Literature Collection

ObjectivesCentral government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders' perceptions of MDTs' current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites.MethodsThirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically.ResultsLocal leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated.ConclusionsLocal contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction.

Objective: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in social communication and repetitive behaviors. This systematic review examines the application of artificial intelligence (AI) in diagnosing ASD, focusing on pediatric populations aged 0-18 years. Materials and methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Inclusion criteria encompassed studies applying AI techniques for ASD diagnosis, primarily evaluated using metriclike accuracy. Non-English articles and studies not focusing on diagnostic applications were excluded. The literature search covered PubMed, ScienceDirect, CENTRAL, ProQuest, Web of Science, and Google Scholar up to November 9, 2024. Bias assessment was performed using the Joanna Briggs Institute checklist for critical appraisal. Results: The review included 25 studies. These studies explored AI-driven approaches that demonstrated high accuracy in classifying ASD using various data modalities, including visual (facial, home videos, eye-tracking), motor function, behavioral, microbiome, genetic, and neuroimaging data. Key findings highlight the efficacy of AI in analyzing complex datasets, identifying subtle ASD markers, and potentially enabling earlier intervention. The studies showed improved diagnostic accuracy, reduced assessment time, and enhanced predictive capabilities. Conclusion: The integration of AI technologies in ASD diagnosis presents a promising frontier for enhancing diagnostic accuracy, efficiency, and early detection. While these tools can increase accessibility to ASD screening in underserved areas, challenges related to data quality, privacy, ethics, and clinical integration remain. Future research should focus on applying diverse AI techniques to large populations for comparative analysis to develop more robust diagnostic models.

BACKGROUND: Adolescents and young adults (AYA) living with sickle cell disease (SCD) transitioning to adult hematology care are at risk of dropping out of care and relying on emergency departments (ED) for acute crisis management. This can result in decreased continuity of care, an increase in serious health complications, and a greater mortality risk. This study aimed to investigate how transitioning to adult care is associated with SCD treatment outcomes, and test whether this association is moderated by comorbid mental health concerns (i.e., symptoms of anxiety and depression). PROCEDURE: We tested differences by age group (16-20, 21-25, 26-33 years) in the number of opioid prescriptions, hydroxyurea prescriptions, and ED visits using unadjusted comparisons and multivariable regression models, hypothesizing increased acute care use and decreased preventive treatment among the older age groups due to the complications associated with transitioning to adult care. We also tested whether there was an exacerbating effect of depression and anxiety symptoms on transition by assessing interaction terms between age group and symptoms in regression models. RESULTS: After adjusting for sociodemographic and mental health symptoms, the 26-33-year-old group had a significantly higher number of opioid prescriptions, and the 21-25 and 26-33 year groups had fewer hydroxyurea prescriptions and a greater number of ED visits than their 16-20-year-old counterparts. The higher number of opioid prescriptions among the older age group was even more pronounced among those with moderate to severe anxiety symptoms. CONCLUSIONS: Transitioning from pediatric to adult hematology poses a significant risk for AYA with SCD, especially for those with anxiety symptoms.

INTRODUCTION: Day care services have a long history in the support of older people, both internationally and in England. However, despite their longevity there is no consensus about the aims of day care services and their contribution to integrated care is unrecognised. This paper defines day care as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs, which support wellbeing and health, and/or support people to remain living at home and/or enable informal carers to sustain care. METHODS: The paper draws on qualitative data collected in a national study to reimagine day care services for older people in England. Eight sites participated, all from the voluntary sector. RESULTS: Day care services act as both a site of, and facilitator to, integrated care and whilst settings experienced many of the challenges faced by voluntary sector organisations, including a reliance on limited and uncertain funding, they had developed a range of strategies to partially manage them. CONCLUSIONS: Collective forms of day care services have the potential to play a more significant role in the provision of local place based integrated care in England.