Purpose The purpose of this paper is to understand the components of a high-quality prison healthcare system and the impact, ten-years on, of the transfer of accountability in England, from a justice ministry to a health ministry. Design/methodology/approach A rapid the evidence review was undertaken, which included a review of 82 papers and qualitative interviews with key informants. The concepts and themes identified were summarised and analysed through a framework analysis, designed to improve population outcomes and address health inequalities. The use of a rapid evidence assessment, rather than a systematic review methodology, the use of abstracts (rather than full-text articles) to extract the data, and limiting the search strategy to articles published in the English language only might mean that some relevant research papers and themes were not identified. The need for the evidence to be produced within a limited time frame and with limited resources determined these pragmatic approaches. Findings The review found that English prison healthcare has undergone "transformation" during this period, leading to increased quality of care through organisational engagement, professionalisation of the healthcare workforce, transparency, use of evidence-based guidance and responsiveness of services. The review also highlighted that there is still room for improvement, for example, relating to the prison regime and the lack of focus on early/preventive interventions, as well as specific challenges from limited resources. Research limitations/implications Time and resource constraints meant a rapid evidence review of papers in the English language was undertaken, rather than a systematic review. This might mean relevant papers have been missed. The review also only covered small number of countries, which may limit the transferability of findings. The lack of qualitative data necessitated the use of quantitative data gathered from key informants. However, this enabled a good understanding of current practice. Practical implications The review findings support the World Health Organisation position on the value of integrated prison and public health systems in improving quality of healthcare. It also recommends future policy needs to take account of the "whole prison approach" recognising that healthcare in prisons cannot operate in isolation from the prison regime or the community. Originality/value This is unique research which has great value in supporting prison reform in England. It will also be of interest internationally due to the paucity of data in the published peer-reviewed literature on the impact of commissioning models on healthcare or health outcomes.
Aim To characterise the patients who were seen between 1998 and 2011 with a diagnosis of PD. Method Retrospective case notes review of 18 identified cases with history and signs consistent with PD. Results The mean age of the 18 patients was 42 (range 20e63); six were Caucasians, six were from Indian subcontinent, five Africans and one Caribbean. All except one gave a history of change in penis shape during erection: six had upward curvature, seven bent to the left, one to the right, two had shortening of penis/distal flaccidity and one had no change. Seven had pain on erection, 10 had history of a penile lump, five had erectile dysfunction and two had difficulty in penetration. The mean duration of symptoms before presentation to the clinician was 64.1 months (range 3 weeks to 264 months), none had a history of penile trauma, intracavernosal injection or Dupuytren's contracture. Of four who had an ultrasound scan of the penis, two were confirmed to have lumps consistent with PD. Of 12 who had primary treatment with colchicine for 2e12 months; three showed improvement in symptoms, three no change and six unknown outcome. Of two who had primary treatment with pentoxifyline for 1e11 months one showed improvement in symptoms and one unknown. Of three who failed to respond to colchicine and were then treated with pentoxifyline, a further one showed improvement. Conclusion (1). 28% of cases had ED. (2). Overall, 33% of the patients had symptomatic improvement with treatment and none had worsened post treatment which is consistent with the findings of other studies. P185A PILOT PROGRAMME FOR THE UNDERGRADUATE TEACHING OF SEXUAL HEALTH USING INTERACTIVE DEMONSTRATION FOR EXPERIENTIAL LEARNING Background In Edinburgh in May 2011, the GUM and FP/SRH departments integrated. A priority for the new service was reviewing and improving the undergraduate teaching offered in sexual health. Aim To increase and improve undergraduate teaching, using experiential learning to develop the skills and attitudes essential for managing patients with sexual health needs. Methods An OSCE format with interactive demonstration was chosen as the method to achieve these aims. Stations focused on effective communication and developing appropriate skills and attitudes. Three OSCE stations, based on common and important sexual health scenarios, were designed for interactive group work using simulated patients. The fourth station facilitated open discussion of sexuality and its implications for the well-being of patients. Four pilot sessions were run. Feedback questionnaires were given to students, facilitators and simulated patients. Strengths, weaknesses, and suggestions for improvement were requested. Participants were asked to score their level of enjoyment (from 1 to 10). Students also scored the course on how useful it was in meeting their educational needs (see abstract P185 table 1). Results Feedback was extremely positive. Students felt the opportunity to practice their communication skills within sexual health consultations in a risk-fr...
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