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Hamilton F, Sperti A. Incrementalism Revisited - The Contrasting Approaches of Italy, England and Wales and Northern Ireland Towards Legalization of Same-Sex Marriage. J Homosex 2024; 71:1782-1807. [PMID: 37099269 DOI: 10.1080/00918369.2023.2205543] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We contrast the approach taken by Italy and two constituent parts of the UK (England, Wales, and Northern Ireland) toward legalization of same-sex marriage. The incrementalist theory or "step-by-step approach" first advocated by Waaldijk in 2000 predicts that states will take prescribed steps en route to same-sex marriage. The core of incrementalism is that each step (decriminalization of same-sex sexual relations, equality of treatment for gays and lesbians, civil partnership, and finally same-sex marriage) is the logical premise for and in fact necessarily leads to the next step. Reflecting on 22 years of experience, we analyze whether this has been followed in practice in the jurisdictions under study. We demonstrate that although helpful in the early stages, incrementalism does not always reflect how legal changes have occurred and in Italy's case gives no answers as to when or if same-sex marriage will be legalized.
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McKinnon I, Keown P. The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism: commentary, McKinnon et al. Br J Psychiatry 2024; 224:180-181. [PMID: 38563223 DOI: 10.1192/bjp.2024.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Iain McKinnon
- Secure Services, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; and Population Health Sciences Institute, Newcastle University, UK
| | - Patrick Keown
- Psychiatric Rehabilitation, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK; and Translational and Clinical Research Institute, Newcastle University, UK
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Cavanagh DE, Northway R, Todd S. Annual health checks for people with intellectual disabilities: An exploration of experiences, follow-up and self-management of health conditions. J Appl Res Intellect Disabil 2024; 37:e13233. [PMID: 38561873 DOI: 10.1111/jar.13233] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this. METHODS People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken. RESULTS Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check. CONCLUSION A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.
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Affiliation(s)
- Dawn E Cavanagh
- Unit for Development in Intellectual and Developmental Disabilities, University of South Wales, Lower Glyntaff Campus, Pontypridd, South Wales, UK
| | - Ruth Northway
- Unit for Development in Intellectual and Developmental Disabilities, University of South Wales, Lower Glyntaff Campus, Pontypridd, South Wales, UK
| | - Stuart Todd
- Unit for Development in Intellectual and Developmental Disabilities, University of South Wales, Lower Glyntaff Campus, Pontypridd, South Wales, UK
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4
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Wise J. Smacking: Paediatricians call for ban in England and Northern Ireland. BMJ 2024; 385:q865. [PMID: 38636977 DOI: 10.1136/bmj.q865] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
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5
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Sloper E, Jezkova J, Thomas J, Dawson K, Halstead J, Gardner J, Burke K, Oruganti S, Calvert J, Evans J, Anderson S, Corrin S, Pottinger C, Murch O. Wales Infants' and childreN's Genome Service (WINGS): providing rapid genetic diagnoses for unwell children. Arch Dis Child 2024; 109:409-413. [PMID: 38320813 DOI: 10.1136/archdischild-2023-326579] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION This study reviews the first 3 years of delivery of the first National Health Service (NHS)-commissioned trio rapid whole genome sequencing (rWGS) service for acutely unwell infants and children in Wales. METHODS Demographic and phenotypic data were prospectively collected as patients and their families were enrolled in the Wales Infants' and childreN's Genome Service (WINGS). These data were reviewed alongside trio rWGS results. RESULTS From April 2020 to March 2023, 82 families underwent WINGS, with a diagnostic yield of 34.1%. The highest diagnostic yields were noted in skeletal dysplasias, neurological or metabolic phenotypes. Mean time to reporting was 9 days. CONCLUSION This study demonstrates that trio rWGS is having a positive impact on the care of acutely unwell infants and children in an NHS setting. In particular, the study shows that rWGS can be applied in an NHS setting, achieving a diagnostic yield comparable with the previously published diagnostic yields achieved in research settings, while also helping to improve patient care and management.
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Affiliation(s)
- Emily Sloper
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Jana Jezkova
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Joanne Thomas
- Faculty of Life Science and Education, University of South Wales, Pontypridd, UK
| | | | - Joseph Halstead
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Jennifer Gardner
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Katherine Burke
- Neonatal Intensive Care Unit, Singleton Hospital, Swansea, UK
| | - Sivakumar Oruganti
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jennifer Calvert
- Neonatal Intensive Care Unit, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Jennifer Evans
- Child Health, Children's Hospital for Wales, Cardiff, UK
| | - Sarah Anderson
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sian Corrin
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Caroline Pottinger
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Oliver Murch
- All Wales Medical Genomics Service, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
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6
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Iacobucci G. Abortion: MPs propose decriminalisation in England and Wales. BMJ 2024; 385:q831. [PMID: 38594030 DOI: 10.1136/bmj.q831] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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7
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Iacobucci G. Hospital doctors in Wales to enter pay negotiations with government. BMJ 2024; 385:q836. [PMID: 38594033 DOI: 10.1136/bmj.q836] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Griffiths C. The development and implementation of the district nursing Welsh Levels of Care Tool. Br J Community Nurs 2024; 29:171-176. [PMID: 38564444 DOI: 10.12968/bjcn.2024.29.4.171] [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] [Indexed: 04/04/2024]
Abstract
District nurses provide a vital service to individuals and their families and carers in the community. With increasing complexity of care and changes in the needs of the UK population, developing evidence-based workforce and workload tools which are fit for purpose is essential. This article describes the development, piloting and implementation of the District Nursing Welsh Levels of Care (DN WLoC), acuity and dependency tool which has been designed to be used alongside nurses professional judgment, to evidence the acuity and dependency of patients, and to help inform decisions of nurse staffing requirements in district nursing services. The initial pilot successfully achieved its objective and demonstrated that the draft DN WLoC tool is applicable in practice by district nurses across Wales, with limited but positive findings in the reliability and validity of the WLoC tool when applied in clinical practice.
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Affiliation(s)
- Ceri Griffiths
- Interim Assistant Director of Nursing, Hywel Dda University Health Board, Carmarthen, Wales
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9
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Francis LJ, Sailer AB, Payne VJ, McKenna U. Engaging the AQ10 to Predict Professional Burnout or Poor Work-Related Psychological Wellbeing Among Anglican Clergy in Wales. J Relig Health 2024; 63:1661-1676. [PMID: 38285247 DOI: 10.1007/s10943-024-02006-7] [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] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
The ten-item Autism Spectrum Quotient (AQ10) is a self-report instrument originally designed to identify referrals for professional diagnosis for Autism Spectrum Disorders (ASD). Recent studies suggest that this instrument may also be tapping more generalised affective disorders. Working with this interpretation, this study examines the predictive power of the AQ10 to account for additional variance, after personal and personality factors have been taken into account, on the two scales of the Francis Burnout Inventory. Data provided by 220 Anglican clergy serving in Wales demonstrated that 8.6% of the participants recorded six or more red flags on the AQ10 (and so qualified for referral for specialist diagnostic assessment) and that higher scores on the AQ10 are associated with significantly lower levels of satisfaction in ministry and with significantly higher levels of emotional exhaustion in ministry. These data suggest that screening with the AQ10 may be helpful in identifying clergy vulnerable to professional burnout and to poor work-related psychological wellbeing, in addition to its primary purpose of screening for ASD.
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Affiliation(s)
- Leslie J Francis
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK.
- World Religions and Education Research Unit, Bishop Grosseteste University, Lincoln, UK.
| | - Alison B Sailer
- College of Life and Health Sciences, Brunel University, London, UK
| | - V John Payne
- Department of Psychology, Wrexham Glyndwr University, Wrexham, UK
| | - Ursula McKenna
- World Religions and Education Research Unit, Bishop Grosseteste University, Lincoln, UK
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10
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DeVito NJ, Morley J, Goldacre B. Barriers and best practices to improving clinical trials transparency at UK public research institutions: A qualitative interview study. Health Policy 2024; 142:104991. [PMID: 38417375 DOI: 10.1016/j.healthpol.2024.104991] [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] [Received: 03/13/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Since 2017, the UK government has made concerted efforts to ensure the dissemination of clinical trials conducted at public research institutions. This study aims to understand how stakeholders within these institutions responded to these pressures and modified internal policies and processes while identifying best practices and barriers to improved transparency practice. METHODS Research governance and trial management staff from UK public research institutions (i.e., Universities and NHS Trusts) in England, Scotland and Wales participated in semi-structured interviews. Interviews were analysed using thematic analysis, aided by the framework method. RESULTS Between November 2020 and July 2021, 14 individual participants were recruited from 11 different institutions. They worked in research governance, administration, and management. Almost universally, new policies and procedures have been established to ensure investigators are aware of, and supported in, fulfilling their transparency commitments, however challenges remain. Trials of medicinal products, as the most closely regulated research, consequently received the most attention. National professional networks aid in sharing knowledge and best practice within this community. CONCLUSIONS Investment in the institutional governance of transparency is essential to achieving optimal transparency practices. Universities and hospitals share responsibility for ensuring research is performed and reported to regulatory standards. Facing political pressure, public research institutions in the UK have made efforts to improve their transparency practice which can provide key insights for similar efforts elsewhere.
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Affiliation(s)
- Nicholas J DeVito
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom.
| | - Jessica Morley
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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Allen D. Why is hospital discharge so difficult? Reconsidering patient trajectories in theory and practice: Insights from an ethnographic study of transitions in hip fracture care. Soc Sci Med 2024; 347:116769. [PMID: 38522231 DOI: 10.1016/j.socscimed.2024.116769] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
This paper combines translational mobilisation theory and assemblage thinking to elaborate the patient trajectory concept. Deploying ethnographic research on transitions in hip fracture care in Wales (2014-2016), it describes and explains the structures and logics that condition transition interfaces, how transition infrastructures enact patients and with what effects. Comparative analysis of transition in three distinctive assemblages offers new insights into the challenges of hospital discharge and opportunities for research and improvement.
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Affiliation(s)
- Davina Allen
- School of Healthcare Sciences Cardiff University, United Kingdom.
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12
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Schilling M, Golding M, Jones BP, Mansfield KL, Gandy S, Medlock J, Johnson N. Sequences Related to Chimay Rhabdovirus Are Widely Distributed in Ixodes ricinus Ticks across England and Wales. Viruses 2024; 16:504. [PMID: 38675847 DOI: 10.3390/v16040504] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Ticks are the main arthropod vector of pathogens to humans and livestock in the British Isles. Despite their role as a vector of disease, many aspects of tick biology, ecology, and microbial association are poorly understood. To address this, we investigated the composition of the microbiome of adult and nymphal Ixodes ricinus ticks. The ticks were collected on a dairy farm in Southwest England and RNA extracted for whole genome sequencing. Sequences were detected from a range of microorganisms, particularly tick-associated viruses, bacteria, and nematodes. A majority of the viruses were attributed to phlebo-like and nairo-like virus groups, demonstrating a high degree of homology with the sequences present in I. ricinus from mainland Europe. A virus sharing a high sequence identity with Chimay rhabdovirus, previously identified in ticks from Belgium, was detected. Further investigations of I. ricinus ticks collected from additional sites in England and Wales also identified Chimay rhabdovirus viral RNA with varying prevalence in all tick populations. This suggests that Chimay rhabdovirus has a wide distribution and highlights the need for an extended exploration of the tick microbiome in the United Kingdom (UK).
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Affiliation(s)
- Mirjam Schilling
- Vector-Borne Diseases Workgroup, Animal and Plant Health Agency, Woodham Lane, Addlestone KT15 3NB, UK
| | - Megan Golding
- Rabies and Viral Zoonoses Workgroup, Animal and Plant Health Agency, Woodham Lane, Addlestone KT15 3NB, UK
| | - Ben P Jones
- Vector-Borne Diseases Workgroup, Animal and Plant Health Agency, Woodham Lane, Addlestone KT15 3NB, UK
| | - Karen L Mansfield
- Vector-Borne Diseases Workgroup, Animal and Plant Health Agency, Woodham Lane, Addlestone KT15 3NB, UK
| | - Sara Gandy
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Jolyon Medlock
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Nicholas Johnson
- Vector-Borne Diseases Workgroup, Animal and Plant Health Agency, Woodham Lane, Addlestone KT15 3NB, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Lang JC, Kura K, Garba SM, Elbasha EH, Chen YH. Comparison of a static cohort model and dynamic transmission model for respiratory syncytial virus intervention programs for infants in England and Wales. Vaccine 2024; 42:1918-1927. [PMID: 38368224 DOI: 10.1016/j.vaccine.2024.02.004] [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] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND A recent study comparing results of multiple cost-effectiveness analyses (CEAs) in a hypothetical population found that monoclonal antibody (mAb) immunoprophylaxis for respiratory syncytial virus (RSV) in infants averted fewer medically attended cases when estimated using dynamic transmission models (DTMs) versus static cohort models (SCMs). We aimed to investigate whether model calibration or parameterization could be the primary driver of inconsistencies between SCM and DTM predictions. METHODS A recently published DTM evaluating the CEA of infant mAb immunoprophylaxis in England and Wales (EW) was selected as the reference model. We adapted our previously published SCM for US infants to EW by utilizing the same data sources used by the DTM. Both models parameterized mAb efficacy from a randomized clinical trial (RCT) that estimated an average efficacy of 74.5% against all medically attended RSV episodes and 62.1% against RSV hospitalizations. To align model assumptions, we modified the SCM to incorporate waning efficacy. Since the estimated indirect effects from the DTM were small (i.e., approximately 100-fold smaller in magnitude than direct effects), we hypothesized that alignment of model parameters should result in alignment of model predictions. Outputs for model comparison comprised averted hospitalizations and averted GP visits, estimated for seasonal (S) and seasonal-with-catchup (SC) immunization strategies. RESULTS When we aligned the SCM intervention parameters to DTM intervention parameters, significantly more averted hospitalizations were predicted by the SCM (S: 32.3%; SC: 51.3%) than the DTM (S: 17.8%; SC: 28.6%). The SCM most closely replicated the DTM results when the initial efficacy of the mAb intervention was 62.1%, leading to an average efficacy of 39.3%. Under this parameterization the SCM predicted 17.4% (S) and 27.7% (SC) averted hospitalizations. Results were similar for averted GP visits. CONCLUSIONS Parameterization of the RSV mAb intervention efficacy is a plausible primary driver of differences between SCM versus DTM model predictions.
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Affiliation(s)
- John C Lang
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck Canada Inc., Kirkland, QC, Canada
| | - Klodeta Kura
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, MSD (UK) Limited, London, United Kingdom.
| | - Salisu M Garba
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Elamin H Elbasha
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, NJ, USA
| | - Yao-Hsuan Chen
- Health Economic Decision Sciences, Biostatistics and Research Decision Sciences, MSD (UK) Limited, London, United Kingdom
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Rowley F, Cottrell S, Howard C, Meredith N, Song J, Barrasa A, Johnson C. Use of invitations and reminders are associated with higher levels of Herpes zoster (shingles) vaccination uptake. A cross-sectional survey of general practices in Wales, and ecological analysis of uptake data, 2022. Vaccine 2024; 42:1682-1689. [PMID: 38360478 DOI: 10.1016/j.vaccine.2024.02.034] [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] [Received: 11/17/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
In 2013, shingles vaccination was introduced in Wales as a routine immunisation programme for older adults. Invitation for this vaccination has historically been recommended but not mandated by vaccination policy. We surveyed general practices to investigate if invitations and reminders are associated with higher uptake of shingles vaccine. Using data from general practices, we calculated practice-level shingles vaccine uptake between 01/07/2021 and 31/06/2022 for registered patients aged 70-84 years. We distributed an online survey via email to all general practices in Wales on their use of vaccination invitations and reminders, method of invitations, and characteristics of their vaccination delivery. We used linear regression to calculate coefficients and 95 %CI to measure associations between invitations and vaccine uptake, adjusting for key demographics, with a multi-level component to account for similarities between general practices within the same health board. Survey response rate was 37 % (143/384). Median vaccine uptake for responding general practices was 57 % (IQR 50-68 %) compared to 58 % (IQR 48-68 %) nationally. General practices inviting all eligible patients (n = 95) had a 9 % (95 %CI 6-13 %) higher vaccination uptake compared to those inviting none or some (n = 48, p < 0.001). Of practices sending invitations, those who reminded all patients (n = 42) had a 6 % (95 %CI 1-11 %, p = 0.02) higher uptake compared to those that reminded none (n = 30). Practice size was associated with higher uptake, with small practices (n = 11, p = 0.02) having coverage 9 % (95 %CI 2-16 %) higher compared to the reference population (medium-sized practices, n = 78). General practices inviting and reminding all eligible patients for shingles vaccination have a higher uptake compared to those inviting and reminding only some or none. From September 2023, shingles vaccination policy in Wales has been updated to explicitly mandate effective universal call and recall mechanisms in general practices.
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Affiliation(s)
- Frances Rowley
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK; UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency (UKHSA), 61 Colindale Avenue, London NW9 5EQ, England, UK.
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Ceriann Howard
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Nicola Meredith
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Jiao Song
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Alicia Barrasa
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency (UKHSA), 61 Colindale Avenue, London NW9 5EQ, England, UK.
| | - Christopher Johnson
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
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Rimmer A. Consultants and SAS doctors in Wales vote to strike. BMJ 2024; 384:q558. [PMID: 38443099 DOI: 10.1136/bmj.q558] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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16
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Securing a lobbying win on XL bully neutering. Vet Rec 2024; 194:277. [PMID: 38551270 DOI: 10.1002/vetr.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Following the introduction of bans on XL bully dogs across Great Britain, and the announcement of restrictions on the breed type in Northern Ireland, we welcomed the extension of the deadlines for neutering XL bullies in England, Wales and Scotland thanks to our campaigning alongside other organisations in the Dog Control Coalition.
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Clifford D. Gender inequalities in unpaid public work: Retention, stratification and segmentation in the volunteer leadership of charities in England and Wales. Br J Sociol 2024; 75:143-167. [PMID: 38141163 DOI: 10.1111/1468-4446.13070] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/15/2023] [Accepted: 12/07/2023] [Indexed: 12/25/2023]
Abstract
While gender inequalities in employment (paid public work) and domestic and reproductive labour (unpaid private work) are a prominent focus within the sociological literature, gender inequalities in volunteering (unpaid public work) have received much less scholarly attention. We analyse a unique longitudinal dataset of volunteer leaders, that follows through time every individual to have served as a board member (trustee) for a charity in England and Wales between 2010 and 2023, to make three foundational contributions to our understanding of gender inequalities in unpaid public work. First, the salience of vertical gender stratification and horizontal gender segmentation in trusteeship shows that gendered inequalities in work extend to public work in general-encompassing unpaid public work, and not only paid public work. In terms of gender segmentation, we find that women are over-represented as trustees in a small number of fields of charitable activity but under-represented across the majority of fields. In terms of gender stratification, we find that women are under-represented on the boards of the largest charities; under-represented as chairs of trustee boards; and particularly under-represented as chairs of the largest charities. Second, the dynamics underlying gendered differences in unpaid public work, which show higher rates of resignation for women trustees, resonate with research on paid employment which emphasises the importance of attrition to an understanding of how gendered inequalities in work are reproduced. This means that increasing the retention of women, not only the recruitment of women, becomes central to the policy agenda. Third, we show that there has been a decline in gender stratification and gender segmentation in trusteeship since 2010. This decline over time in gendered inequalities in unpaid public work provides an interesting counterpoint to influential research documenting a 'stall' in the reduction of gendered inequalities in paid employment.
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Affiliation(s)
- David Clifford
- Department of Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
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Tromans S, Robinson G, Gabrielsson A, Bassett P, Sawhney I, Triantafyllopoulou P, Hassiotis A, Shankar R. The views of psychiatrists on proposed changes to the England and Wales Mental Health Act 1983 legislation for people with intellectual disability: A national study. Int J Soc Psychiatry 2024; 70:388-401. [PMID: 38001564 PMCID: PMC10913297 DOI: 10.1177/00207640231212112] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND The Draft Mental Health Bill proposes removal of both intellectual disability and autism from Section 3 of the Mental Health Act for England and Wales (MHA). This would lead to people with intellectual disability (PwID) and/or autism could not be detained beyond 28 days, in the absence of diagnosed co-occurring mental illness. AIM To obtain views of psychiatrists working with PwID in England and Wales regarding the proposed MHA changes. This study focusses specifically on the impact on PwID. METHODS A cross-sectional online mixed methodology survey of Likert and free-text response questions was developed, to ascertain perceptions of proposed legislative changes to the MHA. A non-discriminatory exponential snowballing technique leading to non-probability sampling was used to disseminate the survey. Quantitative data was analysed using descriptive statistics, Mann-Whitney and Fisher's exact tests. Thematic analysis was conducted on free text responses. RESULTS A total of 82 psychiatrists (33%) from approximately 250 eligible completed the survey. Nearly two-thirds (64%) reported good awareness of the proposed changes, with over half (55%) reporting disagreement with the changes. Psychiatrists working in inpatient settings for PwID reported increased awareness of the changes, less agreement with the reforms, and increased expectations of the reforms having negative unintended consequences, compared to their peers working exclusively in the community. Consultants reported greater disagreement with the changes compared to their non-consultant peers. Qualitative analysis identified five main themes: impact on diagnosis and treatment, seeking alternative options, introducing inequities, resources, and meeting holistic care goals through the Care, Education and Treatment Reviews (CETR) process. CONCLUSION Psychiatrists working with PwID report widespread disagreement with the proposed changes to the MHA for PwID, with greater levels of disagreement among those working in inpatient services. Caution with respect to the proposed changes, and monitoring of the impact of the changes if implemented, is advised.
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Affiliation(s)
- Samuel Tromans
- Department of Population Health Sciences, University of Leicester, UK
- Adult Learning Disability Service, Leicestershire Partnership NHS Trust, UK
| | - Gemma Robinson
- Forensic Community Learning Disability Team, Southern Health NHS Foundation Trust, Calmore, UK
| | | | | | | | | | | | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
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Concerns raised around Wales' 'scrapes' plan. Vet Rec 2024; 194:138. [PMID: 38362986 DOI: 10.1002/vetr.3965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
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20
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Chess J, Roberts G, McLaughlin L, Williams G, Noyes J. What are the factors that determine treatment choices in patients with kidney failure: a retrospective cohort study using data linkage of routinely collected data in Wales. BMJ Open 2024; 14:e082386. [PMID: 38355196 PMCID: PMC10868286 DOI: 10.1136/bmjopen-2023-082386] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To identify the factors that determine treatment choices following pre-dialysis education. DESIGN Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data. SETTING Secondary care National Health Service Wales healthcare system. PARTICIPANTS All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018. MAIN OUTCOME MEASURES Patient choice of dialysis modality and any kidney replacement therapy started. RESULTS Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were 'undecided'. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis. CONCLUSION There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.
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Affiliation(s)
- James Chess
- Renal Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | | | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Gail Williams
- Welsh Kidney Network (Retired), NHS Wales Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Iacobucci G. Junior doctors in Wales announce new strike dates. BMJ 2024; 384:q311. [PMID: 38320780 DOI: 10.1136/bmj.q311] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
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22
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Antonacci G, Williams A, Smith J, Green L. Study of Whole blood in Frontline Trauma (SWiFT): implementation study protocol. BMJ Open 2024; 14:e078953. [PMID: 38316586 DOI: 10.1136/bmjopen-2023-078953] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Uncontrolled bleeding is a major cause of death for patients with major trauma. Current transfusion practices vary, and there is uncertainty about the optimal strategy. Whole blood (WB) transfusion, which contains all components in one bag, is considered potentially advantageous, particularly for resuscitating patients with major bleeding in the prehospital setting. It could potentially improve survival, reduce donor risk and simplify the processes of delivering blood transfusions outside hospitals. However, the evidence supporting the effectiveness and safety of WB compared with the standard separate blood component therapy is limited. A multicentre randomised controlled trial will be conducted, alongside an implementation study, to assess the efficacy, cost-effectiveness and implementation of prehospital WB transfusion in the prehospital environment. The implementation study will focus on evaluating the acceptability and integration of the intervention into clinical settings and on addressing broader contextual factors that may influence its success or failure. METHODS AND ANALYSIS A type 1 effectiveness-implementation hybrid design will be employed. The implementation study will use qualitative methods, encompassing comprehensive interviews and focus groups with operational staff, patients and blood donor representatives. Staff will be purposefully selected to ensure a wide range of perspectives based on their professional background and involvement in the WB pathway. The study design includes: (1) initial assessment of current practice and processes in the WB pathway; (2) qualitative interviews with up to 40 operational staff and (3) five focus groups with staff and donor representatives. Data analysis will be guided by the theoretical lenses of the Normalisation Process Theory and the Theoretical Framework of Acceptability. ETHICS AND DISSEMINATION The study was prospectively registered and approved by the South Central-Oxford C Research Ethics Committee and the Health Research Authority and Health and Care Research Wales. The results will be published in peer-reviewed journals and provided to all relevant stakeholders. TRIAL REGISTRATION NUMBER ISRCTN23657907; EudraCT: 2021-006876-18; IRAS Number: 300414; REC: 22/SC/0072.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Allison Williams
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Jason Smith
- Department of Emergency, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Laura Green
- NHS Blood & Transplant and Barts Health NHS Trust, London, UK
- Queen Mary University of London Blizard Institute, London, UK
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Dosis A, Husnoo N, Roney S, Hendry C, Bonner C, Kronberga M, Moran E, Ninh V, Jha A, Grey T, Saha AK. A census of general surgery consultants in England and Wales: implications for the current and future surgical workforce. Ann R Coll Surg Engl 2024; 106:150-159. [PMID: 37489525 PMCID: PMC10830335 DOI: 10.1308/rcsann.2023.0018] [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: 03/01/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION This study aimed to describe the composition of the current general surgical consultant body in England and Wales and quantify levels of inequality within it as well as describe future workforce challenges. METHODS This is an observational study of all general surgical departments in England and Wales. Consultant general surgeons were identified and data regarding their gender, country of undergraduate medical education, subspecialty and private practice were recorded. RESULTS Of the 2,682 consultant general surgeons in England and Wales identified for this study, just 17% are women, with gender inequality most marked in university teaching hospitals and among certain subspecialties. Almost 40% of consultants did not obtain their primary undergraduate degree in the United Kingdom and there are considerably fewer surgeons who studied abroad in university teaching hospitals. Over 40% of current general surgical consultants have been qualified for more than three decades and there is no equivalent sized group of younger consultants. CONCLUSIONS There remains considerable gender and racial inequality in the consultant general surgical workforce, with pockets of a lack of diversity within university or teaching hospital surgical departments and some subspecialties. The proportion of surgeons in their fourth decade of clinical practice represents the largest group of current practising consultants, which points towards an impending workforce crisis should senior clinicians seek to reduce activity or consider taking early retirement.
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Affiliation(s)
- A Dosis
- Yorkshire and the Humber Deanery, UK
| | - N Husnoo
- University of Sheffield & Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Roney
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | | | - C Bonner
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - M Kronberga
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - E Moran
- Yorkshire and the Humber Deanery, UK
| | - V Ninh
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - A Jha
- South Tees Hospitals NHS Foundation Trust, UK
| | - T Grey
- Calderdale and Huddersfield NHS Foundation Trust, UK
| | - AK Saha
- Calderdale and Huddersfield NHS Foundation Trust, UK
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24
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Launer J. John Launer: How I walked around Wales with "heart failure". BMJ 2024; 384:q217. [PMID: 38296337 DOI: 10.1136/bmj.q217] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
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25
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Rodham A, Zouwail S. An indirect data-mining approach to standardise paediatric serum phosphate reference intervals in Wales. Clin Chem Lab Med 2024; 62:e19-e21. [PMID: 37419656 DOI: 10.1515/cclm-2023-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Annabel Rodham
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Soha Zouwail
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Heath Park, Cardiff, UK
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26
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Havard M, Whistance M, Johns G, Drew S, Cusens C, Thomas S, Khalil S, Ogonovsky M, Ahuja A. Defining digital nursing. Br J Nurs 2024; 33:72-77. [PMID: 38271040 DOI: 10.12968/bjon.2024.33.2.72] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND The use of technology in health care, including nursing, is growing, owing in part to the COVID-19 pandemic and in response to national policy. AIMS To investigate nurses' perceptions of digital nursing (DN). METHODS Community and primary care nurses from across Wales were recruited (n=249) through a survey comprising open and closed questions. This was supplemented with semistructured interviews (n=25). Thematic analysis was used to analyse qualitative data. FINDINGS Nurses had a broad range of perspectives on what DN meant, with four main themes being identified: access; impact on care; technology; and digital future. The positive impacts of DN on ways of working and patient outcomes were supported by answers to closed survey questions. CONCLUSION Many nurses understand the value of digital tools within nursing and are clear about their benefits for patients, nurses and multiprofessional teams. However, there is a need for a clear definition and increased awareness of DN.
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Affiliation(s)
- Megan Havard
- Research Assistant, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Megan Whistance
- Research Assistant, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Gemma Johns
- Head of Research, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Simon Drew
- National Lead for Clinical Adoption and Business Change, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Chiquita Cusens
- National Lead Nurse for Primary and Community Care, Strategic Programme for Primary Care, Aneurin Bevan University Health Board, Newport
| | - Sian Thomas
- Consultant Nurse in Child Health, Department of Nursing, Aneurin Bevan University Health Board, Newport
| | - Sara Khalil
- National Programme Lead, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Mike Ogonovsky
- Director, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Alka Ahuja
- Natiional Clinical Lead, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
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28
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Kent H, Magner-Parsons B, Leckie G, Dulgar T, Lusiandari A, Hogarth L, Williams H, Kirby A. Profiles of vulnerability for suicide and self-harm in UK prisoners: Neurodisability, mood disturbance, substance use, and bullying. PLoS One 2024; 19:e0296078. [PMID: 38170719 PMCID: PMC10763929 DOI: 10.1371/journal.pone.0296078] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Screening for vulnerability factors associated with historic suicidality and self-harm on entry to prison is critical to help prisons understand how to allocate extremely limited mental health resources. It has been established that having previous suicide attempts increases odds of future suicidality and self-harm in prison. We utilised administrative screening data from 665 adult male prisoners on entry to a category B prison in Wales, UK, collected using the Do-IT Profiler. This sample represents 16% of all prisoners who entered that prison during a 26-month period. 12% of prisoners reported a history of attempted suicide, 11% reported historic self-harm, and 8% reported a history of both. Historic traumatic brain injury and substance use problems were associated with a 3.3- and 1.9- times increased odds of a historic suicide attempt, respectively, but no significant increased risk of historic self-harm (95% CI: 1.51-6.60 and 1.02-3.50). However, those who were bullied at school had 2.7 times increased odds of reporting a history of self-harm (95% CI: 1.63-6.09). The most salient risk factors associated with both historic suicide and self-harm were higher levels of functional neurodisability (odds ratio 0.6 for a 1 standard deviation change in score, 95% CI: 0.35-0.75), and mood disturbance (odds ratio 2.1 for a 1 standard deviation change in score, 95% CI: 1.26-3.56). Therefore, it could be beneficial for prisons to screen for broader profiles of needs, to better understand how to provide appropriate services to prisoners vulnerable to suicide and self-harm. Multidisciplinary care pathways for prisoner mental health interventions are important, to account for complex multimorbidity. Adaptations may be needed for mental health interventions to be appropriate for, for example, a prisoner with a brain injury. Understanding this broad profile of vulnerability could also contribute to more compassionate responses to suicide and self-harm from prison staff.
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Affiliation(s)
- Hope Kent
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Bella Magner-Parsons
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - George Leckie
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Tuna Dulgar
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Anggita Lusiandari
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Lee Hogarth
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Huw Williams
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Amanda Kirby
- Emeritus Professor, School of Education, University of South Wales, Wales, United Kingdom
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Hikin LJ, Coombes G, Rice-Davies K, Couchman L, Smith PR, Morley SR. Post mortem blood bromazolam concentrations and co-findings in 96 coronial cases within England and Wales. Forensic Sci Int 2024; 354:111891. [PMID: 38043498 DOI: 10.1016/j.forsciint.2023.111891] [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] [Received: 06/07/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Bromazolam is a newly emerging benzodiazepine drug which is not licensed for medicinal use. It may be sourced as a New Psychoactive Substance (NPS) for its desired effects or be consumed unknowingly via counterfeit Xanax® or Valium® preparations. As part of our Coronial workload, we observed an increase in the detection of bromazolam from September 2021 to November 2022. We report a series of 96 cases in which bromazolam was quantitated by high resolution accurate mass - mass spectrometry (HRAM - MS) in post-mortem blood. The mean (SD) post-mortem blood bromazolam concentration from our case series was 64.6 ( ± 79.4) µg/L (range <1-425 µg/L). Routine toxicological screening results have also been reported; the most commonly encountered drugs taken in combination with bromazolam were cocaine, gabapentinoids and diazepam. In 48% of cases at least one further designer benzodiazepine drug was also present (etizolam, flualprazolam, flubromazolam, flubromazepam). It is essential that laboratories providing toxicological investigations are aware of the limitations of their assays; and inclusion of bromazolam within targeted screening panels using LC-MS/MS is encouraged. Bromazolam has not been associated with death in isolation from resulting toxic concentrations; however, it is likely to enhance adverse clinical effects when taken in combination with stimulant and/or centrally-acting depressant drugs (poly-drug deaths). Bromazolam, similar to other benzodiazepines, may also impair cognition and decision making skills.
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Affiliation(s)
- L J Hikin
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, UK.
| | - G Coombes
- Analytical Services International Ltd, London, UK
| | - K Rice-Davies
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, UK
| | - L Couchman
- Analytical Services International Ltd, London, UK
| | - P R Smith
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, UK
| | - S R Morley
- University Hospitals Leicester, Leicester Royal Infirmary, Leicester, UK
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Wales recruitment initiative re-launched. Br Dent J 2024; 236:87. [PMID: 38278887 DOI: 10.1038/s41415-024-6781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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Aggarwal A, Choudhury A, Fearnhead N, Kearns P, Kirby A, Lawler M, Quinlan S, Palmieri C, Roques T, Simcock R, Walter FM, Price P, Sullivan R. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol 2024; 25:e6-e17. [PMID: 37977167 DOI: 10.1016/s1470-2045(23)00511-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Cancer affects one in two people in the UK and the incidence is set to increase. The UK National Health Service is facing major workforce deficits and cancer services have struggled to recover after the COVID-19 pandemic, with waiting times for cancer care becoming the worst on record. There are severe and widening disparities across the country and survival rates remain unacceptably poor for many cancers. This is at a time when cancer care has become increasingly complex, specialised, and expensive. The current crisis has deep historic roots, and to be reversed, the scale of the challenge must be acknowledged and a fundamental reset is required. The loss of a dedicated National Cancer Control Plan in England and Wales, poor operationalisation of plans elsewhere in the UK, and the closure of the National Cancer Research Institute have all added to a sense of strategic misdirection. The UK finds itself at a crossroads, where the political decisions of governments, the cancer community, and research funders will determine whether we can, together, achieve equitable, affordable, and high-quality cancer care for patients that is commensurate with our wealth, and position our outcomes among the best in the world. In this Policy Review, we describe the challenges and opportunities that are needed to develop radical, yet sustainable plans, which are comprehensive, evidence-based, integrated, patient-outcome focused, and deliver value for money.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ananya Choudhury
- Department of Clinical Oncology and Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pam Kearns
- Institute of Cancer and Genomic Sciences NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast Belfast, UK
| | | | - Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, & Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Roques
- Royal College of Radiologists & Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Richard Simcock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society & Public Health, King's College London, London, UK
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O'Keeffe ST, Donnelly M. Informed consent for capacity assessment. Int J Law Psychiatry 2024; 92:101951. [PMID: 38183686 DOI: 10.1016/j.ijlp.2023.101951] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
In this paper we examine the role of informed consent to capacity assessment, focussing primarily on the two jurisdictions of England and Wales, and Ireland. We argue that in both jurisdictions, a capacity assessment should be regarded as a distinct intervention, separate from the 'original' intervention at issue, and that specific informed consent to the assessment should generally be sought in advance. As part of this, we consider what information should be provided so as to ensure informed consent. Having established a baseline requirement for informed consent, we also recognise that informed consent to assessment will not always be possible, either because the person is unable to understand the information about assessment or because the person refuses to be assessed and so, in the final part of the article, we explore how to proceed when informed consent is either not possible or not forthcoming, including an analysis of the implications of the statutory presumption of capacity.
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Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
| | - Mary Donnelly
- School of Law, University College Cork, Cork, Ireland
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Thayer N, Mackridge AJ, White S. Relationship between deprivation, and the uptake and use of the common ailments service in community pharmacies in Wales. Int J Pharm Pract 2023; 31:594-600. [PMID: 37802918 DOI: 10.1093/ijpp/riad067] [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] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES Since 2013 community pharmacies in Wales have been commissioned to provide a common ailments service (CAS), providing pharmacy medicine without charge to patients. In the first review of national pharmacy data, this study aimed to describe the relationship between provision of CAS and deprivation. METHODS A retrospective observational study, using CAS claims data from April 2022 to March 2023 collected as part of routine service delivery. Consultation data were matched to the index of multiple deprivation (IMD) decile of the providing pharmacy. Linear regression was used to describe the correlation between CAS claims data and IMD deciles of the pharmacy postcode. KEY FINDINGS In the study period, 239 028 consultations were recorded. More than twice as many consultations were carried out in pharmacies located in the most deprived decile (33 950) than in pharmacies in the least deprived decile (14 465). Linear regression demonstrated a significant correlation r(10) = -0.927, P < 0.001. There was a strong relationship between greater numbers of consultations and greater deprivation of the pharmacy postcode (R2 = 0.887). This significant correlation with deprivation was also found in the majority of individual conditions. There was no significant correlation between deprivation decile and the number of consultations per patient. CONCLUSIONS Community pharmacies offer a key resource for tackling health inequalities. Patients in those areas with the greatest need are those most likely to use the CAS in pharmacies and receive the care they need. Commissioning services like this naturally supports deprived communities, through a combination of patient behaviours, location, and accessibility.
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Affiliation(s)
- Nick Thayer
- School of Pharmacy and Bioengineering, Keele University, Keele, ST5 5BG, United Kingdom
| | - Adam John Mackridge
- Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 2PW, United Kingdom
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, Keele, ST5 5BG, United Kingdom
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Strang C, Alarcon P, Cardwell JM, Brunton L. Assessing antibiotic usage data capture accuracy on dairy farms in England and Wales. Vet Rec 2023; 193:e3505. [PMID: 37817555 DOI: 10.1002/vetr.3505] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Accurate farm-level data on antibiotic usage (ABU) are needed for the surveillance of antibiotic resistance. Therefore, this study aimed to determine the accuracy of ABU data capture by dairy farmers in South West England and Wales. METHODS Through a cross-sectional survey of 48 dairy farmers, the accuracy of ABU recording was measured by farmers' assessment of the completeness and timeliness of ABU recording ('perceived accuracy') and the completeness and correctness of on-farm ABU records ('actual accuracy'). Completeness and correctness were compared for paper and software recording methods. RESULTS Perceived accuracy was higher than actual accuracy. Antibiotic names, withdrawal periods and dates that products were fit for human consumption were often incomplete or incorrect. More inaccuracies were seen with paper than software. In some software platforms, the date that milk would be fit for human consumption was frequently rounded down by half a day, increasing the risk of residue failures. LIMITATION The small number of on-farm records assessed limits the generalisability of the results. CONCLUSIONS Electronic recording of ABU should be encouraged. However, functionality needs improvement, alongside consultation with dairy farmers to increase awareness of inaccuracies.
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Affiliation(s)
- Camilla Strang
- Veterinary Epidemiology, Economics and Public Health group, Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Pablo Alarcon
- Veterinary Epidemiology, Economics and Public Health group, Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Jacqueline M Cardwell
- Veterinary Epidemiology, Economics and Public Health group, Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Lucy Brunton
- Veterinary Epidemiology, Economics and Public Health group, Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
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Clarke N, Ferrar J, Pechey E, Ventsel M, Pilling MA, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: A randomized controlled trial. Addiction 2023; 118:2327-2341. [PMID: 37528529 PMCID: PMC10952514 DOI: 10.1111/add.16288] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/29/2023] [Indexed: 08/03/2023]
Abstract
AIMS To estimate the impact on selection and actual purchasing of (a) health warning labels (text-only and image-and-text) on alcoholic drinks and (b) calorie labels on alcoholic and non-alcoholic drinks. DESIGN Parallel-groups randomised controlled trial. SETTING Drinks were selected in a simulated online supermarket, before being purchased in an actual online supermarket. PARTICIPANTS Adults in England and Wales who regularly consumed and purchased beer or wine online (n = 651). Six hundred and eight participants completed the study and were included in the primary analysis. INTERVENTIONS Participants were randomized to one of six groups in a between-subjects three [health warning labels (HWLs) (i): image-and-text HWL; (ii) text-only HWL; (iii) no HWL] × 2 (calorie labels: present versus absent) factorial design (n per group 103-113). MEASUREMENTS The primary outcome measure was the number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased. There was no time limit for selection. For purchasing, participants were directed to purchase their drinks immediately (although they were allowed up to 2 weeks to do so). FINDINGS There was no evidence of main effects for either (a) HWLs or (b) calorie labels on the number of alcohol units selected (HWLs: F(2,599) = 0.406, P = 0.666; calorie labels: F(1,599) = 0.002, P = 0.961). There was also no evidence of an interaction between HWLs and calorie labels, and no evidence of an overall difference on any secondary outcomes. In pre-specified subgroup analyses comparing the 'calorie label only' group (n = 101) with the 'no label' group (n = 104) there was no evidence that calorie labels reduced the number of calories selected (unadjusted means: 1913 calories versus 2203, P = 0.643). Among the 75% of participants who went on to purchase drinks, those in the 'calorie label only' group (n = 74) purchased fewer calories than those in the 'no label' group (n = 79) (unadjusted means: 1532 versus 2090, P = 0.028). CONCLUSIONS There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online retail context. There was some evidence suggesting that calorie labels on alcoholic and non-alcoholic drinks may reduce calories purchased from both types of drinks.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- School of SciencesBath Spa UniversityBathUK
| | - Jennifer Ferrar
- School of Psychological Science, Tobacco and Alcohol Research GroupUniversity of BristolBristolUK
| | - Emily Pechey
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Minna Ventsel
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Mark A. Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Marcus R. Munafò
- School of Psychological Science, Tobacco and Alcohol Research GroupUniversity of BristolBristolUK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- EPPI Centre, UCL Social Research InstituteUniversity College LondonLondonUK
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Terry J. Enablers and barriers for hearing parents with deaf children: Experiences of parents and workers in Wales, UK. Health Expect 2023; 26:2666-2683. [PMID: 37694502 PMCID: PMC10632626 DOI: 10.1111/hex.13864] [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] [Received: 06/28/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND More than 90% of deaf children are born to hearing families who know little about deafness. Benefits from hearing screening at birth are often lost, as families find little information about pathways for deaf children but are key to ensuring deaf children receive relevant language and communication support. Systems surrounding deaf children and family members are crucial for children's health and social development. Experiences of hearing parents raising deaf children and understanding factors that influence families' experience of navigating pathways for deaf children through health and education services are currently underreported. METHODS An exploratory study was conducted in Wales, UK. Twenty participants were interviewed, including 10 hearing parents of deaf children and 10 people who work with deaf children using semistructured interviews. Bronfenbrenner's ecological systems theory was used as a lens to explore the micro-, meso-, exo-, macro- and chronosystems that surround children and families. This study explores potential supports and barriers in those systems. FINDINGS Findings are reported under two broad headings: enablers and barriers. Under enablers, it was found that provision of resources, supporting people and knowledge were key factors. Under barriers, a lack of knowledge, lack of provision and battling services and attitudes were key issues that need addressing. CONCLUSION Hearing parents of deaf children in Wales, UK reported experiencing a range of enablers and barriers that impact upon their experiences of raising a deaf child. Further provision is needed by policymakers and governments to recognise support needs to improve the outcomes for deaf children. PATIENT OR PUBLIC CONTRIBUTION This project was developed from initial discussions with the stakeholder reference group and progressed with the group's deaf panel and hearing parents with deaf children. The project's steering group was involved in study design, recruitment and continuous feedback on all stages of the research process.
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Affiliation(s)
- Julia Terry
- Faculty of Medicine, Health and Life ScienceSwansea UniversitySwanseaWalesUK
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Witzel TC, Nicholls EJ, McCabe L, Weatherburn P, McCormack S, Bonell C, Gafos M, Lampe FC, Speakman A, Dunn D, Ward D, Phillips AN, Pebody R, Gabriel MM, Collaco-Moraes Y, Rodger AJ, Burns FM. Understanding experiences of potential harm among MSM (cis and trans) using HIV self-testing in the SELPHI randomised controlled trial in England and Wales: a mixed-methods study. Sex Transm Infect 2023; 99:534-540. [PMID: 37607814 PMCID: PMC10715485 DOI: 10.1136/sextrans-2023-055840] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The potential of HIV self-testing (HIVST) to cause harm is a concern hindering widespread implementation. The aim of this paper is to understand the relationship between HIVST and harm in SELPHI (An HIV Self-testing Public Health Intervention), the largest randomised trial of HIVST in a high-income country to date. METHODS 10 111 cis and trans men who have sex with men (MSM) recruited online (geolocation social/sexual networking apps, social media), aged 16+, reporting previous anal intercourse and resident in England or Wales were first randomised 60/40 to baseline HIVST (baseline testing, BT) or not (no baseline testing, nBT) (randomisation A). BT participants reporting negative baseline test, sexual risk at 3 months and interest in further HIVST were randomised to three-monthly HIVST (repeat testing, RT) or not (no repeat testing, nRT) (randomisation B). All received an exit survey collecting data on harms (to relationships, well-being, false results or being pressured/persuaded to test). Nine participants reporting harm were interviewed in-depth about their experiences in an exploratory substudy; qualitative data were analysed narratively. RESULTS Baseline: predominantly cis MSM, 90% white, 88% gay, 47% university educated and 7% current/former pre-exposure prophylaxis (PrEP) users. Final survey response rate was: nBT=26% (1056/4062), BT=45% (1674/3741), nRT=41% (471/1147), RT=50% (581/1161).Harms were rare and reported by 4% (n=138/3691) in exit surveys, with an additional two false positive results captured in other study surveys. 1% reported harm to relationships and to well-being in BT, nRT and RT combined. In all arms combined, being pressured or persuaded to test was reported by 1% (n=54/3678) and false positive results in 0.7% (n=34/4665).Qualitative analysis revealed harms arose from the kit itself (technological harms), the intervention (intervention harms) or from the social context of the participant (socially emergent harms). Intervention and socially emergent harms did not reduce HIVST acceptability, whereas technological harms did. DISCUSSION HIVST harms were rare but strategies to link individuals experiencing harms with psychosocial support should be considered for HIVST scale-up. TRIAL REGISTRATION NUMBER ISRCTN20312003.
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Affiliation(s)
- T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Institute for Global Health, University College London, London, UK
| | | | - Leanne McCabe
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Peter Weatherburn
- Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Christopher Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Mitzy Gafos
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | - David Dunn
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Michelle M Gabriel
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
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Read J, Morrison L, Harrop C. An independent audit of electroconvulsive therapy patient information leaflets in Northern Ireland, Scotland and Wales. Psychol Psychother 2023; 96:885-901. [PMID: 37466121 DOI: 10.1111/papt.12481] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent. DESIGN AND METHODS To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit. RESULTS The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the 'most effective treatment' and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives. CONCLUSIONS Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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Neefjes V. Parental Ethical Decision Making and Implications for Advance Care Planning: A Systematic Review and Secondary Analysis of Qualitative Literature from England and Wales, Germany, and the Netherlands. J Palliat Med 2023; 26:1728-1743. [PMID: 37262127 DOI: 10.1089/jpm.2022.0520] [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] [Indexed: 06/03/2023] Open
Abstract
Background: Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled approach outlined by Beauchamp and Childress. How parents make ethical decisions is an under-researched area. A possible model for parental decision making is the Ethics of Care (EoC) theory. Ethical decision making within this framework aims to preserve the caring relationship. What is right or wrong depends on the circumstances at the time. Objective: To identify the parental ethical values and determine whether parental decision making is consistent with EoC, a systematic review and secondary analysis of qualitative research from England and Wales, the Netherlands, and Germany was performed. As part of a larger project investigating conflicts between parents and clinicians about children's medical treatment, the choice of countries was determined by differences in litigation. Methods: Eight databases were searched for articles published between 2010 and 2020 reporting on at least one medical treatment decision made by parents of a child with any life-limiting condition and analyzed using reflexive thematic analysis. Twelve included articles directly addressing advance care planning (ACP) were reanalyzed to investigate whether this specific decision parents are increasingly being asked to make is also consistent with EoC. Results: Forty-three articles were included. Parents use the same 6 ethical values which, consistent with EoC, are mostly in the context of their relationship with the child. All values contributed to the previously identified theme of "being a good parent/person." Analysis of parental decision making in ACP confirmed consistency with EoC. Conclusion: The parental decision-making process is consistent with EoC. That parental decisions aim to maintain the caring relationship and are dependent on the circumstances at the time has implications for parental decision making in ACP and should be reflected in future policies.
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Affiliation(s)
- Veronica Neefjes
- Center for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Manchester, United Kingdom
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40
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Ariyo K, Kane NB, Owen GS, Ruck Keene A. Interpersonal influences on decision-making capacity: a content analysis of court judgments. Med Law Rev 2023; 31:564-593. [PMID: 37295959 PMCID: PMC10681350 DOI: 10.1093/medlaw/fwad017] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
For many purposes in England and Wales, the Court of Protection determines whether a person has or lacks capacity to make a decision, by applying the test within the Mental Capacity Act 2005. This test is regularly described as a cognitive test with cognitive processes discussed as internal characteristics. However, it is unclear how the courts have framed interpersonal influence as negatively impacting upon a person's decision-making processes in a capacity assessment context. We reviewed published court judgments in England and Wales in which interpersonal problems were discussed as relevant to capacity. Through content analysis, we developed a typology that highlights five ways the courts considered influence to be problematic to capacity across these cases. Interpersonal influence problems were constructed as (i) P's inability to preserve their free will or independence, (ii) restricting P's perspective, (iii) valuing or dependence on a relationship, (iv) acting on a general suggestibility to influence, or (v) P denying facts about the relationship. These supposed mechanisms of interpersonal influence problems are poorly understood and clearly merit further consideration. Our typology and case discussion are a start towards more detailed practice guidelines, and raise questions as to whether mental capacity and influence should remain legally distinct.
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Affiliation(s)
- Kevin Ariyo
- Mental Health, Ethics and Law Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Nuala B Kane
- Mental Health, Ethics and Law Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Gareth S Owen
- Mental Health, Ethics and Law Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Alex Ruck Keene
- Mental Health, Ethics and Law Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Dickson Poon School of Law, King’s College London, UK
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Halliday S, Romanis EC, de Proost L, Verweij EJ. The (mis)use of fetal viability as the determinant of non-criminal abortion in the Netherlands and England and Wales. Med Law Rev 2023; 31:538-563. [PMID: 37253391 PMCID: PMC10681352 DOI: 10.1093/medlaw/fwad015] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Time plays a fundamental role in abortion regulation. In this article, we compare the regulatory frameworks in England and Wales and the Netherlands as examples of the centrality accorded to viability in the determination of the parameters of non-criminal abortion, demonstrating that the use of viability as a threshold renders the law uncertain. We assess the role played by the concept of viability, analysing its impact upon the continued criminalization of abortion and categorization of abortion as a medical matter, rather than a reproductive choice. We conclude that viability is misconceived in its application to abortion and that neonatal viability (relating to treatment of the premature infant) and fetal viability (related to the capacity to survive birth) must be distinguished to better reflect the social context within which the law and practice of abortion operate. We show how viability thresholds endanger pregnant people.
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Affiliation(s)
- Samantha Halliday
- Centre for Ethics and Law in the Life Sciences, Durham Law School, Durham DH1 3LE, UK
| | - Elizabeth Chloe Romanis
- Centre for Ethics and Law in the Life Sciences, Durham Law School, Durham DH1 3LE, UK
- Edmond and Lily Safra Center for Ethics and Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard University, Cambridge, Massachusetts 02138, United States
| | - Lien de Proost
- Department of Obstetrics and Gynecology, Erasmus MC, The Netherlands
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, The Netherlands
- Department of Neonatology, Erasmus MC, The Netherlands
| | - E Joanne Verweij
- Department of Obstetrics and Gynecology, Erasmus MC, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, The Netherlands
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Venter B, Ruck Keene A, Cronin AJ. Teenager and the transplant: how the case of William Verden highlights action is needed to optimise equitable access to organs for patients with impaired decision-making. J Med Ethics 2023; 49:803-807. [PMID: 36918263 DOI: 10.1136/jme-2022-108746] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William's position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William's position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity.
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Affiliation(s)
- Bonnie Venter
- Centre for Health, Law, and Society, University of Bristol, Bristol, UK
| | - Alexander Ruck Keene
- 39 Essex Chambers, London, UK
- Dickson Poon School of Law, King's College London, London, UK
| | - Antonia J Cronin
- Transplant Renal and Urology Directorate, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Centre for Nephrology, Urology and Transplantation, King's College London, London, UK
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Bartlett S, Bullock A, Morris F. 'It's the stuff they can do better than us': case studies of general practice surgeries' experiences of optimising the skill-mix contribution of practice-based pharmacists in Wales. BMJ Open 2023; 13:e073778. [PMID: 37993155 PMCID: PMC10668294 DOI: 10.1136/bmjopen-2023-073778] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Pharmacists are increasingly joining the general practice skill-mix. Research is still in relative infancy, but barriers and facilitators to their integration are emerging, as well as indications that pharmacists' skillset remain underutilised. This study explores first-hand experiences and perspectives among general practice teams of the processes that underpin the effective integration and sustained contribution of pharmacists in general practice. DESIGN AND SETTING This research employed a qualitative case study approach involving general practice teams in Wales. Data were collected from eight general practices where each practice represented one case study. Data were collected via online interviews (one-to-one or group) and written feedback. Data were pattern coded and analysed thematically through a constant comparative approach. Data interpretations were confirmed with participants and wider general practice teams. PARTICIPANTS Eight general practice teams across Wales (comprising combinations of practice and business managers, general practitioners (GPs) and general practice pharmacists) represented eight case studies. Cases were required to have had experience of working with a general practice pharmacist. RESULTS Data were yielded from five practice managers, two GPs, three general practice pharmacists and a business manager. A total of 3 hours and 2 min of interview data was recorded as well as 2038 words of written feedback. Three foundations to pharmacists' effective contribution to general practice were identified: defining the role (through identifying the right pharmacist, mapping skillset to demand and utilising the increasing need for specialist skills), appropriate infrastructure and workforce review, and an appropriate employment model. CONCLUSION Pharmacists are becoming increasingly critical to the general practice skill-mix and utilisation of their specialist skillset is crucial. This paper identifies how to enable the effective integration and sustained contribution of pharmacists to general practice.
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Affiliation(s)
- Sophie Bartlett
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Felicity Morris
- Cardiff Unit for Research and Evaluation in Medical and Dental Education, School of Social Sciences, Cardiff University, Cardiff, UK
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Dodkins J, Cook A, Morris M, Nossiter J, Prust S, Waller S, van der Meulen J, Aggarwal A, Clarke N, Payne HA. Organisation and delivery of supportive services for patients with prostate cancer in the National Health Service in England and Wales: a national cross-sectional hospital survey and latent class analysis. BMJ Open 2023; 13:e071674. [PMID: 37989358 PMCID: PMC10668241 DOI: 10.1136/bmjopen-2023-071674] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/29/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES We assessed how often National Health Service (NHS) hospitals reported that they had specific supportive services for patients with prostate cancer available onsite, including nursing support, sexual function and urinary continence services, psychological and genetic counselling, and oncogeriatric services. We identified groups of hospitals with similar patterns of supportive services. DESIGN/SETTING We conducted an organisational survey in 2021 of all NHS hospitals providing prostate cancer services in England and Wales. Latent class analysis grouped hospitals with similar patterns of supportive services. RESULTS In 138 hospitals, an advanced prostate cancer nurse was available in 125 hospitals (90.6%), 107 (77.5%) had a clinical nurse specialist (CNS) attending all clinics, 103 (75.7%) had sexual function services, 111 (81.6%) had continence services and 93 (69.4%) psychological counselling. The availability of genetic counselling (41 hospitals, 30.6%) and oncogeriatric services (15 hospitals, 11.0%) was lower. The hospitals could be divided into three groups. The first and largest group of 85 hospitals provided the most comprehensive supportive services onsite: all hospitals had a CNS attending all clinics, 84 (98.8%) sexual function services and 73 (85.9%) continence services. A key characteristic of the second group of 31 hospitals was that none had a CNS attending all clinics. A key characteristic of the third group of 22 hospitals was that none had sexual function services available. The hospitals in the largest group were more likely to run joint clinics (p<0.001) and host the regional specialist multidisciplinary team (p=0.002). CONCLUSIONS There is considerable variation in supportive services for prostate cancer available onsite in NHS hospitals in England and Wales. Availability of genetic counselling and oncogeriatric services is low. The different patterns of supportive services among hospitals demonstrate that initiatives to improve the availability of the entire range of supportive services to all patients should be carefully targeted.
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Affiliation(s)
- Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Adrian Cook
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Melanie Morris
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Steve Prust
- National Prostate Cancer Audit Patient and Public Involvement (PPI) Forum, Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Steve Waller
- National Prostate Cancer Audit Patient and Public Involvement (PPI) Forum, Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ajay Aggarwal
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Department of Urology, The Christie and Salford Royal Hospitals, The Christie Hospital NHS Trust, Manchester, UK
| | - Heather Ann Payne
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Al Shoaraa OA, Qadus S, Naser AY. Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study. BMJ Open 2023; 13:e079932. [PMID: 37984953 PMCID: PMC10660783 DOI: 10.1136/bmjopen-2023-079932] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020. DESIGN An ecological study. SETTING A population-based study using hospital admission data that are publicly available in the UK. Data in this study were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database in Wales from Wales. The Prescription Cost Analysis database was used to extract the prescription data. PARTICIPANTS Patients who were hospitalised all National Health Service (NHS) trusts and any independent sector funded by NHS trusts. PRIMARY OUTCOME MEASURE Hospitalisation rates related to medication administration errors and its associated prescriptions. RESULTS The annual rate of hospital admissions related to medication administration errors increased by 32.0% (from 184.21 (95% CI 183.0 to 185.4) in 1999 to 243.18 (95% CI 241.9 to 244.4) in 2020 per 100 000 persons. The most common three indications of hospital admissions were T39 (non-opioid analgesics, antipyretics and antirheumatics), T43 (psychotropic drugs), T42 (antiepileptic, sedative-hypnotic and antiparkinsonism drugs). The age group 15-59 years had the highest number of hospital admissions (83.4%). Women contributed to 59.1% of the total number of hospital admissions. Admission rate among men increased by 16.7%. Among women, the admission rate increased by 44.6%. CONCLUSION Admission rates due to medication administration errors increased markedly in the past decade. This increase was correlated with an increase in the prescription rate of several therapeutic classes. Patients taking non-opioid analgesics, antipyretics and antirheumatics, psychiatric medications, antiepileptic, sedative-hypnotic and antiparkinsonism drugs should have their recommended (and administered) doses closely monitored. They should be followed up on a regular basis to ensure that they are taking their medications as prescribed.
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Affiliation(s)
- Oudai Amjad Al Shoaraa
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University Faculty of Pharmacy, Amman, Jordan
| | - Sami Qadus
- Department of Pharmacy, Faculty of Health Sciences, American University of Madaba, Madaba, Jordan
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman, Jordan
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Allen D, Jacob N, Strange H, Jones A, Burton C, Rafferty AM. "It's not just about the numbers": Inside the black box of nurses' professional judgement in nurse staffing systems in England and Wales: Insights from a qualitative cross-case comparative study. Int J Nurs Stud 2023; 147:104586. [PMID: 37672970 DOI: 10.1016/j.ijnurstu.2023.104586] [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] [Received: 06/02/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Whether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have systematically examined the role of professional judgement and its contribution to decision-making. OBJECTIVE To explore nurses' use of professional judgement in nurse staffing systems in England and Wales. METHODS A cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory. FINDINGS Two kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement. CONCLUSIONS The implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated. TWEETABLE ABSTRACT Health systems depend on nurses' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.
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Affiliation(s)
- Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Chris Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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McDonald R. Microenterprise and home care for older adults in England and Wales: A partial revolution? Sociol Health Illn 2023; 45:1591-1608. [PMID: 37209298 DOI: 10.1111/1467-9566.13658] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
Paid carers play an important role in helping older adults with care needs to remain living in their own homes. This paper examines changes in the home care field, specifically the emergence of self-employed care entrepreneurs ('microentrepreneurs'). To do this, it employs Bourdieu's concepts of field, capital and habitus. Drawing on 105 semi-structured interviews with stakeholders working in home care, the paper describes how the interaction of changes to field structures, and altered practices of care have challenged the taken-for-granted acceptance of traditional, transactional forms of care provision. This process has been highly dependent on local state actors, their ability to mobilise relevant forms of capital and the factors which shaped their habitus. It should be seen within the context of changes to local field structures and the hierarchical classification processes which underpin them. These changes threaten the distribution of capital in the home care field in ways that are beneficial to microentrepreneurs. Bourdieu might categorise these developments as 'partial revolutions', which do not challenge the fundamental axioms of the field. However, for care entrepreneurs, formerly employed as low-paid home-care workers, a revolution that is only partial may be better than none at all.
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Affiliation(s)
- Ruth McDonald
- NIHR ARC NENC Multimorbidity, Ageing and Frailty Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Pijeira Perez Y, Wood E, Hughes DA. Costs of orphan medicinal products: longitudinal analysis of expenditure in Wales. Orphanet J Rare Dis 2023; 18:342. [PMID: 37915031 PMCID: PMC10621215 DOI: 10.1186/s13023-023-02956-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The Orphan Regulation ((EC) No 141/2000) has successfully redirected private and public investment towards previously neglected areas through incentives, regulatory obligations and rewards. However, the growth in the number of licensed orphan medicinal products (OMPs) has led to concerns about increased costs. The aims were to investigate the trend in the costs of OMPs to the National Health Service in Wales, to attribute costs of medicines within and outside periods of marketing exclusivity, and estimate the contribution of individual medicines to the overall costs of OMPs. METHODS Expenditure on OMPs in Wales was analysed between the 2014/15 and 2019/20 financial years using data on prescriptions dispensed in primary care, secondary care, and specialised commissioned services. OMP spend was calculated as a proportion of total medicines expenditure, whether it was incurred during, or outside the marketing exclusivity period (MEP), and by therapeutic area and medicine. RESULTS Overall spend on OMPs and all medicines increased from £32 m to £82 m, and from £1,030 m to £1,198 m, respectively, with the proportion of spend on OMPs more than doubling from 3.1% to 6.9% per annum. Average year-on-year growth in the costs of OMPs was 21%, compared to 2% for other medicines. Costs following MEP expiry contributed significantly to overall OMP costs, increasing from £8 m to £30 m, corresponding to an increase from 24% to 37%. Treatments for 'malignant disease and immunosuppression', 'nutrition and blood' and the 'respiratory system' accounted for 90% of all OMP spend. Half of total OMP annual expenditure was on just 4 medicines in 2014/15, increasing to 8 in 2019/20. CONCLUSIONS Both the number of OMPs and the amount spent on OMPs in Wales has increased over time, possibly as a consequence of favourable licensing conditions, permissive health technology assessment policies and dedicated funding.
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Affiliation(s)
- Yankier Pijeira Perez
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Holyhead Road, Bangor, Gwynedd, Wales, LL57 2PZ, UK.
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Saville CWN, Mann R, Lockard AS, Bark-Connell A, Gabuljah SG, Young AM, Thomas DR. Covid and the coalfield: Covid-19 vaccine hesitance in Wales and Appalachia. Soc Sci Med 2023; 337:116295. [PMID: 37857241 DOI: 10.1016/j.socscimed.2023.116295] [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] [Received: 02/08/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Vaccine hesitancy is a barrier to Covid-19 vaccine uptake and displays a social gradient, compounding health disparities. While social gradients are a vital concept in health, they flatten distinctions between types of disadvantaged community. This paper focuses on vaccine hesitance in post-industrial and de-industrialising coalfields. The social consequences of the decline of coal mining may present barriers to vaccine uptake. METHODS We ran parallel surveys in Wales (N = 4187) and US states overlapping with central Appalachia (N = 4864), to examine whether vaccine attitudes and uptake varied between areas with different coal mining histories. These surveys were accompanied by qualitative interviews of 36 residents of these coalfields to explore vaccination decisions and triangulate with survey data. RESULTS Factor analysis identified four axes of attitudes in the survey data: vaccine confidence, covid scepticism, vaccine individualism, and concerned confusion. These themes were echoed in the interviews. Vaccine confidence was lower; and covid scepticism, vaccine individualism, and concerned confusion higher, in residents of areas of Wales with greater mining extent and where pits closed during certain periods. Residents of former US coal counties had lower vaccine confidence and higher covid scepticism, while those in current coal counties had greater vaccine individualism and concerned confusion. In former US coal counties and Welsh areas where pits closed since 1980, vaccine uptake was lower. Differences could not be explained by respondents' income and education. In the interviews, norms of social solidarity were often invoked by vaccinated respondents, while unvaccinated respondents did not frame decisions in the context of the industrial history of their areas. DISCUSSION The legacy of coal-mining's decline presents barriers to public health campaigns. We show evidence of this across two historically significant coalfields. Attention is needed to avert negative public health consequences of global energy transition.
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Affiliation(s)
| | - Robin Mann
- School of History, Law, and Social Sciences, Bangor University, Wales, UK
| | | | | | | | - April M Young
- College of Public Health, University of Kentucky, USA
| | - Daniel Rhys Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Wales, UK
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