Search

This study compares the survival rates of USOs formed by universities in the UK's West Midlands region between 1983 and 2013 with those from existing studies in the literature. Data were collected from a range of secondary sources to enhance the accuracy of the USO dataset. Survival rates were found to be significantly lower than in previous studies despite the existence of prominent research universities within the region. It is proposed that the difference is in part methodological with the current study including USOs that may have been omitted using different methodologies that rely on institutional memories.

Purpose: The purpose of this paper is to evaluate two coaching and mentoring programmes focused on the ever-increasingly important aim of enhancing the chances of professional level employment for undergraduate students, at two UK universities. In addition, to offer recommendations to enhance coaching and mentoring success within higher education (HE). Design/methodology/approach: Two similar programmes are compared; the first study is a coaching programme delivered in two phases involving over 1,500 students within the business school. The second study is a mentoring programme involving over 250 students over a ten-year period within the business school at a different institution. Findings: The two programmes have been compared against the key success criteria from the literature, endorsed by coaching and mentoring experts. The results highlight the importance of integrating with other initiatives, senior management commitment, budget, an application process, clear matching process, trained coaches and mentors, induction for both parties, supportive material, ongoing supervision and robust evaluation and record keeping. Research limitations/implications: The research focuses on two similar institutions, with comparable student demographics. It would have been useful to dig deeper into the effect of the diverse characteristics of coach/mentor and coachee/mentee on the effectiveness of their relationships. In addition, to test the assumptions and recommendations beyond these two institutions, and to validate the reach and application of these best practice recommendations further afield. Practical implications: The results identify a number of best practice recommendations to guide HE institutions when offering coaching and mentoring interventions to support career progression of their students. Originality/value: There are limited comparison studies between universities with undergraduate career-related coaching and mentoring programmes and limited research offering best practice recommendations for coaching and mentoring programmes in HE. The top ten factors offered here to take away will add value to those thinking of running similar programmes within HE.

Background: Palforzia® enables the safe and effective desensitisation of children with peanut allergy. The treatment pathway requires multiple visits for dose escalation, up‐dosing, monitoring of patients taking maintenance therapy and conversion onto daily real‐world peanut consumption. The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner. We undertook a Delphi consensus exercise to determine guidance statements for the implementation of Palforzia®‐based immunotherapy in the NHS. Methods: We undertook focus groups with children and young people who had received peanut immunotherapy to assess what was important for them and their carers. Common themes from patients formed the basis of creating draft statements. A panel of 18 multi‐disciplinary professionals engaged in two rounds of anonymised voting to adapt the statements and score their importance. A final consensus workshop consolidated any variation in comments and scores to develop the final guidance statements. Results: The panel achieved consensus on 91% (29/32) of guidance statements, demonstrating strong consensus around pragmatic principles for assuring the integrity of consent, safety and conversion from Palforzia® to real‐world peanut products. The greatest amount of feedback was generated from three broad issues; (i) whether eligibility assessment should include compulsory peanut challenges and whether these should be designed to assess the threshold at which patients react to peanut, (ii) the governance processes to best ensure that patients' interests are prioritised and (iii) how to safely transition young people to other services, or discharge them, while they are taking daily peanut. Conclusions: This consensus highlights the urgent need for the NHS to increase capacity for undertaking diagnostic food challenges as well as developing Palforzia® immunotherapy pathways. The voting panel agreed that families of peanut allergic children should be made aware of immunotherapy, that eligibility assessment should include how co‐morbid conditions are managed and that services should monitor for adverse effects. The finalised statements are now published online for clinical practice in the UK. These guidance statements will be adapted in the coming years as more evidence is published and as the international experience of peanut immunotherapy evolves. [ABSTRACT FROM AUTHOR]

University spin-offs (USOs) are an important firm class since they constitute an economically important sub-group of high-tech start-up firms: they have, consequently, engendered many academic studies. However, what the firms deliver by way of innovation in the form of new products and services has largely been missing from the academic entrepreneurship literature. By adopting a mixed research methodology of in-depth interviews and a survey, this study highlights key factors associated with the success of product and service development by USO firms in the United Kingdom -- such as understanding customer needs, networks, clear market analysis, applications of technology, and the vision, mission and value of the company. The findings resonate with various studies in innovation management on the key elements of product and service performance predictors. The article also helps to fill a gap in the academic entrepreneurship literature by providing an understanding beyond the success factors in setting up USOs. The study should therefore raise the awareness of and benefit various actors (e.g. academic entrepreneurs and technology transfer offices) with regard to the provision of the activities and skills required to develop products and services successfully.

In this study, we explore the product/service innovation process in university spin-offs (USOs) – a category of micro/small firms operating at the edge of technological frontiers. Our approach reconciles the traditional linear model with a practice-based lens, which characterises firm learning processes as underpinned by two logics of production and development. The findings agree with the extant literature that the process overall does not always follow stages in a standardised model. The lens further suggests that the interplay between the two logics occurs even within an individual so-called stage of the linear model, which makes for a counter-intuitive observation. This interplay also hinges upon customer collaboration and feedback. Overall, the apparent lack of adherence to formal process in USOs innovation is not mere haphazard response to being small and new. Reconciling the linear model and the lens is a step further in accounting for the latter's view of iterative learning and knowledge creation, while preserving the former's relevance as a communication device for multiple stakeholders involving in the process. [ABSTRACT FROM AUTHOR]

This article contributes to the international comparative analysis of university venture capital (UVC), providing a quasi-experimental design for follow-up research and practice. The US venture capital industry, with its unicorn focused high-growth format opened up a venture capital gap. UVC transmutes academic innovation into high-tech firms, industries and regional renewal, filling interstitial funding gaps among angel, public and private venture capital offers. It is a knowledge-based industrial policy by Another Name, with direct/explicit and indirect/implicit versions, on a continuum with variation depending upon shifting ideological and competitive concerns. Beyond as of right "womb" provision, UVC capstones an academic innovation ecosystem of technology transfer, incubation and acceleration, translational research, proof of concept funds and entrepreneurship education. Venture capital, exemplified by Sand Hill Road, de-emphasizes classic regional development objectives, neglecting appropriability conditions such as academic and regional circumstances that UK and China prioritize. More modest firm formation outcomes are dismissed as failures, with entrepreneurs encouraged to return to the entrepreneurial churn. We examine the origin and development of UVC from macro, meso and micro, historical and comparative perspectives. Multi-method/multi-sample, comparative case study, and big data analytics show the constraint, variety, and early affinity of UVC to academic icons with significant untapped potential to inspire widespread economic and social advance. [ABSTRACT FROM AUTHOR]

In the UK and in many other countries, the lack of support for disabled entrepreneurs is an economic, cultural, and societal issue. This is because while disabled entrepreneurs belong to and contribute to public spaces, there are often barriers to their full engagement in the local economy. Where interaction is well established, such entrepreneurs add to the cultural richness of places, to personal and societal well-being and economically by wealth creation. The goal of the study is to identify what can be done to overcome the marginalisation of disabled entrepreneurs, which leads to increased local equality of opportunity, thereby adding to the diversity of local economies and, thus, to a more inclusive society. However, as the evidence from this study of the geography of specialised networks which support disabled entrepreneurs in the UK shows, the entrepreneurial capacity of public spaces (inclusive entrepreneurial ecosystems) for disabled entrepreneurs is better in some places and entirely absent in others. It is this local dimension that has been missing in other studies of disabled entrepreneurs. By focusing on the formal networks that have been established to support disabled entrepreneurs rather than the entrepreneurs themselves, the particular knowledge gap that this paper addresses is the importance of the networks in making those connections and bringing about systemic change in urban spaces. They do this in three ways. They provide access to resources that disabled entrepreneurs need to start and grow a business; in turn, they need to engage with other local public and private sector organisations in order to sustain their own activities, and by their role as advocates on behalf of their members through their leadership, they increase the visibility of disabled entrepreneurs within urban spaces. The contribution to academic literature is to explore the interconnection between the agency of particular organisations to improve inclusive entrepreneurial ecosystems and overcome embedded exclusion within urban spaces. Examples from the UK and from the USA provide empirical insights into what can be done. [ABSTRACT FROM AUTHOR]

Over the last decade policies framing the enterprise agenda for UK higher education institutions (HEIs) have consistently emphasized the potential impact of successful universities on both regional and national economies. Such policies have been backed by significant public funding to ensure that the UK HEI sector is able to compete globally in the creation and exploitation of cutting-edge science. Collectively, these initiatives have led to the development of a "third mission" for universities--increasing the pace and impact of knowledge-exchange activities--while simultaneously maintaining and improving their more traditional research and teaching activities. Previous studies have demonstrated the contribution of universities to the growth of high-technology clusters as well as to knowledge exchange activities more generally. However, the extent to which these activities, particularly the formation of new university-related companies, deliver benefits to particular regions and cities is imperfectly understood. As a consequence, the economic and social impact of companies originating in universities in the UK is generally under-reported by official surveys, which frequently fail to capture details of the trajectories of such companies after formation. These considerations form the context for this paper, which presents the results from a detailed study of the impact of science and technology based academic spin-offs from a cross-section of London's HEIs. (Contains 10 tables, 4 figures and 12 notes.)

This paper examines how Save the Children--an international non-governmental organisation (INGO)--assesses the changes it has brought about in children's lives around the globe. The paper begins with a discussion of the role of INGOs. It moves on to examine how we know we are making a difference and gives an explanation of "Global Impact Monitoring"--the framework that Save the Children uses to plan and assess its impact as well as to determine how this impact came about, or to put it another way, to determine "best practice". The paper explains that Save the Children has chosen this system because it reflects a rights-based approach to development and encourages a culture of reflection and learning. The rest of the paper discusses factors that help and hinder the organisation's ability to assess its impact, with practical examples given throughout. The discussion covers a variety of topics, including: how to involve stakeholders (those directly involved in, and those that have an interest in our work, including staff, governments, communities, and most importantly, children and young people) in measuring and analysing what changes Save the Children has created and how these changes came about; how to build monitoring and data analysis into the programme planning cycle; how to ensure sufficient time and resources are allocated for data collection and analysis; how to measure things that are hard, if not impossible, to measure; and, how to measure change at a global level. The paper finishes with a discussion of how to improve things in the future, concentrating on how to build a learning culture within organisations with sufficient resources and incentives to change the way we think about, and practise, development. (Contains 9 notes.)

A new variant of Streptococcus pyogenes serotype M1 (designated 'M1UK') has been reported in the United Kingdom, linked with seasonal scarlet fever surges, marked increase in invasive infections, and exhibiting enhanced expression of the superantigen SpeA. The progenitor S. pyogenes 'M1global' and M1UK clones can be differentiated by 27 SNPs and 4 indels, yet the mechanism for speA upregulation is unknown. Here we investigate the previously unappreciated expansion of M1UK in Australia, now isolated from the majority of serious infections caused by serotype M1 S. pyogenes. M1UK sub-lineages circulating in Australia also contain a novel toxin repertoire associated with epidemic scarlet fever causing S. pyogenes in Asia. A single SNP in the 5' transcriptional leader sequence of the transfer-messenger RNA gene ssrA drives enhanced SpeA superantigen expression as a result of ssrA terminator read-through in the M1UK lineage. This represents a previously unappreciated mechanism of toxin expression and urges enhanced international surveillance. A variant of group A Streptococcus serotype M1 (UK) has been increasingly reported and can be differentiated from the global variant by its overexpression of the superantigen SpeA. Here, Davies et al probe the mechanism behind enhanced SpeA expression and demonstrate that a SNP in the 5' leader sequence of ssrA is responsible for this virulence phenotype. [ABSTRACT FROM AUTHOR]

Research on the formal role of universities in stimulating regional economic development is relatively recent. However, the role of universities in contributing to regional technological and service variety is underresearched. In this study, we use a data set that has wide geographic coverage. The analysis provides a comprehensive understanding of the UK-wide contribution of university spin-offs (USOs) to the innovation capacity of their host regional economies. We argue that the survival and growth of USOs imply embeddedness in innovation ecosystems in a region. The findings show that the majority of firms in the sample are relatively young, small in size, and are still at the early stages of their life cycle. Hence, the products and services that are offered are fairly small in number. Nevertheless, their products/services based on university research have the potential for value capture by other firms thus implying contributions to a range of related and unrelated industry sectors within a region or beyond the local. [ABSTRACT FROM AUTHOR]

The article offers information about the essential oil generated from the Copaiba. It mentions that Copaiba as a generic term used to refer to several different Copaifera species. It discusses that oleoresin has a long history of indigenous medicinal use and has been used for pharyngitis, skin wounds and ear infection.

The choice of hydrological model, especially on the catchment scale, is never an easy one. This of course is dependent on the problem under consideration and the end user requirement. The continued development in data acquisition and its availability has taken us in the direction of more complex model development and application. Yet, it remains critical to identify a model that is not only parsimonious in parametric space but also provides good results. With the above motivation the purpose of this study is to compare the performance of a widely used lumped conceptual hydrological model (GR4J) and a well‐established fully distributed mesoscale hydrological model (mHM). Model performance is measured by four goodness of fit indicators (GOFIs) as well as five hydrological signatures that examine the capability of the models applied to reproduce different components of the flow. To undertake this comparison, the two models are applied to a set of fifty catchments that are part of the UK benchmark network (UKBN2), supplemented by additional catchments, not so pristine in nature, to incorporate a wider range of catchments. The results, quantified by the GOFIs and hydrological signatures, show that the lumped model performs as well as the fully distributed model and in multiple cases better than the more complex model. However, model results across the set of fifty catchments, examined here, are highly correlated. Model performance is also examined on seasonal basis and a slight deterioration in the model performance whilst simulating the summer flows is observed. Based on the comprehensive comparison undertaken here, we conclude that the applied lumped model might be the model of choice if the problem at hand is an investigation of rainfall‐runoff at the catchment outlet, without the need to consider the spatiotemporal variation of various hydrological states and fluxes. [ABSTRACT FROM AUTHOR]

Doubts remain over the true impact of university spin-offs (USOs), particularly those created outside elite research universities. This paper examines the financial performance of USOs from a single UK post-industrial region, the West Midlands within the framework of signalling theory. It adds to the existing literature on USO performance at company level, a currently under-represented topic, despite the attention and funding devoted to USOs by UK policymakers. By considering a single region, it brings new insight into the regional context of USOs. Key results of the study are a correlation between research strength of a university and ability of its USOs to attract external finance, but a lack of successful exits across the whole region. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. Method: Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. Results: Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. Conclusions: Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. Trial registration: ISRCTN12676087. Date of registration 07/01/2014. Plain English summary: Specialist eating disorders services may improve outcomes and reduce hospitalisations for children and adolescents with anorexia nervosa. Reductions in hospitalisation could save money for the NHS and are better for young people because hospitalisation disrupts their home life, social life and education. This study evaluated outcomes and costs of specialist eating disorders services compared to general child and adolescent mental health services (CAMHS) for children and adolescents with anorexia nervosa. Children and adolescents were identified by contacting child and adolescent psychiatrists in the UK and Ireland and asking them to report any new cases of anorexia nervosa. These psychiatrists identified 298 young people aged 8 to 17 with an anorexia nervosa diagnosis for the first time. The psychiatrists provided information on the health services these young people used and how they were doing when they were first diagnosed and 6 months and 1 year later. Children and adolescents in specialist services were more severely ill than those in CAMHS when they were first diagnosed. Despite this, care for the young people in specialist services cost about the same as for those diagnosed in CAMHS, and their outcomes after 1 year were similar. This work showed that specialist services may be better value for money than CAMHS. [ABSTRACT FROM AUTHOR]

Background: Vignettes are regularly used in nursing research and education to explore complex clinical situations. However, paper-based vignettes lack clinical realism and do not fully recreate the pressures, sights and sounds of clinical settings, limiting their usefulness when studying complex decision-making processes. Aim: To discuss the approach taken by the authors in developing and implementing audiovisual vignettes to collect data remotely in a qualitative study. Discussion: The authors describe how they created audiovisual vignettes for a qualitative 'Think Aloud' study exploring how critical care nurses decide whether to restrain agitated patients with varying degrees of psychomotor agitation. They discuss the practicalities of filming, editing and hosting, as well as the theoretical and clinical background that informed the creation of the vignettes. Conclusion: Audiovisual vignettes are a cost- and time-effective way of remotely exploring decision-making in challenging environments. This innovative method assists in studying decision-making under simulated clinical pressures and captures data about how people make complex decisions. Implications for practice: Audiovisual vignettes are an innovative tool for collecting data and could also be used in educational settings and offer the opportunity to explore complex clinical decision making remotely. Clinical accuracy is essential for immersing participants and simulating an environment and its pressures. The method could be further enhanced by making vignettes responsive to participants' decisions. [ABSTRACT FROM AUTHOR]

This paper explores the effect of external knowledge sources and the uneven geography on innovation activity in small Knowledge Intensive Business Services (KIBS). It draws on results from a survey of 342 small and medium (SME) KIBS located in the UK's North East and West Midlands, both de-industrialized regions. It is shown that innovation is supported by knowledge gained from frequent interaction with customers both regional and UK based as well as international. More frequent interaction with local business networks, informal contacts and national licencing arrangements also enhances innovativeness. Various industry-specific business networks and regional government agencies act as important sources of knowledge and networking and these are more important for KIBS located in the North East. The results indicate that more frequent collaboration with regional universities and regional public sector organizations does not benefit KIBS from either region. Also, while we acknowledge a positive effect of R&D on KIBS innovativeness we argue that its effect is less important compared to regional and extra regional knowledge sources. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore and propose the skills and capabilities required in developing products and services within UK university spin-offs (USOs) by considering the model of products/services development (Verona, 1999). Design/methodology/approach: Mixed methods of 20 in-depth interviews and questionnaire survey with 204 founders of USOs were used in this study. Findings: The findings contribute in filling the literature gap by proposing key knowledge and capabilities required to develop products/services within the unique and non-commercial context, in which USOs are created by academics who do not necessarily have entrepreneurial or business experience. Originality/value: This research contributes to studies of product/service development by proposing a modification of elements within the existing theoretical model to be applicable to the specific firm and country context, such as USOs in the UK. Further, the study extends knowledge on the interplay between knowledge management and product development. The applications of the findings are that they can inform academic entrepreneurs on the capabilities significant in the development process. They can also act as indicators to technology transfer offices in what is needed for the provision of appropriate support and training to academic founders/entrepreneurs to foster and enhance other entrepreneurial activities. [ABSTRACT FROM AUTHOR]

Objective: Carers play an important role within the UK mental health system. Those carers who support persons with psychosis can experience a reduction in their own physical and mental health. As part of the Caring for Caregivers (C4C) trial, we piloted a writing intervention (Positive Written Disclosure) that has been shown to improve wellbeing in other populations. Although we reached our recruitment target, we encountered several barriers that made recruitment slower than anticipated. This paper synthesises the process data collected during the C4C trial that relates to the barriers to recruiting and retaining psychosis carers. Results: We encountered four main carer-specific barriers to the recruitment and retention of participants in our study. These were: (1) poor relationship with mental health clinicians, (2) conflicting with the care recipient's (CR) needs, (3) lack of spare time, and (4) lack of services for mental health carers. The interventions to assist carers need to be informed by robust evidence and this requires trials that reach their recruitment targets. By sharing our practical experiences other researchers and clinicians can modify their practices to minimise recruitment difficulties and delay. Trial registration ISRCTN79116352. Retrospectively registered (before the final participant was recruited) on 23rd January 2017 [ABSTRACT FROM AUTHOR]

Background: In western countries, men who have sex with men (MSM) are most affected by HIV and increasingly likely to engage in risky sexual behaviour. MSM who experience a potential sexual exposure to HIV (PEPSE) and receive a preventative regimen of anti-HIV treatment are at particularly high risk of acquiring HIV and could potentially benefit from targeted risk reduction behavioural interventions such as motivational interviewing (MI). Purpose: The aim of this trial was to examine the impact of augmented MI (MI plus information provision and behavioural skills building), over and above routine care, on reducing risky sexual behaviour in MSM prescribed PEPSE. Secondary aims of the research were to examine whether the intervention reduced sexually transmitted infections (STI) and further requests for PEP. Methods: A parallel-group pragmatic randomised controlled trial was conducted with 175 MSM recruited from five sexual health (SH) clinics in the south east of England. The intervention was two fixed-duration sessions of telephone administered augmented MI. A manual guided the selection of individualised persuasive communication strategies based on underlying change mechanisms specified by the Information, Motivation and Behavioural Skills (IMB) model. Primary outcomes were the number of receptive and active anal intercourse (AI) partners, the use of condoms every time during receptive and active AI and the use of condoms sometimes during receptive and active AI. Results: There were no significant impacts on sexual risk behaviour or any of the psychological measures, and no discernible reduction in requests for repeat PEP or rates of STIs within a year. Conclusion: Our behavioural intervention of augmented MI did not affect risky sexual behaviour, rates of further PEP and STIs, and psychological factors, in MSM prescribed PEPSE. Trial registration numbers: UKCRN ID:11436; . [ABSTRACT FROM AUTHOR]

Introduction: The study describes the development of the first UK national framework to guide undergraduate education in anesthesia, perioperative medicine, critical care, and pain medicine. Methods: We followed an inclusive process of curriculum design aiming to promote high-level learning amongst students. We conducted telephone interviews with senior anesthetic educators at 33 UK medical schools to establish current provision and practice. We then held a consultative national workshop for educators, using focus group interviews to set broad aims for the final framework and gather information. Result: Anesthesia undergraduate educators demonstrated a conceptual focus that moves beyond simple acquisition of knowledge to one geared to encouraging clinical behavioral change in learners to equip them for practice as new doctors. Respondents also highlighted the opportunities for promoting spiral, integrated, and longitudinal learning within the undergraduate curriculum. We also formulated eight key domains of practice in anesthesia and critical care and mapped 63 of the 106 General Medical Council's Outcomes for Graduates against these domains, and created a brief suggested syllabus. Conclusions: The framework aims to provide support and guidance for medical schools in the development of competent, well-rounded doctors who are able to provide safe, patient-centered care in all areas of medical practice. [ABSTRACT FROM AUTHOR]

This article will explore region as a category of analysis for understanding gender, sexual cultures, and the expression of same-sex desire. In unpicking the notion of regional difference in both its tangible and intangible forms, it outlines the corresponding impact on how sexual cultures developed and were experienced in twentieth-century Britain. By recognizing that the area in which an individual lived could have as much impact on their sense of self and their sexual experiences as issues of race, gender, and class, a new and fruitful avenue of interpretation is opened up for the history of sexuality and twentieth-century British history more broadly. Such a methodology has the potential to add a new dimension to all histories of non-state-sanctioned sexual experience such as illegitimacy, premarital sex, extramarital affairs, and prostitution. In using regional case studies and interrogating ideas of sexual taboo, this article offers a unique interpretation of sexual experience that destabilizes current Londoncentric narratives and offers a more democratic and nuanced history of sex. [ABSTRACT FROM AUTHOR]

Abstract: At a time when government funding cuts mean that public libraries face an uncertain future and need to make sure they stay relevant to young users and their families, this paper explores what counts as literacy for young children in a public library in a town in the East Midlands, UK. It is based on a study which adopted an ethnographic approach, drawing on Lefebvre's spatial theory to understand how a library space presents literacy to young children and their carers, and how this then shapes the literacy practices and events that happen in this space. The study shows that dominant discourses are bound up in what the library staff understand to be their role in promoting and supporting young children's literacy, and that, often, they organise the space and literacy events in ways that reflect these discourses. However this paper argues that it is not only the library staff that create space in the library, as carers and their children are sometimes seen to create alternative spaces which challenge and subvert the way the librarians would like the space to be used and understood. [ABSTRACT FROM AUTHOR]

Background: Female-only human papillomavirus (HPV) vaccination will fail to protect men who have sex with men (MSM) against HPV and its sequelae (i.e. genital warts and anal cancers). In the absence of gender-neutral HPV vaccination, targeted vaccination at sexual health clinics for MSM offers a valuable preventive opportunity. This study aimed to identify sexual healthcare professionals' (HCPs) perceived barriers and facilitators for MSM-targeted HPV vaccination.Methods: Nineteen telephone interviews with UK-based self-referred HCPs (13 doctors, three nurses, three health advisers) were conducted in October and November 2014. The interviews were recorded and transcribed verbatim. Data were analysed thematically by two researchers.Results: HCPs were unsure about selection criteria, acceptable healthcare settings and the source of vaccination funding for the introduction of MSM-targeted HPV vaccination. Lack of political and public support, MSMs' limited access to HPV vaccination and disclosure of sexual orientation to HCPs, identification of eligible MSM, patients' poor HPV awareness and motivation to complete HPV vaccination were perceived as significant barriers. HCPs believed that the introduction of official guidelines on HPV vaccination for MSM, awareness campaigns and integrated clinic procedures could improve vaccination coverage.Conclusion: HCPs recognised a need to protect MSM against HPV. However, several challenges and obstacles associated with the introduction of MSM-targeted HPV vaccination in the UK were reported. HCPs' perspectives and concerns need to be addressed when developing policies and guidelines for a potential MSM-targeted HPV vaccination. Future research needs to examine whether negative views of HCPs towards MSM-targeted HPV vaccination are associated with lower HPV vaccine uptake and completion rates in MSM. [ABSTRACT FROM AUTHOR]

Innovation is an integral part of economic development in developed economies. In the post 2008 period, a key policy agenda is that of sustainable development, which calls for innovation in all aspects of value-chains. In this paper, we focus on innovation from the biotech-pharma perspective to see whether or not this will lead to a sustainable future for the regions where there are clusters of firms in this sector. We examine data from a recently completed European Union study of innovation in the Healthcare sector from the UK and Switzerland, countries with an historical base in pharma, to understand how innovation pathways vary at the regional level in the broader life sciences, which incorporate biotech and more. Innovation in the healthcare sector in two regions, Oxfordshire in the UK and Zurich in Switzerland are compared. We contextualize our discussion by drawing on studies that focus on the sector in the US, specifically Boston. The analytical framework comprises three elements: innovation systems and national and regional economic development theories are the first two, followed by approaches which consider organizational or institutional activity. This framework is used to help explain and understand the complexity of how innovation is organized at the sub-national level. The overall context is that it is increasing becoming a condition for government financing of research that it has more immediate application in industry or have the possibility of commercialisation (e.g., translational research). [ABSTRACT FROM AUTHOR]

The incidence of oral cancer is increasing in the United Kingdom. There is evidence that early diagnosis and effective treatment improve survival, but the poor 5-year survival rate (50%), which has not improved for several decades, has been attributed to advanced stage at presentation. To investigate the symptoms associated with cancer of the oral cavity and to explore the role of general practitioners (GP) in the identification and referral of patients, we sent 200 patients questionnaires on the route to diagnosis, symptoms, delay in presentation, and outcomes of consultations with their GP. Of 161 respondents, over half (56%) had been referred to secondary care by their GP and a third (32%) by their dentist. The most commonly reported symptoms were a mouth ulcer (32%), a lump in the face or neck (28%), and pain or soreness in the mouth or throat (27%). Fifteen per cent delayed presentation for more than 3 months. After consultation with a GP (n=109), 53% were referred to a specialist, 22% were referred for tests, 12% were told that their symptom was not serious, and 12% were treated for another condition. GPs have an important role in the identification and referral of people with oral cancer, and the clearly recognised symptoms identified in this study can be used to aid assessment and decision-making. Interventions to promote the prompt identification of oral cancer in general practice such as the opportunistic screening of high-risk patients may help to improve the poor survival rates. [ABSTRACT FROM AUTHOR]

Background: Research partnerships between high-income countries (HICs) and low- or middle-income countries (LMICs) are a leading model in research capacity strengthening activities. Although numerous frameworks and guiding principles for effective research partnerships exist, few include the perspective of the LMIC partner. This paper draws out lessons for establishing and maintaining successful research collaborations, based on partnership dynamics, from the perspectives of both HIC and LMIC stakeholders through the evaluation of a research capacity strengthening partnership award scheme.Methods: A mixed-method retrospective evaluation approach was used. Initially, a cross-sectional survey was administered to all award holders, which focused on partnership outputs and continuation. Fifty individuals were purposively selected to participate in interviews or focus group discussions from 12 different institutions in HICs and LMICs; the sample included the research investigators, research assistants, laboratory scientists and post-doctoral students. The evaluation collected data on critical elements of research partnership dynamics such as research outputs, nature of the partnership, future plans and research capacity. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.Results: The majority of United Kingdom and African award holders stated they would like to pursue future collaborations together. Key aspects within partnerships that appeared to influence this were; the perceived benefits of the partnership at the individual and institutional level such as publication of papers or collaborative grants; ability to influence 'research culture' and instigate critical thinking among mid-career researchers; previous working relationships, for example supervisor-student relationships; and equity within partnerships linked to partnership formation and experience of United Kingdom partners within LMICs. Factors which may hinder development of long term partnerships were also identified such as financial control or differing expectations of partners.Conclusions: This paper provides evidence of what encourages international research partnerships for capacity strengthening to continue past award tenure, from the perspective of researchers in high and LMICs. Although every partnership is unique and individual experiences subjective, this paper provides extension and support of key principles and mechanisms that can contribute to successful research partnerships between researchers. [ABSTRACT FROM AUTHOR]

Introduction: Seeking asylum creates circumstances that impact significantly on occupational opportunities, leading to negative outcomes for individuals, families and the host community. Understanding the specific meaning of occupation during this major life transition provides valuable insights regarding occupation cross-cuIturaIly, during transition or under socio-legal restrictions. Method: This study employed a phenomenological approach, using a series of in-depth interviews to illuminate the role of occupation in the everyday lives of 10 participants. Findings: All participants spoke of the challenges of the asylum process, and the powerful drive to keep busy. They each identified the special role of occupations done for the benefit of others - family, network or community - linking these with cultural ideals and their own desired outcomes of value and purpose. Conclusion: Occupation has enormous potential for enhancing post-migratory experiences, but the choice of occupation is also important. People strive to move beyond simply 'keeping busy' to find occupations of real meaning that foster connections and purpose, and in particular feed their need to feel valued. Occupations undertaken for the benefit of others connect with culturally appropriate collectivist ideals, and seem to do more to promote 'doing, being, belonging' and 'becoming'. [ABSTRACT FROM AUTHOR]

Abstract: A case study of the development of an overall resource assessment for the Wave Hub site in the southwest UK is presented. Wave Hub is one of the earliest large-scale wave farms planned. Several resource assessment studies have been performed for the site, but the published results are high-level and predicted power availability varies significantly. This paper provides a detailed overview and re-analysis of the multiple datasets used in the original studies, which consisted of a combination of physical measurement and numerical modelling. The quality of the datasets is assessed, and reasons for the discrepancies between predicted resource levels investigated. Results from a SWAN model for the region illustrate significant levels of spatial variability in the resource due to the complexity of the local bathymetry, and examination of long-term global model datasets shows notable inter-annual variability. It is thus concluded that a resource assessment methodology utilising datasets from multiple locations and of short duration significantly reduces the accuracy of the predicted levels of resource. From these results, key learnings for future developments are discussed. [Copyright &y& Elsevier]

Background: There are ongoing concerns about the quality of care provision for allergy in primary care. Aims: To identify current training provision in allergy to GP trainees and to understand how this could be enhanced. Methods: A cross-sectional survey of GP Speciality Training (GPST) programme directors was undertaken. Programme directors of the 174 GPST schemes were sent an online questionnaire which was informed by the content of the Royal College of General Practitioners curriculum. Quantitative data were descriptively analysed and a thematic analysis was undertaken of free text responses. Results: We obtained responses from 146 directors representing 106 training programmes. Responses indicated that two-thirds (62%, 95% Cl 53.1 to 71.5) of programmes were providing at least some allergy training, with the remaining third stating that they either provided no training or were unsure. Overall, one-third (33%, 95% Cl 22.7 to 42.2) of programme directors believed that all the relevant allergy-related curriculum requirements were being met. Where provided, this training was believed to be best for organ-specific allergic disorders but was thought to be poorer for systemic allergic disorders, particularly food allergy where 67% (95% Cl 57.5 to 76.5) of respondents indicated that training was poor. There was considerable interest in increasing the allergy training provided, preferably through eLearning modules and problem-based learning materials supported by those with relevant specialist knowledge. Conclusions: This UK-wide survey has identified important gaps in the training of GP trainees in relation to allergy care. Addressing these gaps, particularly in the management of systemic allergic disorders, should help to improve delivery of primary care-based allergy care. [ABSTRACT FROM AUTHOR]

Rhinitis is an inflammatory condition of the nasal mucosa which causes nasal discharge, itching, sneezing, nasal stuffiness, congestion and blockage. Rhinitis can be due to a variety of causes and is classified as allergic, non- allergic and infective. This article focuses on the diagnosis and management of rhinitis with an allergic aetiology. [ABSTRACT FROM AUTHOR]

Constance Garnett has become justly celebrated for her translations from the Russian which brought the work of nineteenth century Russian novelists to prominence in Great Britain. This essay argues that her husband Edward Garnett played an equally important part in 'interpreting' the Russians. In his reviews, articles, and books Garnett sought to teach the British public how to read literature that many initially found baffling; through his work as a publisher's reader Garnett pressed the Russian example upon his protégés in an effort to revivify the British novel. [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper uses findings from a research study called Net.Weight to examine the concepts of interaction, information quality and Internet-based information from the perspective of people engaged in managing their weight. The Net.Weight study was a two-year project funded by the British government's Department of Health and located in the city of Brighton and Hove. It examined the potential for increased, innovative and effective uses of information and communication technologies (ICTs) to support the self management of weight. The study had several inter-related research strands and the findings discussed in the paper emerged primarily from participatory learning workshops and evaluative interviews. The paper demonstrates that the interaction between people is an important aspect of the information process, which is often neglected in the literature. It suggests that exploring the user-user dimension might add to the understanding of information effectiveness. It also suggests that an approach to information and health literacy which includes a social as well as an individual perspective is necessary. On quality assessment, it supports findings from other studies that organisational authority is a key measure of reliability for lay users and that quality assessment tools have a limited role in the assessment process. The Net.Weight participants embraced the Internet as a medium for weight management information only when it added value to their existing information and weight management practices and when it could be integrated into their everyday lives. [ABSTRACT FROM AUTHOR]

Background Urinary tract infection (UTI) is one of the commonest acute infections presenting to primary care. Little is known of women's experiences of UTI; self-care strategies and key triggers for their consulting behaviour are also little known. Aim To explore women's experiences of self-care and their journey to GP care, when faced with symptoms of a UTI. Design of study Qualitative semi-structured interview study with women recruited to a larger UK trial of different management strategies for UTI. Setting General practices across four counties in southern England. Method Twenty-one women were interviewed about the experiences they had prior to their GP visit, self-care strategies, and triggers for help seeking. Interviews were analysed thematically, using principles of analytic induction. Results Women reported a process of evaluation, monitoring, re-evaluation, and, finally, consulting in order to meet their needs. Four key triggers for consulting were identified: failure to alleviate symptoms through self-care; symptom duration and escalation; impeding normal functioning and the fulfilment of social roles; and concern that it may be or become a serious illness. Conclusion Although UTI is often self-limiting, when taking patient histories and formulating their management strategies clinicians need to take into account women's often painful experience, their efforts to resolve symptoms prior to consulting, and their fears that the symptoms may indicate something more serious than a UTI. [ABSTRACT FROM AUTHOR]

Stem cells are at the forefront of hopes for developing treatments for a range of serious diseases. The sources of those stem cells can be controversial, particularly for embryonic stem cell lines. Increasingly parents are opting to collect umbilical cord blood shortly after delivery of the baby, some to satisfy a current treatment need for stem cells and others to ‘future-proof’ their families and themselves against possible disease and preserving for themselves a potentially potent resource for future regenerative treatments. The author reviews recent and forthcoming changes in regulation of this area, potential legal problems and the implications of compliance for biotech companies within the field or who have current treatments which may benefit from collaboration with those who are in the field. The paper looks at, in particular, the legal position in the UK, and issues relating to, for example, ownership of cord blood deposits and anonymity of deposits.Journal of Commercial Biotechnology (2009) 15, 236–244. doi:10.1057/jcb.2008.46; published online 11 November 2008 [ABSTRACT FROM AUTHOR]

Background: Many United Kingdom patients with asthma and rhinitis are allergic, but in primary care few diagnostic and management decisions are made with formal allergy assessment. Arguably, knowing a patient''s atopic status might be helpful in distinguishing the cause of disease and in selecting appropriate treatments. Objectives: Our objective was to estimate the extent to which a formal allergy assessment (a structured allergy history and skin prick tests to 5 common aeroallergens) would improve the precision of allergy diagnosis compared with a patient''s self-report or the structured allergy history alone. Methods: One hundred twenty-seven patients with asthma, rhinitis, or both were recruited from 4 general practices in Wessex, United Kingdom. Allergy status based on the patient''s opinion and on structured allergy history alone was compared with formal allergy assessment. Assessments were validated by an independent allergy specialist reviewing the files. Patients were given written advice specific to their allergies and followed up 3 months later to assess satisfaction, recall, and effect on health and behavior. Results: Self-reporting misclassified allergic status in many patients. A structured allergy history alone was little better and resulted in false-positive rates for cat allergy of 32%, grass pollen of 48%, house dust mite of 75%, tree pollen of 54%, and dog of 27% compared with formal allergy assessment. Skin prick testing combined with a structured history was essential to reach a correct causative diagnosis. Three months later, 41% patients had made changes to lifestyle, medications, or both, and 18% reported clinical improvement. Conclusions: Skin prick testing improves the accuracy of an assessment of allergic status based on patient opinion or a structured allergy history alone. [Copyright &y& Elsevier]

Objective: This article assesses the cost-effectiveness of pentostatin compared with cladribine in the management of hairy cell leukemia (HCL) in the United Kingdom. Methods: A systematic literature search for papers on HCL was performed using MEDLINE, EMBASE, Current Contents, NHS Economic Evaluation Database, and the Cochrane computerized database. Search terms were HCL plus 1 of the following: incidence, prevalence, epidemiology, cladribine, interferon, pentostatin, rituximab, splenectomy, utility, quality of life, cost-effectiveness, cost-utility, resource utilization, economic, or cost. Published clinical outcomes and estimates of health care resource use obtained from 10 consultant hematologists across the United Kingdom were used to construct a 5-year Markov model depicting the current management of HCL in the United Kingdom. Utilities for health states in the model were obtained from the general public using standard gamble, time tradeoff, and visual analog scale techniques. The model was used to consider the decision by a clinician to initially treat an HCL patient with either pentostatin or cladribine and to estimate the relative cost-effectiveness of pentostatin over 5 years (at 2007/2008 prices) from the perspective of the UK''s National Health Service (NHS). Results: According to the model, 64% of all pentostatin-treated patients are expected to be in relapse-free remission at 5 years compared with 49% of cladribine-treated patients (P = 0.04). Repeat treatment of initial partial responders, nonresponders, and those who relapse during the 5 years is expected to result in complete remission in 92% of pentostatintreated patients and 90% of cladribine-treated patients at 5 years. Using pentostatin instead of cladribine is expected to lead to a minimal cost increase (from £21,325 to £21,609) and an improvement in health status (from 3.64 to 3.77 quality-adjusted life-years [QALYs]) over 5 years. Hence, the cost per QALY gained from using pentostatin is expected to be £5000. Moreover, pentostatin has a 0.90 probability of being cost-effective for a threshold of £20,000 per QALY. Accordingly, using pentostatin as a first-line treatment for patients with HCL is an effective use of NHS resources. Conclusion: Based on current practice, this model predicts that pentostatin is a cost-effective treatment compared with cladribine in the management of HCL from the perspective of the UK''s NHS. [Copyright &y& Elsevier]

Background: Human Papillomavirus (HPV) vaccination for men could prevent anal cancers amongst men who have sex with men (MSM).Methods: An e-survey of attitudes towards vaccination for men in the UK was conducted in July-August 2014.Results: Among 325 sexual health professionals, 14% were already vaccinating men against HPV, 83% recommended gender-neutral HPV vaccination and 65% recommended targeting MSM. Over 50% reported having poor knowledge about the use of HPV vaccine for MSM and the skills to identify MSM likely to benefit from HPV vaccination.Conclusions: Clear advice and guidelines on HPV vaccine use for men at sexual health clinics are required to ensure equitable opportunities for vaccination. [ABSTRACT FROM AUTHOR]

The creation of university spin-offs and the development of its biotechnology industry are two of the UK's and many other countries' top research-to-commercialisation priorities. Usually more is known about the numbers of spin-offs than their performance. This paper analyses the performance of 56 biomedical spin-offs from Oxfordshire's universities and public sector research laboratories with respect to human resources, the degree of innovative capability and internationalisation. In so doing, it explores the contribution of this group of firms to the evolution of science-based industry in this particular location which is one of the UK's leading centres of research and innovation. [ABSTRACT FROM PUBLISHER]

This paper examines the changing geography of employment in Knowledge-Intensive Business Services (KIBS) in Britain. KIBS represent an important element of the so-called 'knowledge economy' and have been amongst the fastest growing employment sectors in advanced economies in recent years. However, during the 1990s in Britain, this employment growth was very unevenly distributed, both between regions and at the sub-regional level. The evidence presented in the paper suggests that KIBS growth in the 1990s was strongest in London and in a group of inter-linked local economies stretching in a broad arc to the north, west and south of the capital within the 'Greater South East' region. Examples of strong KIBS sector growth outside this region tend to be more isolated. There is little evidence of significant decentralisation of KIBS employment from the largest cities to smaller settlements. [ABSTRACT FROM AUTHOR]

The NICE Guidelines for Schizophrenia are designed to give guidance on the best practice in treatment and management of schizophrenia. These guidelines have 13 standards which services can use for the purpose of audit. As schizophrenia is our service's most common diagnosis, an audit against the guidelines was undertaken. The results indicated that we met three of the standards. Recommendations have been implemented to improve practice on standards that were not met, and this has led to some creative practice development. Despite the labour-intensive nature of the audit, the results gave a clear indication of areas where there was a need for improvement and will act as a good baseline for re-audit. [ABSTRACT FROM AUTHOR]

Concerns remain that health and social care services often fail people dying of chronic illnesses other than those with cancer. British government policy aims to improve end-of-life care and to enable people to make choices about place of care near the end of life, with the assumption that home is often the preferred option. However, some elderly people may lack suitable social networks, family carers and other resources to remain at home. Community hospitals offer a potentially accessible resource for local provision of end-of-life care. They have the advantage of being located within easy reach for family members, are staffed by local people and in most of them, general practitioners can maintain continuity of care. This paper examines patients’ and family carers’ experiences of end-of-life care in community hospitals. In-depth organisational case studies were conducted in six community hospitals in the south of England. Interviews were undertaken with elderly patients dying of cancer and other advanced conditions ( n = 18) and their family carers ( n = 11). Qualitative analysis of transcribed interviews were undertaken, using the principles of grounded theory. Patients and family carers valued the flexibility, local nature (which facilitated visiting) and personal care afforded to them. Most participants regarded community hospitals as preferable to larger district general hospitals. Our research reveals that these participants regarded community hospitals as acceptable places for end-of-life care. Finally, we discuss the implications of our findings for improving end-of-life care. [ABSTRACT FROM AUTHOR]

This paper's focus is on both the geography of entrepreneurship and on industry-collaborative links internationally, nationally and at the local level in the UK biotech industry, the world's second largest biotech industry. The paper reports on a pilot survey of the UK biotech industry. The survey has two goals: to understand the business goals of the firms and to examine the relative importance of local conditions to the business of biotech. Further evidence on these two themes comes from two studies of Oxfordshire, one of the UK's centres of biomedical science and biotechnology. The first is a survey of the county's biotech firms. The second, of academic spin-offs, demonstrates how the business of biotech in the UK is intimately tied to the national innovation system, which in turn is dependent upon highly localised elite science which in turn signals to world elites that the region is a hot-spot for innovation. [ABSTRACT FROM AUTHOR]

The article focuses on the problem encountered with a pilot online attendance record and feedback scheme for medical students. In one clinical school in Great Britain, students must pass the peri-operative medicine attachment before taking the final examinations. They are assessed according to their attendance and performance in a short examination. Considering the limitations of sign-up sheets, the researchers developed an online system to record attendance during the attachment inorder to lessen the burden of medical students in producing signatures. However, many students felt uncomfortable using the system in the operating theatre because at the end of the pilot period, the hospital authorities developed a policy prohibiting access to the internet from theatre computers.

Background: The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.Aims: To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.Method: An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.Results: No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3-29.0) for TCAs, 28.3 (95% CI 24.3-32.2) for SSRIs and 24.6 (95% CI 20.6-28.9) for lofepramine. Mean health service costs per patient were pound 762 (95% CI 553-1059) for TCAs, pound 875 (95% CI 675-1355) for SSRIs and pound 867 (95% CI 634-1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).Conclusions: The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care. [ABSTRACT FROM AUTHOR]

Objectives To quantify service integration achieved in the national exemplar program for single call access to out of hours care through NHS Direct, and its effect on the wider health system. Design Observational before and after study of demand, activity, and trends in the use of other health services. Participants 34 general practice cooperatives with NHS Direct partners (exemplars): four were case exemplars; 10 control cooperatives. Setting England. Main outcome measures Extent of integration; changes in demand, activity, and trends in emergency ambulance transports; attendances at emergency departments, minor injuries units, and NHS walk-in centers; and emergency admissions to hospital in the first year. Results Of 31 distinct exemplars, 21 (68%) integrated all out of hours call management. Nine (29%) achieved single call access for all patients. In the only case exemplar where direct comparison was possible, a higher proportion of telephone calls were handled by cooperative nurses before integration than by NHS Direct afterwards (2622/6687 (39%) v 2092/7086 (30%): P < 0.0001). Other case exemplars did not achieve 30%. A small but significant downturn in overall demand for care seen in two case exemplars was also seen in the control cooperatives. The number of emergency ambulance transports increased in three of the four case exemplars after integration, reaching statistical significance in two (5%, -0.02% to 10%, P = 0.06; 6%, 1% to 12%, P = 0.02; 7%, 3% to 12%, P = 0.001). This was always accompanied by a significant reduction in the number of calls to the integrated service. Conclusion Most exemplars achieved integration of call management but not single call access for patients. Most patients made at least two telephone calls to contact NHS Direct, and then waited for a nurse to call back. Evidence for transfer of demand from case exemplars to 999 ambulance services may be amenable to change, but NHS Direct may not have sufficient capacity to support national implementation of the program. [ABSTRACT FROM AUTHOR]

In the UK there are concerns that, in certain groups of dying patients such as the old, those with non-cancer diagnoses and those in rural areas, the quality of care is unacceptably variable. There has been no systematic survey of the extent to which community hospitals provide general palliative care for such patients. Therefore, by means of a structured questionnaire we asked senior nurses/managers at all 478 community hospitals in the UK for information on staff expertise, facilities and specialist equipment, liaison arrangements with specialist palliative care providers, priorities, practice and policy in end-of-life care. Of the 346 hospitals (72%) that responded, only 28 were in urban areas. 73% of hospitals employed at least one nurse with additional training in palliative care, 72% had access to 24-hour specialist palliative care advice and 51% had separate overnight accommodation for relatives, but only 22% had designated palliative care beds. Most hospitals did not have written policies or guidelines for patient assessment or symptom control. These findings add to evidence that community hospitals represent an important resource to improve access to palliative care for groups that are currently under-served. [ABSTRACT FROM AUTHOR]