In-work support : what is the role of in-work support in a successful transition to sustained employment? (TM Case Study Summary Theme Report)

This report focuses on the role that in-work support plays in helping employment programme beneficiaries move into sustained employment. It draws on finding from the Talent Match (TM) National Evaluation. TM is a Big Lottery Fund strategic programme investing £108 million in 21 Local Enterprise Partnership (LEP) areas, which have experienced particularly high levels of youth unemployment. The focus of the programme is on developing holistic approaches to combating worklessness amongst long-term NEETs (i.e. young people who are not in education, employment or training). A key aspect of the programme is to bring young people closer to, and into employment. Part One of this report outlines what in-work support is and why it is important. Part Two presents findings from analysis of programme monitoring data on the provision of in-work support and insights from qualitative research in four TM partnerships and case studies of provision of in-work support. Part Three sets out the learning on in-work support emerging from this research

Investigation of bias in meta-analyses due to selective inclusion of trial effect estimates:empirical study

OBJECTIVE: To explore whether systematic reviewers selectively include trial effect estimates in meta-analyses when multiple are available, and what impact this may have on meta-analytic effects. DESIGN: Cross-sectional study. DATA SOURCES: We randomly selected systematic reviews of interventions from 2 clinical specialties published between January 2010 and 2012. The first presented meta-analysis of a continuous outcome in each review was selected (index meta-analysis), and all trial effect estimates that were eligible for inclusion in the meta-analysis (eg, from multiple scales or time points) were extracted from trial reports. ANALYSIS: We calculated a statistic (the Potential Bias Index (PBI)) to quantify and test for evidence of selective inclusion. The PBI ranges from 0 to 1; values above or below 0.5 are suggestive of selective inclusion of effect estimates more or less favourable to the intervention, respectively. The impact of any potential selective inclusion was investigated by comparing the index meta-analytic standardised mean difference (SMD) to the median of a randomly constructed distribution of meta-analytic SMDs (representing the meta-analytic SMD expected when there is no selective inclusion). RESULTS: 31 reviews (250 trials) were included. The estimated PBI was 0.57 (95% CI 0.50 to 0.63), suggesting that trial effect estimates that were more favourable to the intervention were included in meta-analyses slightly more often than expected under a process consistent with random selection; however, the 95% CI included the null hypothesis of no selective inclusion. Any potential selective inclusion did not have an important impact on the meta-analytic effects. CONCLUSION: There was no clear evidence that selective inclusion of trial effect estimates occurred in this sample of meta-analyses. Further research on selective inclusion in other clinical specialties is needed. To enable readers to assess the risk of selective inclusion bias, we recommend that systematic reviewers report the methods used to select effect estimates to include in meta-analyses

The U.S. retail payments system: moving to the future

Payment systems

Recruitment difficulties in a primary care cluster randomised trial:investigating factors contributing to general practitioners' recruitment of patients

BACKGROUND: Recruitment of patients by health professionals is reported as one of the most challenging steps when undertaking studies in primary care settings. Numerous investigations of the barriers to patient recruitment in trials which recruit patients to receive an intervention have been published. However, we are not aware of any studies that have reported on the recruitment barriers as perceived by health professionals to recruiting patients into cluster randomised trials where patients do not directly receive an intervention. This particular subtype of cluster trial is commonly termed a professional-cluster trial. The aim of this study was to investigate factors that contributed to general practitioners recruitment of patients in a professional-cluster trial which evaluated the effectiveness of an intervention to increase general practitioners adherence to a clinical practice guideline for acute low-back pain. METHOD: General practitioners enrolled in the study were posted a questionnaire, consisting of quantitative items and an open-ended question, to assess possible reasons for poor patient recruitment. Descriptive statistics were used to summarise quantitative items and responses to the open-ended question were coded into categories. RESULTS: Seventy-nine general practitioners completed at least one item (79/94 = 84%), representing 68 practices (85% practice response rate), and 44 provided a response to the open-ended question. General practitioners recalled inviting a median of two patients with acute low-back pain to participate in the trial over a seven-month period; they reported that they intended to recruit patients, but forgot to approach patients to participate; and they did not perceive that patients had a strong interest or disinterest in participating. Additional open-ended comments were generally consistent with the quantitative data. CONCLUSION: A number of barriers to the recruitment of patients with acute low-back pain by general practitioners in a professional-cluster trial were identified. These barriers were similar to those that have been identified in the literature surrounding the recruitment of patients in individual patient randomised trials. To advance the evidence base for patient recruitment strategies in primary care settings, trialists undertaking professional-cluster trials need to develop and evaluate patient recruitment strategies that minimise the efforts required by practice staff to recruit patients, while also meeting privacy and ethical responsibilities and minimising the risk of selection bias. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006)

Key worker models : what key worker approaches, capacity and capabilities are important at different stages of the journey to employment? (Talent Match Case Study Theme Report)

This report focuses on the role of key workers (i.e. individuals providing one-to-one advice and support to beneficiaries) in employment programmes and the approaches, capacity and capabilities that are important at different stages of the journey to employment. It draws on findings from the Talent Match (TM) National Evaluation about how key worker support is being delivered, how it has evolved over the lifetime of TM and what key worker support looks like. Talent Match is a Big Lottery Fund strategic programme investing £108 million in 21 Local Enterprise Partnership (LEP) areas, which have experienced particularly high levels of youth unemployment. The focus of the programme is on developing holistic approaches to combating worklessness amongst long-term NEETs. A key aspect of the programme is to bring young people closer to, and into employment. Part One of this report outlines what key workers are and the different approaches they adopt in employment programmes. Part Two presents findings from a survey of all TM partnerships and case studies in four TM partnerships comprising qualitative interviews with partnership leads, key workers and beneficiaries. Based on these findings it presents a model of how key workers support young people on their journey to employment, highlighting the experience, attributes and skill sets needed by key workers at different stages of a young person’s journey to employment. Part Three sets out the learning on key worker approaches, capacity and capabilities emerging from this research

Employer participation in active labour market policy : from reactive gatekeepers to proactive strategic partners

Active labour market policy (ALMP) is a well-established strategy but one aspect is greatly neglected – employer participation – about which there is a lack of systematic evidence. The question of why and how employers participate in ALMP, and whether there may be some shift from employers solely being passive recipients of job-ready candidates to having a more proactive and strategic role, is addressed by drawing on new research into Talent Match, a contemporary UK employability programme which places particular emphasis on employer involvement. The research findings point to a conceptual distinction between employers’ roles as being reactive gatekeepers to jobs and/or being proactive strategic partners, with both evident. It is argued that the Talent Match programme demonstrates potential to benefit employers, jobseekers and programme providers, with devolution of policy to the local level a possible way forward. The conclusion, however, is that the barrier to wider replication is not necessarily a problem of practice but of centralised control of policy and, in particular, commitment to a supply-side approach. Empirical, conceptual and policy contributions are made to this under-researched topic

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Developing theory-informed behaviour change interventions to implement evidence into practice : a systematic approach using the Theoretical Domains Framework

PMID: 22531013 [PubMed - indexed for MEDLINE] PMCID: PMC3443064 Free PMC ArticlePeer reviewedPublisher PD