Responding to the risk of reducing resource: a study of the evolution of English environmental health services

Environmental Health services in the UK have been subject to significant resource reduction over the last 3 years. It is suggested that services risk becoming unsustainable unless efficient and effective ways of working are employed. With this in mind this paper presents the findings of research into the experience of practitioners who are developing and delivering evolving environmental health services in English local authorities in the context of deep cutting budget reductions. The research aims to explore the experience of change and identify lessons learnt in the development and execution of new models of environmental health service delivery to mitigate against risks of unsustainable or undeliverable services. Participants were chosen from a range of local authority officers, managers, commissioners and leading members of the professional body who have been closely involved in the planning and delivery stages of environmental health service changes. Interviews were carried out with the participants to capture their experience of change and the impact on service delivery. A range of service delivery models have been examined including outsourcing, shared services, regional delivery models and discussion of mutual arrangements and at various stages of development from planning through to full transformation. Field work was undertaken between June 2014 and November 2015. Thematic analysis of interview transcripts has identified six emergent themes of the experience of change: managing changes effectively; understanding the reasons for change; understanding the nature of environmental health; meaningful consultation; viability of the proposal; planning and timeliness. Environmental health services undergoing transformation may benefit from taking into account the lessons learnt by organisations that have previously undergone significant change in their response to the risk of a reducing resource. The emergent themes are being developed to provide a framework of lessons learnt for environmental health services to consider when making changes to their model of service delivery

Responding to the risk of reducing resources: development of a framework for future change programmes in environmental health services

Environmental Health services in the UK have been subject to significant resource reduction over the last 5 years. It is suggested that services risk becoming unsustainable unless efficient and effective ways of working are employed. With this in mind this paper presents the findings of research into the experience of practitioners who are developing and delivering evolving Environmental Health services in English local authorities in the context of deep cutting budget reductions. The research explores the experience of change and identifies lessons learnt in the development and execution of new models of Environmental Health service delivery to mitigate against risks of unsustainable or undeliverable services. Interviews were carried out with the participants to capture their experience of change and the impact on service delivery. A range of service delivery models have been examined including outsourcing, shared services, regional delivery models and discussion of mutual arrangements and at various stages of development from planning through to full transformation. Field work was undertaken between 2014 and 2016. Thematic analysis of interview transcripts has identified six emergent themes of the experience of change: managing changes effectively; understanding the reasons for change; understanding the nature of Environmental Health; meaningful consultation; viability of the proposal; planning and timeliness. Environmental Health services undergoing transformation may benefit from taking into account the lessons learnt by organisations that have previously undergone significant change in their response to the risk of a reducing resource. Keywords: Environmental Health; austerity; regulation; emerging risk; outsourcing; managing change

Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice

Objectives: The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach. Method: Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP. Results: Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP’s definitive contribution to patient outcomes. Conclusion: There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS

Organisational involvement in supporting the learned professional.

This paper describes the Doctorate in Professional Studies (DProf) as developed at a UK University and specifically focuses on the specialist doctoral pathways in Health, Environment and Risk in the School of Health and Social Sciences. The paper considers the role of the major stakeholders; Doctoral candidate, Employer Organisation hosting the research, and the University. Since the inception of the DProf there has been recognition of the need for the employer organisation to be an active partner in the research by supporting it through being receptive to the emerging research findings. There is also recognition of the differences between traditional doctoral study and that of the work based professional doctoral candidate. Portwood (2000) considered the concept of the learned worker as the person who is able to develop a reflective and cognisant view of organisational developments and change. Armsby and Costley (2009) took the learned worker concept further by considering the potential risks and barriers encountered through the “situatedness” of the professional doctoral candidate in the organisation, and ultimately their vulnerability should there be internal resistance or apathy towards the research. The paper considers two examples of such resistance and analyses the support required for the learned professional doctoral candidate through utilising the resources of “organisation sapiens”. Recommendations are made on strategy for leading the change process and understanding positive and constructive approaches to questioning organisational change. The paper concludes with a consideration of a more inclusive and participatory approach to organisation stakeholder involvement and potential methodologies that may enable greater partnership in the research

Nanoparticle-infused-biodegradable-microneedles as drug-delivery systems: preparation and characterisation

For almost two decades, scientists were exploring the use of nanoparticles as drug vesicles capable of protecting their cargo and deliver it to the target site while evading detection by the body. However, their translation to clinical use has been slower than expected. To a large degree, this is due to the difficulty to formulate the nanomaterial into a usable form, in which they retain their unique, size-dependent properties without aggregating into a bulk material. In this work, we describe a simple methodology for synthesising novel biodegradable microneedle systems infused with silica nanoparticles (SiNP). SiNP were doped with small library of model anti-cancer drugs or drug surrogates before being characterised and encapsulated into biodegradable microneedles. Detailed preparation and characterisation methods for both the nanoparticles and the microneedles-infused with nanoparticles is presented here. We demonstrated the distribution of the nanoparticles within the microneedle matrix in a uniform, un-aggregated form, which enabled the release of the nanoparticles in a sustained manner. Formulating nanomaterial into biodegradable, hydrogel-like microneedles showed to be effective in preserving their colloidal properties, whilst simultaneously enabling the transdermal delivery of the nanomaterial into the body. Although the concepts of nanoparticles and biodegradable microneedles have been researched individually, the combination of the two, to the best of our knowledge, offers a new pathway to nanomedicine-related applications

Evolution of Chagas’ disease in Brazil. Epidemiological perspective and challenges for the future: a critical review

Aims: This paper aimed to provide a critical review of the evolution of Chagas’ disease in Brazil, its magnitude, historical development and management, and challenges for the future. Methods: A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles’ references. Narrative analysis was structured around five main themes identified: vector transmission, control program, and transfusion, oral and congenital transmission. Results: In Brazil, the Chagas’ disease Control Program was fully implemented in the 1980s, when it reached practically all the endemic areas, and in 1991, the Southern Cone Initiative was created, aiming to eliminate the disease transmission through eliminating the Triatoma infestans and controlling blood banks. As a result, the prevalence of chagasic donors in blood banks reduced from 4.4% in the 80s to 0.2% in 2005. In 2006, PAHO certified the interruption of transmission of Chagas’ disease through this vector in Brazil. However, there are still challenges, such as the domiciliation of new vector species, the need for medical care of the infected individuals, the prevention of alternative mechanisms of transmission, the loss of political concern regarding the disease and, the weakening of the control program. Conclusion: Despite the progress towards control, there are still many challenges ahead to maintain and expand such control and minimise the risk of re-emergence

The fate of bezafibrate, carbamazepine, ciprofloxacin and clarithromycin in the wastewater treatment process

The progress of four pharmaceuticals (bezafibrate, carbamazepine, clarithromycin and ciprofloxacin) is followed through the treatment stages (screened sewage, settled sewage and final effluent) of a large urban wastewater treatment plant (WWTP) employing activated sludge treatment. Concentrations at the inlet to the WWTP are generally higher than those predicted from consideration of local pharmaceutical consumption and typical excretion data. Percentage removal efficiencies are variable (22.5 – 94.3%) with carbamazepine being the most resistant to elimination