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The new National health and physical education curriculum in Australia includes outdoor education activities as a viable way to achieve intended learning outcomes. However, most health and physical education teacher education courses do not provide a strong focus on the theories, skills and pedagogies that are unique to the effective use of outdoor education activities. In this paper, Shulman's concept of signature pedagogies is used to explore the types of teaching and learning that are fundamental to developing outdoor education teachers who are able to think, perform and act with integrity. Drawing on data collected through semi-structured interviews with six experienced outdoor education teacher educators, this paper identifies practical fieldwork as the signature pedagogy for the outdoor education profession. The key characteristics of practical fieldwork, identified by the participants, include learner centeredness, the transition from participant to leader/teacher and the use of reflection to integrate theory and practice. The findings of this study will be helpful for health and physical education teacher educators who want to prepare their students for a more diverse health and physical education curriculum that capitalizes on the educative potential of outdoor education activities. [ABSTRACT FROM AUTHOR]

Vietnam's health system continues to make great progress in improving its capacities and performance. However, despite the many significant achievements that have been made, this paper summaries 11 health system research papers from different perspectives with the aim of providing scientific evidence for policy actions in Vietnam. Health system research is ultimately concerned with improving the health of people and communities, by enhancing the efficiency and effectiveness of the health system as an integral part of the overall process of socioeconomic development, with full involvement of all actors. We hope the findings from this cluster of papers provide some insights into issues of importance for the continued advancement and strengthening of the health system in Vietnam and can be considered a valid and reliable resource to inform planning, management and policy-making decisions. [ABSTRACT FROM AUTHOR]

Whilst an earlier paper (Part 1) in this journal describes the historical, political and economic drivers behind the creation of the City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), this paper (Part 2) focuses on exploring the context within which the service functions. The paper provides an overview of its operational model and is organised into 10 sections. The first section outlines the service's clinical practice, whilst the second addresses the value of GP consultations as a core part of the PCPCS's provision. The third section addresses how the service, as departure from a more ‘pure’ psychoanalytic tradition of providing longer-term therapy, has managed its provision of brief treatments. There is a description of how the service manages its team of multi-disciplinary clinicians and their work in a variety of micro-cultures, conveying some of the challenges faced by the service and the team since its inception. Thereafter, the quantitative and qualitative evidence for the service's clinical and cost effectiveness is assessed, including outcome results and findings from a health economic evaluation. To illustrate some of the service's work in practice, some disguised clinical vignettes are presented. The paper also summarises the service's recent clinical innovations, as well as its contribution to the field of research, audit and training. Finally, the way forward for the service is considered in the context of current and emerging trends in psychological provision in primary care. [ABSTRACT FROM PUBLISHER]

The City and Hackney Primary Care Psychotherapy Consultation Service is an innovative, public sector service designed to support GPs in meeting the needs of patients with complex psychological/physical health issues throughout the London Boroughs of Hackney and the City. This paper provides an account of how this new model for the National Health Service (NHS) developed in the context of psychotherapy provision within the NHS, within the national and local context in the UK and gives an overview of some the service's key features and how it differs from other services operating in primary and secondary care. A linked paper, in this journal, explores the reality within which the service functions and describes clinical outcomes, health economic data, the modifications to the original model and prospects for the future. [ABSTRACT FROM PUBLISHER]

Objectives: Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publiclyfunded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Study design: Qualitative case study of the RSBY in Delhi. Methods: This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. Results: With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. Conclusions: This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. [ABSTRACT FROM AUTHOR]

Purpose – The IAPT programme has been rolled out across England in the last ten years. Although undoubtedly many people have benefited from having greater access to psychological therapy there are several issues with the practicalities of Improving Access to Psychological Therapies (IAPT) and also with its ideology. The paper aims to discuss these issues. Design/methodology/approach – This is a personal reflection of working within the IAPT system for several years. Significant statements heard or interpretations of what has been said are presented alongside an analysis of the implications. Findings – A number of important concerns are presented. The overarching concept of the “McDonaldization” process is discussed as a way of encapsulating the IAPT experience; with its theoretical reliance on the medical model and the real world impact of tendering for services in the modern NHS. The impact of IAPT on cognitive behavioural psychotherapy is also highlighted. Originality/value – A lot has been written in the press and online about IAPT. Many of the criticisms seem to derive from people outside of the IAPT system, many of whom have their own personal or professional agenda for attacking IAPT and Cognitive Behavioural Therapy (CBT); often the criticisms are uninformed. This paper is a reflection of working within the IAPT system and not just an uninformed critique of CBT. Several concerns are raised that without remedy may seriously hold back the progress that psychological therapy has made in recent years. [ABSTRACT FROM AUTHOR]

Purpose – As well as working with people who have serious mental health problems, mental health nurses have to maintain a values-based approach to their interactions with mental health service users. However, some have suggested that students and newly qualified nurses are unprepared for this role. The purpose of this paper is to explore perceptions of practising mental health nurses, third year mental health nurse students and lecturers about how well students are being prepared for practice. Design/methodology/approach – A two-phase phenomenological study within a mental health nurse training institution and with staff from a Mental Health Trust in England. The study collected questionnaire responses from 87 participants (42 third year mental health nurse students, 39 practising mental health nurses and six nurse lecturers). A Likert scale questionnaire with written feedback produced data that formed the schedule for ten subsequent focus groups with 41 participants from the above categories. Focus group data were analysed using a process of interpretive phenomenological analysis. This led to the development of three main study themes. The transition from student to registered nurse is difficult, the importance of learning from experience, violence and aggression is difficult to manage, working effectively with victims of sexual abuse or those who have a diagnosis of personality disorder is difficult. Findings – Whilst the study found some evidence to suggest the development of positive values there is a perception that newly qualified mental health nurses lack confidence in other important areas. Participants also expressed doubt about whether it was possible to prepare someone for practice completely. Another finding was that the relationship between student and the mentor is critical to the quality of practice learning. Research limitations/implications – Study limitations are that this is a small selection of participants from one particular area. The researcher attempted to ensure that this study has internal validity. However, it is possible to question the extent to which findings may apply to other areas. Therefore, this study may be most useful to others as a basis for the discussion and comparison of these issues within mental health nurse educators. Practical implications – The need to encourage proactive learning approaches in students is emphasised. Universities should facilitate the sharing of clinical learning experiences as well as developing realistic training in the management of violence and aggression. It is possible to question how well nurses are prepared to work with the physical health needs of service users. Originality/value – This paper gives information about mental health nurse preparation for practice, which will be of value to training organisations as well as to employers of newly qualified mental health nursing staff. [ABSTRACT FROM AUTHOR]

Investment in early intervention by health visitors to support positive parent-infant relationships is a Welsh Government target. An initiative called 'Flying Start' (FS) employs health visitors to undertake intensive home visiting with families who have a new baby to promote positive family interactions. As part of this role FS health visitors utilise the Newborn Behavioural Observation (NBO) system to observe, assess, support and enhance relationships between parent(s) and child. A project was undertaken to evaluate implementation and make recommendations for future service improvement. This paper describes stage one of the project which set out to evaluate FS health visitors' views of NBO implementation by means of a questionnaire and identifies barriers and facilitating factors to its use. Stage 2 of the project was to identify how NBO use could be improved in health visiting practice, discussed in a further paper. Results revealed a majority of practitioners felt NBO implementation benefited parents and enhanced the parent-infant relationship. It was viewed as an important part of the FS health visitors' role. Barriers included lack of time coupled with chaotic home environments. Variations in practice were identified, contrary to local guidelines. Recommendations are made to enhance NBO implementation that include the development of an NBO champion to support practitioners and provide further training. [ABSTRACT FROM AUTHOR]

Bullying continues to be a concern in schools and communities across the United States and worldwide, yet there is uncertainty regarding the most effective approaches for preventing it and addressing its impacts on children and youth. This paper synthesizes findings from a series of studies and meta-analyses examining the efficacy of bully-ing prevention programs. This paper considers some methodological issues encountered when testing the efficacy and effectiveness of bullying prevention and intervention approaches. It also identifies several areas requiring additional research in order to increase the effectiveness of bullying prevention efforts in real-world settings. Drawing upon a public health perspective and findings from the field of prevention science, this paper aims to inform potential future directions for enhancing the adoption, high quality implementation, and dissemination of evidence-based bullying prevention programs. It is concluded that although bullying prevention programs can be effective in reducing bullying and victimization among school-aged youth, there is a great need for more work to increase the acceptability, fidelity, and sustainability of the existing programs in order to improve bullying-related outcomes for youth. The findings from this review are intended to inform both policy and public health practice related to bullying prevention. [ABSTRACT FROM AUTHOR]

This review seeks to explore and explain what health policy research is and why it matters, through pooling the evidence and providing case examples. Alongside examining the types of research involved, and their rationale the paper identifies the challenges taking part in this sort of research may create. Finally the paper suggests how to make clinical research more accessible to policy makers. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on the findings of the first stage of a project seeking to improve interprofessional working between general practice and adult social care teams. It develops the current evidence base through findings from focus groups and reflects on the implications of the findings for interprofessional collaboration. Design/methodology/approach -- The project involved running seven focus groups with general practice staff and adult social work teams to explore their perceptions and understanding of each other. Findings -- The focus groups highlighted that the negative aspects of interprofessional working outweighed the positives. Negatives included perceptions of different value bases, a lack of knowledge about each others' roles and responsibilities which resulted in resorting to stereotypes, poor interprofessional communication and a sense of an unspoken professional hierarchy with general practitioners (GPs) at the top leading preventing a culture of appropriate challenge. Research limitations/implications -- The research has only been conducted with four GP practices and three social work teams that had expressed an interest in improving their interprofessional working. Therefore the findings may not be generalisable. Practical implications -- The case study suggests that there is a lack of effective interprofessional working between social care teams and general practice. With the current health and social care agenda focused on integration, this suggests there should be a greater focus on this area. Originality/value -- This paper illustrates that despite many years of policy makers promoting better integration, the quality of the interprofessional collaboration between social care teams and general practice remains poor. [ABSTRACT FROM AUTHOR]

Purpose -- With the advent of Clinical Commissioning Groups, the English health system has abolished more managerially led Primary Care Trusts and given greater responsibilities to groups of local general practitioners (GPs). As with all major changes, this brings both opportunities and risks, and the authors know relatively little about what impact this might have on relationships between the NHS and local government. Against this background, the purpose of this paper is to report key findings from a scoping review commissioned by the National Institute of Health Research School for Social Care Research in order to summarise learning from recent literature. Design/methodology/approach -- The paper is based on a review of the literature on older people's services and the relationship between general practice and adult social care, published in the UK from 2000 onwards. Findings -- Despite the longstanding nature of the issues at stake, the review identified only nine relevant studies. These were of mixed quality, and tended to focus on lessons learned from the late 1990s/early 2000s rather than more recent reforms. Overall, these studies suggest similar barriers to those identified in previous policy contexts, and there is a strong sense of relationships starting from a low base (hence the title of our title of "new conversations between old players"). Research limitations/implications -- This review is based on literature on older people's services published since 2000 -- so only provides a snapshot of the issues at stake. However, it confirms the relatively limited nature of the evidence base and the need for new research to help shape future policy and practice. Originality/value -- Despite the central contribution of GPs, the authors still know relatively little about the relationship between general practice and adult social care. Reviewing previous literature (however, limited) is crucial to current attempts to develop more effective joint working at local level. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide evidence on the additional costs of dealing with staff fraud, beyond the initial fraud loss, based on 45 cases of staff fraud. Design/methodology/approach – The research began with a “brainstorming” session with counter fraud professionals to map all potential costs in a staff fraud. It then utilised a twin-track approach of a survey and interviews. A survey was distributed using a number of methods yielding 28 usable cases. Interviews were also sought with organisations willing to discuss staff fraud, which secured a further 17 cases. Both the survey and interview used the same questionnaire, although the latter enabled a deeper questioning of participants. Findings – This study examined 45 cases of staff fraud from a wide range of sectors drawn predominantly from larger organisations. From each of these cases detailed, estimates of the costs of dealing with the fraud were identified. Major additional costs included the costs of investigation, staff suspensions, internal disciplinary costs, external sanctions, permanent staff replacement, miscellaneous costs as well as intangible costs. The findings identified significant costs which are significantly above the initial value of the fraud, particularly on initial frauds under £25,000. Research limitations/implications – Staff fraud is a very sensitive subject with many organisations unwilling to reveal what happens when it occurs. The approach was therefore to secure as much data as possible and as such this might not be representative of the broader economy. Practical implications – The paper highlights the need for greater investment in prevention given the substantial costs of staff fraud to deal with. Originality/value – This is the first attempt to gauge the full costs of staff fraud to an organisation. [ABSTRACT FROM AUTHOR]

Given the vast quantity of obstetric litigation and all its associated complexities, in 2012 the National Health Service Litigation Authority (NHSLA) produced a report entitled Ten Years of Maternity Claims: An Analysis of NHS Litigation Authority Data (the 2012 Report). This document identified, inter alia, a number of problematic areas in respect of litigation trends and illuminated a range of clinical situations in which claims are most likely to arise. It is against this backdrop that this paper seeks to critically analyse a body of case law that has occurred since the publication of the 2012 Report. Focusing on breach of duty, the paper seeks to evaluate whether or not the weighing of risks and benefits, as advocated in the case of Bolitho as a means of assessing the question of breach, has been appropriately utilised by judges in recent childbirth cases. It is an important and original piece of research as it is the first of its kind to investigate how judges have dealt with specific aspects of childbirth identified as being contentious in the wake of the 2012 Report. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is designed to explore the relationship between information and clinical governance in the English NHS. Design/methodology/approach - The paper is a personal reflection based upon the interim report of the National Information Governance Committee (NIGC) of the Care Quality Commission. Findings - The contribution of the NIGC to clinical governance in England has been significant for a number of reasons. Most notably, it has been embedded at the heart of an organisation concerned with the whole spectrum of health and social care, with a role where information is seen predominately as a means to deliver better care rather than an end in itself. The recommendation to establish a specific and mandatory information governance (IG) element of the inspection regime reflects the fact that without validation of the evidence base, the whole inspection regime may be seen as resting on insecure foundations, and provides re-assurance in the integrity of the whole inspection process, well beyond the scope of IG. Originality/value - The paper provides an insight into policy making at the heart of clinical governance, and its relationship with IG. It highlights the fact that the work of the NIGC has placed validation of information at the heart of the new CQC inspection regime, providing increased confidence in the information on which the rest of the inspection process is based. [ABSTRACT FROM AUTHOR]

Purpose – Healthcare organisations face significant productivity pressures and are undergoing major service transformation. The purpose of this paper is to disseminate findings from a Lean healthcare project using a National Health Service Single Point of Access environment as the case study. It demonstrates the relevance and extent that Lean can be applied to this type of healthcare service setting. Design/methodology/approach – Action research was applied and Lean tools used to establish current state processes, identify wastes and develop service improvement opportunities based upon defined customer values. Findings – The quality of referral information was found to be the root cause of a number of process wastes and causes of failure for the service. Recognising the relationship and the nature of interaction with the service’s customer/supplier lead to more effective and sustainable service improvement opportunities and the co-creation of value. It was also recognised that not all the Lean principles could be applied to this type of healthcare setting. Practical implications – The study is useful to organisations using Lean to undertake service improvement activities. The paper outlines how extending the value stream beyond the organisation to include suppliers can lead to improved co-production and generation of service value. Originality/value – The study contributes to service productivity research by demonstrating the relevance and limitations of Lean application in a new healthcare service setting. The case study demonstrates the practical challenges of implementing Lean in reciprocal service design models and adds validity to existing contextual models. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to provide an overview of the role that grandparents play in family life in Britain today with a particular focus on demographic change and the grandparental caring contribution for both children and older adults. Design/methodology/approach - Drawing upon a wide range of sources the author sets out the context, recent demographic and economic trends and presents a way forward. Findings - The research presented in this paper suggests that grandparents are playing an increasingly important role in family life and their caring contribution makes a material difference to maternal employment rates in particular. It also suggests that those who step in to the parenting role face particular challenges which need to be addressed. Research limitations/implications - Further research into the significance of the grandparent/grandchild relationship is needed, together with the caring contribution of those who provide intensive support to families in times of crisis both in terms of the impact that has on the grandparents but also the difference it makes to parents and children. Practical implications - One key practical implication is the need for a formal childcare infrastructure in the UK which does not assume that grandparents will always be there to provide childcare for working parents on the scale they do today. Social implications - Grandparents are living longer so more of them will have longer-lasting relationships with their grandchildren. But mothers are also ageing and so gradually over time the age at which we become grandparents will also be pushed back. This may in turn mean that grandparents in 20 years time may be less involved in childcare in any case. Originality/value - This piece does not present new research but rather provides an overview of existing evidence. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe the principal challenges facing the health and care system in England arising from an ageing population, assess the track record of the coalition government in addressing these and offer a perspective on the priorities likely to be faced by the next incoming government in relation to health and social care for older people. Design/methodology/approach - Assessment of key policy documents and legislation and interpretation of published data on trends in health and social care activity and expenditure. Findings - An ageing population requires a fundamental shift towards a new model of care that offers better coordinated care and promotes independence and healthy ageing. The Care Act 2014 is a significant achievement and NHS spending has been protected, but resulting cuts to local government budgets have since sharp reductions in social care for older people. The next incoming government will need to address a deepening financial crisis in health and care system; the increasingly unsustainability of means tested and rationed social care alongside universal free health care; and the need to make faster progress in developing a new models of integrated care closer to home. Originality/value - The issues raised in this paper affect older people as voters, tax payers and as existing or potential users of health and social care services. As a group they will attract significant attention from political parties in the next election campaign. [ABSTRACT FROM AUTHOR]

Although there is much written on the emotional labour of nursing, there is little research grounded in the experience of so-called ‘unqualified’ care assistants. This paper is drawn from an ethnographic study conducted with care assistants on three dementia care wards in one mental health trust within the United Kingdom National Health Service (NHS). We describe the emotional labour carried out by care assistants in their attempts to provide personalised care for people whose cognitive degeneration renders conventional relationship-building very difficult, produces unpredictable ‘challenging behaviour’ and calls into question the notion of ‘feeling rules’. This context requires the ability to strike a balance between emotional engagement and detachment, and it is the complexities of this relationship that are the focus of this paper, arguing that a degree of detachment is a prerequisite to engagement in this context. In conclusion, we argue that the contribution of care assistants in this context needs to be better acknowledged, supported and remunerated. [ABSTRACT FROM PUBLISHER]

The publication of the fourth edition of Health for All Children (Hall 4) in 2003 marked a shift in health visiting towards a more targeted service. This paper aims to explore, through the accounts of health visitors, the impacts of this changed policy context for health visiting practice and for the health visiting profession. The study, upon which this paper is based, was a qualitative exploration carried out in one NHS locality with broad socio-economic diversity. Semi-structured interviews were undertaken with 16 health visitors. The data was analysed using thematic and narrative techniques. In the study health visitors expressed concerns about the impacts of Hall 4 on health visiting practice, particularly in relation to health visiting expertise and the increase focus on child protection work shaping health visiting practice. In conjunction, health visitors' accounts suggest low morale as a profession. The paper concludes that the impacts of future policy change on health visiting practice must be fully considered; and, measures taken to prepare and support health visitors through periods of policy change. [ABSTRACT FROM AUTHOR]

This paper explores how national Electronic Patient Record (EPR) systems are customized in local settings and, in particular, how the context of their origin plays out with the context of their use. It shows how representations of healthcare organizations and of local clinical practice are built into EPR systems within a complex context whereby different stakeholder groups negotiate to produce an EPR package that aims to meet both local and generic needs. The paper draws from research into the implementation of the National Care Record Service, a part of the National Programme for Information Technology (NPfIT), in the English National Health Service (NHS). The paper makes two arguments. First, customization of national EPR is a distributed process that involves cycles of ‘translation’, which span across geographical, cultural and professional boundaries. Second, ‘translation’ is an inherently political process during which hybrid technology gets consolidated. The paper concludes, that hybrid technology opens up possibilities for standardization of healthcare. [ABSTRACT FROM AUTHOR]

Serious Case Reviews (SCRs) for adults are commissioned to examine the ways in which local professionals and agencies worked together to safeguard a vulnerable adult or take place following harm or death of a vulnerable adult where there are concerns about agencies' actions or engagement. There is no national system in England for their collation or analysis. This paper presents the results of a study investigating SCRs for vulnerable adults where the person who was at risk of harm, harmed or died had a learning disability. Eighteen SCRs were identified and a further three where there are grounds for considering that the victim may have had such a disability. Three themes are presented: staff relationships; family and carers; and biography and chronology to draw out material relevant to social work policy and practice. At a time when the English government has announced plans for SCRs for adults to move to a statutory basis, this paper draws attention to their potential as learning materials, but also the risks of seeing them as presenting a full picture of practice. The case for local flexibility is argued. [ABSTRACT FROM AUTHOR]

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments. [ABSTRACT FROM PUBLISHER]

Deafblindness is a particularly complex impairment and deafblind people are considered to be some of the most vulnerable members of society; this includes vulnerability to abuse and harm. This paper explores this unique impairment in the illustrative case of Beverley Lewis, by reviewing archived published and audio material about the life and circumstances of the death of this young woman, including media reports, parliamentary debates and commentaries. Whilst it appears that the implications of Beverley's deafblindness may have been ‘overshadowed’ in media reports and inquiries, the paper suggests that further lessons for practice can be learned from the case by focusing on this condition. Drawing on contemporary research by specialist charitable organisations (Sense and Deafblind UK), the authors identify research highlighting deficiencies in support for many deafblind adults, which have implications for safeguarding policy and practice. It is concluded that attention is needed in three areas: increased awareness amongst social care and health practitioners of the particular vulnerability to abuse of deafblind adults; improved access to specialist assessment and specialist social care support, including one-to-one human support; and improved communication between social care and health agencies, alongside more tangible signs of acceptance of shared responsibility for supporting deafblind adults. [ABSTRACT FROM AUTHOR]

With unprecedented numbers of people living longer and with higher expectations of how they will live out their last years, the management of end-of-life (EOL) services is being brought into sharper focus. Current models of EOL care have originated from the hospice and palliative care movement whose expertise, developed largely with cancer patients, is now being looked to for guidance in developing EOL practice for non-cancer dying patients. This paper challenges the social work profession to consider whether the hospice and palliative care model needs to be rethought; argues that social work is well positioned to help develop a more adequate model of care; and recommends a social model that builds upon the resources and networks already surrounding individuals. The social work profession is well placed to draw upon its values, culture and experience (particularly from the service user movement) and to get involved in developing new models of EOL care. This paper argues the benefits of community engagement through network mobilisation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the effectiveness of partnership working in public health and draws on a systematic review of public health partnerships and original research conducted by the authors. It then considers in the light of research evidence whether the recently established Health and Wellbeing Boards (HWBs) under the 2012 Health and Social Care Act will help agencies to work together more effectively to improve population health or will go the way of previous initiatives and fall short of their original promise. Design/methodology/approach: The paper is based on a systematic literature review conducted by the authors and empirical research focusing upon the ability of public health partnerships to reduce health inequalities and improve population health outcomes. It also draws on recent studies evaluating HWBs. Findings: The paper finds that, hitherto, public health partnerships have had limited impact on improving population health and reducing health inequalities and that there is a danger that HWBs will follow the same path-dependent manner of previous partnership initiatives with limited impact in improving population health outcomes and reducing health inequalities. Research limitations/implications: The research draws on a systematic literature review and further scoping review of public health partnerships, in addition to empirical research conducted by the authors. It also reviews the current evidence base on HWBs. It is recognised that HWBs are still in their early stages and may not as yet, had the time to fulfil their role in service collaboration and integration. Practical implications: The paper gives an overview of how and why public health partnerships in the past have not lived up to the expectations placed upon them. It then offers practical steps that HWBs need to take to take to ensure the mistakes of the past are not replicated in the future. Social implications: The research outlines how public health partnerships can operate in a more effective manner, to ensure a more seamless provision for service users. The paper then gives pointers as to how this can benefit HWBs and the wider community they serve. Originality/value: The paper draws on a comprehensive research study of the effectiveness of public health partnerships on improving health outcomes and a systematic literature review. In addition, it also draws upon the current evidence base evaluating HWBs, to inform the discussion on their future prospects, in regard to partnership working in public health and promoting service integration. [ABSTRACT FROM AUTHOR]

A number of studies have previously been published on the benefits of GP appraisal. Ours is the first study that compares the views of doctors registered before and after the introduction of appraisals on various core elements of the appraisal process. This study aimed to explore potential differences, between GPs qualifying before and those after the introduction of NHS appraisals, on the utility of the appraisal process. Additionally, to discover the perceived impact of appraisals on interaction with colleagues and patients. Suffolk appraisers were recruited to distribute a paper questionnaire, in two sections, for each appraisal undertaken over a 12-month period. The first part of the questionnaire related to that specific appraisal. The second part, seven questions using Likert scales and free-text comments, asked about the appraisal process in general. The feedback from the second part forms the data for this study. Overall, doctors tended to agree that appraisals had a beneficial impact in the core areas investigated. However, there was a significant difference between generations: those registered before 1998 were less likely to find NHS appraisals beneficial. Both groups reported that preparation took up too much time. Opinions regarding the impact of appraisals on interaction were evenly divided amongst appraisees, with the older cohort more likely to report negatively. There is a generational difference amongst GP in the perceived utility of NHS appraisal. Current plans to redesign the process to make appraisals less onerous will be welcomed by both groups. [ABSTRACT FROM AUTHOR]

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Specialization serves an important purpose in health services, ensuring resources are used efficiently and patients can access specialized skills and interventions. However, specialization also results in services being concentrated in fewer locations, with less patient choice. Focussing upon the example of gender-identity services for trans people in England, this paper outlines contemporary debates regarding hormone prescription pathways and argues that concepts of 'specialization' in health care may at times disadvantage minority populations who have needs that are uncommon but not clinically complex. Supplying gender-identity services in specialized clinics has sometimes been presented as avoiding discrimination that may occur in wider health services, but may reinforce perceptions that other health providers do not need to engage with trans populations. Primary care-led models for providing trans health care operate internationally and are being explored in the UK. However, reform processes may be helped by further critical attention to the purposes and implications of specialization. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The experience of hearing distressing voices is commonly reported by service users with a diagnosis of first‐episode psychosis, but their access to formal conversations about voices in the form of psychological therapies can be limited.Service users within Early Intervention in Psychosis (EIP) services can benefit from informal opportunities to talk about their voice hearing experiences. However, they can be reluctant to engage with these conversations.Little is known about the experiences of EIP practitioners as they try to engage service users in conversations about their voices. What does the paper add to existing knowledge?: Despite EIP Services specializing in the treatment of the symptoms of psychosis such as voice hearing, practitioners can still be reluctant to initiate and continue informal conversations about voices. What are the implications for practice?: EIP practitioners may benefit from the introduction of interview guides and brief interventions to assist them with the initiation and continuation of conversations about voices. Introduction: Hearing voices is a common and distressing symptom of first‐episode psychosis. Formal and informal conversations about voices are helpful, but service users within Early Intervention in Psychosis (EIP) Services can be reluctant to discuss their voice hearing experiences. There is currently no literature that explores the experiences of EIP practitioners as they try to facilitate conversations about distressing voices. Aim/Question: A qualitative methodology was used to investigate how EIP practitioners work with service users who hear voices. Ten practitioners were interviewed, and interviews were analysed using template analysis. Results: Two themes that offer novel insights are presented: "starting a conversation about voices" and "continuing the conversation about voices." Discussion: Starting and continuing a conversation about voices was considered important but not all practitioners were confident in this respect. The initiation and continuation of these conversations may need to be systematically supported. Implications for practice: To support the initiation of informal conversations, a standardized interview guide for voice hearing could be introduced and systematically utilized. The continuation of these conversations could be supported by practitioners being given the opportunity to receive training in and the opportunity to deliver brief symptom‐specific therapies for distressing voices. [ABSTRACT FROM AUTHOR]

GW Research Ltd. provided two separate, but similar, submissions to the National Institute for Health and Care Excellence (NICE) on the clinical and cost-effectiveness of cannabidiol (CBD) 10 mg/kg/day, trade name Epidyolex®, for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). This paper highlights important methodological issues related to the company submissions, the Evidence Review Group (ERG) reports, and the subsequent development of the NICE guidance by the Appraisal Committee (AC) for the use of CBD. The company identified four randomised controlled trials (RCTs) of CBD (GWPCARE1 and GWPCARE2 for DS, and GWPCARE3 and GWPCARE4 for LGS) and an ongoing open-label extension study (GWPCARE5) as relevant to both submissions. In these RCTs, CBD in addition to current clinical management (CCM) was compared to CCM without CBD (i.e. CCM plus placebo). GWPCARE2 and GWPCARE3 were three-arm studies and compared two dosages of CBD (10 mg/kg/day and 20 mg/kg/day) in addition to CCM and CCM plus placebo. GWPCARE1 and GWPCARE4 compared CBD (20 mg/kg/day) in addition to CCM and CCM plus placebo. Both DS patients in GWPCARE2 and LGS patients in GWPCARE3 who received 10 mg/kg/day CBD in addition to CCM achieved better seizure frequency outcomes than those who received CCM plus placebo. In the company's base case, use of CBD for LGS patients resulted in an incremental cost-effectiveness ratio (ICER) of £31,107 per quality-adjusted life year (QALY) gained and, for DS patients, £36,046 per QALY gained versus CCM. The ERG considered that these ICERs were extremely uncertain and suffered from validity issues concerning model structure (e.g. patients receiving CCM moved back to baseline drop seizure frequency), input (e.g. inclusion of caregivers' QALYs), and transparency issues (e.g. hidden worksheets and coding in Visual Basic for Applications), and hence incorporated adjustments to the original base case which increased the ICERs. During the process, the European Medicines Agency (EMA) licence granted marketing authorisation for CBD only in conjunction with clobazam. Hence, the company provided evidence from this subgroup in an additional submission, which resulted in an ICER of £33,721 per QALY gained for LGS and an ICER of £32,471 per QALY gained for DS. In this submission and clarifications, the ERG was able to verify and validate most of the company's responses to the ERG's concerns. However, some issues remained regarding the face validity of model assumptions on patient pathways after treatment discontinuation. Finally, the AC recommended CBD with clobazam as an option for treating seizures associated with LGS and DS in patients aged 2 years and older only if (1) the frequency of drop seizures is checked every 6 months and CBD is stopped if the frequency has not fallen by at least 30% compared with 6 months before starting treatment and (2) the company provides CBD according to the commercial arrangement. [ABSTRACT FROM AUTHOR]

Background: The National Institute for Health and Care Excellence's (NICE) United Kingdom (UK) geographic search filters for MEDLINE and Embase (OVID) retrieve evidence in literature searches for UK‐focused research topics with high recall. Their precision and number‐needed‐to‐read (NNR) was examined previously in case studies using a single review. This paper details a larger post‐development study that was conducted to test the NICE UK filters' precision and NNR more extensively. Methods: The filters' recall of included UK references from 100 reviews was calculated. As reproducible search strategies were not available for every review, the MEDLINE filter's precision and NNR were calculated using strategies from 25 reviews. Strategies from nine reviews were used for the Embase filter. Results: The MEDLINE filter achieved an average of 96.4% recall for the included UK references from the 100 reviews and the Embase filter achieved an average of 97.4% recall. Compared to not using a filter, the MEDLINE filter achieved an average of 98.9% recall for the 25 reviews. Precision was increased by an average of 7.8 times, reducing the NNR from 357 to 46. The Embase filter achieved an average of 97.1% recall for the nine reviews. Precision was increased by an average of 5.1 times, reducing the NNR from 746 to 146. Conclusion: There is more evidence to demonstrate that the NICE UK filters retrieve the majority of UK evidence from MEDLINE and Embase while increasing precision and reducing NNR. The filters can save time spent on selecting evidence for UK‐focused research topics. [ABSTRACT FROM AUTHOR]

Loneliness is a global public health concern linked to a range of negative health outcomes (Cacioppo & Cacioppo, 2018. The Lancet. 391(10119), 426). Internationally, this has led to the development of a number of interventions, but these are rarely implemented or evaluated on a large scale. This paper is one of the first of its kind to describe elements of an evaluation of a large‐scale national social prescribing scheme to reduce loneliness, deploying individual link workers to signpost people to community activities. Reporting on findings from interviews with staff (n = 25 of which 6 were repeat interviews) and volunteers (n = 9) between October 2017 and December 2018 in localities across the United Kingdom. We reflect on the complexities of the link worker role, the challenges of service delivery and the importance of community infrastructure. There was evidence that highly skilled link workers who had developed positive relationships with providers and service‐users were key to the success of the intervention. As well as providing an effective liaison and signposting function, successful link workers tailored the national programme to local need to proactively address specific gaps in existing service provision. For social prescribing services to be successful and sustainable, commissioners must consider additional funding of community infrastructure. [ABSTRACT FROM AUTHOR]

This paper sought to investigate non-medical prescribers' awareness of compliance and what is required for them to be compliant when prescribing in an acute NHS trust. This was a quantitative pilot study using a survey technique with an online questionnaire. A purposive sample from 85 registered non-medical prescribers who were actively prescribing were invited to participate. Data analysis was restricted because of the limited number of respondents (n=14), making this a pilot study. Data were analysed using descriptive statistical analysis IBM SPSS 25 software. The majority (85.7%) of non-medical prescribers were shown to be compliant, highlighting 14.3% as non-compliant. Furthermore, 28% prescribed outside of their personal formulary, which is in breach of the non-medical prescribers' trust policy. A further 85% participated in continuous professional development and 72% requested regular continuous professional development. Despite the majority being compliant with the non-medical prescribers' policy, 14.3% were not. This clearly has implications for patient safety and practitioner professionalism, in terms of responsibility and accountability. Although limited by small respondent size, the findings highlight the need for further research to inform recommendations for practice. [ABSTRACT FROM AUTHOR]

Objectives: To identify and synthesise the available evidence regarding the oral health needs of and the oral health promotion provided for older, cultural and linguistically diverse (CALD) migrants in developed countries. Method: Databases were searched using search terms to identify all relevant English‐language research studies published between 2000 and January 2018. Results: Thirty‐nine articles met the review criteria. Thirty‐three papers reported on the oral health needs of CALD older migrants and 6 on oral health programs provided for older migrants. Conclusions: Cultural and linguistically diverse older migrants have high oral health needs and poor oral status and face a variety of barriers in accessing oral health care in their host countries. Recommendations to improve their access to oral health programs include building transcultural dental training into the educational requirements of dental students and developing oral health promotion programs that include culturally and linguistically customised information. [ABSTRACT FROM AUTHOR]

The responsibility of the district nurse (DN), alongside complex case management and leadership, is to ensure Specialist Practitioner Qualification District Nurse (SPQDN) education continues to create practitioners delivering quality evidence-based care. DN leadership and its importance have come to the fore during the COVID-19 crisis, where hospital discharges have increased rapidly to make way for highly complex admissions (HM Government, 2020). This paper examines the importance of the SPQDN qualification, exploring the role of the DN within practice education. Continuation of the vital DN qualification will ensure that the numbers of qualified DNs increase, ultimately protecting community capacity. With a move towards an apprenticeship model to achieve the SPQDN, DNs must engage with and influence curriculum development to confirm courses deliver requirements of the workplace, commissioners and the 2019 NHS Long Term Plan. Expectations of the DN role within practice education have changed, moving away from the practice teacher standards to the new Nursing and Midwifery Council Standards for Student Support and Assessment. This poses new challenges in DN education in practice. The implications of this transition threaten to de-value the quality of the assessment process by removing the high standards of preparation previously demanded; ultimately, this is a risk to the provision of the quality practice education that previously existed. [ABSTRACT FROM AUTHOR]

This article examines the accounts given by child protection practitioners of how the current economic climate has impacted on their practice. We build our discussion on empirical findings emerging from a small but rigorous qualitative research project conducted by one of the authors. This original study examined Scottish and Finnish social workers' perceptions of their abilities to engage effectively with children and families in what many have described as an "age of austerity." It set out to explore challenges encountered in daily practice through a cross‐national comparative thematic analysis. The paper illuminates practitioners' shared reality of frontline practice in Scottish and Finnish contexts. Despite differing socio‐political environments, participating practitioners found austerity measures to impact negatively on both their professional resources and on the communities they work with. Significantly, practitioners regarded themselves as the key resource, taking individual responsibility to ensure families received a quality service. For many, austerity had resulted in greater empathy for families and awareness of the wider economic and structural impact on their lives. The increased centrality of social justice was pivotal to everyday practice. [ABSTRACT FROM AUTHOR]

Background: Unequivocal identification of patients is a precondition for a safe medical journey through different information systems (ISs) and software applications that are communicating and exchanging interoperable data. A master patient index (MPI) can facilitate this task. Being a repository of patient identity traits, a MPI allows an accurate surveillance of the patients' "medical identities". Up to 2014, the Grand Duchy of Luxembourg did not possess a MPI. Here, we describe our experience in the establishment of a national MPI for the Grand Duchy of Luxembourg.Methods: The different steps that were used to establish the MPI system are described. Firstly, through the identification of the suitable application and, secondly, through the implementation of the MPI to the eHealth national platform and its connection to the national health care system. In parallel to the first two phases, the identity management policies were defined and implemented.Results: Since 2014, when the MPI was integrated to the eHealth platform, we observed a continuous increase of identity profiles. At the latest update (31 December 2018), 2.418.336 identity profiles have been counted, including almost the totality of Luxembourgish residents (95.2%) as well as all the cross-border workers that are affiliated to the Luxembourgish social security system. An analysis of the identification domains connected to the platform highlighted a yearly increase in the usage rate of the identities by external applications (currently representing 70%). The evaluation of the quality of information contained in each identity profile showed low rejection rates (0.2%), indicating a high quality and a good level of completeness in regards to the required identity traits.Conclusions: This paper presents the current state of patient identity management in Luxembourg and discusses how this synergistically supports the functioning of the national electronic health record (EHR) known as DSP (from the French Dossier de Soins Partagé) and the Luxemburgish health care system. The here described national MPI has refined the identification of patients, leading to an improvement of their safety during their medical journey. Nevertheless, the application regularly undergoes updates to better meet the current requirements of the Luxembourgish health system. [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

In this brief paper, I argue that the coronavirus pandemic is functioning like an ethnomethodological 'breaching experiment'. In short, it is putting a gigantic spanner in the works of neoliberal governance, in the process exposing the widening cracks and fissures of what I have called the 'fractured society'. I begin by recalling Garfinkel's notion of the breaching experiment and by listing the principal attributes of the fractured society. I then explore the response to the coronavirus in the UK, from the government's initial commitment to 'herd immunity' to its present policy of 'muddling through'. The bulk of the remainder of this contribution addresses precisely how this global health crisis shines a harsh and unforgiving searchlight on the strategies and policies pursued by governments in the UK since 2010, and most especially after the passing of the Health and Social Care Act of 2012. In the closing paragraphs, I examine possible scenarios for a post-fractured society, making particular use of Fraser's concepts on 'reactionary' versus 'progressive populism', and conclude with a comment on sociology and engagement. [ABSTRACT FROM AUTHOR]

The central role of the Portuguese National Health Service (P-NHS) guarantees virtually free universal coverage. Key policy papers, such as the National Health Plan and the National Plan for Patient Safety have implications for pharmacists, including an engagement in medicines reconciliation. These primary health care reform, while not explicitly contemplating a role for pharmacists, offer opportunities for the involvement of primary care pharmacists in medicines management. Primary care pharmacists, who as employees of the P-NHS work closely with an interdisciplinary team, have launched a pilot service to manage polypharmacy in people living with multimorbidities, involving potential referral to community pharmacy. Full integration of community pharmacy into primary health care is challenging due to their nature as private providers, which implies the need for the recognition that public and private health sectors are mutually complementary and may maximize universal health coverage. The scope of practice of community pharmacies has been shifting to service provision, currently supported by law and in some cases, including the needle and syringe exchange program and generic substitution, remunerated. Key changes envisaged for the future of pharmacists and their integration in primary care comprise the development and establishment of clinical pharmacy as a specialization area, peer clinician recognition and better integration in primary care teams, including full access to clinical records. These key changes would enable pharmacists to apply their competence in medicines optimization for improved patient outcomes. [ABSTRACT FROM AUTHOR]

Malnutrition in hospitalized patients remains a significant problem. Protected Mealtimes is a complex, inter-professional ward-based intervention that was first introduced in the United Kingdom to address this issue. Now implemented internationally, the approach still remains in key policy documents including the National Health Service Essence of Care. This review aims to synthesize the nutrition, satisfaction and quality of life patient/resident outcomes that arise from the implementation of Protected Mealtimes in hospitals and residential aged care facilities and to consider fidelity issues that have been reported in previous research. A defined search strategy was implemented in seven databases to identify full text papers of original research that evaluated Protected Mealtimes implementation. After screening, data were extracted from eight studies (7 quantitative and 1 qualitative study) that were conducted in hospitals. There was no research identified from the aged care sector. There were few positive outcomes that resulted from Protected Mealtimes implementation, many fidelity issues with the intervention were reported. It is apparent that Protected Mealtimes provide few, if any, benefits for hospitalized patients. It is a complex, multi-pronged initiative that has limited fidelity and limited outcomes. As such, we recommend that disinvestment by policy makers for hospitals should be considered, with the implementation of other evidence based mealtime initiatives. We provide no recommendation for disinvestment in the aged care sector, since the approach has not been evaluated against any of the eligible outcomes of this review. [ABSTRACT FROM AUTHOR]

This paper reports on research exploring the effects of music played for 12 dyads: a care home resident ('resident') with dementia and someone closely connected to him/her ('carer'). Six individualised music interventions (3 live and 3 pre-recorded) were played by the first author on solo cello within five Scottish non-NHS care homes. All interventions were video-recorded. Semi-structured interviews with carer participants, key staff, and managers explored their responses to interventions. Thick descriptions of video recordings and interview transcripts were thematically coded using Nvivo. A key finding was that structural elements of the interventions combined with characteristics of the music played facilitated an internalised experience of 'haven'; sonically transporting listeners away from their present reality and fulfilling the basic human needs for inclusion, comfort, identity, occupation and attachment. [ABSTRACT FROM AUTHOR]

Background: Off-label drug use among ambulatory patients is often based on little or no scientific support. This paper reports the impact of a health warning about the risks of off-label flutamide use by women and the actions subsequently implemented by the public health service targeting such use.Method: The study was undertaken in a region in north-west Spain. We designed a segmented regression model of an interrupted time series, in which the dependent variable was the monthly value of defined daily doses of flutamide per 1000 inhabitants/day (DDD/TID), both total and stratified by sex. The following two data sources were used: flutamide prescriptions billed to the Spanish National Health Service; and flutamide deliveries made by wholesale drug distributors to pharmacies. The intervention assessed consisted of the issue of an official health warning and the actions subsequently taken to implement it.Results: There was an immediate reduction of 49.33% in DDD/TID billed to the Spanish National Health Service in respect of women; the mean value of the population percentage of DDD/TID of flutamide billed in respect of women fell from 34.4% pre-intervention to 23.72% post-intervention. There was an immediate reduction of 19.92% (95%CI: 6.68-33.15%) in total DDD/TID invoiced. There were no significant changes in DDD/TID billed in respect of men or in flutamide use in the private medical sector.Conclusions: Off-label drug misuse is a reality among ambulatory patients, even after actions are implemented following a toxicity warning issued by the competent Health Authority. [ABSTRACT FROM AUTHOR]

This paper is based on the keynote presentation for the biennial meeting of the International Society for Research on Child and Adolescent Psychopathology (ISRCAP) in Los Angeles, California. The topic was purposively selected to raise awareness of how the measurement of child behavioral health care quality at the national level, and corresponding standards for reliability and clinical validity, substantially differ from those traditionally applied to the measurement of child psychopathology. Under a federal mandate, an initial Core Set of quality measures for children was created for voluntary reporting by State Medicaid agencies. The four national child behavioral health quality measures in the 2019 Child Core Set encompass timeliness of care, vary by child age range, and two different types of psychotropic medication treatments. Measures are described and implications for data interpretation are provided. Findings are summarized from: 1) a systematic literature review; 2) State adherence rates; and 3) ten-year national trends in adherence rates by health plan type. Scientific evidence supporting the clinical validity of the measures is scarce, statewide adherence rates widely vary, and improvement over time has been modest. Nevertheless, State Medicaid agencies will be mandated to report measure adherence rates beginning in 2024. Together, these findings stimulate recommendations for health policies to allocate additional resources for data infrastructure to monitor child mental health care quality and identify areas for future research. [ABSTRACT FROM AUTHOR]

Background: Within the UK, there are now opportunities for paramedics to work across a variety of healthcare settings away from their traditional ambulance service employer, with many opting to move into primary care.Aim: To provide an overview of the types of clinical roles paramedics are undertaking in primary and urgent care settings within the UK.Design and Setting: A systematic review.Method: Searches were conducted of MEDLINE, CINAHL, Embase, the National Institute for Health and Care Excellence, the Journal of Paramedic Practice, and the Cochrane Database from January 2004 to March 2019 for papers detailing the role, scope of practice, clinician and patient satisfaction, and costs of paramedics in primary and urgent care settings. Free-text keywords and subject headings focused on two key concepts: paramedic and general practice/primary care.Results: In total, 6765 references were screened by title and/or abstract. After full-text review, 24 studies were included. Key findings focused on the description of the clinical role, the clinical work environment, the contribution of paramedics to the primary care workforce, the clinical activities they undertook, patient satisfaction, and education and training for paramedics moving from the ambulance service into primary care.Conclusion: Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. More research needs to be done to determine how, why, and in what context paramedics are now working in primary and urgent care, and what their overall contribution is to the primary care workforce. [ABSTRACT FROM AUTHOR]

Driving improvements in patient safety has been a core goal of the Academic Health Science Networks (AHSNs) in England since their inception in 2013. The National Patient Safety Collaborative Programme, nested within the 15 geographically located AHSNs, was established in 2014 in response to the Berwick review. In 2019, the new NHS national patient safety strategy was published, which placed the AHSNs as a key vehicle for delivering its ambitions. This paper explores the achievements of, and opportunities presented by, the collaborative in addressing some of the key patient safety challenges facing physicians and their wider teams. Case studies illustrate the AHSNs' contribution to support national ambitions, including the adoption of the National Early Warning Score (NEWS) 2, and the impact of regionally-led work on patient outcomes, such as reducing mortality from sepsis and acute kidney injury. We set out current activities, opportunities for physician engagement and plans for future work. [ABSTRACT FROM AUTHOR]

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants' narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort. [ABSTRACT FROM AUTHOR]

The National Institute for Health and Care Excellence (NICE) invited Alimera Sciences, the company manufacturing fluocinolone acetonide intravitreal implant (FAc) 0.19 mg (tradename ILUVIEN®), to submit evidence on the clinical and cost-effectiveness of FAc for treating recurrent non-infectious uveitis. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Centre + , was commissioned to act as the independent Evidence Review Group (ERG). This paper contains a summary of the clinical and cost-effectiveness evidence submitted by the company, the ERG's critique on the submitted evidence, and the guidance issued by the NICE Appraisal Committee (AC). The company submission (CS) was mainly informed by the PSV-FAI-001 trial in which FAc was compared with (limited) current practice [(L)CP], which was not considered to be representative of UK clinical practice by the ERG. There was no comparison of FAc to any treatment listed in the final scope, and especially to the dexamethasone intravitreal implant (dexamethasone), which was considered to be a relevant comparator by the AC. The primary outcome of the PSV-FAI-001 was recurrence of uveitis in the treated eye. Most of the events for the primary outcome were imputed during the PSV-FAI-001 trial, which probably led to an overestimation of the number of recurrences of disease, and a biased estimate of the relative effectiveness of FAc versus (L)CP. Finally, the place of FAc in the treatment pathway was not clearly defined by the company. Substantial uncertainty surrounded the cost-effectiveness results due to the shortcomings of the clinical evidence. Additionally, the quality of life of patients was not measured during the PSV-FAI-001 trial and long-term effectiveness data of FAc were lacking. The ERG adjusted several issues identified in the CS and added dexamethasone as a comparator in the decision analytic model. The ERG presented multiple analyses as base-cases because several elements of the assessment remained uncertain. The fully incremental ERG results ranged from dexamethasone (extendedly) dominating FAc (when assuming a hazard ratio of 1 or 0.7 for dexamethasone versus FAc) to an incremental cost-effectiveness ratio (ICER) of £30,153 per quality-adjusted life-year (QALY) gained for FAc versus (L)CP [when assuming a hazard ratio of 0.456 for dexamethasone versus (L)CP]. The ICER of FAc versus (L)CP ranged from £12,325 to £30,153 per QALY gained. After a second AC meeting where alternative company scenarios comparing FAc with dexamethasone were considered by the AC, the AC concluded that "the results of the company's analyses ranged from the fluocinolone acetonide implant being dominant (that is, it was more effective and costs less), to an ICER of £29,461 per QALY gained, and most of the ICERs were below £20,000 per QALY gained". Therefore, the AC recommended FAc as a cost-effective use of National Health Service (NHS) resources for treating recurrent non-infectious uveitis affecting the posterior segment of the eye in the final TA590 guidance (published July 2019). [ABSTRACT FROM AUTHOR]

Indigenous people's health in Brazil is organized by the indigenous health subsystem, structured according to that of SUS, and described in the National Policy for Health Care of Indigenous Peoples. Alcohol consumption has been regarded as a health issue among indigenous peoples. In this paper, we describe the representations attributed by health professionals concerning alcohol use among indigenous peoples, and how these influence care practices. This is a descriptive ethnographic study based on interviews and participant observation. Analysis and interpretation were made with the support of Software Atlas TI 8.0. Excessive consumption occurs in specific contexts, and professionals view alcohol use as a problem. Drinking patterns vary with ethnicity, religion, and location, thus resulting in the need to develop cultural competencies that support implementation of effective actions and that also allow for collective construction, as stipulated in the policies. A network of supporters is described, among which are indigenous leaders, traditional healers, and the Evangelical Church. The study shows the difficulties of both carrying out policies and implementing actions which correspond to the indigenous peoples' expectations, recognizing the cultural and social rationale related to alcohol use. [ABSTRACT FROM AUTHOR]