Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Re-conceptualising talent management and development within the context of the low paid

Those working in organisations have choices to make not only associated with the goods and services they produce but also their wider social and economic impact. The number of employees in low skilled/low paid jobs and the high proportion of companies adopting business strategies based on low-specification goods and services are a concern for many developed and developing economies. Addressing this problem is not traditionally the concern of Human Resource Development however we argue that through exploring the role that a wider, more balanced approach to Sustainable Talent Management and Development (S-TMD) may play within the context of the low skilled in the UK provides a crucial link to enhancing an organisation’s performance and responsibility to society. At the heart of this approach lies a shift to appreciate the collective endeavour of work practices, an enhanced role for stakeholders and identification of, and participation in skills eco-systems to support sustainable development. The paper identifies the opportunity for S-TMD to move from a predominantly individualist, managerial and unitarist understanding to one grounded in the value of tacit and embedded development processes undertaken to reflect a pluralist, multi-voiced approach to understanding of a skills eco-system

Patients' experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study

Background: Fibromyalgia syndrome (FMS) presents a challenge for patients and health care staff across many medical specialities. The aetiology is multi-dimensional, involving somatic, psychological and social factors. Patients' views were obtained to understand their experience of living with this long-term condition, using qualitative interviews. Methods: 12 patients were recruited and stratified by age, gender and ethnicity from one rheumatology outpatient clinic, and a departmental held database of patients diagnosed with FMS. Results: Patients' accounts of their experience of FMS resonated well with two central concepts: social identity and illness intrusiveness. These suggested three themes for the analytical framework: life before and after diagnosis (e.g. lack of information about FMS, invisibility of FMS); change in health identity (e.g. mental distress, impact on social life) and perceived quality of care (e.g. lack of contact with nurses, attitudes of specialists). The information provided from one male participant did not differ from the female patients, but black and ethnic community patients expressed a degree of suspicion towards the medication prescribed, and the attitudes displayed by some doctors, a finding that has not been previously reported amongst this patient group. Patients expected more consultation time and effective treatment than they received. Subjective experiences and objective physical and emotional changes were non-overlapping. Patients' accounts revealed that their physical, mental and social health was compromised, at times overwhelming and affected their identity. Conclusion: FMS is a condition that intrudes upon many aspects of patients' lives and is little understood. At the same time, it is a syndrome that evokes uneasiness in health care staff ( as current diagnostic criteria are not well supported by objective markers of physiological or biochemical nature, and indeed because of doubt about the existence of the condition) and places great demands on resources in clinical practice. Greater attention needs to be paid to the links between the explanatory models of patients and staff, and most important, to the interrelationship between the complex physical, psychological and social needs of patients with FMS. Taking a less medical but more holistic approach when drawing up new diagnostic criteria for FMS might match better individuals' somatic and psycho-social symptom profile and may result in more effective treatment

Search for 3p-3h States in the A=16 System

This work was supported by the National Science Foundation Grant NSF PHY 78-22774 A02 & A03 and by Indiana Universit

The use of work-based learning pedagogical perspectives to inform flexible practice within higher education

The renewed emphasis on developing flexible learning practices in higher education underscores the importance of understanding pedagogies for students who are based in the workplace or undertake significant work-related elements of study. This paper draws on research that explores how work-based learning (WBL) pedagogy operates in UK higher education using three main perspectives that help to conceptualise the existing range of practice: discipline-centred, learner-centred and employer-centred. Data was collected from twenty academic practitioners with expertise in WBL using qualitative interviews, documents and observations at fourteen different institutions from seven regions in England. The research findings suggest that there are both commonalities and distinctive attributes across the range of practice that influence how academics develop and orient their pedagogy. It is argued that the characteristics and discursive features of these WBL perspectives present pedagogical approaches that could be adapted to inform more flexible mainstream provision

Pay progression in routinised service sector work: navigating the internal labour market in a fast food multinational company

The United Kingdom's widespread use of low‐skill, low‐paid employment has been well documented. It has been argued internal labour markets (ILMs) benefit such workers, affording them with opportunities for progression. Relatively little is known, however, about the impact of ILMs on entry level workers undertaking routinised service sector work. Drawing on qualitative data, this article explores the prospects on offer in a market leading, fast food multinational company. Potential enabling features include on‐the‐job training, a transparent and integrated pay structure and a professed culture of progression. Occupational movements to positions above the low‐pay threshold are, however, relatively rare. We conjecture this contradiction is the result of the business context in which the firm operates. The findings suggest that in sectors where price leadership strategies dominate, escape from low pay is likely to be exceptional, even within large organisations featuring some of the classic characteristics of ‘pure’ or strong ILMs