Suchergebnisse

Funded by the Arts and Humanities Research Council under the UKRI COVID-19 Rapid Response call, the Observatory for Monitoring Data-Driven Approaches to COVID-19 (OMDDAC) is a collaboration between Northumbria University and the Royal United Services Institute (RUSI). This project has involved a multidisciplinary team of researchers (with expertise in the law on technology, data protection, and medicine as well as practical ethics, computer science, data science, applied statistics in health, technology and security studies and behavioural science) to investigate the legal, ethical, policy and operationalchallenges encountered in relation to key data-driven responses to the pandemic.The COVID-19 pandemic has accelerated the consideration of several priorities in the data and technology space, which are reflected in the UK Government's present strategies. The National Data Strategy, in particular, pledges to take account of the lessons learned from the COVID-19 response and draw uponthe UK's values of transparency, accountability and inclusion. Seeking to inform the lessons learned from the pandemic, the project used a mixed-methods research design that included case study analysis, interviews with key stakeholders (individuals with relevant expertise and/or experience in relation to the data-driven pandemic response), representative public surveys, and engagement with young people through a children's rights charity. OMDDAC has published four snapshot reports focused on data-driven public policy, tech-driven approaches to public health, policing and public safety and key findings from the public perceptions survey. The emerging issues identified in those reports align closely with the four pillars of the National Data Strategy, which form the framework for this final project report:1. Data Foundations (data quality issues and infrastructure);2. Data Skills (data literacy of decision-makers);3. Data Availability (data sharing); and4. Responsibility (law, ethics, transparency, and public trust).

Background: People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence. Methods: A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed. Results: 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators. Conclusions: The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

Introduction: The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) has quickly accelerated into a pandemic. As COVID-19 has swept across the globe, health systems have adapted, including the cessation of routine surgery and the re-deployment of staff to critical care settings. Prompt interventions such as endotracheal (ET) intubation, are deemed essential in patients with Acute Respiratory Distress Syndrome. Intubation requires a coordinated approach and effective teamwork, as it is a high-risk procedure not least because it is an aerosol-generating intervention with increased infection risk. As a result, teams responsible for performing ET intubation are required to wear Personal Protective Equipment (PPE), which in turn hinders communication and situational awareness, and can hamper team work. Method: This review considers the effects of wearing PPE on performance and situational awareness in a healthcare environment. Drawing on literature from the fire service and military, the review will explore approaches to improving communication and situational awareness for teams who, at times, are unfamiliar with one another. The review will consider human factors and, identify approaches that assist teams, including teams that are unfamiliar with one another, to adapt to new ways of working while performing high-risk procedures. Conclusion: Literature indicates that standardisation, pre-brief and training are important elements of developing improved situational awareness and team working in individuals whose senses may be affected by PPE. In addition, checklists provide a useful way of standardising procedures and can form the basis of a structured pre-brief. Checklists exist for both intubation and patient proning, which, alongside simulation-based team training, provide a useful method of preparing an often unfamiliar workforce for their roles during an epidemic or pandemic. The multi-phase nature of most pandemics provides an opportunity to review processes and implement such procedures, and to develop staff using team-based training during the post-peak period.

Background: Telecare could greatly facilitate chronic disease management in the community, but despite government promotion and positive demonstrations its implementation has been limited. This study aimed to identify factors inhibiting the implementation and integration of telecare systems for chronic disease management in the community. Methods: Large scale comparative study employing qualitative data collection techniques: semi-structured interviews with key informants, task-groups, and workshops; framework analysis of qualitative data informed by Normalization Process Theory. Drawn from telecare services in community and domestic settings in England and Scotland, 221 participants were included, consisting of health professionals and managers; patients and carers; social care professionals and managers; and service suppliers and manufacturers. Results: Key barriers to telecare integration were uncertainties about coherent and sustainable service and business models; lack of coordination across social and primary care boundaries, lack of financial or other incentives to include telecare within primary care services; a lack of a sense of continuity with previous service provision and self-care work undertaken by patients; and general uncertainty about the adequacy of telecare systems. These problems led to poor integration of policy and practice. Conclusion: Telecare services may offer a cost effective and safe form of care for some people living with chronic illness. Slow and uneven implementation and integration do not stem from problems of adoption. They result from incomplete understanding of the role of telecare systems and subsequent adaption and embeddedness to context, and uncertainties about the best way to develop, coordinate, and sustain services that assist with chronic disease management. Interventions are therefore needed that (i) reduce uncertainty about the ownership of implementation processes and that lock together health and social care agencies; and (ii) ensure user centred rather than biomedical/service-centred models of care.

It is estimated that an additional 6.4 million allied health professionals are required to address India's health challenges. Physiotherapy is amongst the largest of these professions. Over the last decade, thousands of Indian physiotherapists have sought to study and work overseas. In this study, 19 physiotherapists from across India were interviewed. Data were collected and analysed using construct+ivist grounded theory methods. The findings indicate that the Indian physiotherapy profession faces many political and clinical hierarchical challenges within the Indian healthcare infrastructure. The profession's education provision has developed, and the private clinical sector has grown, but there are significant disparities in quality and standards across the sector. The profession in India has variable autonomy, is not nationally regulated, is poorly paid, and the leadership has been divided. The political, educational, and clinical context in Indian physiotherapy impacts upon physiotherapists' ability to practise effectively to their professional satisfaction. Individual physiotherapists are frustrated by their workplace and travel overseas where they hear that the physiotherapy profession and practice is different. Whilst the disjunctures influencing these factors continue, and overseas physiotherapy practice is perceived as different and superior, Indian physiotherapists will continue to seek to migrate overseas, and facilitating their return will be challenging.

Aim Understanding COVID-19 risk perceptions and their impact on behaviour can improve the effectiveness of public health strategies. Prior evidence suggests that, when people perceive uncontrollable risks to their health, they are less likely to engage in healthful behaviour. This article aims to understand the extent to which COVID-19 is perceived as an uncontrollable risk, and to assess whether this perceived risk is associated with health behaviour. Subject and methods We surveyed a nationally representative sample of 496 participants during the first UK lockdown. We assessed perceptions of COVID-19-related risk, self-reported adherence to infection control measures recommended by the UK Government, and general health behaviours. We predicted that increased perceived extrinsic mortality risk (the portion of mortality risk perceived to be uncontrollable) would disincentivise healthy behaviour. Results Perceived threat to life was the most consistent predictor of reported adherence to infection control measures. Perceived extrinsic mortality risk was found to have increased due to the pandemic, and was associated with lower reported adherence to Government advice on diet, physical activity, and smoking. Conclusions Our findings suggest that health messages that highlight threat to life may be effective in increasing adherence to infection control, but may also lead to a reduction in health-promoting behaviours. We suggest that messages that highlight threat to life should be accompanied by statements of efficacy. Further, messages evoking feelings of concern for others may be effective in promoting compliance with anti-infection measures, without the potential for the unwelcome side-effect of discouraging healthy behaviour.

The mental health needs of young people who offend have become more widely recognised and attempting to meet these needs is now a global priority for governments and health agencies. Young people who offend experience a range of complex difficulties and have significantly worse health and social outcomes than their mainstream counterparts. These problems usually persist and often increase in severity through adolescence and into later life. There is growing acceptance of the potential value of co-designing services that recognise and address problems to improve the outcomes of young people with mental health problems yet to date, this methodological approach remains relatively unexplored in forensic service provision. Experience-based co-design (EBCD) is an approach to healthcare improvement that enables staff and service users to jointly co-design services. Central to the approach is the idea that understanding the experiences of service users and the 'touchpoints' (e.g., critical points or moments) in their journey through a service are integral to service improvement. The aim of this study was to explore whether EBCD could be applied to facilitate recognition of, and service developments for, young people presenting in community forensic settings. Qualitative methods used in this study included: observational fieldwork in four police custody suites (n = 30 hours), in-depth interviews with staff in community forensic services (n = 13) and researcher staff (n = 7). In this paper, the challenges of applying EBCD in community forensic settings with this population were: working with and across agencies; gaining access to participants; understanding knowledge and power dimensions amongst participants and understanding the context. This paper argues that innovative approaches to discovering the touchpoints for young people who offend – a key component of the EBCD approach - through combining analyses of secondary data and direct observations in community forensic settings can facilitate engagement with these ...

Background Findings are presented from the evaluation of Public Health England's (PHE) Prioritization Framework (PF) aimed to assist local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings. Methods Semi-structured interviews (n = 30) across three local authorities supplemented by participant observation of workshops. Results Participants acknowledged that the PF provided a systematic means of guiding priority-setting and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in the local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success. Conclusions The study assessed the value and impact of PHE's PF tool in three early adopter local authorities. Further research could explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending.

BACKGROUND: The Scottish Government's ambition is to ensure that health services are co-designed with the communities they serve. Crohn's and Colitis UK and the Scottish Government acknowledged the need to review and update the current IBD care model. An online survey was conducted asking IBD patients about their experiences of the NHS care they receive. This survey was the first step of co-designing and developing a national strategy for IBD service improvement in Scotland. AIM: To explore IBD patients' experiences of current services and make recommendations for future service development. METHODS: This study was part of a wider cross-sectional on-line survey. Participants were patients with IBD across Scotland. 777 people with IBD took part in the survey. Thematic analysis of all data was conducted independently by two researchers. RESULTS: Three key themes emerged: Quality of life: Participants highlighted the impact the disease has on quality of life and the desperate need for IBD services to address this more holistically. IBD clinicians and access: Participants recognised the need for more IBD nurses and gastroenterologists along with better access to them. Those with a named IBD nurse reported to be more satisfied with their care. An explicit IBD care pathway: Patients with IBD identified the need of making the IBD care pathway more explicit to service users. CONCLUSIONS: Participants expressed the need for a more holistic approach to their IBD care. This includes integrating psychological, counselling and dietetic services into IBD care with better access to IBD clinicians and a more explicit IBD care pathway.

Background: Healthcare processes in hospitals, likewise processes in companies or governmental organizations, may accumulate problems and obstacles over time, which consequently cause the processes to become ineffective. BPM (Business Process Management) is an approach to process modeling, improvement and automating, which has been used with great success for process improvement. Methods: This work was to examine the possibility of improving healthcare process by using BPM. To implement BPM ideas, a revised TAD (Tabular Application Development) methodology was developed, representing an important contribution to BPM. The first three phases of the TAD methodology were introduced in a step-bystep approach. The first phase deals with process identification, the second develops the "as-is" model, and the third phase discusses process improvement by developing a "to-be" model. Results: We found that (a) the Surgery process is efficient and well organized; (b) patient stay in the Department could be shortened; however for humane and social reasons the leadership prefers to leave the residence time as it is; (c) the process is associated with some time-consuming activities that are performed by other departments and represent the bottleneck of the process. Conclusions: The following were concluded (a) BPM proved to be a suitable approach for carrying out healthcare process improvement; (b) the revised TAD methodology showed to be consistent and efficient in performing BPM approach; (c) The Surgery process discussed was found to be an effective one and no changes or improvements are needed; (d) Concerning time-consuming activities, the leadership decided to discuss this problem with the management of the departments where the activities are executed.

Background: Co-production of research evidence is valued by local government to improve effective decision-making about public services in times of austerity. However, underlying structural issues of power (so-called 'dark shadows of co production') challenge this ambition with limited evidence on how to embed research use sustainably. In this paper we reflect on mechanisms for increasing co-production in local government. Methods: This paper presents findings from a Health Foundation funded research project that explored how a culture of evidence use to improve population health could be embedded in UK local government. Five linked work packages were undertaken using mixed methods. In this paper, we report the views of UK local authority staff who participated in four workshops (n=54), informed by a rapid literature review and an online scoping survey. Results: We identified five themes that facilitate public health evidence use in local government: 1) new governance arrangements to integrate national and local policies , 2) codifying research evidence through local system-wide approaches and 3) ongoing evaluation of programmes , and 4) overcoming political and cultural barriers by increasing absorptive capacity of Local Authorities to embed co-produced knowledge in their cognitive structures. This requires adaptive governance through relationship building between academic researchers and Local Authority staff and shared understanding of fragmented local policy making, which are supported by 5) collective spaces for reflection within local government. Conclusions: Creating collective spaces for reflection in between government departments allows for iterative, interactive processes of co-production with external partners that support emergence of new governance structures to socially action the co produced knowledge in context and build capacity for sustained evidence use.

Objectives To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA). Setting SA. Design Scoping review. Search methods We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results. Results Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available. Conclusion This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.

Health inequalities are differences in health experiences and outcomes which arise through the everyday circumstances of people's lives and the appropriateness of the systems put in place to support them. Such differences stem from social inequalities. As they can be alleviated through social policy, they are a key concern for global public health. Worldwide, they are the focus of governmental efforts to reduce avoidable differences in health (e.g., in the UK, Health equity in England 2020 [1] and in the USA, Healthy People 2030 [2]). The salience of health inequalities in public life cannot be over-emphasized; for example, it has informed policymaking since Engels' [3] 1845 ground-breaking text on the condition of the working class in England and numerous policy initiatives since then (e.g., in the UK, The Black Report 1979, The Acheson Inquiry 1998, Fair Society, Healthy Lives 2010).

The 21st century has witnessed the rise of a genre of literature that has taken both the reading public and the publishing industry by storm. The 'medimoir'—or medical memoir—is not in itself a new genre of writing, but has risen to prominence in a contemporary British context of renewed focus on public health and wellbeing, a proliferation of professional confessionals in publishing, and debates about the future of the free-at-point-of-care British National Health Service (NHS). The most prolific medimoir published to date is Adam Kay's This Is Going to Hurt (2017), a reflective diary that chronicles his time as a trainee gynaecologist in the NHS, and his subsequent exit from medical training in the face of growing personal and political pressures on his profession. This article contextualises and considers the rise of the medimoir, and examines why this genre of medical narrative has become such a critical, literary, and publishing success in the first two decades of the new millennium.

Background - The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed. Methods - We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI). Findings - Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015. Interpretation - The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking's global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.