Realist evaluation of the impact of paediatric nurse practitioner clinics, specialist paediatric nurses, and a children’s community nursing team in deflecting attendance at emergency departments and urgent care centres by children with long-term conditions

In 2018, the Greater Manchester Children’s Health and Wellbeing Board developed a 10-point strategy to achieve its objectives, the sixth of which was to reduce unnecessary hospital attendances and admissions for children with long term conditions such as asthma, diabetes and epilepsy. Funding was secured from Manchester Academic Health Science Centre to commission an exploration of the impact of the Paediatric Nurse Practitioner Clinic within the context of the Family Services Model and the impact that the service was having on reducing attendance at urgent care centres or admission to hospital. Alternatives to taking children to the ED/UCC can be a preference. An integrated system, with elements able to book directly into others, with rapid access, information, health promotion, and follow-up were essential to success. Extra consultation time for proactive intervention, with sufficient nurses to provide a seven-days service were valued. Advertisement of the service to the public and to professionals is vital for uptake by professionals and the public

Assessing the effects of the first 2 years of industry-led badger culling in England on the incidence of bovine tuberculosis in cattle in 2013–2015

Culling badgers to control the transmission of bovine tuberculosis (TB) between this wildlife reservoir and cattle has been widely debated. Industry-led culling began in Somerset and Gloucestershire between August and November 2013 to reduce local badger populations. Industry-led culling is not designed to be a randomised and controlled trial of the impact of culling on cattle incidence. Nevertheless, it is important to monitor the effects of the culling and, taking the study limitations into account, perform a cautious evaluation of the impacts. A standardised method for selecting areas matched to culling areas in factors found to affect cattle TB risk has been developed to evaluate the impact of badger culling on cattle TB incidence. The association between cattle TB incidence and badger culling in the first two years has been assessed. Descriptive analyses without controlling for confounding showed no association between culling and TB incidence for Somerset, or for either of the buffer areas for the first two years since culling began. A weak association was observed in Gloucestershire for Year 1 only. Multivariable analysis adjusting for confounding factors showed that reductions in TB incidence were associated with culling in the first two years in both the Somerset and Gloucestershire intervention areas when compared to areas with no culling (IRR: 0.79, 95%CI: 0.72-0.87, p<0.001 and IRR: 0.42, 95%CI: 0.34-0.51, p<0.001 respectively). An increase in incidence was associated with culling in the 2 km buffer surrounding the Somerset intervention area (IRR: 1.38, 95%CI: 1.09-1.75, p=0.008), but not in Gloucestershire (IRR: 0.91, 95%CI: 0.77-1.07, p=0.243). As only two intervention areas with two years’ of data are available for analysis, and the biological cause-effect relationship behind the statistical associations is difficult to determine, it would be unwise to use these findings to develop generalisable inferences about the effectiveness of the policy at present

Safer clinical systems : interim report, August 2010

Safer Clinical Systems is the Health Foundation’s new five year programme of work to test and demonstrate ways to improve healthcare systems and processes, to develop safer systems that improve patient safety. It builds on learning from the Safer Patients Initiative (SPI) and models of system improvement from both healthcare and other industries. Learning from the SPI highlighted the need to take a clinical systems approach to improving safety. SPI highlighted that many hospitals struggle to implement improvement in clinical areas due to inherent problems with support mechanisms. Clinical processes and systems, rather than individuals, are often the contributors to breakdown in patient safety. The Safer Clinical Systems programme aimed to measure the reliability of clinical processes, identify defects within those processes, and identify the systems that result in those defects. Methods to improve system reliability were then to be tested and re-developed in order to reduce the risk of harm being caused to patients. Such system-level awareness should lead to improvements in other patient care pathways. The relationship between system reliability and actual harm is challenging to identify and measure. Specific, well-defined, small-scale processes have been used in other programmes, and system reliability has been shown to have a direct causal relationship with harm (e.g. care bundle compliance in an intensive care unit can reduce the incidence of ventilator-associated pneumonia). However, it has become evident that harm can be caused by a variety of factors over time; when working in broader, more complex and dynamic systems, change in outcome can be difficult to attribute to specific improvements and difficulties are also associated with relating evidence to resulting harm. The overall aim of Phase 1 of the Safer Clinical Systems programme was to demonstrate proof-of-concept that using a systems-based approach could contribute to improved patient safety. In Phase 1, experienced NHS teams from four locations worked together with expert advisers to co-design the Safer Clinical Systems programme

Serious violent offenders : developing a risk assessment framework

In order to establish a complementary language of risk across all agencies, it is recommended that the Scottish Government and the Risk Management Authority actively disseminate MAPPA guidance through the RMA's specialist training programme and through the development of protocols and memoranda of agreement. Prior to a violent offender framework being implemented, an audit of existing numbers, staffing, budgetary and other resources should be undertaken across the Community Justice Authorities to ascertain projected needs

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Training healthcare assistants working in adult acute inpatient wards in Psychological First Aid: An implementation and evaluation study.

WHAT IS KNOWN ON THE SUBJECT: Healthcare assistants are untrained and unregistered frontline staff but are expected to be proactive in preventing and responding to 'untoward' incidents quickly and efficiently when working within adult acute inpatient psychiatric settings. Healthcare assistants should be trained to provide enhanced care to service users residing in acute psychiatric settings. To date, a training programme in Psychological First Aid has not been expended in such a setting with nonregistered staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study demonstrates that training healthcare assistants in Psychological First Aid is useful in improving their confidence in caring for service users, therapeutic engagement with service users and ward culture in general. WHAT ARE THE IMPLICATIONS FOR PRACTICE: A training programme in Psychological First Aid for healthcare assistants to enhance ward culture can be implemented in different practice environments. Psychological First Aid is harmonious with nursing values and provides healthcare assistants with a relevant, useful and easily understood toolkit to apply in acute psychiatric settings. ABSTRACT: Introduction Healthcare assistants working within adult acute inpatient psychiatric settings are untrained and unregistered, however, they can contribute to quality service if they receive some training. Psychological First Aid training has never been expended in these settings, so this study intends to fill this gap in the existing evidence with this category of healthcare personnel. Aim The aim of this study was to introduce and evaluate first aid training for healthcare assistants. Method A pre/post design was adopted to gather data using questionnaires and interviews. The groups of participants included 16 healthcare assistants trained in Psychological First Aid, a sample of service users and four ward managers. Results Post-training, (a) healthcare assistants and service users ranked the therapeutic milieu of the ward more favourably, (b) the self-efficacy of the healthcare assistants increased, and the number of 'untoward' incidents decreased, and (c) health care assistants' confidence in their skills was high. The ward manager interviews post-training revealed four themes: (a) staff utilization of new skills and renewed enthusiasm, (b) calmer atmosphere on the ward and staff togetherness, (c) confidence and reflection on practice and (d) therapeutic engagement. Discussion Training healthcare assistants is useful in improving staff confidence, therapeutic engagement with service users and ward culture in general. Implications for practice Techniques and skills learnt are relevant and useful to healthcare assistants and provide an easily understood toolkit that is harmonious with nursing values. If executed correctly, the training can enhance practice and care outcomes and the overall service user experience

The New Multi-Ministry Response to Conduct Problems: A SWOT analysis

The Inter-agency Plan for Conduct Disorder/Severe Antisocial Behaviour 2007-2012 (Ministry of Social Development, 2007) is assessed according to the SWOT dimensions of strengths, weaknesses, opportunities and threats. The document is one of the most important statements for the social services in New Zealand because of the primacy that it gives to current knowledge about conduct problems and for its endorsement of research-based practices. The plan's limitations include its risk-focused approach, its unsystematic response to 0-2 year-olds in difficult care-giving circumstances, and its lack of reference to adolescent girls with emotional issues who can contribute to the next generation of antisocial young people. As well, the plan might have considered the role of social systems in regard to conduct problems like the school, the neighbourhood, and community values. The implementation of the document could be imperilled by numerous influences, such as contrasting professional perspectives and non-empirical emphases in education

From the “broadband ditch” to the release of the 2010 US national broadband plan. A short history of the broadband penetration debate in the US

The paper provides an historical account of the policy debate that took place in the United States after the 2007 release of the OECD's broadband statistics. It explains why and in what context such a debate occurred (lack of relevant statistics from the FCC, dissatisfaction of some stakeholders with the deregulation of broadband, role of new players). The paper reviews the policy options proposed by the main players to foster the deployment of broadband, among others the potential inclusion of broadband in the scope of the US universal service, the need for a national policy, and implementation/funding issues. It puts into perspective the national broadband plan proposed by the FCC in March 2010.broadband, competition, industrial policies, government intervention, universal service, open internet, deregulation, rankings/ benchmarking countries.