Search

FaceBookTwitterGoogle+

AIS Annual Report 2011

PDF SmallDownload the Full Report (PDF, 1.3Mb).


 

1               Activity

 

 

Actual

Planned

Assessments

27

24

Vagus Nerve Stimulation

1

7

Anterior Cingulotomy

6

5

Follow-up

10

12

 

1.1.             Referrals

Forty-one referrals were received during the reporting period (16 men and 26 women); with a mean age of 48.5 years. This is a similar demographic to previous years. There were 37 referrals (87.8%) from Scotland, 4 referrals (9.8%) from England, and 1 referral (2.4%) from Northern Ireland.

1.2.             Assessments

Twenty-seven assessments were conducted during the 2010/11 financial year. Seventeen men and 10 women were seen, with a mean age of 47.9 years (range 26.1 – 69.1 years). Five assessments were conducted outwith the SLA.

Approximately 50% of patients had a diagnosis of unipolar major depression, and approximately 30% of patients had a primary diagnosis of obsessive-compulsive disorder; up from 20% last year.

1.3.             Procedures

Six Anterior Cingulotomy procedures and one VNS implantation were performed during 2010/11. Four patients came from England.

2               Mortality Data & Adverse Effects

There were no deaths and no post-operative infections during the reporting year. One individual had a small post-operative haemorrhage which had no clinically-detectable effects and was only seen on MRI scan. One patient experienced non-stimulation-related voice alteration following implantation of a VNS stimulator – this is expected to resolve.

3               Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.6 ± 3.7 weeks. This is similar to the previous year. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as delays in receiving formal confirmation of funding (for English patients) and delays in the service being sent clinical case notes which are necessary for assessment.

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

Of the 2 patients who had undergone Anterior Cingulotomy for depression and were followed up in 2010/11, one met criteria for response, although none met criteria for remission (categories not mutually exclusive). The majority of patients undergoing ablative neurosurgery experienced reductions in symptoms ranging from 19% to 50%. One patient underwent cingulotomy for OCD and experienced full clinical remission one year after surgery.

Of the 6 patients who were reviewed following VNS, three met criteria for response. One met criteria for remission.

6               Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level. Staff continue to publish in peer-reviewed journals on 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.

7               Service Developments and Future Plans

The service is participating in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression, and has currently enrolled the first participant. 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.

8               Summary and Conclusions

Neurosurgical activity in 2010/11 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 are 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 2011

PDF SmallDownload the Full Report (PDF, 446Kb).

 


AIS Annual Report 2010

PDF SmallDownload the Full Report (PDF, 1.7Mb)


1               Activity

 

 

Actual

Planned

Assessments

29

24

Vagus Nerve Stimulation

1

7

Anterior Cingulotomy

1

5

Follow-up

11

12

There were 5 follow-up assessments for ablative procedures and 6 follow-ups for VNS in this reporting period.

1.1.             Referrals

Forty-two referrals were received during the reporting period (18 men and 24 women); with a mean age of 46.8 years. A number were not considered to fall within the remit of the service and advice on further management was provided to the referrer.

There were 2 (4.8%) referrals from England, and 40 (95.2%) from Scotland.

1.2.             Assessments

Twenty-nine assessments were conducted during the 2009/10 financial year. Fourteen men and 15 women were seen, with a mean age of 49.5 years (range 20.3 – 85.2 years). Two assessments were conducted outwith the SLA.

Approximately 50% of patients had a diagnosis of unipolar major depression, and approximately 20% of patients had a primary diagnosis of obsessive-compulsive disorder. Other disorders made up the remaining 30% of assessments.

1.3.             Procedures

One Anterior Cingulotomy and one VNS implantation were performed during 2009/10. Both patients came from Scotland.

2               Mortality Data

There were no deaths, no post-operative infections and no significant adverse events during the reporting year.

3               Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.2 ± 3.4 weeks. This is slightly less than the previous year, but may reflect levels of activity. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as rescheduled appointments at the request of the patient.

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

Of the 5 patients who had undergone Anterior Cingulotomy and were followed up in 2009/10, two met criteria for response, and one met criteria for remission (categories not mutually exclusive). All patients undergoing ablative neurosurgery experienced variable degrees of symptom reduction.

Of the 6 patients who were reviewed following VNS, none met criteria for response or remission. Two patients had modest symptom improvement at follow-up. It is recognised that this is a very refractory population, and the service continues to collect very detailed outcomes from all patients.  

6               Teaching and Research Activities

Members of the team continue to deliver presentations at a local and national level. Members of staff have been very active from a research perspective, publishing extensively in peer-reviewed journals, contributing to textbooks in psychiatry, and contributing to national clinical guidelines.

In addition, the service contributes to undergraduate and postgraduate teaching programmes (local and national) and individuals have supervised projects at an undergraduate and postgraduate (PhD) level.

7               Service Developments and Future Plans

Agreements, in principle, have been reached for our service to participate in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression, which will hopefully begin recruiting later in 2010. This will enable us to not only advance patient care but also to develop patient choice in this clinical area. Uniquely, in Dundee, we will have the opportunity to evaluate the outcomes for this DBS alongside those for other neurosurgical therapies.

8               Summary and Conclusions

Although neurosurgical activity in 2009/10 is less than that of 2008/09, it is recognised that such activity varies from one year to the next. In addition, the level of activity is dependent upon the nature of the patients referred, and it remains the situation that in many cases, further treatment recommendations are given before the patient may return for consideration for a neurosurgical intervention. Further, surgery rates for the next reporting period are predicted to be higher, with a number of patients already on the pathway for neurosurgery.


 

AIS Six-Month Report 2010

PDF SmallDownload the Full Report (PDF, 685Kb).

 

AIS Annual Report 2009

PDF SmallDownload the Full Report (PDF, 1.0Mb)


1.1         Introduction

The Dundee Advanced Interventions (Neurosurgery for Mental Disorder) Service was first designated as a National Specialist Service in April 2006, and became fully staffed in the first quarter of 2007. We are therefore reporting on the second full year of service activity.

1.2         Activity

 

 

Actual

Planned

Assessments

26

24

Vagus Nerve Stimulation

4

7

Anterior Cingulotomy

3

5

Follow-up

11

12

 

1.2.1        Referrals

Twenty-five referrals were received during 2008/09. Twenty-two (88%) came from Scotland, 2 (8%) came from England, and 1 (4%) came from Northern Ireland.

1.2.2        Assessments

Twenty-six assessments were performed. One patient did not attend for initial assessment. The source of assessments mirrored that of referrals, with 3 assessments being conducted outwith the Service Level Agreement (SLA) and was funded by referring NHS Trust in England/ Ireland).

Approximately 60% of assessments had a primary diagnosis of unipolar major depression. Approximately 20% had a diagnosis of Obsessive-Compulsive Disorder. Bipolar disorder, organic disorders, personality disorder, and other anxiety disorders made up the remaining diagnoses.

1.2.3        Procedures

During 2008/09, 7 procedures (3 cingulotomies and 4 Vagus Nerve Stimulator implantations) were performed. Five procedures were funded outwith the SLA.

1.3         Mortality Data

There were no deaths, no post-operative infections and no significant adverse events during the current year.

1.4         Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 10.7 ± 6 weeks. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as rescheduled appointments at the request of the patient.

1.5         Quality of Care

1.5.1        Formal Complaints

There were no formal complaints.

1.5.2        Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for both outpatient assessment and inpatient admission was consistently high, with the majority of patients rating their experience positively. The service was rated highly for quality of assessment. Inpatient experience was uniformly positive.

1.6         Best Value Healthcare – Clinical Audit and Outcomes

1.6.1        Outcome Data

In the patients reviewed during 2008/09, six had undergone ACING (four as their second procedure) and five had undergone VNS. Response rates for VNS were 20%. This is believed to reflect the high levels of chronicity, disability and treatment-resistance within the patient group treated in Dundee. With respect to these clinical features, the VNS patients treated in Dundee were not comparable to those typically included in published studies where higher response rates have been described. Two out of 4 (50%) patients undergoing a second ACING for major depression achieved clinical remission.

1.7         Teaching and Research Activities

Staff have delivered a range of presentations at national and regional meetings throughout the year. Invited presentations have also been given at postgraduate psychiatry meetings in Scotland.

The service continues to publish academic papers on NMD and related topics  and a number of AIS staff have been awarded grants for further research.

1.8         Service Developments and Future Plans

Dundee AIS continues to build links with local mental health services and a variety of third-sector organisations. In the last year, members of the team have visited tertiary-level inpatient OCD treatment services in London.

The service is optimistic about the possibilities for participation in international multi-centre trials of Deep Brain Stimulation (DBS) for both depression and OCD.

1.9         Summary and Conclusions

Although of the referral rate for assessments was lower this year than last, we continue to exceed our SLA recommended activity level. This reporting year has been busier with respect to neurosurgical activity and our engagement in post-operative care planning with referring services has continued to build and evolve.

New members of the team bring with them exciting possibilities for the service to build on its existing research portfolio and to ensure the delivery of best clinical practise in the delivery of complex and advanced interventions for chronic, refractory psychiatric illness.


 

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

NHS Tayside LogoSpacer 40x80Dundee University Logo