Digital methods to enhance the usefulness of patient experience data in services for long-term conditions: the DEPEND mixed-methods study

Background Collecting NHS patient experience data is critical to ensure the delivery of high-quality services. Data are obtained from multiple sources, including service-specific surveys and widely used generic surveys. There are concerns about the timeliness of feedback, that some groups of patients and carers do not give feedback and that free-text feedback may be useful but is difficult to analyse. Objective To understand how to improve the collection and usefulness of patient experience data in services for people with long-term conditions using digital data capture and improved analysis of comments. Design The DEPEND study is a mixed-methods study with four parts: qualitative research to explore the perspectives of patients, carers and staff; use of computer science text-analytics methods to analyse comments; co-design of new tools to improve data collection and usefulness; and implementation and process evaluation to assess use of the tools and any impacts. Setting Services for people with severe mental illness and musculoskeletal conditions at four sites as exemplars to reflect both mental health and physical long-terms conditions: an acute trust (site A), a mental health trust (site B) and two general practices (sites C1 and C2). Participants A total of 100 staff members with diverse roles in patient experience management, clinical practice and information technology; 59 patients and 21 carers participated in the qualitative research components. Interventions The tools comprised a digital survey completed using a tablet device (kiosk) or a pen and paper/online version; guidance and information for patients, carers and staff; text-mining programs; reporting templates; and a process for eliciting and recording verbal feedback in community mental health services. Results We found a lack of understanding and experience of the process of giving feedback. People wanted more meaningful and informal feedback to suit local contexts. Text mining enabled systematic analysis, although challenges remained, and qualitative analysis provided additional insights. All sites managed to collect feedback digitally; however, there was a perceived need for additional resources, and engagement varied. Observation indicated that patients were apprehensive about using kiosks but often would participate with support. The process for collecting and recording verbal feedback in mental health services made sense to participants, but was not successfully adopted, with staff workload and technical problems often highlighted as barriers. Staff thought that new methods were insightful, but observation did not reveal changes in services during the testing period. Conclusions The use of digital methods can produce some improvements in the collection and usefulness of feedback. Context and flexibility are important, and digital methods need to be complemented with alternative methods. Text mining can provide useful analysis for reporting on large data sets within large organisations, but qualitative analysis may be more useful for small data sets and in small organisations. Limitations New practices need time and support to be adopted and this study had limited resources and a limited testing time. Future work Further research is needed to improve text-analysis methods for routine use in services and to evaluate the impact of methods (digital and non-digital) on service improvement in varied contexts and among diverse patients and carers. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 28. See the NIHR Journals Library website for further project information

Co-designing new tools for collecting, analysing and presenting patient experience data in NHS services: working in partnership with patients and carers

Background The way we collect and use patient experience data is vital to optimise the quality and safety of health services. Yet, some patients and carers do not give feedback because of the limited ways data is collected, analysed and presented. In this study, we worked together with researchers, staff, patient and carer participants, and patient and public involvement and engagement (PPIE) contributors, to co-design new tools for the collection and use of patient experience data in multiple health settings. This paper outlines how the range of PPIE and research activities enabled the co-design of new tools to collect patient experience data. Methods Eight public contributors represented a range of relevant patient and carer experiences in specialist services with varied levels of PPIE experience, and eleven members of Patient and Participation Groups (PPGs) from two general practices formed our PPIE group at the start of the study. Slide sets were used to trigger co-design discussions with staff, patient and carer research participants, and PPIE contributors. Feedback from PPIE contributors alongside verbatim quotes from staff, patient and carer research participants is presented in relation to the themes from the research data. Results PPIE insights from four themes: capturing experience data; adopting digital or non-digital tools; ensuring privacy and confidentiality; and co-design of a suite of new tools with guidance, informed joint decisions on the shaping of the tools and how these were implemented. Our PPIE contributors took different roles during co-design and testing of the new tools, which supported co-production of the study. Conclusions Our experiences of developing multiple components of PPIE work for this complex study demonstrates the importance of tailoring PPIE to suit different settings, and to maximise individual strengths and capacity. Our study shows the value of bringing diverse experiences together, putting patients and carers at the heart of improving NHS services, and a shared approach to managing involvement in co-design, with the effects shown through the research process, outcomes and the partnership. We reflect on how we worked together to create a supportive environment when unforeseen challenges emerged (such as, sudden bereavement)

The effects of environmental degradation on agriculture: Evidence from European countries

Currently, one of the most significant challenges of agricultural sector of an economy is to keep pace with the world’s rapidly growing population in order to feed them. But continuous environmental degradation is posing serious threat to the agricultural production. The objective of this study is to look at how environmental degradation in the form of biodiversity loss, deforestation and agricultural emissions can affect agricultural production as well as cereal and vegetable production in 35 countries of Europe. The study utilizes Driscoll and Kraay estimator to understand the potential impacts of environmental degradation as well as other variables such as organic farming, renewable energy, political stability, e-governance, social progress and women empowerment on agriculture. The result reveals that biodiversity loss harms agricultural, cereal and vegetable production while forest area increase positively affect the cereal production and vegetable production. Agricultural emissions, on the other hand, does not significantly affect the three independent variables but it has a negative effect on cereal and positive impact on vegetable production. Renewable energy use, political stability and women empowerment all have positive and significant impacts on all the three dependent variables. E-governance significantly and positively affects agricultural and vegetable production and social progress has positive but insignificant effect on the dependent variables. Finally, the study provides crucial policy implications for the agricultural sector of Europ

ISOLATION AND CHARACTERIZATION OF SHEEP SALMONELLAE IN AND AROUND BANGLADESH AGRICULTURAL UNIVERSITY CAMPUS

The study was carried out for isolation of Salmonella spp. and their characterization from sheep during the period from November 2006 to May 2007. For this study a total number of 63 rectal swab samples of sheep were collected. Out of 63 samples, 9 samples were identified as positive for Salmonella and each positive sample was treated as one isolate. All the Salmonella isolates revealed the same morphological, cultural and biochemical characteristics. In the stab culture on TSI agar slant, all of the isolated Salmonella isolates produced acid (yellow) and gas in the butt, the production of hydrogen sulfide gas in both butt and slant, and the alkaline (red) reaction in the slant. For the slide agglutination test, Salmonella agglutinating antiserum (poly ‘O ’ and poly ‘H’) was used which agglutinated all the isolates and thereby identified the organism as Salmonella. The pathogenicity of the isolates was studied in mice and it revealed that the isolates were pathogenic. After isolation of Salmonella, eight commonly used antibiotics were used for the antibiogram study of isolated Salmonella. Among the isolates, 77.78 % were highly sensitive and 22.22 % were moderately sensitive to ciprofloxacin and spiramycin, 66.67% were highly sensitive and 33.33 % were moderately sensitive to gentamicin. 55.56 % were moderately sensitive and 44.44% were less sensitive to oxytetracycline and streptomycin, 33.33 % were moderately sensitive and 66.67 % were less sensitive to amoxycillin, 11.11 % were moderately sensitive, 33.33 % were less sensitive and 66.67 % were resistant to sulphamethoxazole, 11.11 % were less sensitive and 88.89 % were resistant to penicillin-G. From the results it may be concluded that th