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Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that children and young people with neurological conditions who missed outpatient appointments have more emergency inpatient admissions and Accident and Emergency centre (A&E) visits than those who missed none.Method: Retrospective cohort of individuals aged up to 19 years with neurological conditions, identified from routine hospital data in England, UK from April 1st, 2003 to March 31st, 2015 using an International Statistical Classification of Diseases and Related Health Problems, coding framework. Counts of emergency inpatient admissions and A&E visits per person per year were modelled (random intercept negative binomial regression) with outpatient attendance the independent variable of interest.Results: The cohort numbered 524 613 individuals. Those who missed outpatient appointments had 19 per cent (95% confidence interval [CI] 18-19) more emergency inpatient admissions and 16 per cent (95% CI 15-17) more A&E visits per year than those who missed none. 'Did not attends' had a larger increase in unplanned health care than patient or provider cancellations. If no appointments were missed, the models predict there would have been 107 000 fewer A&E visits from 2007/2008 to 2014/2015 and 104 000 fewer emergency inpatient admissions from 2003/2004 to 2014/2015.Interpretation: Missed outpatient appointments were associated with increased unplanned health care. Improving outpatient attendance may have the potential to reduce emergency inpatient admissions and A&E visits.What This Paper Adds: Missed outpatient appointments by children and young people with neurological conditions are associated with increased unplanned health care. Both emergency inpatient admissions and Accident and Emergency centre visits are increased. 'Did not attends' are more strongly associated with unplanned health care than cancellations. [ABSTRACT FROM AUTHOR]

This paper reports a structured review of the service development and organisational (SDO) research literature focused on prisoners with mental disorders. A large number of databases were searched, using a combined free-text and thesaurus approach. Papers were included if they had been published since 1983, were written in English, and contained research findings. Commentaries or descriptions of local service innovation were excluded. In all, 103 papers were identified that met all criteria; these were divided into 13 categories (e.g. screening, 18 papers; professional roles, 13 papers). The paper concludes that there is a clear need to consider commissioning SDO research for offenders in England and Wales in a coherent programme. [ABSTRACT FROM AUTHOR]

In the move towards improving retention rates for substance-misuse treatment programmes, interest is growing in interventions that complement existing programmes. This paper describes a multi-method research design used to explore the experience of seven participants who took part in a seven session group-drumming intervention called Health Rhythms (HR). The study inquires into the efficacy of this intervention as part of a structured day-services treatment programme for adult substance-misusers in West Hertfordshire in the UK. Semi-structured interviews, combined with a measurement instrument and attendance records provided a triangulated approach for data collection, with findings subjected to qualitative and quantitative analysis. The main findings can be summarized as: (a) showing support for the therapeutic elements of group-drumming found in previous studies; and (b) indicating that HR sessions are a popular addition to substance-misuse treatment programmes, with implications for attendance and retention rates. The paper concludes with suggestions for further study and implications for the use of drumming groups in a range of health-care settings. [ABSTRACT FROM AUTHOR]

Background: There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare.Methods: Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method.Results: This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'.Conclusions: The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services. [ABSTRACT FROM AUTHOR]

Background: Rising cancer incidence, the cost of cancer pharmaceuticals and the introduction of the Cancer Drugs Fund in England, but not other United Kingdom(UK) countries means evidence of 'postcode prescribing' in cancer is important. There have been no systematic reviews considering access to cancer drugs by geographical characteristics in the UK.Methods: Studies describing receipt of cancer drugs, according to healthcare boundaries (e.g. cancer network [UK]) were identified through a systematic search of electronic databases and grey literature. Due to study heterogeneity a meta-analysis was not possible and a narrative synthesis was performed.Results: 8,780 unique studies were identified and twenty-six included following a systematic search last updated in 2015. The majority of papers demonstrated substantial variability in the likelihood of receiving chemotherapy between hospitals, health authorities, cancer networks and UK countries (England and Wales). After case-mix adjustment, there was up to a 4-5 fold difference in chemotherapy utilisation between the highest and lowest prescribing cancer networks. There was no strong evidence that rurality or distance travelled were associated with the likelihood of receiving chemotherapy and conflicting evidence for an effect of travel time.Conclusions: Considerable variation in chemotherapy prescribing between healthcare boundaries has been identified. The absence of associations with natural geographical characteristics (e.g. rurality) and receipt of chemotherapy suggests that local treatment habits, capacity and policy are more influential. [ABSTRACT FROM AUTHOR]

Politeness is of particular importance in health care contexts, where a number of international agreements and consensus statements formulated by policy makers demand that accord should be maintained, agreement should be solicited, and an attitude of respect be sustained especially when burdensome or intimate matters are being discussed. This paper explores the patterns of politeness in a corpus of material from a UK study of telephone encounters between NHS Direct health advisers and callers presenting with a need for advice over medication. In the opening sequences of interaction the questions that advisers asked the callers often included multiple politeness markers, for example through terms such as “may” and “just”, as in “may I just ask you?”. Politeness markers were often multiply layered, falling into three part structures which occurred when mundane information such as callers' names and telephone numbers were being elicited. Where more intimate matters were at stake, advisers minimized imposition and, arguably, undertook rapport building by means of preambles to the question such that the impending intrusion is accounted for, explained or mitigated. A potentially problematic question could also be followed up by further relational work and humour. There are important implications here for understanding politeness itself, especially where it is displayed by an institutionally more powerful or symbolically credentialed interactant towards one who is less advantaged. [ABSTRACT FROM AUTHOR]

Members of the public are increasingly consulted over health care and research priorities. Patient involvement in determining cancer research priorities, however, has remained underdeveloped. This paper presents the findings of the first consultation to be conducted with UK cancer patients concerning research priorities. The study adopted a participatory approach using a collaborative model that sought joint ownership of the study with people affected by cancer. An exploratory, qualitative approach was used. Consultation groups were the main method, combining focus group and nominal group techniques. Seventeen groups were held with a total of 105 patients broadly representative of the UK cancer population. Fifteen areas for research were identified. Top priority areas included the impact cancer has on life, how to live with cancer and related support issues; risk factors and causes of cancer; early detection and prevention. Although biological and treatment related aspects of science were identified as important, patients rated the management of practical, social and emotional issues as a higher priority. There is a mismatch between the research priorities identified by participants and the current UK research portfolio. Current research activity should be broadened to reflect the priorities of people affected by the disease. [ABSTRACT FROM AUTHOR]

The article presents evaluations of research related to the professional development of healthcare providers in Great Britain. The critic says that the article "The Training Service Continuum: Exploring the Training Service Balance of Senior House Officer Activities" was an interesting paper, however, it has flaws. In the article "Cross-Cultural Medicine," the critic states that it contains a number of resources. "Teaching Professionalism Artfully" used different media to teach professionalism.

This paper presents the first full micro costing of a commonly used cancer genetic counselling and testing protocol used in the UK. Costs were estimated for the Cardiff clinic of the Cancer Genetics Service in Wales by issuing a questionnaire to all staff, conducting an audit of clinic rooms and equipment and obtaining gross unit costs from the finance department. A total of 22 distinct event pathways were identified for patients at risk of developing breast, ovarian, breast and ovarian or colorectal cancer. The mean cost per patient were pound sterling 97- pound sterling 151 for patients at moderate risk, pound sterling 975- pound sterling 3072 for patients at high risk of developing colorectal cancer and pound sterling 675- pound sterling 2909 for patients at high risk of developing breast or ovarian cancer. The most expensive element of cancer genetic services was labour. Labour costs were dependent upon the amount of labour, staff grade, number of counsellors used and the proportion of staff time devoted to indirect patient contact. With the growing demand for cancer genetic services and the growing number of national and regional cancer genetic centers, there is a need for the different protocols being used to be thoroughly evaluated in terms of costs and outcomes. [ABSTRACT FROM AUTHOR]

AIM: To examine factors influencing the achievement of evidence-based practice. BACKGROUND: This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS: A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS: Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION: Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential. [ABSTRACT FROM AUTHOR]

Part VI. Looks at some of the key issues that need to be considered when preparing research findings for dissemination in Great Britain. Importance of writing for a specific audience; Guidelines on how to report qualitative and quantitative research; Outline of some of the key criteria editors use when reviewing a paper for publication.

Cervical screening has been carried out in the UK since at least the 1960s. As a central aspect of health policy it is the focus of a sustained research agenda across the social and biomedical sciences. On the whole there is considerable consensus concerning its effectiveness as a preventive strategy, although screening is also subject to substantial scrutiny across a range of persistent issues. However, the expansion of screening raises new challenges for the social sciences. These are reflected in recent studies which exemplify a notable shift in the frameworks adopted by social scientists in their approach to cervical screening. While this work focuses on distinct aspects of cervical screening, in common to many studies is the identification of various degrees and forms of uncertainty which are embedded within, and generated by, the processes and practices of cervical screening. This paper presents a synthesis of recent research on cervical screening, describes these points of uncertainty and outlines the implications of the analysis presented for a social science research agenda. [ABSTRACT FROM AUTHOR]

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

This paper looks at the issue of private health care from the perspective of black (Afro-Caribbean) women in Britain. The research on which it is based (Thorogood 1988) indicates that these women have a particular relationship to health care, one aspect of which is their use of private consultations with General Practitioners. This is, I suggest, a consequence of their historical and contemporary experiences. [ABSTRACT FROM AUTHOR]

This section offers news briefs concerning research in Great Britain. The study "Quality of Life in Group Homes and Older Persons' Homes" found that older people suffering from intellectual disability have better quality of life outcomes. The green paper "Shaping the Future of Care Together" is open to suggestions on delivery of care and funding for it.