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Husain L, Finlay T, Husain A, Wherton J, Hughes G, Greenhalgh T. Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised: a qualitative study. Br J Gen Pract 2024:BJGP.2023.0412. [PMID: 38242714 PMCID: PMC10947364 DOI: 10.3399/bjgp.2023.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. AIM To develop and test a set of personas to reflect the lived experiences and challenges that older people who are disadvantaged face when navigating remote and digital primary care services. DESIGN AND SETTING Qualitative study of digital disparities in NHS community health services offering video appointments. METHOD Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, and poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across all participant interviews, we produced personas and refined these following focus groups involving health professionals, patients, and advocates (n = 12). RESULTS Digital services create significant challenges for older patients with limited economic, social, and linguistic resources and low digital, health, or system literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency, and mistrust of services and providers. CONCLUSION Personas can illuminate the multiple and intersecting dimensions of disadvantage in patient populations who are marginalised and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.
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Affiliation(s)
- Laiba Husain
- The Healthcare Improvement Studies Institute research fellow
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Arqam Husain
- School of Medicine, Wayne State University, Detroit, MI, US
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- School of Business, University of Leicester, Leicester, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Jestico E, Taylor B, Finlay T, Schutz S. The ecomap: a tool for extending understanding in hermeneutic phenomenological research. Nurse Res 2023; 31:6-13. [PMID: 37559545 DOI: 10.7748/nr.2023.e1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Ecomaps are tools used in nursing practice to assess families' social support systems. Ecomaps have been used effectively in qualitative research but little attention has been given to their use as a tool in the methodological approach of hermeneutic phenomenology. AIM To demonstrate that the use of ecomaps is congruent with the Heideggerian philosophical foundations of hermeneutic phenomenology. DISCUSSION This article reflects on a study in which the researchers used ecomaps to explore how parents of children with cancer are supported with decision-making about their children's care. Exploration of the Heideggerian concepts of 'being in the world', 'being with' and 'temporality' prompted reflections about how constructing ecomaps furthers understanding of participants' unique contexts. Using an ecomap in an in-depth interview enabled interviewees to return to their experiences of being supported with decision-making; it also further developed the researcher's understanding of how each participant's experience was situated in their evolving relationships with others. CONCLUSION Constructing ecomaps in hermeneutic phenomenology is in tune with Heideggerian philosophical concepts. Ecomaps can open a door to participants' experiences, deepen the researcher's understanding and find further meaning in those experiences. IMPLICATIONS FOR PRACTICE Ecomaps are a useful way of shining a light on participants' experiences in hermeneutic phenomenological research. The article provides practical tips to optimise their use in future research.
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Affiliation(s)
- Elizabeth Jestico
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, England
| | | | - Teresa Finlay
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, England
| | - Susan Schutz
- Oxford School of Nursing and Midwifery, Oxford Brookes University, Oxford, England
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Wieringa S, Neves AL, Rushforth A, Ladds E, Husain L, Finlay T, Pope C, Greenhalgh T. Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care. BMJ Qual Saf 2023; 32:732-741. [PMID: 35260414 PMCID: PMC8927927 DOI: 10.1136/bmjqs-2021-013305] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/05/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians' experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care. SETTING AND SAMPLE UK primary healthcare. A subset of relevant data was drawn from five linked in-pandemic qualitative studies. The data set, on a total of 87 participants recruited via social media, patient groups and snowballing, comprised free text excerpts from narrative interviews (10 survivors of acute COVID-19), online focus groups (20 patients and 30 clinicians), contributions to a Delphi panel (12 clinicians) and fieldnotes from an online workshop (15 patients, clinicians and stakeholders). METHODS Data were uploaded onto NVivo. Coding was initially deductive and informed by WHO and Institute of Medicine frameworks of quality and safety. Further inductive analysis refined our theorisation using a wider range of theories-including those of risk, resilience, crisis management and social justice. RESULTS In the early weeks of the pandemic, patient safety was compromised by the driving logic of 'stay home' and 'protect the NHS', in which both patients and clinicians were encouraged to act in a way that helped reduce pressure on an overloaded system facing a novel pathogen with insufficient staff, tools, processes and systems. Furthermore, patients and clinicians observed a shift to a more transactional approach characterised by overuse of algorithms and decision support tools, limited empathy and lack of holistic assessment. CONCLUSION Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care's role as the 'risk sink' of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.
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Affiliation(s)
- Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ana Luisa Neves
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexander Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- CWTS, University of Leiden, Leiden, The Netherlands
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Leung T, Greenhalgh T, Hughes G, Finlay T, Wherton J. Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage. J Med Internet Res 2022; 24:e42358. [PMID: 36383632 PMCID: PMC9773024 DOI: 10.2196/42358] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.
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Affiliation(s)
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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5
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Greenhalgh T, Rosen R, Shaw SE, Byng R, Faulkner S, Finlay T, Grundy E, Husain L, Hughes G, Leone C, Moore L, Papoutsi C, Pope C, Rybczynska-Bunt S, Rushforth A, Wherton J, Wieringa S, Wood GW. Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics. Front Digit Health 2021; 3:726095. [PMID: 34713199 PMCID: PMC8521880 DOI: 10.3389/fdgth.2021.726095] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022] Open
Abstract
Establishing and running remote consultation services is challenging politically (interest groups may gain or lose), organizationally (remote consulting requires implementation work and new roles and workflows), economically (costs and benefits are unevenly distributed across the system), technically (excellent care needs dependable links and high-quality audio and images), relationally (interpersonal interactions are altered), and clinically (patients are unique, some examinations require contact, and clinicians have deeply-held habits, dispositions and norms). Many of these challenges have an under-examined ethical dimension. In this paper, we present a novel framework, Planning and Evaluating Remote Consultation Services (PERCS), built from a literature review and ongoing research. PERCS has 7 domains-the reason for consulting, the patient, the clinical relationship, the home and family, technologies, staff, the healthcare organization, and the wider system-and considers how these domains interact and evolve over time as a complex system. It focuses attention on the organization's digital maturity and digital inclusion efforts. We have found that both during and beyond the pandemic, policymakers envisaged an efficient, safe and accessible remote consultation service delivered through state-of-the art digital technologies and implemented via rational allocation criteria and quality standards. In contrast, our empirical data reveal that strategic decisions about establishing remote consultation services, allocation decisions for appointment type (phone, video, e-, face-to-face), and clinical decisions when consulting remotely are fraught with contradictions and tensions-for example, between demand management and patient choice-leading to both large- and small-scale ethical dilemmas for managers, support staff, and clinicians. These dilemmas cannot be resolved by standard operating procedures or algorithms. Rather, they must be managed by attending to here-and-now practicalities and emergent narratives, drawing on guiding principles applied with contextual judgement. We complement the PERCS framework with a set of principles for informing its application in practice, including education of professionals and patients.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Byng
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, United Kingdom
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Rybczynska-Bunt
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, United Kingdom
| | - Alexander Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
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6
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Vat LE, Finlay T, Robinson P, Barbareschi G, Boudes M, Diaz Ponce AM, Dinboeck M, Eichmann L, Ferrer E, Fruytier SE, Hey C, Broerse JEW, Schuitmaker‐Warnaar TJ. Evaluation of patient engagement in medicine development: A multi-stakeholder framework with metrics. Health Expect 2021; 24:491-506. [PMID: 33629470 PMCID: PMC8077089 DOI: 10.1111/hex.13191] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patient engagement is becoming more customary in medicine development. However, embedding it in organizational decision-making remains challenging, partly due to lack of agreement on its value and the means to evaluate it. The objective of this project was to develop a monitoring and evaluation framework, with metrics, to demonstrate impact and enhance learning. METHODS A consortium of five patient groups, 15 biopharmaceutical companies and two academic groups iteratively created a framework in a multi-phase participatory process, including analysis of its application in 24 cases. RESULTS The framework includes six components, with 87 metrics and 15 context factors distributed among (sub)components: (a) Input: expectations, preparations, resources, representativeness of stakeholders; (b) Activities/process: structure, management, interactions, satisfaction; (c) Learnings and changes; (d) Impacts: research relevance, study ethics and inclusiveness, study quality and efficiency, quality of evidence and uptake of products, empowerment, reputation and trust, embedding of patient engagement; (e) Context: policy, institutional, community, decision-making contextual factors. Case study findings show a wide variation in use of metrics. There is no 'one size fits all' set of metrics appropriate for every initiative or organization. Presented sample sets of metrics can be tailored to individual situations. CONCLUSION Introducing change into any process is best done when the value of that change is clear. This framework allows participants to select what metrics they value and assess to what extent patient engagement has contributed. PATIENT CONTRIBUTION Five patient groups were involved in all phases of the study (design, conduct, interpretation of data) and in writing the manuscript.
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Affiliation(s)
- Lidewij Eva Vat
- Athena InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Teresa Finlay
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | | | - Mathieu Boudes
- European Patients' Forum (EPF)Chaussée d’EtterbeekBrusselsBelgium
| | | | | | | | | | - Sevgi E. Fruytier
- Athena InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Erikainen S, Friesen P, Rand L, Jongsma K, Dunn M, Sorbie A, McCoy M, Bell J, Burgess M, Chen H, Chico V, Cunningham-Burley S, Darbyshire J, Dawson R, Evans A, Fahy N, Finlay T, Frith L, Goldenberg A, Hinton L, Hoppe N, Hughes N, Koenig B, Lignou S, McGowan M, Parker M, Prainsack B, Shabani M, Staunton C, Thompson R, Varnai K, Vayena E, Williams O, Williamson M, Chan S, Sheehan M. Public involvement in the governance of population-level biomedical research: unresolved questions and future directions. J Med Ethics 2020; 47:medethics-2020-106530. [PMID: 33023977 DOI: 10.1136/medethics-2020-106530] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 05/26/2023]
Abstract
Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance.
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Affiliation(s)
- Sonja Erikainen
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Phoebe Friesen
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Leah Rand
- Harvard Medical School and PORTAL, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karin Jongsma
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michael Dunn
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Annie Sorbie
- Mason Institute for Medicine, Life Sciences and the Law, Edinburgh Law School, University of Edinburgh, Edinburgh, UK
| | - Matthew McCoy
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman, Philadelphia, Pennsylvania, USA
| | - Jessica Bell
- HeLEX, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Burgess
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Haidan Chen
- School of Health Humanities, Peking University, Beijing, China
| | - Vicky Chico
- School of Law, University of Sheffield, Sheffield, UK
| | - Sarah Cunningham-Burley
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Julie Darbyshire
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Nick Fahy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Teresa Finlay
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Frith
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Aaron Goldenberg
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Nils Hoppe
- Centre for Ethics and Law in the Life Sciences, Leibniz University, Hannover, Germany
| | - Nigel Hughes
- Observational Health Data Analytics/Epidemiology, Janssen Research and Development, Raritan, New Jersey, USA
| | - Barbara Koenig
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Sapfo Lignou
- NeuroSec and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Michelle McGowan
- Ethics Center, Cincinnati Children's Hospital Medical Center Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Parker
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Mahsa Shabani
- Faculty of Criminology, Criminal Law and Social Law, University of Ghent, Ghent, Belgium
| | - Ciara Staunton
- Middlesex University School of Law, Middlesex University London, London, UK
| | - Rachel Thompson
- Research Institute for Ethics and Law, Swansea University, Swansea, UK
| | - Kinga Varnai
- OUH NHS FT and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Effy Vayena
- The Health Ethics and Policy Lab, University of Zurich, Zurich, Switzerland
| | - Oli Williams
- King's College London and THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Sarah Chan
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark Sheehan
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Vat LE, Finlay T, Jan Schuitmaker-Warnaar T, Fahy N, Robinson P, Boudes M, Diaz A, Ferrer E, Hivert V, Purman G, Kürzinger ML, Kroes RA, Hey C, Broerse JEW. Evaluating the "return on patient engagement initiatives" in medicines research and development: A literature review. Health Expect 2019; 23:5-18. [PMID: 31489988 PMCID: PMC6978865 DOI: 10.1111/hex.12951] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/02/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022] Open
Abstract
Background Showing how engagement adds value for all stakeholders can be an effective motivator for broader implementation of patient engagement. However, it is unclear what methods can best be used to evaluate patient engagement. This paper is focused on ways to evaluate patient engagement at three decision‐making points in the medicines research and development process: research priority setting, clinical trial design and early dialogues with regulators and health technology assessment bodies. Objective Our aim was to review the literature on monitoring and evaluation of patient engagement, with a focus on indicators and methods. Search strategy and inclusion criteria We undertook a scoping literature review using a systematic search, including academic and grey literature with a focus on evaluation approaches or outcomes associated with patient engagement. No date limits were applied other than a cut‐off of publications after July 2018. Data extraction and synthesis Data were extracted from 91 publications, coded and thematically analysed. Main results A total of 18 benefits and 5 costs of patient engagement were identified, mapped with 28 possible indicators for their evaluation. Several quantitative and qualitative methods were found for the evaluation of benefits and costs of patient engagement. Discussion and conclusions Currently available indicators and methods are of some use in measuring impact but are not sufficient to understand the pathway to impact, nor whether interaction between researchers and patients leads to change. We suggest that the impacts of patient engagement can best be determined not by applying single indicators, but a coherent set of measures.
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Affiliation(s)
- Lidewij Eva Vat
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Ana Diaz
- Alzheimer Europe, Luxembourg, Luxembourg
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Greenhalgh T, Hinton L, Finlay T, Macfarlane A, Fahy N, Clyde B, Chant A. Frameworks for supporting patient and public involvement in research: Systematic review and co-design pilot. Health Expect 2019; 22:785-801. [PMID: 31012259 PMCID: PMC6737756 DOI: 10.1111/hex.12888] [Citation(s) in RCA: 358] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/13/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Numerous frameworks for supporting, evaluating and reporting patient and public involvement in research exist. The literature is diverse and theoretically heterogeneous. Objectives To identify and synthesize published frameworks, consider whether and how these have been used, and apply design principles to improve usability. Search strategy Keyword search of six databases; hand search of eight journals; ancestry and snowball search; requests to experts. Inclusion criteria Published, systematic approaches (frameworks) designed to support, evaluate or report on patient or public involvement in health‐related research. Data extraction and synthesis Data were extracted on provenance; collaborators and sponsors; theoretical basis; lay input; intended user(s) and use(s); topics covered; examples of use; critiques; and updates. We used the Canadian Centre for Excellence on Partnerships with Patients and Public (CEPPP) evaluation tool and hermeneutic methodology to grade and synthesize the frameworks. In five co‐design workshops, we tested evidence‐based resources based on the review findings. Results Our final data set consisted of 65 frameworks, most of which scored highly on the CEPPP tool. They had different provenances, intended purposes, strengths and limitations. We grouped them into five categories: power‐focused; priority‐setting; study‐focused; report‐focused; and partnership‐focused. Frameworks were used mainly by the groups who developed them. The empirical component of our study generated a structured format and evidence‐based facilitator notes for a “build your own framework” co‐design workshop. Conclusion The plethora of frameworks combined with evidence of limited transferability suggests that a single, off‐the‐shelf framework may be less useful than a menu of evidence‐based resources which stakeholders can use to co‐design their own frameworks.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nick Fahy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Clyde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alan Chant
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Coathup V, Finlay T, Teare HJA, Kaye J, South M, Watt FE, Luqmani R. Making the most of the waiting room: Electronic patient engagement, a mixed methods study. Digit Health 2018; 4:2055207617751304. [PMID: 29942623 PMCID: PMC6001187 DOI: 10.1177/2055207617751304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 11/30/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore whether patients with musculoskeletal conditions would agree to use digital technologies to learn about research registries and make a decision about signing up whilst in the clinic waiting room. METHODS Patients were recruited from four hospital clinics across Oxfordshire. We used an explanatory mixed methods design with two sequential phases comprising an exploratory, cross-sectional questionnaire (n = 84), followed by focus group interviews (n = 8) to provide context for the findings from the questionnaire. Multivariate ordinal logistic regression models were used to explore relationships between patient preferences and characteristics. Thematic analysis was used to understand the reasons for patient preferences regarding digital technologies and research registries. RESULTS As participants' age increased, they were more likely to report a preference for face-to-face recruitment methods compared to those using digital technologies. Findings from the focus groups indicated this was primarily due to a fear of technology and physical limitations associated with a patient's condition. Patients also reported a preference for making a decision about signing up at a later date, which was attributed to patients feeling distracted whilst in the waiting room due to anxieties related to their upcoming appointment. CONCLUSIONS Many patients with musculoskeletal conditions in the UK may be interested in learning about opportunities to participate in research whilst using digital technologies within the waiting room. The results suggest the need for choice regarding the presentation and format of information and whether it can be accessed at a later date at home.
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Affiliation(s)
- Victoria Coathup
- Centre for Health, Law and Emerging Technologies, University of Oxford, UK
| | - Teresa Finlay
- Centre for Health, Law and Emerging Technologies, University of Oxford, UK
| | - Harriet JA Teare
- Centre for Health, Law and Emerging Technologies, University of Oxford, UK
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, University of Oxford, UK
| | - Matthew South
- Oxford Centre for Human Brain Activity (OHBA), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fiona E Watt
- Arthritis Research UK Centre for Osteoarthritis Pathogenesis, University of Oxford, UK
| | - Raashid Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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Coathup V, Hamakawa N, Finlay T, Bell J, Kaye J, Kato K. Participant-Centric Initiatives and Medical Research: Scoping Review Protocol. JMIR Res Protoc 2017; 6:e245. [PMID: 29233800 PMCID: PMC5743923 DOI: 10.2196/resprot.7407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/30/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background Significant advances in digital technologies have meant that health care data can be collected, stored, transferred, and analyzed for research purposes more easily than ever before. Participant-centric initiatives (PCI) are defined as “tools, programs, and projects that empower participants to engage in the research process” using digital technologies and have the potential to provide a number of benefits to both participants and researchers, including the promotion of public trust in medical research, improved quality of research, increased recruitment and retention, and improved health care delivery. Objective The main objective of this scoping review is to describe the extent and range of PCIs across the United Kingdom, United States, and Japan that are designed to facilitate medical research. Methods The methodological framework described by Levac et al will be applied to this scoping review. We will search electronic databases (MEDLINE, EMBASE, PsychINFO, Cumulative Index to Nursing, and Allied Health Literature and CiNii), grey literature sources, Internet search engines (Google and Bing), and hand search key journals and reference lists of relevant articles. All digital tools and programs will be eligible for inclusion if there is a description of key features and functions that fall within the parameters of a PCI. Only those that play a role in medical research will be included. Results Preliminary searches conducted in MEDLINE and EMBASE retrieved 1820 and 2322 results, respectively. The scoping review will be completed by January 2018. Conclusions The scoping review will be the first to map the extent and range of PCIs currently available across the United Kingdom, United States, and Japan, and will be the first review to contribute to a better understanding of what PCIs patients may benefit from. Researchers and practitioners will be able to use information in this review as a guide for patients and also as a guide for the development of future tools and programs. The results will be disseminated through a peer-reviewed publication and conference presentations.
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Affiliation(s)
- Victoria Coathup
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nao Hamakawa
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Teresa Finlay
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jessica Bell
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kazuto Kato
- Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Budin-Ljøsne I, Teare HJA, Kaye J, Beck S, Bentzen HB, Caenazzo L, Collett C, D'Abramo F, Felzmann H, Finlay T, Javaid MK, Jones E, Katić V, Simpson A, Mascalzoni D. Dynamic Consent: a potential solution to some of the challenges of modern biomedical research. BMC Med Ethics 2017; 18:4. [PMID: 28122615 PMCID: PMC5264333 DOI: 10.1186/s12910-016-0162-9] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/26/2016] [Indexed: 01/04/2023] Open
Abstract
Background Innovations in technology have contributed to rapid changes in the way that modern biomedical research is carried out. Researchers are increasingly required to endorse adaptive and flexible approaches to accommodate these innovations and comply with ethical, legal and regulatory requirements. This paper explores how Dynamic Consent may provide solutions to address challenges encountered when researchers invite individuals to participate in research and follow them up over time in a continuously changing environment. Methods An interdisciplinary workshop jointly organised by the University of Oxford and the COST Action CHIP ME gathered clinicians, researchers, ethicists, lawyers, research participants and patient representatives to discuss experiences of using Dynamic Consent, and how such use may facilitate the conduct of specific research tasks. The data collected during the workshop were analysed using a content analysis approach. Results Dynamic Consent can provide practical, sustainable and future-proof solutions to challenges related to participant recruitment, the attainment of informed consent, participant retention and consent management, and may bring economic efficiencies. Conclusions Dynamic Consent offers opportunities for ongoing communication between researchers and research participants that can positively impact research. Dynamic Consent supports inter-sector, cross-border approaches and large scale data-sharing. Whilst it is relatively easy to set up and maintain, its implementation will require that researchers re-consider their relationship with research participants and adopt new procedures.
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Affiliation(s)
- Isabelle Budin-Ljøsne
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318, Oslo, Norway. .,Norwegian Cancer Genomics Consortium, cancergenomics.no, Oslo, Norway.
| | - Harriet J A Teare
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Stephan Beck
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318, Oslo, Norway.,Norwegian Cancer Genomics Consortium, cancergenomics.no, Oslo, Norway.,Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
| | | | | | | | - Heike Felzmann
- Centre of Bioethical Research & Analysis, NUI Galway, Galway, Ireland
| | - Teresa Finlay
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Muhammad Kassim Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Erica Jones
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Višnja Katić
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Deborah Mascalzoni
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.,Centre for Biomedicine, EURAC, Bolzano, Italy
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13
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Jestico E, Finlay T. "A stressful and frightening experience"? Children's nurses' perceived readiness to care for children with cancer following pre-registration nurse education: A qualitative study. Nurse Educ Today 2017; 48:62-66. [PMID: 27710826 DOI: 10.1016/j.nedt.2016.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/09/2016] [Accepted: 09/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the UK children with cancer are cared for by children's nurses in a variety of settings, specialist and non-specialist. Whilst post-registration specialist education is available to some nurses, many nurses rely solely on pre-registration education to competently care for these children. This study explores whether nurses perceive that this adequately prepares them. OBJECTIVES To explore the extent to which qualified nurses perceive that pre-registration nurse education prepares them to care for children with cancer; to consider the implications for children's nursing pre-registration curricula. DESIGN A small-scale qualitative study was undertaken using an interpretivist approach. METHODS Semi-structured interviews were conducted with six qualified children's nurses in two clinical areas - a specialist children's cancer inpatient ward, and a general children's ward where inpatients included children with cancer. RESULTS Findings are discussed in relation to three emergent themes: Learning in Theory and Practice, Care of the Child and Family, and Resilience. Participants attached significance to the quantity and quality of practice experience. They reflected on barriers to specific and transferable theoretical learning and stressed the importance of integrating theory and practice. Understanding of family-centred care formed a significant part of their preparation. Preconceptions, communication with families and the emotional impact of this speciality were stressful. Improved pre-registration preparation may have developed participants' resilience. CONCLUSION The complexities of caring for children with cancer and their families require well-prepared nurses. Participants' perceptions of preparedness were influenced by aspects of pre-registration education. Their experiences suggest that curricula should be practice-focused and include a range of placements. Specialist theoretical content must be integrated with practice and transferability of knowledge and skills made explicit. Reflection and problem-based learning may foster coping mechanisms and resilience that will equip them to care for children with cancer.
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Affiliation(s)
- Elizabeth Jestico
- Oxford Brookes University, Jack Straw's Lane, Oxford, OX3 0FL, United Kingdom.
| | - Teresa Finlay
- Oxford Brookes University, Jack Straw's Lane, Oxford, OX3 0FL, United Kingdom.
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14
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Bell J, Ancillotti M, Coathup V, Coy S, Rigter T, Tatum T, Grewal J, Akcesme FB, Brkić J, Causevic-Ramosevac A, Milovanovic G, Nobile M, Pavlidis C, Finlay T, Kaye J. Challenges and opportunities for ELSI early career researchers. BMC Med Ethics 2016; 17:37. [PMID: 27390930 PMCID: PMC4939044 DOI: 10.1186/s12910-016-0121-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background Over the past 25 years, there has been growing recognition of the importance of studying the Ethical, Legal and Social Implications (ELSI) of genetic and genomic research. A large investment into ELSI research from the National Institutes of Health (NIH) Human Genomic Project budget in 1990 stimulated the growth of this emerging field; ELSI research has continued to develop and is starting to emerge as a field in its own right. The evolving subject matter of ELSI research continues to raise new research questions as well as prompt re-evaluation of earlier work and a growing number of scholars working in this area now identify themselves as ELSI scholars rather than with a particular discipline. Main text Due to the international and interdisciplinary nature of ELSI research, scholars can often find themselves isolated from disciplinary or regionally situated support structures. We conducted a workshop with Early Career Researchers (ECRs) in Oxford, UK, and this paper discusses some of the particular challenges that were highlighted. While ELSI ECRs may face many of the universal challenges faced by ECRs, we argue that a number of challenges are either unique or exacerbated in the case of ELSI ECRs and discuss some of the reasons as to why this may be the case. We identify some of the most pressing issues for ELSI ECRs as: interdisciplinary angst and expertise, isolation from traditional support structures, limited resources and funding opportunities, and uncertainty regarding how research contributions will be measured. We discuss the potential opportunity to use web 2.0 technologies to transform academic support structures and address some of the challenges faced by ELSI ECRs, by helping to facilitate mentoring and support, access to resources and new accreditation metrics. Conclusion As our field develops it is crucial for the ELSI community to continue looking forward to identify how emerging digital solutions can be used to facilitate the international and interdisciplinary research we perform, and to offer support for those embarking on, progressing through, and transitioning into an ELSI research career.
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Affiliation(s)
- Jessica Bell
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Mirko Ancillotti
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Victoria Coathup
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sarah Coy
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tessel Rigter
- VU University Medical Center, Dept. of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Travis Tatum
- Dynamics Lab - UCD Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - Jasjote Grewal
- CELLS - Centre for Ethics and Law in the Life Sciences, Leibniz Universitaet Hannover, Hannover, Germany
| | - Faruk Berat Akcesme
- Genetics and Bioengineering, International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jovana Brkić
- Centre for Developing Pharmaceutical and Biochemical Practice, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Anida Causevic-Ramosevac
- Bosnalijek Joint Stock Company, Pharmaceutical and Chemical Industry, Jukiceva 53, Sarajevo, Bosnia and Herzegovina
| | | | - Marianna Nobile
- Dipartimento di Giurisprudenza, Università degli Studi di Milano-Bicocca, Milan, Italy
| | | | - Teresa Finlay
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Jane Kaye
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Abstract
This article reports on an evaluation of a established pre-assessment clinic for children scheduled for day surgery. The results suggest that the pre-assessment clinic increases the efficiency and effectiveness of the admissions process for children. The authors discuss the results in detail and make recommendations for further research and nursing practice. They suggest, for example, that evaluative research can provide a framework for assessing new services.
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Affiliation(s)
- Jessica Higson
- Children's Day Care Ward, Oxford Radcliffe Hospitals NHS Trust.
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16
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Krikun G, Schatz F, Finlay T, Kadner S, Mesia A, Gerrets R, Lockwood CJ. Expression of angiopoietin-2 by human endometrial endothelial cells: regulation by hypoxia and inflammation. Biochem Biophys Res Commun 2000; 275:159-63. [PMID: 10944458 DOI: 10.1006/bbrc.2000.3277] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The functional endometrial layer receives the implanting blastocyst, but is sloughed off during menstruation. Angiogenesis regulates growth and repair of cycling human endometrium. While vascular endothelial growth factor initiates angiogenesis, the angiopoietins (Angs) acting via the Tie2 receptor, are key regulators of subsequent angiogenic steps. This study is the first to localize Ang-2 and Tie2 in human endometrium and to study Ang-2 regulation in cultured human endometrial endothelial cells (HEECs). Immunohistochemistry revealed that expression of Ang-2 and Tie2 was absent from the glands, low in stromal cells, and intense in the endothelial cells. In contrast, only weak expression of Ang-1 was detected. The phase of the menstrual cycle did not appear to affect the expression of Ang-2 or Tie2. In vitro studies were carried out utilizing isolated HEECs, the most relevant model for endometrial microvascular biology studies. Both hypoxia and phorbol-myristate-acetate enhanced Ang-2 mRNA levels in HEECs. These results suggest that Ang-2 plays a role in endometrial pathologies complicated by impaired blood flow and inflammation.
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Affiliation(s)
- G Krikun
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, 10016, USA
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Abstract
Following the UKCC's publication of The Scope of Professional Practice (Scope) in 1992, it commissioned a study to investigate the document's impact. As part of the study, a review of the literature relating to Scope and its application was undertaken. Given the association of expanded practice using Scope, with new nursing roles and titles, the British and American literature relating to clinical nurse specialists and advanced practice was included in the review. This was undertaken because of the considerable influence from America on developments in this area in Britain.
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Finlay T. Inflammatory bowel diseases. Nurs Times 1999; 95:50-3. [PMID: 10326521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- T Finlay
- Oxford Radcliffe Hospitals NHS Trust/Oxford Brookes University
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Finlay T. Making sense of ... parenteral nutrition in adult patients. Nurs Times 1997; 93:35-6. [PMID: 9016124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Parenteral nutrition is used to support people who have problems eating and drinking or who cannot absorb nutrients through their gut. This paper outlines the rationale for employing parenteral nutrition, the constituents of the solutions used and issues arising from the administration of the therapy.
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Affiliation(s)
- T Finlay
- Nightingale Institute, King's College, London
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Finlay T. Making sense of bowel preparation. Nurs Times 1996; 92:38-9. [PMID: 9000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Investigation and surgery of the gastrointestinal tract requires careful preparation to ensure success of the procedure and a recovery that is free from complications. Different parts of the tract require different preparation. This article outlines the principles of bowel preparation and examines some of the approaches and agents used.
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Affiliation(s)
- T Finlay
- Nightingale Institute, King's College, London
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Finlay T. Making sense of the care of patients with pancreatitis. Nurs Times 1996; 92:38-9. [PMID: 8826417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pancreatitis is a painful condition with potentially long-term after-effects. This paper describes the condition, its causes and the factors that need to be taken into account both in its immediate management and in terms of its impact on a person's lifestyle.
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Finlay T, Burns S. Professional development. Digestive tract cancers. Revision notes. Nurs Times 1995; 91:suppl 9-12; quiz suppl 13-4. [PMID: 9060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Finlay
- Nightingale Institute, King's College, London
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Hoskins IA, Katz J, Kadner SS, Young BK, Finlay T. Use of esterase inhibitors and zone electrophoresis to define bacterial esterases in amniotic fluid. Am J Obstet Gynecol 1992; 167:1579-82. [PMID: 1471669 DOI: 10.1016/0002-9378(92)91744-u] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of our study was to define further the role of bacterial esterases in amniotic fluid obtained from women with chorioamnionitis. STUDY DESIGN Amniotic fluid samples from 39 patients with chorioamnionitis were submitted for bacterial cultures and in vitro assay. Esterase inhibitors diisopropyl fluorophosphate and iodoacetic acid were added and the degree of inhibition calculated. These results were compared with the amniotic fluid culture results. Chi square analysis was performed to compare the results of the esterase assay and the inhibition assay between the uninfected and infected amniotic fluid samples. RESULTS Thirty-one patients had positive bacterial cultures, with 21 being infected with gram-negative organisms. All samples showed significant inhibition (range 55% to 82%) with diisopropyl fluorophosphate. There was partial inhibition with iodoacetic acid (range 10% to 30%) in the gram-negative samples but no inhibition in the gram-positive and uninfected samples. Six infected and two uninfected samples were analyzed by using zone electrophoresis with human plasma as a control. Minimal esterase motility was noted in the amniotic fluid samples as compared with that in plasma. CONCLUSION The esterases in amniotic fluid appeared to be of bacterial, not human, origin. Furthermore, different groups of bacteria appeared to produce different esterases in infected amniotic fluid.
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Affiliation(s)
- I A Hoskins
- Department of Obstetrics and Gynecology, New York University School of Medicine, NY 10016
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Finlay T. Care and companionship. Care study. Nurs Times 1990; 86:38-40. [PMID: 2255622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Finlay T. From text book to reality. Student nurse training needs in stoma care. Prof Nurse 1990; 5:617-22. [PMID: 2217215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Student nurses on a stoma care placement can feel out of their depth. Guidance from experienced nurses can help them acquire the practical and emotional skills required, and gain new confidence.
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