An action research study of Patient and Public Involvement (PPI) in the NHS: How can PPI influence healthcare planning and decision making?

ABSTRACT Background: Patient and Public Involvement (PPI) has been in health policy for the NHS for the last 30 years and yet there is little evidence of their involvement influencing healthcare planning and decision making. PPI is a legislative duty for NHS bodies and yet there remains what is perceived as a ‘brick wall’ between the outputs of PPI and the outcomes in terms of influencing change (Commission for Health Improvement (CHI), 2004) . Aims: To explore how PPI can influence healthcare planning and decisionmaking in the NHS. The objective was to explore, interpret and obtain a deeper understanding of the views and perceptions of staff within an NHS organisation and identify the attributes and enablers that facilitate PPI to influence planning and decision-making. Method: This is an action research (AR) study, using semi-structured interviews and a critical document review as a pre-step, followed by the formation of an AR team following the cycle of steps. Results: The yardstick of success against which PCTs were measured nationally and against which my colleagues and I measured our own practice, was one that celebrated outputs not outcomes and policy did little to persuade that PPI should influence planning and decision making. Staff and organisational rhetoric placed high importance on PPI, but change as a result was peripheral; however, robust project management through the AR process is a critical enabler. Conclusions: New contributions to knowledge are provided by my proposal for an approach to enabling PPI in healthcare planning and decision-making using an AR project management methodology to ensure that measures of 4 success are set and repeatedly reassessed, and that follow through to change in healthcare service as a result takes place and the use of an AR methodology for this issue. The study has already directly contributed to national policy as findings were continually shared with the Department of Health

Tainted Glory: Truth and Fiction in Contemporary Hollywood

In the earliest days of cinema, the image of the African American on screen matched the off-screen image. When a 12-minute version of Uncle Tom\u27s Cabin (1903) was filmed, Tom shows were the most popular stage shows, the Stowe novel was still a top-seller, and the notion that white southerners were the real victims of the peculiar institution was gaining increasing acceptance in academic circles. When D.W. Griffith\u27s epic and revolutionary Birth of a Nation (1915) depicted a set of stock African-American movie characters — the subservient overweight domestic servant; the indifferent, coquettish mulatto; the savage, sexually driven buck; and the marauding bands of black men with weapons — these images were being promoted in other arenas as well. Woodrow Wilson had refused to integrate the federal work places, and Jim Crow segregation was prevalent throughout the South. Time and space don\u27t permit me to review the entire history of African Americans on screen. As distorted as we know these images to be, we cannot truly indict Hollywood unless we also condemn society at large. In relying on caricatures of African Americans, filmmakers were merely echoing the prevailing sentiments and attitudes about race

Reel Blacks: A Kinder, Gentler FBI

Revisionist interpretations of the Federal Bureau of Investigation\u27s (FBI) role in enforcing civil rights legislation and its monitoring of black activists have proliferated during the last decade. Agents of Repression: The FBI\u27s Secret Wars Against the Black Panther Party and the American Indian Movement by Ward Churchill and Jim Vander Wall, Racial Matters by Kenneth O\u27Reilly, and The FBI and Martin Luther King, Jr. by David Garrow are just a few of the numerous books to chronicle the FBI\u27s somewhat embarrassing record on race-related issues. Given this wealth of documentation in print, it is even more startling that in the world of cinema, the FBI is still being depicted as heroically as it was in the days when J. Edgar Hoover manipulated the agency\u27s public image. Costas Gavras\u27 Betrayal and Alan Parker\u27s Mississippi Burning feature celluloid FBI agents who no doubt would have been sources of great pride to the late director

Reel Blacks: Blacks in Disguise

Gremlins and Little Shop of Horrors are very likeable films. The former is rather charming, and the latter is one of the most originally-rendered musicals ever produced. Indeed, it is the positive surface of the films that makes their underlying message so insidious. Fortunately, the final twist common to both films can give solace to the viewer who would like to see the disguised blacks triumph. At the end of Gremlins the original Mogwi is still alive, albeit back in the capable hands of the mysterious Chinese man, and Little Shop closes as the camera follows Seymour and Audrey into the yard of a model suburban home and then pans from their happy faces to the garden where a seemingly nondescript little Audrey II is nestled in among the blooming flowers. Temporarily subdued by the white heroes, the blacks in disguise might triumph in the future

Reel Blacks: Everything is Not Satisfactual

An unaccompanied black adult female at a matinee performance of Song of the South is about as out of place as Big Bird at a cockfight. However, having encouraged the students in my course on black media images to see the film during its fortieth anniversary run, I felt obligated to reexamine it myself. So there I sat, surrounded by exuberant white pre-schoolers and their parents, watching as animation and live action seamlessly interchanged on the screen in Walt Disney’s adaptation for Joel Chandler Harris’ classic collection of Afro-American folktales

The Role of Multi-Drug Resistance Associated Protein 4 and P-glycoprotein in Resistance of Neuroblastoma to Topotecan and Irinotecan

High-risk neuroblastoma presents a significant therapeutic challenge because the 5-year survival rate remains less than 30% despite the use of surgery, multi-agent chemotherapy, radiation, and autologous bone marrow transplant. Novel therapeutic modalities are under development. The camptothecin analogs topotecan and irinotecan have been identified as successful cytotoxic agents. For topotecan, pharmacokinetically guided dosing to achieve a systemic exposure associated with preclinical anti-tumor activity in neuroblastoma xenograft models is feasible and has elicited favorable responses in children with high-risk neuroblastoma. However, some children with high-risk disease did not respond to the putatively effective topotecan systemic exposure. These children represent a subset of the disease intrinsically resistant to topotecan. Furthermore, mRNA expression of the adenosine triphosphate (ATP)-binding cassette (ABC) transporters P-glycoprotein (Pgp) and multidrug resistance associated protein 1 (MRP1), which efflux many drugs used in neuroblastoma therapy, has been implicated in poor outcome in neuroblastoma. Therefore, the purpose of our studies was to determine the role of ABC transport protein expression in neuroblastoma resistance to the camptothecin analogs topotecan and irinotecan. Initially studies focused on determining the expression of ABC transporters for which the camptothecin analogs are substrates in neuroblastoma cell lines. By western blot analysis we demonstrated MRP4 and Pgp expression in neuroblastoma cell lines relatively resistant to topotecan (e.g., NB1691), but not in cell lines sensitive to topotecan (e.g., NB1643). In contrast, MRP1, MRP2, and breast cancer resistance protein (BCRP) expression did not discriminate between sensitive and resistant cell lines. To determine the functional contribution of both MRP4 and Pgp in neuroblastoma, we used RNA interference (RNAi) to silence MRP4 and Pgp expression in NB1691. Long term, stable expression of retroviral vector mediated short hairpin RNA (shRNA) reduced MRP4 and Pgp expression. Isogenic cell lines with reduced expression of MRP4 and Pgp exhibited an increase in sensitivity to both topotecan and SN-38, the active moiety of the prodrug irinotecan. In addition, we overexpressed MRP4 in NB1643, which resulted in increased topotecan resistance. The NB1691 cell lines with reduced MRP4 expression were subsequently transplanted as xenografts into severe combined immunodeficiency (SCID) mice to determine the effect of MRP4 expression on the in vivo response to topotecan. Unexpectedly, MRP4 silencing did not persist in vivo, and none of the xenograft models responded to topotecan. However, MRP4 expression was associated with failure to respond to topotecan, supporting the hypothesis that MRP4 mediates resistance to topotecan. Finally, we determined the ABC transporter expression profile in primary tumor specimens from patients with high-risk neuroblastoma who were treated with pharmacokinetically guided topotecan. Of the 14 specimens studied, MRP4 was expressed in 2 samples, and Pgp was expressed in 4 samples. BCRP was not expressed in any of the neuroblastoma cell lines in vitro, but immunohistochemical analysis demonstrated BCRP expression in nine primary neuroblastoma samples. Although we predicted that MRP4 and/or Pgp expression would be associated with failure to respond to topotecan, results of immunohistochemical analysis did not demonstrate such an association. The results of the in vitro studies demonstrate that MRP4 and Pgp confer resistance to topotecan and SN-38. In the xenograft studies, MRP4 expression was associated with failure to respond to topotecan. However, this phenotype was not recapitulated in children treated with topotecan. These results may be confounded by small sample size and timing of sample acquisition. Further investigation of the role of ABC transporters in children with neuroblastoma who receive either topotecan or irinotecan may be warranted. In addition to the camptothecin analogs, patients will receive other drugs effluxed by the ABC transporters (e.g., doxorubicin, vincristine, etoposide, cyclophosphamide). Therefore, analyzing ABC transporter expression by immunohistochemistry in diagnostic tumor specimens may help to select agents not subject to efflux by ABC transporters expressed in the tumor. However, eliminating drugs effluxed by ABC transporters from the treatment regimen creates a potential gap in therapy and may reduce drug intensity. Therefore, further rational design and development of drugs that evade ABC transporter-mediated efflux, and potentially other resistance mechanisms in neuroblastoma, is also warranted

Reel Blacks: The Good Old Days

Like most of my colleagues engaged in film studies rather than film practice, I occasionally allow myself to fantasize about the kind of films I would produce if I were a film maker. Several commercial films popular in the last fifteen years have inspired in me a bare bones scenario. My movie would have an all black “ensemble” cast. The plot would contain flashbacks tracing the events in the characters’ adolescence that solidified their friendship. These flashbacks would be punctuated by rhythmless music performed by white artists, Although no hint of “soul” would be tolerated on my movie’s soundtrack, my black characters would enthusiastically embrace it as if it were their own. I doubt that my film would achieve any real commercial success, in spite of the fact that so many recent movies have portrayed the reverse situation. Ever since George Lucas’ classic American Graffiti broke box office records in 1973, white film makers have endeavored to find innovative ways of turning nostalgia for the late l950s and early 1960s into movie making success in the 1970s and 1980s. The more notable efforts have included George Landis’ raucous view of early l960s fraternity life in Animal House, Steven Spielberg’s time travel adventure in Back to the Future, Francis Ford Coppola’s foray into fantasy in Peggy Sue Got Married, Lawrence Kasdan’s depiction of a reunion weekend in The Big Chill, and Rob Reiner’s glimpse of 1950s coming of age in Stand By Me