At present, 'gold standard' diagnosis of autism spectrum disorders (ASD) is a lengthy and time consuming process that requires suitably qualified multi-disciplinary team (MDT) personnel to assess behavioural, historical, and parent-report information to determine a diagnosis. A number of different tools have been developed to assist in determination. To optimise the diagnostic procedures, the best diagnostic instruments need to be identified. This study is a systematic review addressing the accuracy, reliability, validity and utility of reported diagnostic tools and assessments. To be included in this review, studies must have (1) identified an ASD diagnostic tool; (2) investigated either diagnostic procedure or the tools or personnel required; (3) be presented in English; (4) be conducted in the Western world; (5) be one of three types of studies [adapted from Samtani et al. in Cochrane Database Syst Rev 3:1-13, 2011], viz. (a) cohort studies or cross-sectional studies, (b) randomised studies of test accuracy, (c) case-control studies. MEDLINE, PsychINFO, Scopus, EMBASE, and Cochrane Library databases were scrutinised for relevant literature published from 2000 inclusive on 20th January 2012. In total, 68 articles were included. 17 tools were assessed. However, many lacked an evidence base of high quality-independent studies. The Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) stood out with the largest evidence base and highest sensitivity and specificity. When the ADI-R and ADOS were used in combination they revealed levels of accuracy very similar to the correct classification rates for the current 'gold standard' diagnostic procedure viz. 80.8% for ASD. There is scope for future studies on the use of the ADI-R and ADOS in combination.

Purpose Research is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time. Methods We used qualitative interviews (N = 49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team. Results Existing mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to the community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health. Conclusion There is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.

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158 HMORN 2013 -Selected Abstracts safety net population. Methods: This randomized controlled trial began in October 2011 among patients of Cambridge Health Alliance (CHA), an urban safety net health care system. We identified patients discharged from the medical service with lengths of stay 3 days or more, admission in the prior 6 months, age 60+ years, or admission for COPD or congestive heart failure. We randomized patients to the PN intervention or usual care alone. In the PN intervention, a bilingual hospital-based CHW engaged in discharge planning and made outreach phone calls to patients for 30 days after initial discharge and upon subsequent readmission. PNs assisted patients with follow-up appointments, obtaining and taking medications, transportation, financial barriers, and linkages to community resources. Sociodemographic, clinical, and utilization data were obtained from electronic medical records. Primary outcomes were the proportion of patients readmitted within 30 days, number of readmissions per patient, total number of hospital days within 180 days post-discharge, and proportion of patients with a primary care visit or an emergency department (ED) visit within 30 days. The trial will continue through spring 2013. Results: As of October 2012, 423 patients were in the PN group and 513 in the control group. Fewer PN patients (12.1%) were readmitted within 30 days of an index discharge than controls (13.6%). Readmissions per patient were lower in the PN group compared to controls (0.70 vs. 0.81), as were total hospital days (3.42 vs. 3.59). More PN patients than controls had a primary care visit within 30 days (77.1% vs. 68.6%), but similar percentages had an ED visit within 30 days (11.3% vs. 10.9%). Conclusions: Preliminary results show a trend toward a reduction in probability of 30-day readmission, number of readmissions, and total hospital days for safety net patients receiving a PN intervention, and a trend toward greater probability of a primary care visit within 30 days of discharge. Background/Aims: Implementation science (IS) is a priority topic in the renewal funding of the Cancer Research Network and encompasses a broad range of constructs and uses measures from a variety of disciplines. However, there has been little standardization of measures or agreement on definitions of constructs across different studies, fields, authors, or research groups. Moreover, many measures developed are not practical in real-world settings such as healthcare delivery systems. To further the field of IS, there is a need to both identify and evaluate IS measures on both their validity and practical relevance. Methods: We describe a collaborative, web-based activity using the National Cancer Institute's (NCI) Grid-Enabled Measures (GEM) portal that uses a wiki platform to focus discussion and engage the research community to enhance the quality and harmonization of measures for IS health-related research and practice. We present the history, process, and data from 8 months of the GEM Dissemination & Impleme...

Psychiatric decision units have been developed in many countries internationally to address the pressure on inpatient services and dissatisfactory, long waits people in mental health crisis can experience in emergency departments. Research into these units lags behind their development, as they are implemented by healthcare providers to address these problems. This is the first-ever national survey to identify their prevalence, structure, activities, and contextual setting within health services, in order to provide a robust basis for future research. The response rate was high (94%), and six PDUs in England were identified. The results indicated that PDUs open 24/7, accept only voluntary patients, provide recliner chairs for sleeping rather than beds, and limit stays to 12-72 hours. PDUs are predominantly staffed by senior, qualified mental health nurses and healthcare assistants, with psychiatry input. Staff:patient ratios are high (1:2.1 during the day shift). Differences in PDU structure and activities (including referral pathway, length of stay, and staff:patient ratios) were identified, suggesting the optimal configuration for PDUs has not yet been established. Further research into the efficacy of this innovation is needed; PDUs potentially have a role in an integrated crisis care pathway which provides a variety of care options to service users.