NHS England Always Events® program: Developing a national model for co-production

NHS England, the Institute for Healthcare Improvement, Picker and NHS Improvement started the work described in this article to strengthen how patients, carers and staff working together in co-design and co-production can make a real difference in improving experience of care. Always Events®, which is an improvement methodology for the co-design and consistent implementation of those aspects of patient experience that matter most to patients in a health care setting, was chosen. The approach has been to first test the methodology with three organizations then to spread to a substantial proportion of acute health care providers, with concurrent scale-up within organizations that were early adopters in single settings, and then spread to other providers including care homes, primary care and integrated care systems. For organizations to be successful in embedding and sustaining Always Events, and to have a significant impact on improving experience, we learnt that health organizations should: a) co-produce with patients/service users from the very start and throughout every phase, b) integrate quality improvement, patient experience and person-centered care, c) identify an Executive Leader champion who can support the team to gain momentum from the beginning, d) keep an open mind and not be tempted to pre-determine what changes need to be made; patients/service users & staff know the challenges and have the best, simplest and most affordable ideas for improvement and finally, e) involving point of care staff from the beginning and co-designing the Always Event with them will support engagement and reduce resistance to change

An audit of acute oncology services: patient experiences of admission procedures and staff utilisation of a new telephone triage system.

OBJECTIVES: In 2010, St. James Institute of Oncology (Leeds, UK) created a new acute oncology service (AOS) consisting of a new admissions unit with a nurse-led telephone triage (TT) system. This audit cycle (March 2011 and June 2013) evaluated patient experiences of the reconfigured AOS and staff use of the TT system. METHODS: Patient views were elicited via a questionnaire and semi-structured interviews. The TT forms were analysed descriptively evaluating completion and data quality, reported symptoms and their severity and advice given (including admission rates). RESULTS: Patients (n = 40) reported high satisfaction with the new AOS. However, 56 % of patients delayed 2 days or more before contacting the unit. In 2011, 26 % of all the admitted patients were triaged via the TT system; 133 TT forms were completed. In June 2013, 49 % of the admitted patients were triaged; 264 forms were completed. The most commonly reported symptoms on the TT forms were pain, pyrexia/rigors/infection, diarrhoea, vomiting and dyspnoea. Half of the patients using the TT system were admitted (52 % in 2011, 49 % in 2013). CONCLUSIONS: Our audit provided evidence of successful implementation of the TT system with the number of TT forms doubling from 2011 to 2013. The new AOS was endorsed by patients, with the majority satisfied with the care they received

Public engagement with carbon and climate change: To what extent is the public 'carbon capable'?

The relevance of climate change for society seems indisputable: scientific evidence points to a significant human contribution in causing climate change, and impacts which will increasingly affect human welfare. In order to meet national and international greenhouse gas (GHG) emissions reduction targets, there is an urgent need to understand and enable societal engagement inmitigation. Yet recent research indicates that this involvement is currently limited: although awareness of climate change is widespread, understanding and behavioral engagement are far lower. Proposals for mitigative ‘personal carbon budgets’ imply a need for public understanding of the causes and consequences of carbon emissions, as well as the ability to reduce emissions. However, little has been done to consider the situated meanings of carbon and energy in everyday life and decisions. This paper builds on the concept of ‘carbon capability’, a term which captures the contextual meanings associated with carbon and individuals’ abilities and motivations to reduce emissions. We present empirical findings from a UK survey of public engagement with climate change and carbon capability, focusing on both individual and institutional dimensions. These findings highlight the diverse public understandings about ‘carbon’, encompassing technical, social, and moral discourses; and provide further evidence for the environmental value-action gap in relation to adoption of low-carbon lifestyles. Implications of these findings for promoting public engagement with climate change and carbon capability are discussed

Low plasma citrulline levels are associated with acute respiratory distress syndrome in patients with severe sepsis

INTRODUCTION: The role of nitric oxide synthase (NOS) in the pathophysiology of acute respiratory distress syndrome (ARDS) is not well understood. Inducible NOS is upregulated during physiologic stress; however, if NOS substrate is insufficient then NOS can uncouple and switch from NO generation to production of damaging peroxynitrites. We hypothesized that NOS substrate levels are low in patients with severe sepsis and that low levels of the NOS substrate citrulline would be associated with end organ damage including ARDS in severe sepsis. METHODS: Plasma citrulline, arginine and ornithine levels and nitrate/nitrite were measured at baseline in 135 patients with severe sepsis. ARDS was diagnosed by consensus definitions. RESULTS: Plasma citrulline levels were below normal in all patients (median 9.2 uM, IQR 5.2 - 14.4) and were significantly lower in ARDS compared to the no ARDS group (6.0 (3.3 - 10.4) vs. 10.1 (6.2 - 16.6), P = 0.002). The rate of ARDS was 50% in the lowest citrulline quartile compared to 15% in the highest citrulline quartile (P = 0.002). In multivariable analyses, citrulline levels were associated with ARDS even after adjustment for covariates including severity of illness. CONCLUSIONS: In severe sepsis, levels of the NOS substrate citrulline are low and are associated with ARDS. Low NOS substrate levels have been shown in other disease states to lead to NOS uncoupling and oxidative injury suggesting a potential mechanism for the association between low citrulline and ARDS. Further studies are needed to determine whether citrulline supplementation could prevent the development of ARDS in patients with severe sepsis and to determine its role in NOS coupling and function

Fetishism and the social value of objects.

The idea of the fetish has a particular presence in the writings of both Marx and Freud. It implies for these two theorists of the social, a particular form of relation between human beings and objects. In the work of both the idea of the fetish involves attributing properties to objects that they do not 'really' have and that should correctly be recognised as human. While Marx's account of fetishism addresses the exchange-value of commodities at the level of the economic relations of production, it fails to deal in any detail with the use-value or consumption of commodities. In contrast Freud's concept of the fetish as a desired substitute for a suitable sex object explores how objects are desired and consumed. Drawing on both Marx and Freud, Baudrillard breaks with their analyses of fetishism as demonstrating a human relation with unreal objects. He explores the creation of value in objects through the social exchange of sign values, showing how objects are fetishised in ostentation. This paper argues that while Baudrillard breaks with the realism characteristic of Marx's and Freud's analyses of fetishism, he does not go far enough in describing the social and discursive practices in which objects are used and sometimes transformed into fetishes. It is proposed that the fetishisation of objects involves an overdetermination of their social value through a discursive negotiation of the capacities of objects that stimulates fantasy and desire for them

Framing the Narrative: Female Fighters, External Audience Attitudes, and Transnational Support for Armed Rebellions

Female combatants play a central role in rebel efforts to cultivate and disseminate positive narratives regarding the movement and its political goals. Yet, the effectiveness of such strategies in shaping audience attitudes or generating tangible benefits for the group remains unclear. We propose and test a theory regarding the channels through which female fighters advance rebel goals. We argue that female fighters positively influence audience attitudes toward rebel groups by strengthening observers’ beliefs about their legitimacy and their decision to use armed tactics. We further contend that these effects directly help them secure support from transnational non-state actors and indirectly promote state support. We assess our arguments by combining a novel survey experiment in two countries with analyses of new cross-national data on female combatants and information about transnational support for rebels. The empirical results support our arguments and demonstrate the impact of gender framing on rebel efforts to secure support