Workplace-based interventions to promote healthy lifestyles in the NHS workforce : a rapid scoping and evidence map

Background:The health and well-being of staff working in the NHS is a significant issue for UK health care. We sought to identify research relevant to the promotion of healthy lifestyles among NHS staff on behalf of NHS England. Objectives:To map existing reviews on workplace-based interventions to promote health and well-being, and to assess the scope for further evidence synthesis work. Design:Rapid and responsive scoping search and evidence map. Participants:Adult employees in any occupational setting and in any role. Interventions:Any intervention aimed at promoting or maintaining physical or mental health and well-being. Early intervention initiatives and those addressing violence against staff, workplace bullying or harassment were also included. Main outcome measures:Any outcome related to the effectiveness, cost-effectiveness or implementation of interventions.Data sources:A scoping search of nine databases was conducted to identify systematic reviews on health and well-being at work. Searches were limited by publication date (2000 to January/February 2019). Review methods:The titles and abstracts of over 8241 records were screened and a total of 408 potentially relevant publications were identified. Information on key characteristics were extracted from the titles and abstracts of all potentially relevant publications. Descriptive statistics (counts and percentages) for key characteristics were generated and data from reviews and ‘reviews of reviews’ were used to produce the evidence map. Results:Evidence related to a broad range of physical and mental health issues was identified across 12 ‘reviews of reviews’ and 312 other reviews, including 16 Cochrane reviews. There also exists National Institute for Health and Care Excellence guidance addressing multiple issues of potential relevance. A large number of reviews focused on mental health, changing lifestyle behaviour, such as physical activity, or on general workplace health/health promotion. Most of the reviews that focused only on health-care staff addressed mental health issues, and stress/burnout in particular. Limitations:The scoping search process was extensive and clearly effective at identifying relevant publications, but the strategy used may not have identified every potentially relevant review. Owing to the large number of potentially relevant reviews identified from the scoping search, it was necessary to produce the evidence map using information from the titles and abstracts of reviews only. Conclusions: It is doubtful that further evidence synthesis work at this stage would generate substantial new knowledge, particularly within the context of the NHS Health and Wellbeing Framework published in 2018. Additional synthesis work may be useful if it addressed an identifiable need and it was possible to identify one of the following: (1) a specific and focused research question arising from the current evidence map; it may then be appropriate to focus on a smaller number of reviews only, and provide a more thorough and critical assessment of the available evidence; and (2) a specific gap in the literature (i.e. an issue not already addressed by existing reviews or guidance); it may then be possible to undertake further literature searching and conduct a new evidence review

Informing NHS policy in 'digital-first primary care': a rapid evidence synthesis

Background In ‘digital-first primary care’ models of health-care delivery, a patient’s first point of contact with a general practitioner or other health professional is through a digital channel, rather than a face-to-face consultation. Patients are able to access advice and treatment remotely from their home or workplace via a number of different technologies. Objectives This rapid responsive evidence synthesis was undertaken to inform NHS England policy in ‘digital-first primary care’. It was conducted in two stages: (1) scoping the published evidence and (2) addressing a refined set of questions produced by NHS England from the evidence retrieved during the scoping stage. Data sources Searches were conducted of five electronic databases (MEDLINE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and PROSPERO were searched in July 2018) and relevant research/policy and government websites, as well as the National Institute for Health Research Health Service and Delivery Research programme database of ongoing and completed projects. No date or geographical limitations were applied. Review methods After examining the initial scoping material, NHS England provided a list of questions relating to the potential effects of digital modes and models of engagement, and the contracting and integration of these models into primary care. Systematic reviews and evidence syntheses, including evidence on the use of digital (online) modes and models of engagement between patients and primary care, were examined more closely, as was ongoing research and any incidentally identified primary studies focused on the use of digital (online) modes and models of engagement. All records were screened by two reviewers, with disagreements resolved by consensus or consulting a third reviewer. Results Evidence suggests that uptake of existing digital modes of engagement is currently low. Patients who use digital alternatives to face-to-face consultations are likely to be younger, female and have higher income and education levels. There is some evidence that online triage tools can divert demand away from primary care, but results vary between interventions and outcome measures. A number of potential barriers exist to using digital alternatives to face-to-face consultations, including inadequate NHS technology and staff concerns about workload and confidentiality. There are currently insufficient empirical data to either substantiate or allay such concerns. Very little evidence exists on outcomes related to quality of care, service delivery, benefits or harms for patients, or on financial costs/cost-effectiveness. No studies examining how to contract and commission alternatives to face-to-face consultations were identified. Limitations The quality of the included reviews was variable. Poor reporting of methodology and a lack of adequate study details were common issues. Much of the evidence focused on exploring stakeholder views rather than on objective measurement of potential impacts. The current evidence synthesis is based on a rapid scoping exercise and cannot provide the breadth or depth of insight that might have been achieved with a full systematic review. Conclusions Rapid scoping of the literature suggests that there is little high-quality evidence relating to ‘digital-first primary care’ as defined by NHS England. The broader evidence on alternatives to face-to-face consultation addresses certain policy-maker concerns, such as the possible impact of new technologies on workload and workforce, inequalities, local implementation and integration with existing services. However, although this evidence gives an insight into the views and experiences of health professionals in relation to such concerns, quantitative empirical data are lacking

Release and Establishment of Megamelus scutellaris (Hemiptera: Delphacidae) on Waterhyacinth in Florida

More than 73,000 Megamelus scutellaris (Hemiptera: Delphacidae) were released in Florida over a 2 to 3 yr period at 10 sites in an attempt to establish sustainable populations on waterhyacinth, Eichhornia crassipes Mart. Solms (Commelinales: Pontederiaceae). Insect populations persisted at most sites including those furthest north and consecutive overwintering was confirmed in as many as three times at some sites. Establishment appeared to be promoted at sites with some cover or shading compared to open areas. Insects readily dispersed over short distances which made detection and monitoring difficultFil: Tipping, Philip W.. Invasive Plant Research Laboratory; Estados UnidosFil: Sosa, Alejandro Joaquín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para el Estudio de Especies Invasivas; ArgentinaFil: Pokorny, Eileen N.. Invasive Plant Research Laboratory; Estados UnidosFil: Foley, Jeremiah. Invasive Plant Research Laboratory; Estados UnidosFil: Schmitz, Don C.. Florida Fish and Wildlife Conservation Commission; Estados UnidosFil: Lane, Jon S.. U.S. Army Corps of Engineers; Estados UnidosFil: Rodgers, Leroy. South Florida Water Management District; Estados UnidosFil: Mccloud, Lori. St. Johns River Water Management District; Estados UnidosFil: Livingston-Way, Pam. St. Johns River Water Management District; Estados UnidosFil: Cole, Matthew S.. St. Johns River Water Management District; Estados UnidosFil: Nichols, Gary. St. Johns River Water Management District; Estados Unido

(±)-9-exo-Amino-5,6,7,8-tetrahydro-5,8-methano-9H-benzocyclohepten-8-ol Hydrochloride

This is the published version, also available here: http://www.dx.doi.org/10.1107/S0567740878004458

Stress Preconditioning of Spreading Depression in the Locust CNS

Cortical spreading depression (CSD) is closely associated with important pathologies including stroke, seizures and migraine. The mechanisms underlying SD in its various forms are still incompletely understood. Here we describe SD-like events in an invertebrate model, the ventilatory central pattern generator (CPG) of locusts. Using K+ -sensitive microelectrodes, we measured extracellular K+ concentration ([K+]o) in the metathoracic neuropile of the CPG while monitoring CPG output electromyographically from muscle 161 in the second abdominal segment to investigate the role K+ in failure of neural circuit operation induced by various stressors. Failure of ventilation in response to different stressors (hyperthermia, anoxia, ATP depletion, Na+/K+ ATPase impairment, K+ injection) was associated with a disturbance of CNS ion homeostasis that shares the characteristics of CSD and SD-like events in vertebrates. Hyperthermic failure was preconditioned by prior heat shock (3 h, 45°C) and induced-thermotolerance was associated with an increase in the rate of clearance of extracellular K+ that was not linked to changes in ATP levels or total Na+/K+ ATPase activity. Our findings suggest that SD-like events in locusts are adaptive to terminate neural network operation and conserve energy during stress and that they can be preconditioned by experience. We propose that they share mechanisms with CSD in mammals suggesting a common evolutionary origin

Regulating and inspecting integrated health and social care in the UK : scoping the literature

Background: The integration of care, particularly across the health and social care sectors, has been a long-standing policy objective in the UK. We sought to scope the evidence related to the regulation and inspection of integrated care. Objective(s): To identify and classify published material that could potentially address four key questions: 1. What models of regulation and inspection of integrated care have been proposed? (Including approaches taken in other countries) 2. What evidence is available on the effectiveness of such models? 3. What are the barriers and enablers of effective regulation and inspection of integrated care? 4. Can barriers to effective regulation and inspection be overcome without legislative change? Design: Rapid scoping review. Publication type and focus: Both empirical and non-empirical publications related to the regulation and inspection of integrated care were included. Setting: Publications focused on the integration of health and social care services, or provision delivered across other settings/sectors by different professional groups working together. Outcomes: Empirical studies reporting on any outcome relevant to the regulation and/or inspection of integrated care. Non-empirical publications focusing on any relevant issue including proposed models of regulation or outcome frameworks. Data sources: A targeted search of five databases was undertaken. Additionally, we conducted supplementary searches of the websites of key organisations and searched for other grey literature using the advanced search function of Google. Key contacts were also approached, and a request made for relevant documents. Review methods: The title and abstracts of 5380 records were screened and a total of 166 publications were included. Documents were coded based on key characteristics, and a descriptive summary of the literature produced. No attempt was made to assess the quality or synthesise the findings of the retrieved evidence. Results Out of the 166 included publications, 71 were identified from database searches and 95 were included from supplementary website searches. While there were records that could be classified as relevant to one or more of the research questions identified through the stakeholder consultation, there was a notable absence of evidence relating to (a) effectiveness of regulatory/inspection strategies and (b) professional regulation. Conclusions and future work The evidence base relating to the regulation or inspection of integrated care is relatively small. There may be an opportunity to synthesise some of the existing views and experience data on system regulation and inspection identified in a more formal systematic review. However, before a useful evidence base can be developed, policy makers and researchers need to agree what constitutes ‘effective’ regulation, how this can be measured, and which study designs are most appropriate for evaluation. Related questions about what constitutes ‘successful’ integration of care should also be taken into account when planning such research. While potentially useful reforms have been proposed, empirical evidence in relation to professional regulation appears particularly scarce. Organisations responsible for regulating professionals might therefore consider incorporating some form of evaluation into any planned strategic reforms. Limitations The degree of focus on integration or regulation was a difficult criterion to apply with strict consistency

Cognitive and Behavioral Resilience Among Young Gay and Bisexual Men Living with HIV

Purpose: HIV/AIDS disproportionately affects young gay, bisexual, and other men who have sex with men (Y-GBMSM). Resilience remains understudied among Y-GBMSM living with HIV, but represents a potentially important framework for improving HIV-related outcomes in this population. We sought to explore cognitive and behavioral dimensions of resilience and their correlates among Y-GBMSM to gain insights to inform future interventions

Trajectory mapping: A tool for validation of trace gas observations

We investigate the effectiveness of trajectory mapping(TM) as a data validation tool. TM combines a dynamical model of the atmosphere with trace gas observations to provide more statistically robust estimates of instrument performance over much broader geographic areas than traditional techniques are able to provide. We present four detailed case studies selected so that the traditional techniques are expected to work well. In each case the TM results are equivalent to or improve upon the measurement comparisons performed with traditional approaches. The TM results are statistically more robust than those achieved using traditional approaches since the TM comparisons occur over a much larger range of geophysical variability. In the first case study we compare ozone data from the Halogen Occultation Experiment (HALOE) with Microwave Limb Sounder(MLS). TM comparisons appear to introduce little to no error as compared to the traditional approach. In the second case study we compare ozone data from HALOE with that from the Stratospheric Aerosol and Gas Experiment TT(SAGE TT). TM results in differences of less than 5% as compared to the traditional approach at altitudes between 18 and 25 km and less than 10% at altitudes between 25 and 40 km.In the third case study we show that ozone profiles generated from HALOE data using TM compare well with profiles from five European ozonesondes. In the fourth case study we evaluate the precision of MLS H20 using TM and find typical precision uncertainties of 3-7% at most latitudes and altitudes. The TM results agree well with previous estimates but are the result of a global analysis of the data rather than an analysis in the limited latitude bands in which traditional approaches work. Finally, sensitivity studies using the MLS H20 data show the following: (1) a combination of forward and backward trajectory calculations minimize uncertainties in isentropic TM; (2) although the uncertainty of the technique increases with trajectory duration,TM calculations of up to 14 days can provide reliable information for use in data validation studies; (3) a correlation coincidence criterion of 400 km produces the best TM results under most circumstances; (4) TM performs well compared to (and sometimes better than) traditional approaches at all latitudes and in most seasons and; (5) TM introduces no statistically significant biases at altitudes between 22 and 40 km

The stroke ‘Act FAST’ campaign: Remembered but not understood?

Background: The stroke awareness raising campaign ‘Act FAST' (Face, Arms, Speech: Time to call Emergency Medical Services) has been rolled out in multiple waves in England, but impact on stroke recognition and response remains unclear. Purpose: The purpose of this study was to test whether providing knowledge of the FAST acronym through a standard Act FAST campaign leaflet increases accurate recognition and response in stroke-based scenario measures. Methods: This is a population-based, cross-sectional survey of adults in Newcastle upon Tyne, UK, sampled using the electoral register, with individuals randomized to receive a questionnaire and Act FAST leaflet (n = 2500) or a questionnaire only (n = 2500) in 2012. Campaign message retention, stroke recognition, and response measured through 16 scenario-based vignettes were assessed. Data were analyzed in 2013. Results: Questionnaire return rate was 32·3% (n = 1615). No differences were found between the leaflet and no-leaflet groups in return rate or demographics. Participants who received a leaflet showed better campaign recall (75·7% vs. 68·2%, P = 0·003) and recalled more FAST mnemonic elements (66·1% vs. 45·3% elements named correctly, P < 0·001). However, there were no between-group differences for stroke recognition and response to stroke-based scenarios (P > 0·05). Conclusions: Despite greater levels of recall of specific ‘Act FAST' elements among those receiving the Act FAST leaflet, there was no impact on stroke recognition and response measures

Cost-Effectiveness of Treating Upper Limb Spasticity Due to Stroke with Botulinum Toxin Type A: Results from the Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial

Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY) gained of botulinum toxin type A plus therapy relative to therapy alone. The base case incremental cost-effectiveness ratio (ICER) of botulinum toxin type A plus therapy was £93,500 per QALY gained. The probability of botulinum toxin type A plus therapy being cost-effective at the England and Wales cost-effectiveness threshold value of £20,000 per QALY was 0.36. The point estimates of the ICER remained above £20,000 per QALY for a range of sensitivity analyses, and the probability of botulinum toxin type A plus therapy being cost-effective at the threshold value did not exceed 0.39, regardless of the assumptions made