Mortality is closely linked to age, sex, and social and historical context. Standardised Mortality Rates (SMR) address these contextual factors by comparing mortality in a population under study with that in people of the same age and sex, the same period in history and from a similar cultural context. We use records from the Hatton Asylum and contemporaneous census data in order to calculate SMR in the asylum population, showing rates that were about 2.5 times greater than the population at the time. This is much lower than crude mortality rates, which we calculated as being more than seven times greater than in the population. The SMR method may enable a more meaningful understanding of mortality in asylums or other institutions.

Aims and method The impact of flexible assertive community treatment (FACT) has been observed in people previously supported by assertive community treatment (ACT) teams, but its effect on those previously with a community mental health team (CMHT) has not been studied in the UK. An observational study was conducted of 380 people from 3 CMHTs and 95 people from an ACT team, all with a history of psychosis, following service reconfiguration to 3 FACT teams. Results People previously with a CMHT required less time in hospital when the FACT model was introduced. A smaller reduction was observed in people coming from the ACT team. Both groups required less crisis resolution home treatment (CRHT) team input. Clinical implications FACT may be a better model than standard CMHT care for people with a history of psychosis, as a result of reduced need for acute (CRHT and in-patient) services.

The OCTET randomised controlled trial (RCT) 1 Burns T Rugkasa J Molodynski A et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Lancet. 2013; 381: 1627-1633 Summary Full Text Full Text PDF PubMed Scopus (268) Google Scholar of supervised community treatment orders (CTOs) for patients with psychosis found no difference in the primary outcome of readmission to hospital in those with CTOs compared with those receiving section 17 leave under the England and Wales Mental Health Act, which provides similar levels of compulsory supervision and treatment before final discharge from hospital. Despite the authors' conclusions that CTOs do not benefit patients, they have continued to be widely used. 2 Care Quality CommissionMonitoring the Mental Health Act in 2013/14. http://www.cqc.org.uk/sites/default/files/20150204_monitoring_the_mha_2013-14_report_web.pdfDate: 2015 Google Scholar

Background: Studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK.Aims: To observe the long-term effect of ACT on bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design.Methods: Bed use was compared for equal periods of time either side of starting support from an ACT team.Results: Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018).Conclusions: The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.

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Background: Assertive Outreach has yet to be demonstrated to be effective in the UK. Few studies have explored its implementation in rural settings. Aims: To establish whether the Assertive Outreach Team (AOT) model is effective in reducing hospital bed use and in improving engagement with services and social functioning in a mixed rural and urban area in the UK. Method: A prospective within subject control design, following a cohort of 42 patients during a period of 2 years prior to the implementation of an AOT, and for the first year of its operation. Results: There was a statistically significant reduction in bed use among the cohort during the first year of AOT, with secondary findings of improved engagement with services and social functioning. Conclusions: AOT can be effectively implemented in a mainstream NHS setting, in an area with a substantial rural population. Declaration of interest: None.

We present a case of possible olanzapine-induced rhabdomyolysis in the absence of other features of neuroleptic malignant syndrome (NMS). There is evidence to suggest that there are different underlying pathophysiological mechanisms for rhabdomyolysis occurring alone, in contrast to when it presents as part of NMS. This has possible implications for drug rechallenge which is discussed.

Estimation of intestinal unstirred layer thickness usually involves inducing transmural potential difference changes by altering the content of the solution used to perfuse the small intestine. Osmotically active solutes, such as mannitol, when added to the luminal solution diffuse across the unstirred water layer (UWL) and induce osmotically dependent changes in potential difference. As an alternative procedure, the sodium ion in the luminal fluid can be replaced by another ion. As the sodium ion diffuses out of the UWL, the change in concentration next to the intestinal membrane alters the transmural potential difference. In both cases, UWL thickness is calculated from the time course of the potential difference changes, using a solution to the diffusion equation. The diffusion equation solution which allows the calculation of intestinal unstirred layer thickness was examined by simulation, using the method of numerical solutions. This process readily allows examination of the time course of diffusion under various imposed circumstances. The existing model for diffusion across the unstirred layer is based on auxiliary conditions which are unlikely to be fulfilled in the same intestine. The present simulation additionally incorporated the effects of membrane permeability, fluid absorption and less than instantaneous bulk phase concentration change. Simulation indicated that changes within the physiologically relevant range in the chosen auxiliary conditions (with the real unstirred layer length kept constant) can alter estimates of the apparent half-time. Consequently, changes in parameters unassociated with the unstirred layer would be misconstrued as alterations in unstirred layer thickness.