What counts as evidence? The communication of information about older people between health and social care practitioners

This paper draws on a study to provide an evidence base for strategies and effectiveness of the transfer of information about older people between health and social care practitioners at the health and social care interface. It reports on the development of a systematic approach to the review of the related research literature and presents some key findings. It goes on to discuss some methodological issues arising from a review covering both health and social care research. By locating this study - a systematic review - within the wider debate on evidence-based practice, this paper considers the nature and scope of this form of evidence alongside other forms of evidence and their use in professional practice. It concludes with some observations regarding the relevance of the findings from this study for both practice and further research

Paying clinicians to join clinical trials : a review of guidelines and interview study of trialists

Background: The motivations of clinicians to participate in clinical trials have been little studied. This project explored the potential role of payment for participation in publicly funded clinical trials in the UK. The aims were to review relevant guidelines and to collate and analyse views of clinical trialists on the role of payments and other factors that motivated clinicians to join clinical trials. Methods: Review of guidelines governing payments to clinicians for recruitment to trials. Semistructured interviews with a range of NHS clinical trial leaders, analysed using qualititative methods. Results: While UK guidelines had little to say specifically on payments linked to recruitment, all payments have become highly regulated and increasingly transparent. Interview participants believed that expenses arising from research should be covered. Payments in excess of expenses were seen as likely to increase participation but with the risk of reducing quality. Motivations such as interest in the topic, the scope for patients to benefit and intellectual curiosity were considered more important. Barriers to involvement included bureaucracy and lack of time. Discussion: Limited scope exists for paying clinicians over-and-above the cost of their time to be involved in research. Most trialists favour full payment of all expenses related to research. Conclusion: Payment of clinicians beyond expenses is perceived to be a less important motivating factor than researching important, salient questions, and facilitating research by reducing bureaucracy and delay

Interleukin-1 beta has atheroprotective effects in advanced atherosclerotic lesions of mice

Despite decades of research, our understanding of the processes controlling late-stage atherosclerotic plaque stability remains poor. A prevailing hypothesis is that reducing inflammation may improve advanced plaque stability, as recently tested in the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) trial, in which post-myocardial infarction subjects were treated with an IL-1β antibody. Here, we performed intervention studies in which smooth muscle cell (SMC) lineage-tracing Apoe-/- mice with advanced atherosclerosis were treated with anti-IL-1β or IgG control antibodies. Surprisingly, we found that IL-1β antibody treatment between 18 and 26 weeks of Western diet feeding induced a marked reduction in SMC and collagen content, but increased macrophage numbers in the fibrous cap. Moreover, although IL-1β antibody treatment had no effect on lesion size, it completely inhibited beneficial outward remodeling. We also found that SMC-specific knockout of Il1r1 (encoding IL-1 receptor type 1) resulted in smaller lesions nearly devoid of SMCs and lacking a fibrous cap, whereas macrophage-selective loss of IL-1R1 had no effect on lesion size or composition. Taken together, these results show that IL-1β has multiple beneficial effects in late-stage murine atherosclerosis, including promotion of outward remodeling and formation and maintenance of an SMC- and collagen-rich fibrous cap

Counselling as emotional labour

This thesis is a study of counsellors and the significance that their work has in their lives. It approaches counselling work as a particular form of emotional labour and refers to it as 'pure' emotional labour. The fieldwork undertaken for the thesis involved collecting material through a range of qualitative methods including semi-structured interviews and non-participant observation. These data were analysed with a view to examining various aspects of how informants' counselling work related to their wider lives. Particular attention was paid to the routes into counselling work and their counselling careers, social and personal characteristics, the nature of the counselling relationship, the costs and rewards to them and the notion of a shared counselling culture expressed both formally and informally. The thesis also considers the significance of the growth of counselling in contemporary society, arguing that earlier interpretations of this growth as an expression of secularization offer only a partial explanation.The main findings of the research were that counsellors (many of whom work in a voluntary capacity) derive great personal benefit from their counselling work in addition to the satisfaction gained from helping others. Theories of emotional labour were found to be of great value in making sense of many of the counsellors' negative experiences, but it is argued that such theories need to take into account neglected aspects of emotion work that are positive. Furthermore the argument is developed that while sociology has much to offer the study of counselling (for example through the analysis of professionalisation), the study of counselling also has much to teach sociologists. In particular it is suggested that emotions are not easily accessible to social scientists who employ conventional interviewing methods, and that theorising emotions sociologically is fraught with difficulties as well as having great potential.</p

Family diversity and change in Britain and Western Europe

The authors examine recent changes in family relationships in Britain and other countries in Western Europe. To begin with, the authors focus on demographic change, in particular the increased diversity in people's partnership behavior. In considering theoretical accounts that have been given for these changes, the authors explore the ways in which the character of partnership commitment is altering. Particular attention is paid to the growth of cohabitation and the effect this has on cultural understandings of marital commitment. The implications for wider kinship solidarities of changing practices around partnership commitment are discussed. A key theme within this concerns the diversity and complexity of the manner in which family and kinship are negotiated and constructed

Delivering care across professional boundaries: the communication of information about older people between health and social care practitioners.

Aim: to provide an evidence base for strategies, and effectiveness of the transfer of patient information between hospital and community for older people with physical illness. Design: a systematic review of qualitative and quantitative literature. Search strategy: literature from medical, health-related and social science databases as well as work in progress from national databases, the Internet, British PhD theses and other grey literature and policy documents. Selection criteria: literature relating to similar healthcare systems published between January 1994 and June 2000 on hospital discharge planning. Empirical studies from peer reviewed sources; theoretical papers from non-peer reviewed sources; research papers from non-peer reviewed sources and professional documents. Data collection and analysis: extracted data from empirical studies under the headings of location, sector, research questions and study design and duration. We made structured summaries of all other data sources and used them to supply context and background. We categorized literature and analysed it in terms of method and analysis, quality and strength of evidence and its relevance to the research questions. We synthesized the results and presented them in terms of answers to our research questions. Results: a database of 373 potentially relevant studies and of these, 53 were accepted for further analysis. Thirty-one were empirical studies, most of which were qualitative or a combination of qualitative and quantitative in design. The most effective strategy for transferring information is the appointment of a ‘key worker’, who can provide a point of contact for workers from hospital and community. Nevertheless, problems have arisen because both settings are under pressure and pursuing different goals. Neither setting is fully aware of the needs, limitations and pressures of the other. Conclusion: raised awareness and the establishment of common goals are the first steps needed to bridge the divide between health and social care staff in hospital and the community

Appraising the evidence : reviewing disparate data systematically.

The authors describe a method of systematically reviewing research from different paradigms. They draw on the methods adapted, developed, and designed during a study concerned with the delivery of care across professional boundaries. Informed by the established method of systematic review, the authors undertook the review in distinct stages. They describe the methods developed for each stage and outline the difficulties encountered, the solutions devised, and the appraisal tools developed. Although many of the problems encountered were related to the critical assessment of qualitative research, the authors argue that the method of systematic review can be adapted for use with different data and across disciplines