What Does a Systems Approach to Quality Improvement Look Like in Practice?

Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice

Community recovery as a public health intervention: The contagion of hope

There is a growing evidence base for recovery as a journey that involves reduced relapse risk, improved citizenship, and better global health and well-being. Although this is the case, there is a risk of omitting one of the prime benefits of a diverse range of recovery activities—the impact on families and the wider community. What the current article does is to summarize evidence around the “social contagion” of recovery through communities and its potential role in transmitting hope and the belief that recovery is possible even to those who are not yet ready to commit to abstinence. And further, that in doing so, visible recovery increases community cohesion and challenges stigmatisation and exclusion of recovery populations. The implications for public health from an emerging visible and high-profile social identity of recovery is discussed

How important is ‘implementation science’ for national genomics policy?

The traditional translation pathway of ‘bench- to-bedside’ will not be enough to integrate genomics into routine clinical care. It requires the use of validated and systematic ‘implementation science’ methods. Within the pipeline of evidence-based translation of new technologies, implementation science is the phase that informs policy regarding the appropriateness, adoption, feasibility, acceptability, fidelity, penetration, and sustainability of technologies being transferred from research settings into the real world. Without implementation science, barriers can emerge unchecked and key drivers neglected. Health services researchers now have a large knowledge base which identifies barriers and drivers for implementation of new technologies into healthcare

Prudence or speed: Health and social care innovation in rural Wales

As social enterprise and third sector organisations have become more central to traditional public sector provision in Wales, there has been increased use in rural areas of multi-agency teams to deliver services. This paper draws on a study of twenty projects delivered under the auspices of NHS Wales and the first implementation phase of the Rural Health Plan (2010-11); key themes of which include access, integration and, community cohesion and engagement. The need for speed of induced innovation emphasises reactivity in some instances and transfer of practices from more developed (or urban) environments to rural communities without acknowledgement of cultural, social and economic contexts and conditions. Inclusion of social enterprise practitioners, particularly those with community development and capacity building expertise in co-production of services may allow for the development of integrated and innovative working across health and social care, which may also be more aligned with a Welsh focus on prudent healthcare. In this respect, the paper considers the role of social enterprise in identifying and fostering innovation in low income, rural areas in ways that provide close-to-patient/service user services and address local issues and health determinants to provide more sustainable and resilient community based health and social care provision

Demographic and Socioeconomic Factors Associated With HPV Vaccination in Georgia’s South Central Health District

Background: Human Papillomavirus (HPV) subtypes are the primary cause of cervical cancer. Despite introduction of the HPV vaccine in 2006, vaccination percentages remain low across Georgia counties. The primary objective of this research was to conduct a descriptive epidemiological study of HPV vaccination coverage among individuals in the South Central Health District (SCHD) to provide guidance for targeted vaccination campaigns aimed at adolescents residing in rural communities. Methods: Data from the Georgia Registry of Immunization Transactions and Services and AEGIS.net, Inc. were used to analyze demographic and socioeconomic factors associated with HPV vaccine uptake among individuals visiting county health departments in the SCHD from 2007-2014. Descriptive statistics were used to evaluate the relationship between sex, age at first vaccination, county of vaccine administration, race, and insurance status to vaccine series completion. Results: In the SCHD, Johnson County had the highest completion percentage (50%); Montgomery County had the lowest (20%). However, Montgomery County had the fastest time to completion (334 days). Throughout the district, males were fully vaccinated at much lower percentages than females (p \u3c 0.001). Race was a significant variable (p=0.011) for vaccine completion. Compared to other racial groups, more White individuals completed the HPV vaccine. Absolute counts of HPV vaccine doses peaked in the study population during 2010 (n=507). Conclusions: Due to overall low rates, community-based intervention methods should be considered to increase HPV vaccine uptake across the SCHD. School-based programs may be useful in targeting at-risk populations and increasing rates of HPV vaccine initiation and completion. Expanded efforts are needed to determine the best structure for effective school-based programs

TRIM5α: A Protean Architect of Viral Recognition and Innate Immunity

The evolutionary pressures exerted by viral infections have led to the development of various cellular proteins with potent antiviral activities, some of which are known as antiviral restriction factors. TRIpartite Motif-containing protein 5 alpha (TRIM5α) is a well-studied restriction factor of retroviruses that exhibits virus- and host-species-specific functions in protecting against cross-primate transmission of specific lentiviruses. This specificity is achieved at the level of the host gene through positive selection predominantly within its C-terminal B30.2/PRYSPRY domain, which is responsible for the highly specific recognition of retroviral capsids. However, more recent work has challenged this paradigm, demonstrating TRIM5α as a restriction factor for retroelements as well as phylogenetically distinct viral families, acting similarly through the recognition of viral gene products via B30.2/PRYSPRY. This spectrum of antiviral activity raises questions regarding the genetic and structural plasticity of this protein as a mediator of the recognition of a potentially diverse array of viral molecular patterns. This review highlights the dynamic evolutionary footprint of the B30.2/PRYSPRY domain in response to retroviruses while exploring the guided ‘specificity’ conferred by the totality of TRIM5α’s additional domains that may account for its recently identified promiscuity

Increasing Retention in STEM: Results from a STEM Talent Expansion Program at the University of Memphis

MemphiSTEP is a five-year STEM Talent Expansion Program at the University of Memphis sponsored by the National Science Foundation. The project focuses on retention and persistence to graduation to increase the number of STEM majors and graduates. The project includes a range of student retention programs, including a Summer Mathematics Bridge Bootcamp, Networking Program, Research Award Program, Travel Award program and STEM Learning Communities; Results from the first four years of the project suggest that MemphiSTEP is making a positive impact on student retention and performance in STEM fields. Our data indicate that even after controlling for gender, race, and prior performance, STEM students taking part in MemphiSTEP activities are retained at higher rates and perform better than University of Memphis STEM students who have not participated in MemphiSTEP activities

Theory Designed Strategies to Support Implementation of Genomics in Nephrology

Background: Genomic testing is increasingly utilized as a clinical tool; however, its integration into nephrology remains limited. The purpose of this study was to identify barriers and prioritize interventions for the widespread implementation of genomics in nephrology. Methods: Qualitative, semi-structured interviews were conducted with 25 Australian adult nephrologists to determine their perspectives on interventions and models of care to support implementation of genomics in nephrology. Interviews were guided by a validated theoretical framework for the implementation of genomic medicine—the Consolidated Framework of Implementation Research (CFIR). Results: Nephrologists were from 18 hospitals, with 7 having a dedicated multidisciplinary kidney genetics service. Most practiced in the public healthcare system (n = 24), a large number were early-career (n = 13), and few had genomics experience (n = 4). The top three preferred interventions were increased funding, access to genomics champions, and education and training. Where interventions to barriers were not reported, we used the CFIR/Expert Recommendations for Implementing Change matching tool to generate theory-informed approaches. The preferred model of service delivery was a multidisciplinary kidney genetics clinic. Conclusions: This study identified surmountable barriers and practical interventions for the implementation of genomics in nephrology, with multidisciplinary kidney genetics clinics identified as the preferred model of care. The integration of genomics education into nephrology training, secure funding for testing, and counselling along with the identification of genomics champions should be pursued by health services more broadly