Public involvement in health research: a case study of one NHS project over 5 years

Background: Public involvement, both in the National Health Service (NHS) and in clinical research, is promoted as an important democratic principle. The declared aims are to reduce professional autocracy and allow a broader ownership of the research agenda; also to improve the design of, and recruitment and retention of patients to, clinical studies. There have been a number of national initiatives in the UK to improve public input to clinical research activities, but very few reports of effective and sustainable partnerships over time. This study reports the evaluation of one example, which is embedded in the NHS and university partnerships in the Norfolk area of England. Objectives Evaluate: • Putting principles into practice of public involvement in research over a 5 year period for one specific project (Patient and Public Involvement in Research). • How the model contributes to, and impacts upon, all stages of the research process. • Attitudes of the research community and lay volunteers to their mutual experiences of public involvement. • Key factors and strengths of this project, and areas for improvement. Methods: A mixed methods approach related to the 5 years from start of 2003 to end of 2007. This used descriptive statistics of volunteer activity, interviews with key stakeholders (13), questionnaires (53% response rate), and focus group with 10 volunteers to explore emergent themes. We analysed findings using a policy framework approach. Results: About 47 of the original 55 volunteers remained on the panel after 5 years. All have undertaken training, 38% have been involved in the full range of research activities offered, and 75% have attended at least one research project meeting. Some are active in governance, ethics, and advisory committees. Both the research community and the volunteers are very positive about the project. The researchers find it provides well prepared personnel, and gives a speedy and efficient way of fulfilling the expectations of funders for lay input. The volunteers find it gives them important opportunities to influence the quality of research and thus support improvements in patient care. Areas for improvement include increasing social diversity among the volunteers, and improving feedback on input from volunteers, without which volunteers tend to lose confidence and motivation. Conclusion: Long-term sustainable and valuable public input to research is possible. Key factors are committing resources, embedding the service in the infrastructure of a research consortium, and ongoing responsiveness by NHS staff and researchers. Additional activity to recruit and support access may be needed to attract people from a broad range of sociodemographic backgrounds. Some volunteers want more involvement than this model currently offers

Evaluation of a 'drop box' doorstep assessment service to aid remote assessments for COVID-19 in general practice.

From PubMed via Jisc Publications RouterHistory: received 2020-08-04, revised 2021-02-08, accepted 2021-03-17Publication status: ppublishThe COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site 'clean' including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Choosing rewarding flowers; perceptual limitations and innate preferences influence decision making in bumblebees and honeybees

Flowers exhibit great intra-specific variation in the rewards they offer. At any one time, a significant proportion of flowers often contain little or no reward. Hence, foraging profitably for floral rewards is problematic and any ability to discriminate between flowers and avoid those that are less rewarding will confer great advantages. In this study, we examine discrimination by foraging bees among flowers of nasturtium, Tropaeolum majus. Bee visitors included carpenter bees, Xylocopa violacea, which were primary nectar robbers; honeybees, Apis mellifera, which either acted as secondary nectar robbers or gathered pollen legitimately and bumblebees, Bombus hortorum, which were the only bees able to gather nectar legitimately. Many flowers were damaged by phytophagous insects. Nectar volume was markedly lower in flowers with damaged petals (which were also likely to be older) and in flowers that had nectar-robbing holes. We test whether bees exhibit selectivity with regards to the individual flowers, which they approach and enter, and whether this selectivity enhances foraging efficiency. The flowers approached (within 2 cm) by A. mellifera and B. hortorum were non-random when compared to the floral population; both species selectively approached un-blemished flowers. They both approached more yellow flowers than would be expected by chance, presumably a reflection of innate colour preferences, for nectar standing crop did not vary according to flower colour. Bees were also more likely to accept (land on) un-blemished flowers. A. mellifera gathering nectar exhibited selectivity with regards to the presence of robbing holes, being more likely to land on robbed flowers (they are not able to feed on un-robbed flowers). That they frequently approached un-robbed flowers suggests that they are not able to detect robbing holes at long-range, so that foraging efficiency may be limited by visual acuity. Nevertheless, by using a combination of long-range and short-range selectivity, nectar-gathering A. mellifera and B. hortorum greatly increased the average reward from the flowers on which they landed (by 68% and 48%, respectively) compared to the average standing crop in the flower population. Overall, our results demonstrate that bees use obvious floral cues (colour and petal blemishes) at long-range, but can switch to using more subtle cues (robbing holes) at close range. They also make many mistakes and some cues used do not correlate with floral rewards