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AIS Annual Report 2016

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1 Activity

1.1. Summary of activity for year ending March 2016

 

Actual

Planned

Assessments

31

24

Anterior Cingulotomy

4

3-5

Follow-up

4

12

Intensive OCD treatment

3

4-6

 

1.2. Referrals

Sixty-one referrals were received during the reporting period (32 men and 29 women); with a mean age of 49.4 years. There were 54 referrals (88.5%) from Scotland, and 7 referrals (9.8%) from England.

1.3. Assessments

Forty-one assessments were conducted during the 2015/16 financial year for 34 patients. Sixteen men and 18 women were seen, with a mean age of 50.2 years (range 23.2 – 74.7 years). Most (97.1%) assessments were for Scottish patients. No assessments were conducted outwith the SLA. The location for assessments was as follows: Ninewells Hospital (80.5%); Other Hospital in Scotland (17.1%); Patient’s Home (2.4%).

We have continued to see a high number of people with OCD (20.6%), with 26.5% having major depression. A range of other disorders were also represented – these indicate the diagnosis made by the AIS (rather than the referrer) and reflect the nature of complex and comorbid mental disorders reaching tertiary and quaternary services.

1.4. Procedures

Four neurosurgical procedures were performed during 2015/16. The procedures were Anterior Cingulotomy (N=3) and Anterior Capsulotomy (N=1). One DBS procedure was performed as part of a clinical trial but this individual isn’t included here. Two patients were Scottish and two patients were English.

2 Mortality Data & Adverse Effects

There have been no deaths and no post-operative infections during the reporting year. Rates of adverse effects are unchanged from previous years, and are consistent with the published literature on the procedures undertaken. We continue to see no consistent and widespread effects on neuropsychological functioning.

3 Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.8 ± 4.0 weeks. This is unchanged from previous years. Overall, 50% of Scottish patients waited less than 8.1 weeks to be seen. Only 11.8% waited longer than 12 weeks and these were for reasons outwith the control of the AIS.

4 Quality of Care

4.1. Formal Complaints

There were no formal complaints.

4.2. Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service. This high level of patient satisfaction has been maintained over the last six years.

5 Best Value Healthcare – Clinical Audit and Outcomes

5.1. Outcome Data for Cingulotomy

The following table only includes those patients reviewed in 2014-15. It is not possible to generalise to all patients undergoing the procedure.

 

Size of change in symptom scores (categories are exclusive)

Indication for surgery

≤20%

≥20%

≥35%

≥50%

Depression (N=4)

2

0

1

1

 

6 Intensive OCD treatment

Three patients have been treated as part of the intensive OCD treatment programme. Two completed a full course of treatment. Two patients underwent outpatient / home-based treatment as an alternative to inpatient treatment. Of the two patients who completed the treatment programme, one did not meet criteria for response whilst the other had a reduction of 55%; meeting ‘responder’ criteria.

Outcomes from treatment are comparable to other specialist centres.

7 Teaching and Research Activities

Members of the team deliver presentations at a regional, national, and international level and the service continues to publish in peer-reviewed journals. The research output of the service continues to be of a high-standard and is internationally-recognised.

8 Service Developments and Future Plans

The intensive OCD programme has been running for three years. We are currently reviewing fully the structure and elements of the content of the programme and will report on these adjustments in subsequent reports.

The neurosurgical pathways established with NHNN in London are working well and we continue to meet regularly with neurosurgical colleagues.

8 Summary and Conclusions

The service continues to meet a relatively niche but important need in Scottish mental health services. The outcomes from neurosurgical treatment and intensive OCD treatment are comparable to other expert centres worldwide and we enjoy good relationships with teams throughout the UK.

 

AIS Annual Report 2015

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1 Activity

1.1. Summary of activity for year ending March 2015

 

Actual

Planned

Assessments

35

24

Anterior Cingulotomy

1

3-5

Follow-up

7

12

Intensive OCD treatment

4

4-6

 

1.2. Referrals

Forty-eight referrals were received during the reporting period (23 men and 25 women); with a mean age of 44.1 years. There were 47 referrals (97.9%) from Scotland, and 1 referrals (2.1%) from England.

1.3. Assessments

Thirty-eight assessments were conducted during the 2014/15 financial year for 35 patients. Fifteen men and 20 women were seen, with a mean age of 44.8 years (range 16.9 – 66.6 years). Most (97.1%) assessments were for Scottish patients. One assessment was conducted outwith the SLA.

We have continued to see a high number of people with OCD (22.9%), with 20.0% having major depression. A range of other disorders were also represented – these indicate the diagnosis made by the AIS (rather than the referrer) and reflect the nature of complex and comorbid mental disorders reaching tertiary and quaternary services. Of note is that 11.4% of assessments were given a diagnosis of autism spectrum disorder.

1.4. Procedures

One neurosurgical procedure (Anterior Cingulotomy) was performed during 2014/15. The patient was Scottish.

2 Mortality Data & Adverse Effects

There have been no deaths and no post-operative infections during the reporting year. Rates of adverse effects were largely unchanged from previous years, and are consistent with the published literature on the procedures undertaken.

3 Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.9 ± 5.7 weeks. This is consistent with the previous year. Overall, 50% of Scottish patients waited less than 8 weeks to be seen. Only 11.4% waited longer than 12 weeks and there were unavoidable reasons for all of these.

4 Quality of Care

4.1. Formal Complaints

There were no formal complaints.

4.2. Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

5 Best Value Healthcare – Clinical Audit and Outcomes

5.1. Outcome Data for Cingulotomy

The following table only includes those patients reviewed in 2014-15. It is not possible to generalise to all patients undergoing the procedure.

 

Size of change in symptom scores (categories are exclusive)

Indication for surgery

≤20%

≥20%

≥35%

≥50%

Depression (N=5)

2

1

0

2

OCD (N=1)

0

0

0

1

 

6 Intensive OCD treatment

Four patients have been treated as part of the intensive OCD treatment programme. Three completed a course of treatment. At the point of discharge from hospital two patients (66.6%) were responders and one patient (33.3%) was a non-responder.

7 Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level and publish in peer-reviewed journals. The research output of the service continues to be of a high-standard and is internationally-recognised.

8 Service Developments and Future Plans

The retiral of the neurosurgeon in the service meant that we established a partnership with experienced neurosurgeons at the National Hospital for Neurology and Neurosurgery in London. More information is provided below in section C1.

8 Summary and Conclusions

The service has experienced a temporary interruption to the provision of neurosurgery during this financial year but we have been able to ensure continued provision due to partnership with the NHNN in London. The intensive OCD programme has run successfully over the last year and outcomes are comparable with other specialist centres. The number of referrals and assessments continues to be above the planned level.

 

AIS Annual Report 2014

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1 Activity

1.1. Summary of activity for year ending March 2014

 

Actual

Planned

Assessments

26

24

Anterior Cingulotomy

2

5

Follow-up

8

12

 

1.2. Referrals

Fifty-five referrals were received during the reporting period (24 men and 31 women); with a mean age of 45.3 years. There were 48 referrals (87.3%) from Scotland, and 9 referrals (9.1%) from England. Two referrals (3.6%) came from Northern Ireland.

1.3. Assessments

Twenty-six assessments were conducted during the 2013/14 financial year. Twelve men and 14 women were seen, with a mean age of 44.9 years (range 18.4 – 63.1 years). Most (92.2%) assessments were for Scottish patients. Two assessments were conducted outwith the SLA.

Compared to previous years, a greater proportion (42.3%) of patients had a diagnosis of OCD, with 15.4% having major depression. A range of other disorders were also represented – these reflect the diagnosis made by the AIS, not the referrer, and reflect the nature of complex and comorbid mental disorders reaching tertiary and quaternary services.

1.4. Procedures

Two Anterior Cingulotomies were performed during 2013/14. Both were Scottish patients.

2 Mortality Data & Adverse Effects

There have been no deaths and no post-operative infections during the reporting year. Rates of adverse effects were largely unchanged from previous years, and are consistent with the published literature on the procedures undertaken.

3 Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.5 ± 2.6 weeks. This is slightly shorter than the previous year. The percentage of Scottish patients seen within 12 weeks was 87.5%, with documented reasons for delays for the three patients that waited slightly longer.

4 Quality of Care

4.1. Formal Complaints

There was one formal complaint (unrelated to the neurosurgical or intensive OCD pathway) which was resolved within the NHS Tayside complaints procedure.

4.2. Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

5 Best Value Healthcare – Clinical Audit and Outcomes

5.1. Outcome Data for Cingulotomy

The following table only includes those patients reviewed in 2013-14. It is not possible to generalise to all patients undergoing the procedure.

 

Size of change in symptom scores (categories are exclusive)

Indication for surgery

≤20%

≥20%

≥35%

≥50%

Depression (N=7)

4

1

0

2

OCD (N=1)

1

0

0

0

 

6 Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level and publish in peer-reviewed journals in fields such as: neurosurgery; ablative neurosurgery; vagus nerve stimulation; neuroimaging; and neuropsychology.

The service is research active, and members of the team continue to publish extensively in journals.

7 Service Developments and Future Plans

Three patients have been treated as part of the intensive OCD treatment programme. Two-thirds of patients (who were all severely unwell) were responders after inpatient treatment.

8 Summary and Conclusions

Referrals to the service for patients with OCD have increased and this is likely to be due to our ability to deliver specialist intensive treatment programmes as part of our SLA. Neurosurgical activity remains only one part of an extensive treatment service which involves close working with patients, carers, and mental health services.

AIS Annual Report 2013

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1 Activity

1.1. Summary of activity for year ending March 2013

 

Actual

Planned

Assessments

40

24

Anterior Cingulotomy

1

5

Follow-up

11

12

 

1.2. Referrals

Forty-five referrals were received during the reporting period (26 men and 19 women); with a mean age of 45.4 years. There were 36 referrals (80%) from Scotland, and 9 referrals (20%) from England.

1.3. Assessments

Forty assessments were conducted during the 2012/13 financial year. Twenty-two men and 18 women were seen, with a mean age of 44.9 years (range 18.4 – 63.1 years). Nine assessments were conducted outwith the SLA.

Approximately 30% of patients had a diagnosis of unipolar major depression, and 37.5% of patients had a primary diagnosis of obsessive-compulsive disorder; this is a similar diagnostic breakdown to previous years. The presence of other diagnoses reflects the complexity and comorbidity of chronic mental illness.

1.4. Procedures

One Anterior Cingulotomy wasperformed during 2012/13. The service also performed implantation of Deep Brain Stimulation as part of an international research study.

2 Mortality Data & Adverse Effects

There have been no deaths and no post-operative infections during the reporting year. Adverse effects are largely unchanged from previous years, and are consistent with the published literature on the procedures undertaken.

3 Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 7.5 ± 2.7 weeks. This is slightly shorter than the previous year. Ninety percent of patients were seen within 18 weeks, with documented reasons for delays for the threepatients that waited longer.

4 Quality of Care

4.1. Formal Complaints

There was one formal complaint which was resolved within the NHS Tayside complaints procedure.

4.2. Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

5 Best Value Healthcare – Clinical Audit and Outcomes

5.1. Outcome Data

 

Size of change in symptom scores (categories are exclusive)

Indication for surgery

≥20%

≥35%

≥50%

Depression (N=7)

2

0

1

OCD (N=2)

0

1

0

 

6 Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level and publish in peer-reviewed journals in fields such as: neurosurgery; ablative neurosurgery; vagus nerve stimulation; neuroimaging; and neuropsychology.

The service is research active, with a range of active research projects, some of which are part of international, multi-centre clinical trials of neuromodulation for depression. The service is also participating in a novel clinical study of deep brain stimulation for OCD which is funded by the Medical Research Council.

7 Service Developments and Future Plans

The service is participating in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression. This will enable us to not only advance treatments in this refractory population but also to develop patient choice in this clinical area. Uniquely, in Dundee, we will have the opportunity to evaluate the outcomes for DBS alongside those for other neurosurgical therapies.

Following the deliberations and recommendations of the Expert Advisory Group that conducted the 5 year review on behalf of NSD, it has been agreedthat the activities of the AIS be formally extended within the SLA to allow inpatient treatment for OCD to be provided in Dundee for patients in NHS Scotland.This part of the service has been in place since 1 April 2013.

8 Summary and Conclusions

Neurosurgical activity in 2012/13 continues to be variable but it is recognised that clinical activity varies from one year to the next and is dependent upon the nature of the patients referred. We believe that there remain considerable numbers of patients with unmet needs and we are keen to ensure that they have the opportunity to be referred to the service.

AIS Six-Month Report 2013

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National Services Scotland

Advanced Interventions Service
Area 7, Level 6
South Block
Ninewells Hospital and Medical School
Dundee, DD1 9SY. UK.
Tel: +44 (0)1382 496233

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