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Experts say more research is needed on impact of routine enquiry into adverse childhood experiences

IntroductionHealth promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. MethodsAn exploratory study was planned between the months of January – February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. ResultsThe study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. ConclusionWe concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

BackgroundAnalysis of routine data makes an important contribution to service evaluation and research, providing cost-efficiencies, objective outcomes, burden reduction for patient and the public and is promoted by both policy and funders. Organisational, legal and ethical governance provide a framework for research but there is an onus on researchers to maintain their awareness of good practice when working with routine data.
Aim To co-produce with data provider, researcher and public stakeholders a training curriculum for researchers working with routine data.
Methods A curriculum for online and face-to-face training will be developed through consultations with three stakeholder groups. The first are researchers with existing interest /experience of using routine data. An online survey will be disseminated via UK research networks encompassing a range of disciplines and sectors. The non-probabilistic survey addresses current challenges, training experiences and learning preferences. Focus groups with three UK data provider organisations (SAIL, NHS Digital, National Pupil Database) will address provider's experience of working with researchers, any training or support they either require, provide or sign-post to and opportunities to support best practice. Thirdly, a facilitated public consultation exercise using a deliberative enquiry process will be undertaken as a day's workshop and include lay contributors identified via the HealthWise Wales cohort.
ResultsWe will present initial results from each stakeholder engagement activity and show how this has informed the draft training curriculum and our understanding of potential benefits that the training will deliver.
ConclusionsThe public may remain largely unaware of data captured when using public services, how it may contribute to research and the protections that apply. Involving the public in the development of researcher training informs this process and enables researchers to more effectively engage with patients and participants. Training will be promoted through data provider and research networks across sectors in the UK.

Domestic abuse is increasingly recognised as a serious, worldwide public health concern. There is a significant body of literature regarding domestic abuse, but little is known about health professionals' beliefs about domestic abuse disclosure. In addition, the intersection between health professionals' beliefs and abused women's views remains uninvestigated. We report on a two-phase, qualitative study using Critical Incident Technique (CIT) that aimed to explore community health professionals' beliefs about domestic abuse and the issue of disclosure. We investigated this from the perspectives of both health professionals and abused women. The study took place in Scotland during 2011. The study was informed theoretically by the Common Sense Model of Self-Regulation of Health and Illness (CSM). This model is typically used in disease-orientated research. In our innovative use, however, CSM was used to study the social phenomenon, domestic abuse. The study involved semi-structured, individual CIT interviews with health professionals and focus groups with women who had experienced domestic abuse. Twenty-nine health professionals (Midwives, Health Visitors and General Practitioners) participated in the first phase of the study. In the second phase, three focus groups were conducted with a total of 14 women. Data were analysed using a combination of an inductive classification and framework analysis. Findings highlight the points of convergence and divergence between abused women's and health professionals' beliefs about abuse. Although there was some agreement, they do not always share the same views. For example, women want to be asked about abuse, but many health professionals do not feel confident or comfortable discussing the issue. Overall, the study shows the dynamic interaction between women's and health professionals' beliefs about domestic abuse and readiness to discuss and respond to it. Understanding these complex dynamics assists in the employment of appropriate strategies to support women post-disclosure. © 2013 John Wiley & Sons Ltd.

AbstractIntroductionWhile HIV index testing and partner notification (PN) services have the potential to reach adolescent girls and young women (AGYW) aged 15 to 24 and their sexual partners in need of HIV testing services, the potential social harms have not yet been studied. This commentary highlights the risks of this approach, including intimate partner violence (IPV), stigma and discrimination, and outlines an urgent research agenda to fully understand the potential harms of PN for AGYW, calling for the development of mitigation strategies.DiscussionA substantial evidence base exists demonstrating the feasibility, acceptability and effectiveness of index testing and partner notification for adults aged 18 years and older in low‐ and middle‐income countries (LMICs), particularly for men, and for adults who are married/cohabiting and referring a current sexual partner. AGYW who are most vulnerable to HIV infection in LMICs do not reflect these demographics. Instead, they are often in age‐disparate partnerships, have limited negotiating power within relationships, experience high rates of violence and face economic challenges that necessitate transactional sex. PN services may be particularly difficult for adolescent girls under 18 who face restrictions on their decision making and are at increased risk of rape. Adolescent girls may also face coercion to notify partners due to unequal power dynamics in the provider–adolescent client relationship, as well as judgemental attitudes towards adolescent sexual activity among providers.ConclusionsAs index testing and PN with AGYW is already being rolled out in some LMICs, research is urgently needed to assess its feasibility and acceptability. Implementation science studies should assess the availability, accessibility, acceptability and quality of HIV PN services for AGYW. Qualitative studies and routine monitoring with age‐disaggregated data are critical to capture potential social harms, PN preferences and support needs for AGYW aged 15 to 17, 18 to 20 and 21 to 24. To mitigate potential harms, PN methods should prioritize confidentiality and avoidance of adverse outcomes. Healthcare providers should be trained to conduct routine enquiry for IPV and provide first‐line support. Support services for AGYW living with HIV and survivors of violence should be implemented alongside HIV PN.

Unnecessary repeat requesting of tests can make up a large proportion of a laboratory's workload. This audit set out to establish the size of this problem and to identify the circumstances under which these repeat requests were made in a government tertiary hospital immunology laboratory. The numbers of tests for immunoglobulin measurement, common autoantibodies, and tumour markers that were repeated over a 12 month period were analysed by interrogating the Delphic laboratory computer system using a management information system for raw data enquiry protocol. Repeat requests within 12 weeks of a previous request made up 16.78% of the total workload. The total cost of the tests was estimated at US$ 132 151. The waste of technician time and reagents as a result of unnecessary repeat testing is excessive. Many of these tests might be eliminated with the use of interventions such as computerised reminders. ; published_or_final_version

One of the key concepts of the neo-institutional studies of organizations has been routine—an established, rule-governed pattern of action. The concept of routine creates difficulties when used for making sense of the emergence of new practices or change in organizations and institutions. There are two reasons for this. First, routine was introduced originally to account for the continuity of organizational life. Second, it is based on theories of action and behaviour that focus exclusively on the pre-reflective and embodied aspects of human practice. This paper seeks an alternative approach by using the concepts of epistemic object and artefact mediation of human activity. It argues that representational artefacts, such as concepts and models, are instrumental in inducing change in human practices. Using the work of occupational health and safety inspectors as an example, it is shown how a practice or set of routines is made into an object of enquiry in order to generate a working hypothesis for an alternative practice. The hypothesis is further objectified by designing a set of informational tools and procedures that carry on the new practice.

Interrogating supply/demand from an inter- and multi-disciplinary perspective, this collection broadens engagement beyond the routine analysis of the locus of violence in prostitution and the validity of the prostitute's consent. A focus on the supply/demand dynamic brings into play a range of other societal, economic and psychological factors such as the social construction of sexuality, the viability of alternative choices for prostitutes and clients, and the impact of regulatory regimes on the provision of sexual services. The factors which underlie each component of the supply/demand dyad are also studied and an examination is made of their dynamic interrelation. The collection emphasizes the importance of rendering policy makers alert to the evidence emerging from empirical studies conducted in different fields of enquiry, in the hope of moving beyond polarity and politics at the local, national and international level.

The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into "good doctoring" in the case of antibiotic prescribing at a time when the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing "non-medical issues," they refer to routines, clinical expertise, experiences with their patients, and decision-making based more on contextual circumstances than molecular conditions—and on the fact that such conditions can be hard to assess. This article's contribution to knowledge about how new and global health problems challenge professional actors affirms the importance of such a research agenda and the need for further exploration of the core problems posed by transnational sociology of professions.

Lean Construction has become a popular concept to improve performance and reduce costs in construction projects. Assessment tools and implementation strategies that focus on lean practices such as the Last Planner System, the use of Kanbans, the routine of Kaizens and, recently, the integration with information technology are also common. However, barriers to the wide adoption of lean principles remain and implementation challenges continue to intrigue scholars. Previous studies suggest that barriers to the successful implementation can be either political, economical, social and/or technical, with the focus on lack of knowledge about lean concepts, resistance to the required organisational culture change, and lack of support from top management. Few studies present the lean implementation process from the practitioners' perspective. Using the narrative enquiry methodology, the authors aim to describe how a construction company from Brazil matured from the implementation of lean operational tools to achieve excellence in the lean culture and mindset. Key themes that emerge from this study for a successful lean construction journey are; effort to stabilise the environment, knowledge creation and management, transparency in the process to enable simplicity and shared understanding, and building trust for further growth. ®

Dealing with long-term and cross-cutting issues poses a number of challenges to established routines and the organisation of governments and parliaments based on the division of labour: Long-term social development trends and long-term effects of political measures must be identified and taken into account. Political action must be coordinated between a large number of affected departments. A high degree of coordination with social interest groups is necessary if long-term political goals are to be realised. Subject and objective of the study The TAB project, which was commissioned by the Committee on Education, Research and Technology Assessment and started on 5 July 2000, pursued the question of which procedures and forms of institutionalisation (e.g. interdepartmental programmes, creation of specialised scientific institutions, commissions of enquiry, councils of experts, forums for communication between politics and society) are chosen by European parliaments and governments in dealing with long-term and cross-cutting issues in order to meet the challenges mentioned. In addition to a comparison of countries with regard to sustainability policy in Europe, TAB has compiled an inventory of the advisory institutions for technology assessment established in a number of European countries at the national ...

Lean Construction has become a popular concept to improve performance and reduce costs in construction projects. Assessment tools and implementation strategies that focus on lean practices such as the Last Planner® System, the use of Kanbans, the routine of Kaizens and, recently, the integration with information technology are also common. However, barriers to the wide adoption of lean principles remain and implementation challenges continue to intrigue scholars. Previous studies suggest that barriers to the successful implementation can be either political, economical, social and/or technical, with the focus on lack of knowledge about lean concepts, resistance to the required organisational culture change, and lack of support from top management. Few studies present the lean implementation process from the practitioners' perspective. Using the narrative enquiry methodology, the authors aim to describe how a construction company from Brazil matured from the implementation of lean operational tools to achieve excellence in the lean culture and mindset. Key themes that emerge from this study for a successful lean construction journey are; effort to stabilise the environment, knowledge creation and management, transparency in the process to enable simplicity and shared understanding, and building trust for further growth.

INTRODUCTION: Optimal tuberculosis contact investigation impacts TB prevention, timely case finding and linkage to care, however data on routine implementation in high burden contexts is limited. MATERIALS AND METHODS: In a multi-method qualitative study based on individual interviews with TB patients, facility observations and focus group discussions with health workers (HWs) in 13 public health facilities, and key informant interviews with governmental and non-governmental experts, we describe TB contact investigation in the context of an urban setting in Kenya and identify opportunities for optimization. RESULTS: Invitation of TB patients to bring close contacts by HWs was key for all patient decisions that led to contact screening in addition to patients' understanding of TB transmission and desire to avoid contacts suffering from TB. Sub-optimal HW enquiry of TB patients and contacts presenting at the facility were missed opportunities which stemmed from lack of standardized operational procedures, documentation tools and HW training. Stakeholders proposed provision of fast tracked and holistic health packages for contacts seeking TB screening, and sustainable government led funding for the requisite infrastructure and workforce. CONCLUSION: TB contact invitation by HWs leading to contact screening occurs in this context. Stakeholder perspectives inform the design of an operational framework for optimized delivery.

PurposeThis paper aims to present the process and results of a local‐level South African action research project on introducing foresight methods into a local government planning process.Design/methodology/approachThe paper outlines the evolutionary process followed, and documents the practical insights gained and lessons learnt in relation to the concept of pro‐poor foresight.FindingsPositive outcomes in the King Sabata Dalindyebo (KSD) foresight process included a high level of stakeholder engagement and senior management buy‐in, supported by positive evaluations by diverse participants. The learning was subsequently incorporated into long‐term development plans and proposals such as the ten‐year development plan for the region. The experience yielded key lessons about the recruitment of participants, policy alignment, communication in diversity, active participation, facilitation as learning, the influence of technical inputs, and the importance of integration.Research limitations/implicationsFurther academic research could build upon this case study to investigate longer‐term impacts of the initiative in KSD, tracking replications and adaptations of the KSD experiment, comparative research between contexts where foresight is used and where it is not in development policy and planning processes, enquiry into how foresight might be formally incorporated in the routine development policy and planning processes of municipalities, and undertaking more theoretical enquiry on the "localising foresight" concept and experience, including the development of guiding criteria and indicators for procedural and outcome success.Practical implicationsThe case focuses on learning in a developing world context where foresight is less advanced than in other contexts. The results of the exercise in KSD suggest that it is possible to embed pro‐poor foresight in a large‐scale policy programme to enhance the resilience of communities, supported by appropriate plans and budgets.Social implicationsThe long‐term nature of foresight can create a "safe" platform for an otherwise difficult engagement, as is this case where three levels of government and various segments of civil society are to be beneficially engaged.Originality/valueThis was a unique action research project in South Africa, where foresight has tended to be mainly at a top or central level – that being the level of corporate executives, national government, or national‐level stakeholders.