Lessons learned from England's Health Checks Programme : Using qualitative research to identify and share best practice

Background: This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. Methods: Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. Results: Findings indicated that there is no ‘one size fits all’ blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual’s ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. Conclusions: The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that GP Practices are informed when patients take up services such as smoking cessation or alcohol harm reduction programmes run by social services

Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

Background NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. Methods NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. Results The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check. However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. Conclusions The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities

Definición de una arquitectura de referencia para plataformas de servicios de datos

Big Data se refiere a conjuntos de datos cuyo volumen, velocidad y variedad dificultan su captura, gestión y procesamiento mediante tecnologías y herramientas convencionales. Este concepto ha generado nuevas necesidades en las organizaciones para permitir la captura, almacenamiento y análisis de datos con estas características y así obtener información relevante para la toma de decisiones. Un reto para las organizaciones es la implementación de una arquitectura que permita cubrir estas necesidades, ya que deben considerar las diferentes tecnologías existentes y deben establecer las políticas para el gobierno de datos que están en manos de los usuarios. Una arquitectura de referencia de una plataforma de analítica de datos, que se desvincule de herramientas tecnológicas es una guía que le permite a las organizaciones trazar un camino para lograr la gestión de grandes volúmenes de datos y así tener herramientas efectivas para la toma de decisiones empresariales. La arquitectura de referencia es lo suficientemente general como para implementarse con diferentes tecnologías, paradigmas informáticos y software analítico, dependiendo de los requisitos y propósitos de cada organización. En el proyecto desarrollado se realizó la implementación de la arquitectura con datos de la atención de urgencias en centros hospitalarios de la ciudad de Medellín. Uno de los resultados del trabajo de investigación es que la arquitectura propuesta considera diferentes tipos de usuario y de fuentes de datos, no genera dependencia por el tipo de herramientas tecnológica que se utilizan y establece una capa para el gobierno de datos.Big Data refers to data set whose volume, velocity, and variety make it difficult to capture, manage and process using conventional technologies and tools. This concept is generating new needs in organizations to allow the capture, storage, and analysis of data with these characteristics and thus obtain relevant information for decision-making. A challenge for organizations is the implementation of an architecture that covers these needs, since they must consider the different existing technologies and must establish the policies for data governance that will be available to users. A reference architecture of a data analytics platform that is capable of decoupling from technological tools will be a guide that will allow organizations to define a path to achieve the management of these data and thus have effective tools for make decisions in the company. The reference architecture is general enough to be implemented with different technologies, computing paradigms and analytical software, depending on the requirements and purposes of each organization. In the developed project, the architecture was implemented with data from emergency care in hospitals in the Medellín city. One of the results of the research work is that the proposed architecture considers different types of user and data sources, does not generate dependency due to the type of technological tools used and establishes a layer for data governance.Magíster en Ingeniería de SoftwareMaestrí

RADON: Rational decomposition and orchestration for serverless computing

Emerging serverless computing technologies, such as function as a service (FaaS), enable developers to virtualize the internal logic of an application, simplifying the management of cloud-native services and allowing cost savings through billing and scaling at the level of individual functions. Serverless computing is therefore rapidly shifting the attention of software vendors to the challenge of developing cloud applications deployable on FaaS platforms. In this vision paper, we present the research agenda of the RADON project (http://radon-h2020.eu), which aims to develop a model-driven DevOps framework for creating and managing applications based on serverless computing. RADON applications will consist of fine-grained and independent microservices that can efficiently and optimally exploit FaaS and container technologies. Our methodology strives to tackle complexity in designing such applications, including the solution of optimal decomposition, the reuse of serverless functions as well as the abstraction and actuation of event processing chains, while avoiding cloud vendor lock-in through models

Patients’ willingness to attend the NHS cardiovascular health checks in primary care: A qualitative interview study

Background: The NHS Cardiovascular Health Check (NHSHC) programme was introduced in England in 2009 to reduce cardiovascular disease mortality and morbidity for all patients aged 40 to 74 years old. Programme cost-effectiveness was based on an assumed uptake of 75% but current estimates of uptake in primary care are less than 50%. The purpose of this study was to identify factors influencing patients’ willingness to attend an NHSHC. For those who attended, their views, experiences and their future willingness to engage in the programme were explored. Method: Telephone or face-to-face interviews were conducted with patients who had recently been invited for an NHSHC by a letter from four general practices in Torbay, England. Patients were purposefully sampled (by gender, age, attendance status). Interviews were audio recorded, transcribed verbatim and analysed thematically. Results: 17 attendees and 10 non-attendees were interviewed. Patients who attended an NHSHC viewed it as worthwhile. Proactive attitudes towards their health, a desire to prevent disease before they developed symptoms, and a willingness to accept screening and health check invitations motivated many individuals to attend. Non-attendees cited not seeing the NHSHC as a priority, or how it differed from regular monitoring already received for other conditions as barriers to attendance. Some non-attendees actively avoided GP practices when feeling well, while others did not want to waste health professionals’ time. Misunderstandings of what the NHSHC involved and negative views of what the likely outcome might be were common. Conclusion: While a minority of non-attendees simply had made an informed choice not to have an NHSHC, improving the clarity and brevity of invitational materials, better advertising, and simple administrative interventions such as sending reminder letters, have considerable potential to improve NHSHC uptake

Protein functionality as a potential bottleneck for somatic revertant variants

Transplantation and immunomodulatio

The provision of NHS health checks in a community setting: an ethnographic account

Background: The UK National Health Service Health Checks programme aims to reduce avoidable cardiovascular deaths, disability and health inequalities in England. However, due to the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease, there are concerns that NHS Health Checks may increase inequalities in health. This study aimed to examine the feasibility and acceptability of community outreach NHS Health Checks targeted at the Afro-Caribbean community. Methods: This paper reports findings from an ethnographic study including direct observation of four outreach events in four different community venues in inner-city Bristol, England and follow up semi-structured interviews with attendees (n = 16) and staff (n = 4). Interviews and field notes were transcribed, anonymized and analysed thematically using a process of constant comparison. Results: Analysis revealed the value of community assets (community engagement workers, churches, and community centres) to publicise the event and engage community members. People were motivated to attend for preventative reasons, often prompted by familial experience of cardiovascular disease. Attendees valued outreach NHS Health Checks, reinforcing or prompting some to make healthy lifestyle changes. The NHS Health Check provided an opportunity for attendees to raise other health concerns with health staff and to discuss their test results with peers. For some participants, the communication of test results, risk and lifestyle information was confusing and unwelcome. The findings additionally highlight the need to ensure community venues are fit for purpose in terms of assuring confidentiality. Conclusions: Outreach events provide evidence of how local health partnerships (family practice staff and health trainers) and community assets, including informal networks, can enhance the delivery of outreach NHS Health Checks and in promoting the health of targeted communities. To deliver NHS Health Checks effectively, the location and timing of events needs to be carefully considered and staff need to be provided with the appropriate training to ensure patients are supported and enabled to make lifestyle changes

Clinical heterogeneity can hamper the diagnosis of patients with ZAP70 deficiency

One of the severe combined immunodeficiencies (SCIDs), which is caused by a genetic defect in the signal transduction pathways involved in T-cell activation, is the ZAP70 deficiency. Mutations in ZAP70 lead to both abnormal thymic development and defective T-cell receptor (TCR) signaling of peripheral T-cells. In contrast to the lymphopenia in most SCID patients, ZAP70-deficient patients have lymphocytosis, despite the selective absence of CD8+ T-cells. The clinical presentation is usually before 2 years of age with typical findings of SCID. Here, we present three new ZAP70-deficient patients who vary in their clinical presentation. One of the ZAP70-deficient patients presented as a classical SCID, the second patient presented as a healthy looking wheezy infant, whereas the third patient came to clinical attention for the eczematous skin lesions simulating atopic dermatitis with eosinophilia and elevated immunoglobulin E (IgE), similar to the Omenn syndrome. This study illustrates that awareness of the clinical heterogeneity of ZAP70 deficiency is of utmost importance for making a fast and accurate diagnosis, which will contribute to the improvement of the adequate treatment of this severe immunodeficiency