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Patient and public involvement and engagement (PPIE) has evolved to become widely established practice in social care, health and public health research in the UK. The COVID‐19 pandemic has caused rapid change in practice in PPIE, notably in moving from face‐to‐face meetings to virtual ones. This has opened a space for reflecting on established PPIE practice, but there is a risk this is conducted too narrowly, such as only weighing our preferences and the relative pros and cons with regard to in‐person versus virtual meetings. The pandemic has also demonstrated the wide inequalities in society, and hence, we argue that an inequalities lens ought to guide a deeper and wider reflection on PPIE practice. We do not seek to criticize practice pre‐ or during the pandemic, but to encourage using the inequalities lens as a means of encouraging debate and focusing energy on a more rigorous review of PPIE practice to widen involvement in social care, health and public health research.

Background Co‐design and associated terms are increasingly being used to facilitate values‐based approaches to health‐care improvement. It is messy and complex, involving diverse actors. Methods We explore the notion that initiatives have outcomes other than initially planned is neither new nor novel but is overlooked when thinking about co‐design. We explore some of the unintended consequences and outline some optimal conditions that can mitigate challenges. Discussion Although co‐design approaches are being applied in health care, questions remain regarding its ability to produce gains in health outcomes. Little is known about determining whether co‐design is the most suitable approach to achieve the given project goals, the levels of involvement required to realize the benefits of co‐design or the potential unintended consequences. There is a risk of further marginalizing or adding burden to under‐represented populations and/or over‐researched populations. Conclusion Undertaking a co‐design approach without the optimal conditions for inclusive involvement by all may not result in an equal partnership or improve health or care quality outcomes. Co‐design requires on‐going reflective discussions and deliberative thinking to remove any power imbalances. However, without adequate resources, a focus on implementation and support from senior leaders, it is a tough ask to achieve. Patient or Public Contribution This viewpoint article was written by two academics who have undertaken a significant amount of PPI and co‐design work with members of the public and patient's right across the health system. Our work guided the focus of this viewpoint as we reflected on our experiences.

While Coronavirus Disease 2019 (COVID‐19) does not discriminate against particular groups, our social structures and systems mean some people are more at risk in a pandemic context—from both the disease and the social and policy responses to the pandemic. This is particularly so for people with disability, in part because they often have poorer health outcomes from underlying conditions but also due to discrimination and social exclusion. Here, we draw from a survey about the impacts of the COVID‐19 pandemic on Australian children and young people with disability and their families. Respondents faced a range of inequities prior to the pandemic, and COVID‐19 has further exposed and often exacerbated them. We conclude that recent developments in the Australian disability context to personalize services have arguably made people with disability and their families less safe within a pandemic context, and we outline some ways in which these issues might be addressed.

As the architect of racial disparity, racism shapes the vulnerability of communities. Socially vulnerable communities are less resilient in their ability to respond to and recover from natural and man‐made disasters when compared to resourced communities. This essay argues that racism exposes existing practices and structures in public administration that, along with the effects of COVID‐19, have led to disproportionate infection and death rates of Black people. Using the Centers for Disease Control's Social Vulnerability Index (SVI) authors analyze the ways Black bodies occupy the most vulnerable communities, making them bear the brunt of COVID‐19’s impact. Findings suggest that existing disparities exacerbate COVID‐19 outcomes for Black people. Targeted universalism is offered as an administrative framework to meet the needs of all people impacted by COVID‐19. This article is protected by copyright. All rights reserved.

COVID‐19 provides numerous opportunities for policymakers to consider matters of social equity in relation to the field of public health. Specifically, by reflecting on health disparities in relation to the disproportionate impact of COVID‐19 on minority and historically underserved populations, we can leverage a needed discourse on health outcomes for many communities. Grounded in the social determinants of health conceptual framework, this article explores the application of the disproportionate impact of COVID‐19 on vulnerable populations and communities of color for a discussion on strategies for minimizing health disparities. This article is protected by copyright. All rights reserved.

The COVID‐19 pandemic poses unprecedented challenges to public healthcare systems and demands intergovernmental coordination to cope with the resulting medical surge. This article analyzes the operation of Paired Assistance Programs (PAPs) in China, offering a timely comparative case for researchers and practitioners to examine when reflecting on the classic debate over the hierarchical versus network approaches to coordination in emergency management. PAPs highlight the importance of network management and necessity of institutionalizing mechanisms of governance to facilitate coordination within multilevel response systems. This article is protected by copyright. All rights reserved.

COVID‐19 is exposing a nexus between communities disproportionately suffering from underlying health conditions, policy‐reinforced disparities, and susceptibility to the disease. As the virus spreads, policy responses will need to shift from focusing on surveillance and mitigation to recovery and prevention. Local governments, with their histories of mutual aid and familiarity with local communities, are capable of meeting these challenges. However, funding must flow in a flexible enough fashion for local governments to tailor their efforts to preserve vital services and rebuild local economies. We argue in this article that the Community Development Block Grant (CDBG) and the Energy Efficiency and Conservation Block Grant (EECBG) programs are mechanisms for how to provide funds in a manner adaptable to local context while also focusing on increasing social equity. Administrators must emphasize the fourth pillar of public administration ‐‐ social equity ‐‐ in framing government responses to the pandemic.

Zhejiang Province achieved one of the best records in containing the COVID‐19 pandemic in China, what lessons can the world learn from it? What roles do community‐based organizations play in its success story? Based on more than 100 interviews during and after the outbreak in Zhejiang, this article provides a roadmap of how community‐based organizations were involved in the three distinct stages of Zhejiang's responses to COVID‐19. We recommend that public sector leaders strategically leverage the strengths of community‐based organizations in multiple stages of COVID‐19 responses; incentivize volunteers to participate in epidemic prevention and control; provide data infrastructure and digital tracking platforms; and build trust and long‐term capacity of community‐based organizations. This article is protected by copyright. All rights reserved.

The wide application of patient engagement and its associated benefits has increased across government, academic and pharmaceutical research. However, neither an identified standard practice for the process of engagement, nor utilization of common metrics to assess associated outcomes, exists. Parkinson's Foundation developed a patient engagement framework and metrics to assess engagement within the academic research and drug development sectors. This approach was developed over the course of several years through assessing the literature, acquiring feedback from researchers and people with Parkinson's disease and adapting practices to be relevant and generalizable across patient engagement projects. This framework includes the: 1) creation of a scope of work, 2) establishment of guiding principles, 3) selection and training of participants, 4) co‐determination of project metrics, 5) execution of the project and 6) dissemination of project findings. Parkinson's Foundation has also worked with academic, government and pharmaceutical stakeholders to identify metrics that assess both the quality of patient engagement and outcomes associated with patient engagement on projects. By improving patient engagement project methodologies and metrics, global clinical trials can have access to evidence‐based patient engagement practices to more efficiently capture the needs of, and potentially benefit, the patient community.

Background Processes of the patient and public involvement (PPI) in health research shifted quickly during 2020. Faced with large‐scale issues, such as the COVID‐19 pandemic, the need to adapt processes of PPI to uphold commitments to nurturing the practice of ‘nothing about us without us’ in research has been urgent and profound. We describe how processes of PPI in research on patient‐oriented methods of knowledge translation and implementation science were adapted by four teams in a Canadian setting. Methods As part of an ongoing quality improvement self‐study to enhance PPI within these teams, team members shared their experiences of PPI in the context of this pivotal year during interviews and facilitated discussions. Drawing on these experiences, we outline challenges and reflections for adapting processes of PPI in health research on methods in times of urgency, conflict and fast‐moving change. Discussion Our reflections offer insight into common issues encountered across teams that may be amplified during times of rapid change, including handling change and uncertainty, sustaining relationship‐building and hearing differing perspectives in processes of PPI. Conclusion These learnings present an opportunity to help others active in or planning patient‐oriented methods research to reflect on the changing nature of PPI and how to adapt PPI processes in response to turbulent situations in the future., Patient and Public Contributions The key reflections presented draw heavily from perspectives shared by eight patient and public partners in interviews and facilitated discussions (the conduct and analysis of data in the quality improvement self‐study).

This viewpoint reflects on basic aspects of American public health and politics that are making the COVID crisis response less effective than it might be. The performance of public service during a crisis depends as much on self‐reflectiveness and hope as on the achievement of measurable results. Anthony Fauci is offered as an exemplar of authentic public service, understood as “living within the truth.” This article is protected by copyright. All rights reserved.

The COVID‐19 pandemic has exposed fundamental flaws in the design of public administration in late democracies. While much writing to date focuses on the initial and vital responses to COVID‐19, the magnitude of this event also furthers insights into the risks of incomplete institutional designs and practices, such as the case of Brazil, an example of the administrative flaws in late democracies. This article is not a critique of responses to COVID‐19 per se, but an examination of these considering democratization processes that include state‐building and the need for another push in administrative and political reforms. Shortcomings in state‐building, which existed before COVID‐19, inflict heavy costs on society and, if left unaddressed, add to the costs of future disasters and unraveling of support for state and democratic institutions.

While practitioners often prefer centralized and hierarchical solutions in times of crisis, this study highlights the potential of reflexive and adaptive use of multiactor networks to cope with the extraordinary.Administrations that are prepared and that display a high quality in their network cooperation with other administrations and with civil society, on average, performed significantly better in their respective crises.Knowledge management and resource sharing-both among administrative units and with civil society-increase organizational ability to perform well in crisis situations.Administrations do best when lessons learned in crises are accessibly stored and when previously successful crisis networks can be quickly revitalized, thus allowing for intercrisis learning-documentation of best practices during crises-via smart or traditional forms of data storing and organizational memory keeping-further boost the performance of administrations during succeeding crises.In the early stages of a crisis, decision makers need to invest in organizational self-awareness of how challenges are mastered and how insights about optimal coping are best passed on.

This Viewpoint essay examines the service delivery responses of nonprofit organizations that offer homeless support services amid the COVID‐19 pandemic. Government mandates and severe human needs have forced nonprofits to adapt quickly. Literature reviews provide little information about how nonprofits should manage service continuity under pandemics. Data collected from websites and interviews with nonprofits executives provide an understanding of adaptions and innovations. The study uses a crisis response model: “Disruptions‐Ambiguities‐Innovations‐Challenges” (DAIC) to demonstrate how social service nonprofits are responding to challenges under COVID‐19. Lessons learned are useful for scholars and practitioners to understand ways nonprofits have remained agile and innovative. This article is protected by copyright. All rights reserved.

Responding to COVID‐19 presents unprecedented challenges for public sector practitioners and addressing those challenges requires knowledge about the problems public sector workers face. This Viewpoint essay argues that timely, up‐to‐date surveys of public sector workers are an essential tool for identifying problems, resolving bottlenecks and enabling public sector workers to operate effectively during and in response to the challenges posed by the global pandemic. This article presents the COVID‐19 Survey of Public Servants, which is currently rolled out in several countries by the Global Survey of Public Servants Consortium to assist governments in strategically compiling evidence to operate effectively during the COVID‐19 pandemic. This article is protected by copyright. All rights reserved.

At this point, little is known about local government responses to the economic crisis caused by COVID‐19. This crisis is happening on Main Streets around the nation. This article examines how some local governments are taking collective action in partnership with others as well as organizations at the local and regional levels. What is unique is that collective action is rare as it relates to traditional economic development practices, yet it is occurring and leading to the offerings of multi‐institutional grants and low interest loans. However, some newer supply‐ and demand‐side actions are the result of a lack of resources and need for expediency. Practitioners can learn about these collaborative economic development actions other governments are taking, and how these partnerships can stabilize their local economies. This article is protected by copyright. All rights reserved.

The COVID‐19 dramatically changed employment across sectors in 2020. This Viewpoint essay examines public sector labor relations during the pandemic and describes the impact bargaining process used to protect public employees. We draw on our own experience in impact bargaining negotiations and the public labor relations, conflict management, and civil service reform literatures to develop recommendations for public union labor leaders in times of crisis. We suggest that public unions have an important role in crisis management, but must act strategically in order to develop good working relationships with leadership and successfully negotiate employee protections in uncertain times. This article is protected by copyright. All rights reserved.

If the COVID‐19 pandemic has already taught us anything, it is that policymakers, experts and public managers need to be capable of interpreting comparative data on their government's performance in a meaningful way. Simultaneously, they are confronted with different data sources (and measurements) surrounding COVID‐19 without necessarily having the tools to assess these sources strategically. Due to the speed with which decisions are required and the different data sources, it can be challenging for any policymaker, expert or public manager to make sense of how COVID‐19 has an impact, especially from a comparative perspective. Starting from the question “How can we benchmark COVID‐19 performance data across countries?”, this article presents important indicators, measurements, and their strengths and weaknesses, and concludes with practical recommendations. These include a focus on measurement equivalence, systems thinking, spatial and temporal thinking, multilevel governance and multimethod designs. This article is protected by copyright. All rights reserved.

The explosion of the coronavirus onto the global stage has posed unprecedented challenges for governance. In the United States, the question of how best to respond to these challenges has fractured along intergovernmental lines. The federal government left most of the decisions to the states, and the states went in very different directions. Some of those decisions naturally flowed from the disease's emerging patterns. But to a surprising degree, there were systematic variations in the governors' decisions, and these variations were embedded in a subtle but growing pattern of differences among the states in a host of policy areas, ranging from decisions about embracing the Affordable Care Act to improving their infrastructure. These patterns raise fundamental questions about the role of the federal government's leadership in an issue that was truly national in scope, and whether such varied state reactions were in the public interest. The debate reinforces the emerging reality of an increasingly divided states of America. This article is protected by copyright. All rights reserved.

Through the lens of paradoxes, this essay understands China's COVID‐19 responses, focusing on normal and non‐normal governance, competing values, expertise and politics, centralization and decentralization, public and private, and technology and institution. Preliminary lessons are drawn regarding pandemic governance: embedding resilience into all aspects of governance; developing a public value framework for pandemic governance and improving individuals' ethical capacity; institutionalizing policy capacity on pandemic governance and requiring expertise in relevant positions; balancing centralized coordination and decentralized responses with a stable and ready‐to‐work commanding center; enabling businesses and nonprofits for pandemic governance but regulating them appropriately; and enacting technologies to revolutionize pandemic governance with proper institutional safeguards. This article is protected by copyright. All rights reserved.

The rate of expansion and the breadth of COVID-19 caught the world by surprise. From the perspective of nonprofit and public entities responsible for service provision, this pandemic is also unprecedented. The authors offer a RISE framework for navigating the fiscal effects of COVID-19 and rely on recent surveys to assess the response strategies of local governments and nonprofit organizations. They find that many nonprofits were hit fastest and hardest by the pandemic and that local governments are, essentially, trying to figure out their financial condition moving into the next budget cycle.

The COVID‐19 pandemic has created a crisis that is challenging national and local governments to innovate in their response to novel problems. Despite similarities to the challenges confronted in developed countries, Latin American governments face these problems amplified by structural obstacles such as social inequalities. These countries need to respond with capacities and resources often limited by spoils systems, as well as social and political polarization. In this context, we provide an overview of some innovative practices happening in Argentina, Brazil, Chile, Colombia, and México. In particular, we concentrate on some salient collaborative efforts in the region. To draw some lessons from these practices, we focus on the formal and informal institutions that facilitate or obstruct collaborations across jurisdictions. Moreover, we discuss our findings in terms of transaction costs for collaboration identified in these experiences.

In the United States and around the world, COVID‐19 represents a mass fatality incident, as there are more bodies than can be handled using existing resources. Although the management and disposition of bodies is distressing and heartrending, it is a task that local, state, and federal governments must plan for and respond to collaboratively with the private sector and faith‐based community. When mass fatalities are mismanaged, there are grave emotional and mental health consequences that can delay recovery and undermine community resilience. Using insights from one of the author's mass fatality management research during the 2010 Haiti earthquake, this article explores how mass fatalities are being managed in response to COVID‐19. Based on the researcher's findings a decade ago, it is apparent that many lessons have not been learnt. This article concludes by providing governments with practical lessons on how to manage mass fatalities to facilitate and promote community resilience.

The COVID‐19 pandemic is seen as the biggest crisis since World War II. What started out as a public health issue, has quickly morphed into a political, economic, and societal crisis of epic proportions. Administrative capacity is a major factor in determining whether societies will emerge from this unprecedented situation with resilience and optimism, or despair and disconnectedness, and whether trust in government will increase or decrease. Autonomous and competent public managers are key producers of such administrative capacity. This paper addresses those public managers, the unsung administrative heroes leading us through times of crisis from behind the scenes. Translating the state of the art in public administration literature, with a particular emphasis on publications in this journal, into accessible practitioner recommendations, it identifies three key competencies paramount to public managers in times of crisis: managing stakeholders, political masters, and collaborative networks. This article is protected by copyright. All rights reserved.

Governments are being put to the test as they struggle with the fast and wide spread of COVID‐19. This article discusses the compelling challenges posed by the COVID‐19 pandemic by examining how this wicked problem has been managed by the South Korean government with agile‐adaptive, transparent actions to mitigate the surge of COVID‐19. Unlike many Western countries, South Korea has been able to contain the spread of COVID‐19 without a harsh forced lockdown of the epicenter of the virus. This essay argues that an agile‐adaptive approach, a policy of transparency in communicating risk, and citizens’ voluntary cooperation are critical factors. It also suggests that the South Korean government learned costly lessons from the MERS failure of 2015. This essay suggests ways that Western countries can manage future wicked problems such as COVID‐19 without paying too much cost and maintaining quality of life in open and free societies.

The COVID-19 crisis has shown that European countries still remain poorly prepared for dealing and coping with health crises and for responding in a coordinated way to a severe influenza pandemic. Within the EU, the response to the COVID-19 virus has a striking diversity in its approach. By focusing on Belgium, France, Germany and Italy, four countries which represent different models of administrative systems in Europe, the analysis shows that major similarities and convergences have become apparent from a cross-countries perspective. Moreover, coping with the crises has been first and foremost an issue of the national states whereas the European voice has been weak. Hence, the countries' immediate responses has appeared to be Corona-nationalistic, which we label as Coronationalism. The paper shows to what extent the four countries adopted different crisis management strategies and which factors explain this variance, with a special focus on their institutional settings and administrative systems. This article is protected by copyright. All rights reserved. ispartof: Public Administration Review vol:80 issue:5 pages:765-773 ispartof: location:United States status: published

Background The majority of studies included in recent reviews of impact for public and patient involvement (PPI) in health research had a qualitative design. PPI in solely quantitative designs is underexplored, particularly its impact on statistical analysis. Statisticians in practice have a long history of working in both consultative (indirect) and collaborative (direct) roles in health research, yet their perspective on PPI in quantitative health research has never been explicitly examined. Objective To explore the potential and challenges of PPI from a statistical perspective at distinct stages of quantitative research, that is sampling, measurement and statistical analysis, distinguishing between indirect and direct PPI. Conclusions Statistical analysis is underpinned by having a representative sample, and a collaborative or direct approach to PPI may help achieve that by supporting access to and increasing participation of under‐represented groups in the population. Acknowledging and valuing the role of lay knowledge of the context in statistical analysis and in deciding what variables to measure may support collective learning and advance scientific understanding, as evidenced by the use of participatory modelling in other disciplines. A recurring issue for quantitative researchers, which reflects quantitative sampling methods, is the selection and required number of PPI contributors, and this requires further methodological development. Direct approaches to PPI in quantitative health research may potentially increase its impact, but the facilitation and partnership skills required may require further training for all stakeholders, including statisticians.

Background By integrating Youth–Adult Partnerships (Y-APs) in organizational decision making and programming in health-care settings, youth can be engaged in decisions that affect them in a way that draws on their unique skills and expertise. Despite challenges, Y-APs can have many benefits for youth and adults alike, as well as for the programmes and initiatives that they undertake together. Objective This article describes the development, implementation and success of a Y-AP initiative at the McCain Centre at the Centre for Addiction and Mental Health, a large urban hospital. Method The McCain Y-AP implementation model was developed based on the existing literature, guided by the team's progressive experience. The development and implementation procedure is described, with indicators of the model's success and recommendations for organizations interested integrating youth engagement. Results The McCain Y-AP has integrated youth into a wide range of mental health and substance use-related initiatives, including research projects, conferences and educational presentations. The model of youth engagement is flexible to include varying degrees of involvement, allowing youth to contribute in ways that fit their availability, interest and skills. Youth satisfaction has been strong and both the youth and adult partners have learned from the experience. Discussion Through the McCain Y-AP initiative, youth engagement has helped advance numerous initiatives in a variety of ways. Flexible engagement, multifaceted mentorship, reciprocal learning and authentic decision making have led to a successful partnership that has provided opportunities for growth for all those involved. Health-care organizations interested in engaging youth can learn from the McCain Y-AP experience to guide their engagement initiatives and maximize success.

In the COVID-19 crisis, society pins its hopes on science to play an authoritative role in reducing uncertainty and ambiguity. But is science up to the task? This is far from self-evident. The demands on science in times of crisis run counter to the values of good, normal science. Crisis science needs to be fast, univocal, personalized, and direct, while normal science is slow, contentious, collective, and sensitive to complexity. Science can only play its atypical role if it is staged in the public arena. Some patterns of staging stand out: personalization, visualization, and connection to lived experiences. So far, the staging of science has been successful, but it is fragile. The COVID-19 crisis shows the potential of well-staged forms of alliance between science and policy, but when the general assumption is that scientists will "solve" societal "problems," the staging of science has gone too far.

Contains fulltext : 219246.pdf (Author’s version postprint ) (Open Access) Contains fulltext : 219246pub.pdf (Publisher’s version ) (Closed access) Co‐production is blooming under Covid‐19, but can we expect it to last? Most likely, in post‐COVID‐19 times people and institutions will easily slip back into ‘business as usual’. This article addresses the relevance of co‐production under COVID‐19 and argues for the need of co‐production initiatives to persist well beyond the pandemic. The conditions that made co‐production emerge are likely to change, as emergency regulations and funds are abandoned and as the sense of urgency disappears. Areas of public life where there could be a more lasting effect are those where the basic conditions for successful co‐production are already in place and where only a push was necessary for co‐production to take off. These conditions include basic commitment, complementarity and supportive regulative frameworks, all of which can be sustained beyond the crisis with targeted choices and sufficient support. 02 juni 2020 5 p.

This paper addresses how the Norwegian government has handled the corona pandemic. Compared to many other countries Norway performs well in handling the crises and this must be understood in the context of competent politicians, a high trust society with a reliable and professional bureaucracy, a strong state, a good economic situation, a big welfare state and low density of the population. The government managed to control the pandemic rather quickly by adopting a suppression strategy, followed by a control strategy, based on a collaborative and pragmatic decision‐making style, successful communication with the public, a lot of resources and a high level of citizens' trust in government. The alleged success of the Norwegian case is about the relationship between crisis management capacity and legitimacy. Crisis management is most successful when it is able to combine democratic legitimacy with government capacity. This article is protected by copyright. All rights reserved.

Background Patient engagement in clinical practice guideline (CPG) development is recommended by multiple institutions and instruments measuring guideline quality. Approaches to engaging patients, however, vary between oversight organizations, quality tools and guideline developers. Objective We propose a ten-step framework outlining steps and options for patient engagement in guideline development with the goal of highlighting steps for patient engagement and methods by which this can be achieved. Discussion This framework provides a model for continuous patient engagement in CPGs by outlining ten steps of guideline development occurring at the levels of the developer/committee and the individual guideline project. At the developer level, patients can assist in topic nomination (step 1), topic prioritization (step 2) and guideline development group selection (step 3). Within specific guideline projects, patients’ opinions may be incorporated when framing the question (step 4), creating an analytic framework and research plan (step 5), conducting the systematic review and conclusion formation (step 6), development of recommendations (step 7) and dissemination and implementation (step 8). At the end of process, patients can again be engaged at the developer level by helping determine when guidelines need updating (step 9) and evaluating the developer's approach to patient engagement (step 10). Conclusions Patient engagement at each CPG development step has different purposes, mechanisms, advantages and disadvantages, and implications for resource utilization. This framework can serve as a resource for guideline developers desiring to increase patient engagement and reference for researchers investigating engagement methodology at different steps of the CPG lifecycle.

Canine glaucoma is a group of disorders that are generally associated with increased intraocular pressure (IOP) resulting in a characteristic optic neuropathy. Glaucoma is a leading cause of irreversible vision loss in dogs and may be either primary or secondary. Despite the growing spectrum of medical and surgical therapies, there is no cure, and many affected dogs go blind. Often eyes are enucleated because of painfully high, uncontrollable IOP. While progressive vision loss due to primary glaucoma is considered preventable in some humans, this is mostly not true for dogs. There is an urgent need for more effective, affordable treatment options. Because newly developed glaucoma medications are emerging at a very slow rate and may not be effective in dogs, work toward improving surgical options may be the most rewarding approach in the near term. This Viewpoint Article summarizes the discussions and recommended research strategies of both a Think Tank and a Consortium focused on the development of more effective therapies for canine glaucoma; both were organized and funded by the American College of Veterinary Ophthalmologists Vision for Animals Foundation (ACVO‐VAF). The recommendations consist of (a) better understanding of disease mechanisms, (b) early glaucoma diagnosis and disease staging, (c) optimization of IOP‐lowering medical treatment, (d) new surgical therapies to control IOP, and (e) novel treatment strategies, such as gene and stem cell therapies, neuroprotection, and neuroregeneration. In order to address these needs, increases in research funding specifically focused on canine glaucoma are necessary.

Conflicting health information is increasing in amount and visibility, as evidenced most recently by the controversy surrounding the risks and benefits of childhood vaccinations. The mechanisms through which conflicting information affects individuals are poorly understood; thus, we are unprepared to help people process conflicting information when making important health decisions. In this viewpoint article, we describe this problem, summarize insights from the existing literature on the prevalence and effects of conflicting health information, and identify important knowledge gaps. We propose a working definition of conflicting health information and describe a conceptual typology to guide future research in this area. The typology classifies conflicting information according to four fundamental dimensions: the substantive issue under conflict, the number of conflicting sources (multiplicity), the degree of evidence heterogeneity and the degree of temporal inconsistency.

UNLABELLED: Infants within neonatal intensive care units can receive multiple medically essential painful procedures per day. How they respond to these events, how best to alleviate the negative effects, and the long-term consequences for the infant are all significant questions that have yet to be fully answered. In recent years, several studies have examined cortical responses to noxious stimuli in the neonate through the use of near-infrared spectroscopy (NIRS) and electroencephalography (EEG). These investigations dispel any notion that the newborn infant does not process noxious stimuli at a cortical level and open the way for future research. In this Viewpoint Article, we review these studies and discuss key clinical challenges which may be elucidated with the use of these techniques. CONCLUSION: Simultaneously measuring the changes that are evoked in behaviour, physiology and the cortex following noxious events will provide the best approach to understanding the neonate's experience of pain.

Background Patient or service user involvement in mental health services (MHS) is a hallmark of the recovery approach. Objective In this viewpoint article, we review Tambuyzer et al. paper ‘Patient involvement in mental health care: One size does not fit all’ in order to express our opinion of their work. We also suggest specific actions that may enhance the implementation of patient involvement in MHS. Discussion We make three main points about Tambuyzer et al. model. First, the cultural dimension of patient involvement seems underemphasized in the model. Second, the model might be improved if the increasing role of communications technology in patient involvement is taken into consideration. Third, it is important to acknowledge that the process of patient involvement is not linear, and participation is not a homogeneous experience. Conclusions We suggest that the model be expanded and that further work be carried out on the implementation of patient involvement in MHS.

Contains fulltext : 170947.pdf (Publisher’s version ) (Open Access) Measuring clinicians' shared decision-making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries - yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient-reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an assumption of patient awareness of 'decision points' and (ii) an assumption that there is only one decision point in each healthcare consultation. We provide detailed examples of these threats and their impact on accurate assessment of SDM processes and outcomes, which may hamper efforts to introduce incentives for SDM implementation. We propose cognitive interviewing as a recommended method of involving patients in the design of PRMs in the field of SDM and provide a practical example of this approach.

There are more than 6000 rare diseases (defined as affecting

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care.

Patient‐reported outcome measures have received increasing attention with regard to ensuring quality improvement across the health service. However, there is a risk that people with disabilities and low literacy are systematically excluded from the development of these measures as well as their application in clinical practice. This editorial highlights some of these risks and the potential consequences of exclusion for these groups.

Shared decision making (SDM) is being increasingly challenged for promoting an innovative role model while adhering to an archaic approach to patient‐clinician communication, both in clinical practice and the research field. Too often, SDM has been studied at the individual level, which ignores the interpersonal system between patients and physicians. We aimed to encourage debate by reflecting on the essentials of SDM in terms of epistemology. We operationalized the SDM core concept of information exchange in terms of social systems theory. An epistemological analysis of the term information refers to its inherent process character. Exchange of information thereby becomes synonymous with social sense construction, indicating that, rather than just being a vehicle, the act of communication itself is the information. We plead for the adoption of existing dyadic analytical methods such as those offered by the interpersonal paradigm. Implications of an updated concept of information for the use of SDM‐evaluation methods, for SDM‐goal setting, and for clinical practice of SDM are described.

The English health-care system is moving towards increasing consumers' choice. Following economic thinking, it is assumed that such a policy will improve quality, enhance patient satisfaction and reduce health disparities. Indeed, the English health-care system has already built the necessary infrastructure to increase patients' choice. Before expanding the range of choices further, however, it is important that policy makers be aware of the limitations and hurdles that such a policy contains. Here, we highlight these limitations by drawing on the influential work of Kenneth Arrow, who has argued that we cannot treat the health-care market as if it was just another market, and the ideas of Herbert Simon, who questioned whether people had sufficient cognitive abilities to make effective choices in an information-rich environment. In the light of these two strands of thought, we review evidence suggesting that many older adults have low (health) literacy levels, raising concerns over their ability to obtain, process and understand medical-related information, with its increasing complexity, associated risks and emotional involvement. We also discuss recent findings from the United States highlighting the difficulties older users of health-care face with a wide range of prescription drug insurance plans from which to choose. Thus, learning from the experience of health-care systems where choice is abundant could help any health system interested in extending patients' choice to better target the domains where more choice could be beneficial and possibly avoid those where it could be detrimental.