More than just a chat: Bringing service user involvement to an online community practice

The Department of Health (DH) advocates communities of practice (CoPs) as a key vehicle for delivering service transformation (DH, 2011). In 2012, a health visitors' online community of practice (Kendall and Ikioda, 2014) extended the concept through a web-supported platform. A recent development involved a closed Facebook group to bring a group of health visitors and service users together through a series of online ‘chats’, aimed at learning more about the service user perspective of receiving an evidence-based service. This article explores the experience of service user involvement in the interpretation of research-based practice, drawing on the narratives of both groups, and considers the impact this could have on service deliver

Emerging school sport development policy, practice and governance in England: Big Society, autonomy and decentralisation

International interest in developing mass sports participation through systems of school and community sports development has become a growing field of public leisure policy interest. This research paper considers the policy change from School Sport Partnerships to the new 2012 School Games model of networked partnerships to establish characteristics of the changes in governance modes and implications from practice in England. The research project is based on a regional case study drawing upon indepth,face-to-face interviews with key public policy stakeholders to inform an analysis of change. Initial findings indicate that the emergent networks are characterised by more networked-based mode of governance than previous hierarchical models present under UK New Labour. The study also shows the fragility of a reliance on partnership structures and the potential implications for incongruence in delivering policy outcomes and improving access to physical activity and school sport opportunities

The systematic guideline review: method, rationale, and test on chronic heart failure

Background: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources-especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development-the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). Methods: A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Results: Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. Conclusion: The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines

Does media coverage influence public attitudes towards welfare recipients? The impact of the 2011 English riots

Following the shooting of Mark Duggan by police on 4 August 2011, there were riots in many large cities in the UK. As the rioting was widely perceived to be perpetrated by the urban poor, links were quickly made with Britain's welfare policies. In this paper, we examine whether the riots, and the subsequent media coverage, influenced attitudes toward welfare recipients. Using the British Social Attitudes survey, we use multivariate difference-in-differences regression models to compare attitudes toward welfare recipients among those interviewed before (pre-intervention: i.e. prior to 6 August) and after (post-intervention: 10 August–10 September) the riots occurred (N?=?3,311). We use variation in exposure to the media coverage to test theories of media persuasion in the context of attitudes toward welfare recipients. Before the riots, there were no significant differences between newspaper readers and non-readers in their attitudes towards welfare recipients. However, after the riots, attitudes diverged. Newspaper readers became more likely than non-readers to believe that those on welfare did not really deserve help, that the unemployed could find a job if they wanted to and that those on the dole were being dishonest in claiming benefits. Although the divergence was clearest between right-leaning newspaper and non-newspaper readers, we do not a find statistically significant difference between right- and left-leaning newspapers. These results suggest that media coverage of the riots influenced attitudes towards welfare recipients; specifically, newspaper coverage of the riots increased the likelihood that readers of the print media expressed negative attitudes towards welfare recipients when compared with the rest of the population

Does media coverage influence public attitudes towards welfare recipients? the impact of the 2011 English riots

Following the shooting of Mark Duggan by police on the 4th August 2011, there were riots in many large cities in the UK. As the rioting was widely perceived to be perpetrated by the urban poor, links were quickly made with Britain’s welfare policies. In this paper, we examine whether the riots, and the subsequent media coverage, influenced attitudes toward welfare recipients. Using the British Social Attitudes survey, we use multivariate difference-in-differences regression models to compare attitudes toward welfare recipients among those interviewed before (pre-intervention: i.e. prior to the 6th of August) and after (post-intervention: 10th of August – 10th of September) the riots occurred (N = 3,311). We use variation in exposure to the media coverage to test theories of media persuasion in the context of attitudes toward welfare recipients. Before the riots, there were no significant differences between newspaper readers and non-readers in their attitudes towards welfare recipients. However, after the riots, attitudes diverged. Newspaper readers became more likely than non-readers to believe that those on welfare did not really deserve help, that the unemployed could find a job if they wanted to and that those on the dole were being dishonest in claiming benefits. Although the divergence was clearest between right-leaning newspaper and non-newspaper readers, we do not a find statistically significant difference between right- and left-leaning newspapers. These results suggest that media coverage of the riots influenced attitudes towards welfare recipients; specifically, newspaper coverage of the riots increased the likelihood that readers of the print media expressed negative attitudes towards welfare recipients when compared with the rest of the population

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Background: The feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy. Objectives: To (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care. Design: Two separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care. Interventions: Aggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings. Main outcome measures: Aggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being. Data sources: Searches of electronic databases and forwards and backwards citation tracking. Review methods: Realist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care. Results: Providers were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit. Strengths and limitations: There was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories. Conclusions: PROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality. Future work: Future research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care

An impact assessment for urban stormwater use

The adoption of stormwater collection and use for a range of non-potable applications requires that the perceived risks, particularly those associated with public health, are addressed. Pollutant impacts have been assessed using E. coli and a scoring system on a scale of 0 to 5 to identify the magnitude of impacts and also the likelihood of exposure to stormwater during different applications. Combining these identifies that low or medium risks are generally predicted except for domestic car washing and occupational irrigation of edible raw food crops where the predicted high risk would necessitate the introduction of remedial action

Access and quality of parks and associations with obesity: A cross-sectional study.

Public health is increasingly engaging with multi-faceted obesity prevention efforts. Although parks represent key community assets for broader public health, they may not be distributed equitably and associations with obesity are equivocal. We investigated park access and quality relative to deprivation and obesity with individual-level data from the Yorkshire Health Study. Compared to the least deprived areas, the moderately and most deprived areas had a greater park access and park quality in terms of features and amenities. However, parks in the moderately and most deprived areas also had the most safety concerns and incivilities. Although deprivation was associated with obesity, contrary to current policy guidance, both park access and quality appear less important for understanding variations in obesity within this study. Although sub-group analyses by deprivation tertile revealed that low quality park amenities in highly and moderately deprived areas may be important for understanding obesity prevalence, all other associations were non-significant

OPTIMA prelim: a randomised feasibility study of personalised care in the treatment of women with early breast cancer

Abstract Background There is uncertainty about the chemotherapy sensitivity of some oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers. Multiparameter assays that measure the expression of several tumour genes simultaneously have been developed to guide the use of adjuvant chemotherapy for this breast cancer subtype. The assays provide prognostic information and have been claimed to predict chemotherapy sensitivity. There is a dearth of prospective validation studies. The Optimal Personalised Treatment of early breast cancer usIng Multiparameter Analysis preliminary study (OPTIMA prelim) is the feasibility phase of a randomised controlled trial (RCT) designed to validate the use of multiparameter assay directed chemotherapy decisions in the NHS. Objectives OPTIMA prelim was designed to establish the acceptability to patients and clinicians of randomisation to test-driven treatment assignment compared with usual care and to select an assay for study in the main RCT. Design Partially blinded RCT with adaptive design. Setting Thirty-five UK hospitals. Participants Patients aged ≥ 40 years with surgically treated ER-positive HER2-negative primary breast cancer and with 1–9 involved axillary nodes, or, if node negative, a tumour at least 30 mm in diameter. Interventions Randomisation between two treatment options. Option 1 was standard care consisting of chemotherapy followed by endocrine therapy. In option 2, an Oncotype DX® test (Genomic Health Inc., Redwood City, CA, USA) performed on the resected tumour was used to assign patients either to standard care [if ‘recurrence score’ (RS) was > 25] or to endocrine therapy alone (if RS was ≤ 25). Patients allocated chemotherapy were blind to their randomisation. Main outcome measures The pre-specified success criteria were recruitment of 300 patients in no longer than 2 years and, for the final 150 patients, (1) an acceptance rate of at least 40%; (2) recruitment taking no longer than 6 months; and (3) chemotherapy starting within 6 weeks of consent in at least 85% of patients. Results Between September 2012 and 3 June 2014, 350 patients consented to join OPTIMA prelim and 313 were randomised; the final 150 patients were recruited in 6 months, of whom 92% assigned chemotherapy started treatment within 6 weeks. The acceptance rate for the 750 patients invited to participate was 47%. Twelve out of the 325 patients with data (3.7%, 95% confidence interval 1.7% to 5.8%) were deemed ineligible on central review of receptor status. Interviews with researchers and recordings of potential participant consultations made as part of the integral qualitative recruitment study provided insights into recruitment barriers and led to interventions designed to improve recruitment. Patient information was changed as the result of feedback from three patient focus groups. Additional multiparameter analysis was performed on 302 tumour samples. Although Oncotype DX, MammaPrint®/BluePrint® (Agendia Inc., Irvine, CA, USA), Prosigna® (NanoString Technologies Inc., Seattle, WA, USA), IHC4, IHC4 automated quantitative immunofluorescence (AQUA®) [NexCourse BreastTM (Genoptix Inc. Carlsbad, CA, USA)] and MammaTyper® (BioNTech Diagnostics GmbH, Mainz, Germany) categorised comparable numbers of tumours into low- or high-risk groups and/or equivalent molecular subtypes, there was only moderate agreement between tests at an individual tumour level (kappa ranges 0.33–0.60 and 0.39–0.55 for tests providing risks and subtypes, respectively). Health economics modelling showed the value of information to the NHS from further research into multiparameter testing is high irrespective of the test evaluated. Prosigna is currently the highest priority for further study. Conclusions OPTIMA prelim has achieved its aims of demonstrating that a large UK clinical trial of multiparameter assay-based selection of chemotherapy in hormone-sensitive early breast cancer is feasible. The economic analysis shows that a trial would be economically worthwhile for the NHS. Based on the outcome of the OPTIMA prelim, a large-scale RCT to evaluate the clinical effectiveness and cost-effectiveness of multiparameter assay-directed chemotherapy decisions in hormone-sensitive HER2-negative early breast would be appropriate to take place in the NHS