One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process

<p>Abstract</p> <p>Background</p> <p>Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland), which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes.</p> <p>Methods</p> <p>We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia.</p> <p>Results</p> <p>Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale.</p> <p>Conclusions</p> <p>If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for gaining research governance approval need improvement. Attention is needed in process implementation and management, particularly in relation to staff training, as well as clarity in guidance and communication within and between organisations.</p

Promotion of breast-feeding, health, and growth among hospital-born neonates, and among infants of a rural area of Costa Rica

capítulo de libro -- Universidad de Costa Rica. Instituto de investigaciones en Salud, 1983. Publicado en Diarrhea and Malnutrition. Interactions, Mechanisms and Interventions. L.C. Chen & N.S. Scrimshaw, editors. Plenum Press, N.Y. pp. 177-202, 1983.decline in the incidence of breast-feeding in many developing nations \--as been recorded in recent years, often in conjunction with (a) rapid changes in way of life, (b) migration from rural to urban,- centers, (c) incorporation of women into the labor force (especially in industry), and (d) increase in stress, anxiety, and violence in transitional and modern societies. The marked decline in incidence and duration of breast-feeding throughout the world is a matter of international concern. The importance of breast-feeding, particularly in developing societies, stems from its health-promoting effect, as it provides the best food known for infants, protects the child against a variety of debilitating infectious processes, and encourages attachment between mother and infant.' Furthermore, successful breast-feeding indirectly reduces the ills of bottle- feeding, especially in developing nations, as epidemiological observation in many countries has revealed that early weaning is often associated with severe infant malnutrition, neglect, child abuse, abandonment, and premature deathUniversidad de Costa Rica.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA