the management of selected medical emergencies, to the authors’ knowledge, this is the first study to demonstrate these benefits across a range of clinical scenarios, within an interprofessional environment.     

What do clinicians understand about deaths reportable to the Coroner?

SettingThe study setting is a tertiary referral hospital of over 980 beds, in Victoria, Australia. The hospital is a long established major academic public health service providing healthcare, health professional education and health research. The hospital has 103,756 in-patient admissions, 190,756 outpatient attendances and over 82,000 presentations to the Emergency Department annually.Participants22 clinicians completed an in-depth, audio-recorded interview: 12 medical and 10 nursing staff, with a variety of clinical experience.Intervention(s)Each audio recorded interview was transcribed verbatim for thematic analysis. The semi structured questions were designed to explore the clinician's understanding of deaths that meet the criteria to be reported to Coroners Court of Victoria (CCOV), and why such reporting was required. There was also the opportunity to identify any barriers or enablers to the reporting process, whether internal or external to the organisation.ResultsTwo main themes emerged from the interviews: 1. lack of awareness of which deaths are reportable to the coroner and 2. the need for educational support. Several subthemes were also identified such as accountability, the need for feedback and blame.DiscussionThe understanding of clinicians as to which deaths meet the reportable criteria in healthcare is quite variable and this indicates that there might be a level of under reporting. Apart from the potential of not meeting legal obligations, there may also be the loss of a valuable opportunity for lessons to inform clinical practice and enhance the delivery of safe patient care.     

Does advanced practice in radiography benefit the healthcare system? A literature review

ObjectiveWith ever-increasing demands on the National Health Service (NHS), members of staff are blurring their professional boundaries in the attempt to benefit the healthcare system. This review aims to establish whether advancing practice within radiography does benefit the healthcare system by examining published literature.Key findingsKey words were input into databases such as: CINAHL, Science Direct and PubMed. Various filters were applied to narrow down the articles. Key themes were identified within the literature: cost, job satisfaction, patient benefits, restrictions and workload. Having advanced practitioners undertake some of the radiologists' workload was potentially cost effective whilst continuing/increasing the standard of quality. Patients benefitted from the quality of their examinations, the high accuracy of their reports and the speed those reports were attained.ConclusionEvidence within the literature emphasises that advanced practice does benefit the healthcare system by means of: cost reduction, job satisfaction, patient benefits and workload.     

A literature review exploring the perceived impact,challenges and barriers of advanced and consultant practice in therapeutic radiography

ObjectivesThis review seeks to explore the perceived impact, challenges and barriers of advanced and consultant radiographer roles on staff, patients and healthcare. A systematic approach was used to search for and identify suitable literature for review. All appropriate literature was critically appraised and analysed qualitatively by thematic analysis. The results were integrated to give an overall evaluation of the impact of advanced and consultant practice within Therapeutic Radiography.Key findingsThe literature found eleven studies that met the inclusion criteria and after critical appraisal, all were included in the analysis. Five key themes emerged from the analysis which is in keeping with the literature: education, quality of working life, patient care, benefit to healthcare and implementation obstacles.ConclusionMost advanced and consultant radiographers felt unprepared for these roles and the education requirements were varied and misunderstood. It was well documented that the advanced and consultant radiographer found great satisfaction from these roles and felt that it benefitted the patients as well as themselves and their career. Advanced and consultant roles benefitted patients by streamlining pathways and increasing satisfaction and there was a clear benefit to healthcare due to time and cost savings. The implementation obstacles focused around a lack of understanding and support from colleagues. There is a positive impact from advanced and consultant roles in therapeutic radiography to patients, staff and the healthcare system.Implications for practiceThere are challenges with respect to educational requirements, implementation obstacles and understanding of these roles which need to be addressed. There needs to be more education about the benefits of these roles so that they are encouraged and the staff are supported     

A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service

Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005–2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships.     

How to safely and sustainably reorganise a large general radiography service facing the COVID-19 pandemic

ObjectivesThis paper aims to share our experience in reorganising our general radiography service during the coronavirus disease (COVID-19) pandemic from the viewpoint of a large tertiary referral medical centre.Key findingsRe-organization of the radiography workforce, patient segregation, and modification of routine radiographic practices are key measures to help radiographic services deal with the COVID-19 pandemic. Specific emphasis on deploying more mobile radiographic units, segregating equipment, developing consistent image acquisition workflows, and strict adherence to infection control protocols are paramount to minimize the possibility of in-hospital transmission and ensure a safe environment for both patients and staff. Streamlining communication channels between leadership and ground staff allows quick dissemination of information to ultimately facilitate safe provision of services.ConclusionCOVID-19 has drastically altered the way general radiography teams provide services. The institution of several key measures will allow hospitals to safely and sustainably provide radiographic services. To date, there have been zero incidences of radiographer healthcare worker transmission within our institution during the course of work.Implication for practiceRadiographers are facing the challenge of providing high-quality services while simultaneously minimizing pathogen exposure to staff and patients. Our experience may lend support to other radiographic services responding to the COVID-19 outbreak and serve as a blueprint for future infectious disease outbreak contingency plans.