‘They can move’ – or can they? Freedom of movement, Brexit and working-class stasis

Freedom of movement is a central pillar of the European Union – and the one that British voters rejected in the referendum. Sophie Moullin argues that we need to recognise why some people – particularly the white working-class – do not want to move, and resent being told that EU migrants work harder than they do. But this instinct is not something we should accept as laudable or even inevitable. It stems from deep inequalities in British society

Implementation science in community pharmacy : development of frameworks, models and tools for introducing and integrating professional services

University of Technology Sydney. Graduate School of Health.Background: Internationally, professional pharmacy services are being remunerated and community pharmacies are beginning to implement, however there appears to be a pervasive challenge to achieving widespread support and integration into routine practice. The use of implementation science to conduct implementation studies and evaluate implementation efforts may assist community pharmacy move towards the ultimate goal of sustained service provision and improved health outcomes for the communities they serve. Objectives: To synthesise, analyse and progress knowledge concerning implementation science, then contextualise and apply this knowledge for the implementation of professional services in community pharmacy internationally. The research aims to conceptualise and define the process, influences and indicators for the implementation of professional services in community pharmacy. Methodology: Mixed methodologies were employed. Two theoretical works were conducted to develop definitions and models based on reviews of pharmacy practice, health services and implementation science literature (chapters 3 and 6). A systematic review methodology was used to investigate implementation frameworks of innovations in healthcare (chapter 4). A qualitative study involving semi‐structured interviews examined the implementation process and influences in community pharmacies across Australia. Thematic framework analysis of the data was performed (chapter 5). In Spain, both qualitative and quantitative approaches were applied to develop and test two tools, for the medication review with follow‐up service being implemented in Spain, as measures of the implementation outcome, fidelity (chapter 7). Results: Professional pharmacy services were defined and placed within a model of the overall service offering of a pharmacy (chapter 3). The core concepts across implementation frameworks (i.e. (i) an innovation, (ii) a multi-level context, (iii) a complex multi‐stage process, influenced by a range of (iv) factors, (v) strategies and (vi) evaluations), were collated in a cross‐disciplinary, overarching Generic Implementation Framework (GIF) (chapter 4). The concepts were contextualised for community pharmacy as the Framework for the Implementation of Services in Pharmacy (FISpH) (chapter 5). A model for the evaluation of implementation programs and professional pharmacy services was designed to include implementation impact, process and outcome indicators (chapter 6). Two implementation tools were developed and tested: a 39 item adherence index and a 12 item, 2‐factor patient responsiveness scale (chapter 7). Conclusion: Implementation science provides a base for community pharmacy as they move towards the introduction and integration of professional pharmacy service. The incorporated definitions, models and tools of the framework have been applied in practice to develop implementation programs and implementation research protocols, both in Australia and Spain. [Español] Antecedentes: A nivel internacional, los servicios profesionales farmacéuticos están siendo remunerados y las farmacias comunitarias están empezando a implantarlos; sin embargo, lograr su integración generalizada en la práctica rutinaria está resultando un importante desafío. El uso de la ciencia de implantación para desarrollar estudios de implantación y medir indicadores de implantación de servicios puede ayudar a la farmacia comunitaria a avanzar hacia el objetivo final de la prestación sostenible de servicios y la mejora de los resultados de salud para las comunidades que atienden. Objetivos: Sintetizar, analizar y avanzar el conocimiento relativo a la ciencia de implantación para su posterior contextualización y aplicación en la implantación de servicios profesionales en farmacia comunitaria. Más concretamente, la investigación pretende conceptualizar y definir los procesos, influencias e indicadores para la implantación de dichos servicios profesionales. Metodología: Se emplearon metodologías mixtas. Se realizaron dos trabajos teóricos basados en la literatura científica del ámbito de la práctica de farmacia, los servicios de salud y la ciencia de implantación para desarrollar definiciones y modelos que contextualizaran el trabajo a realizar (capítulos 3 y 6). Se realizó una revisión sistemática para investigar los marcos teóricos para la implantación de innovaciones en el área de la asistencia sanitaria (capitulo 4). Tambien se llevó a cabo un estudio cualitativo con entrevistas semi‐estructuradas que examinó el proceso de implantación y los factores que lo influyen en las farmacias comunitarias en Australia (capitulo 5). En España, se aplicaron metodologías cualitativas y cuantitativas para desarrollar y testar dos herramientas que permitieran medir los resultados de la implantación del servicio de Seguimiento Farmacoterapéutico; concretamente la fidelidad (capitulo 7). Resultados: Los servicios profesionales de la farmacia fueron definidos y contextualizados dentro de la oferta global de servicios que puede realizar una farmacia comunitaria (capitulo 3). Los conceptos fundamentales incluidos en los marcos de implantación (es decir, (i) una innovación, (ii) un contexto multinivel, (iii) un proceso complejo de varias etapas, influido por una serie de (iv) factores, (v) estrategias y (vi) evaluaciones), se recopilaron en un marco interdisciplinario general, el Marco Genérico de la Implantación (capitulo 4). Estos conceptos fueron contextualizados para la farmacia comunitaria en una nueva versión adaptada del mencionado marco (Marco para la Implantación de Servicios en la Farmacia) (capitulo 5). Se desarrolló un modelo para la evaluación de los programas de implantación y los servicios profesionales farmacéuticos, incluyendo indicadores de impacto, proceso y resultados de la implantación (capitulo 6). Finalmente, se desarrollaron y testaron dos herramientas de para medir la implantación de servicios profesionales: un índice de adherencia de 39 ítems y una escala de receptividad del paciente de 12 ítems en 2 factores (capitulo 7). Conclusiones: La ciencia de la implantación proporciona una base para la introducción e integración de los servicios profesionales en la farmacia comunitaria. Las definiciones, modelos y herramientas incorporadas en el marco genérico de la implantación derivado de esta tesis, se han aplicado en la práctica para el desarrollo de protocolos de investigación y programas de implantación, tanto en Australia y España

Perineal Drainage in Inveterate Stricture of the Penile Part of the Urethra.

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The Pathology of Enlargement of the Prostate.

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The impact of commercial and artistic photography on the portrayal of reality

This report discusses the impact of commercial and artistic photography on the portrayal of reality. It is based on my six-month experience as an intern at Atelier Mai 98 in Paris, a studio devoted to the production of pictures for the luxury market. In my reflection I intend to demonstrate the close bonds between photography and the advertising industry as far as its conception, distribution and aestheticization are concerned. My aim is to discuss how commercial photography creates codes that modify the perception of reality for commercial reasons whereas artistic photography designs an alternative world by revealing the invisible

Notes on a Case of Backward Dislocation of the Head of the Humerus Caused by Muscular Action.

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Improving and evaluating performance with the Public Sector Scorecard

Purpose – The Public Sector Scorecard (PSS) is an integrated performance management framework incorporating strategy mapping, service improvement, and measurement and evaluation. It adapts and extends the balanced scorecard to suit the culture and values of the public and voluntary sectors. The purpose of this paper is to assess, with the aid of two case studies across organisational boundaries, how the PSS addresses a number of critical success factors for performance management and improvement in the public and third sectors. Design/methodology/approach – The research takes a case study approach assessing the use of the PSS for the UK Ethnic Minority Employment Task Force, and for Sheffield Let’s Change4Life, a £10 million programme addressing obesity in children and families. Findings – This paper concludes that the PSS is an effective framework to help organisations improve outcomes for service users and stakeholders without increasing overall cost, and develop measures of performance that help them improve and assure quality without motivating staff to achieve arbitrary targets at the expense of poor service to the public. Key to this is its emphasis on developing a performance management culture based on improvement, innovation and learning rather than a top-down blame culture. Originality/value – There have been many research papers describing the problems and pitfalls of public sector performance management, but few which offer a solution. A particular innovation is how the theory of planned behaviour was integrated with a performance management framework for a behaviour change programme addressing childhood obesity

Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

Background: Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Methods: A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1-5 scale). Results: In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5). Conclusion: This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available

The value of implementation science in bridging the evidence gap in bereavement care

There is a gap in the use of evidence in bereavement care. Implementation science is a field focused on moving evidence into practice and therefore may help close the gap. Implementation science advances the design, relevance, and dissemination of research and the adoption, implementation, and maintenance of evidence-based practices. We provide an overview of implementation science, describe five implementation frameworks (Knowledge to Action; Behavior Change Wheel; Exploration Preparation Implementation Sustainment; Interactive Systems Framework; and Reach, Adoption, Implementation, Maintenance), and illustrate their application in bereavement care. These advancements will promote high-quality bereavement care that improves the lives of bereaved people