Positioning Children’s Voice in Clinical Trials Research: A New Model for Planning, Collaboration, and Reflection

Following the United Nations Convention on the Rights of the Child, there has been considerable growth in research with children about health and services that affect them. Creative methods to engage with children have also been developed. One area where progress has been slower is the inclusion of children’s perspectives in qualitative research in the context of clinical trials or feasibility studies. Addressing this gap, this article discusses experiences of, and reflections on, the process of researching children’s views as part of a clinical feasibility study. The article considers what worked well and highlights remaining dilemmas. A new continuum of children’s engagement in research is presented, designed to assist researchers to make explicit the contingent demands on their research, and to suggest a range of techniques from within the broader fields of health, childhood studies, and education research that could be used to forward qualitative research in clinical contexts

Between early prevention and statutory intervention: meeting the needs for targeted support for children and families

The subject is services for vulnerable children aged up to fourteen years and their families in the Winchester area of southern England. The services comprise three group-work based programmes, each lasting for twelve months. Their review comprised a two stage study designed to scope future objectives for a host charity in its development alongside faith agencies. The first stage used a Delphi process to define the principal priorities of trustees. These were then rated and applied to a follow up client satisfaction survey across the three programmes for 40 families. The overall 55% rate indicated a positive response from service users with a multi-dimensional approach to resilience building strongly endorsed. However, the analysis also scoped three areas for improvement. Findings indicated first, that the significance of help with preparation for work and education is understated by trustees less familiar with employment shortfalls; secondly that family focused services should recognize the particular needs of fathers and not be slanted towards mothers and their children; and thirdly, decisions on social enterprise status must take into account potential disconnects between the values of service recipients and those of different socio-economic means in governance roles. These findings are relevant to comparable voluntary sector agencies

Creational narratives for new housing communities: evidence synthesis.

Purpose: This paper reports the findings of a rapid evidence synthesis commissioned by the Diocese of Winchester with a remit to provide an empirical basis for church contributions to large housing community developments. It sought to respond to three questions concerning new community developments. These related to risks and causes of failure; learning from past corporate and intermediate tier interventions at diocesan and equivalent levels by religious denominations; and the transferable learning available from developments described in Community Health and Liveability literatures.\ud Design/methodology/approach: The review took a purposive approach to sampling evidence from within academic literature, policy and ‘think tank’ outputs and theological texts. The search was instigated with the use of key words (including New Settlements, Urban Redevelopment, Diocese, Faith and Community), principally within the SCOPUS, NIHR, PUBMED and Google Scholar databases. A pragmatic snowballing approach to relevant references was then employed.\ud Findings: Segregation and separation were identified as the main risk for new settlements. Connectivity is required between and across neighbours, ensuring communal access to services, transport and recreation. Communal places where people can come together for conversation and social interaction are identified as contributing significantly to healthy communities. Churches have a particular positive contribution to make here, through a focus on inclusion, hospitality and common values, rather than single faith-based, evangelical approaches.\ud Research limitations/implications:\ud The initial effect of the study has been to increase confidence in and awareness of the diocesan contribution. In the longer term the three areas of practice highlighted for enhanced faith based contributions are those of public communications, community integration and civic leadership. An evidence based approach appears to be especially significant in facilitating the latter.\ud Originality/value: The importance of ‘creational narratives’ in defining and making explicit the values underpinning new housing communities, is identified as a singular source of shared motivation for planning and faith agencies

Wellbeing agencies in the High Street: the rebirth of primary health care?

This scoping review combines a secondary data analysis of global exemplars with case studies of increasingly diverse wellbeing agencies in highly ‘liveable’ Winchester and Melbourne. It identifies a research agenda, which includes the roles of social and commercial enterprises and their needs for effective community governance

Combined horizontal and vertical integration of care: a goal of practice-based commissioning

Practice-based commissioning (PBC) in the UK is intended to improve both the vertical and horizontal integration of health care, in order to avoid escalating costs and enhance population health. Vertical integration involves patient pathways to treat named medical conditions that transcend organisational boundaries and connect communitybased generalists with largely hospital-sited specialists, whereas horizontal integration involves peerbased and cross-sectoral collaboration to improve overall health. Effective mechanisms are now needed to permit ongoing dialogue between the vertical and horizontal dimensions to ensure that medical and nonmedical care are both used to their best advantage. This paper proposes three different models for combining vertical and horizontal integration – each is a hybrid of internationally recognised ideal types of primary care organisation. Leaders of PBC should consider a range of models and apply them in ways that are relevant to the local context. General practitioners, policy makers and others whose job it is to facilitate horizontal and vertical integration must learn to lead such combined approaches to integration if the UK is to avoid the mistakes of the USA in over-medicalising health issues

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

International sources of learning for the organisation of primary care

This article explores the potential to learn from emerging international models of primary care organisation. It examines a series of exemplars from Southern Europe and Latin America which may help support moves towards a 'new localism' in he public management of primary care. Six lessons for the UK are identified. © 2012 Royal College of General Practitioners

The capacity of health services research to support integrated care in England

Purpose – This report aims to examine the capacity for research to support integrated care developments. The focus is on health service research agencies in English universities. It is designed to promote an understanding of alternative approaches as national research programmes offer new opportunities for larger and more rigorous studies. Design/methodology/approach – The approach draws on three analyses of different data from relevant programmes of the National Institute for Health Research (NIHR) over a 30 month period. The data are derived from commissioning briefs, monitoring reports and annual reviews. Relevant international comparisons indicate possible responses to deficits. Findings – The review points to a process of normalisation, through which integrated care has become an important standard dimension of health services research in England. While the commissioning of studies related to integrated care is shown to demonstrate a sustained and enhanced profile, the capacity of higher education providers appears to be changing. The growing emphasis on health services research corresponds with increased research leadership from clinical and public health academics, which raises questions regarding future multi-disciplinary and social sciences contributions and projects on lateral forms of integrated care. Research limitations/implications – The findings are only derived from a single source from the NIHR portfolio, and a period in which there were significant and structural changes in the NHS and administration of relevant NIHR programmes. Originality/value – The review is the first of its kind in employing aggregate NIHR programme data. It offers an original typology of higher education research agencies and novel insights into comparable developments elsewhere