The experience of community first responders in co-producing rural health care : in the liminal gap between citizen and professional

Non peer reviewedPublisher PD

Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

Background: Recent developments within the United Kingdom's (UK) health care system have reawakened interest in community hospitals (CHs) and their role in the provision of health care. This integrative literature review sought to identify and assess the current evidence base for CHs. Methods: A range of electronic reference databases were searched from January 1984 to either December 2004 or February 2005: Medline, Embase, Web of Knowledge, BNI, CINAHL, HMIC, ASSIA, PsychInfo, SIGLE, Dissertation Abstracts, Cochrane Library, Kings Fund website, using both keywords and text words. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying unifying concepts and discrepant issues. Results: The search strategy identified over 16,000 international references. We included papers of any study design focussing on hospitals in which care was led principally by general practitioners or nurses. Papers from developing countries were excluded. A review of titles revealed 641 potentially relevant references; abstract appraisal identified 161 references for review. During data extraction, a further 48 papers were excluded, leaving 113 papers in the final review. The most common methodological approaches were cross-sectional/descriptive studies, commentaries and expert opinion. There were few experimental studies, systematic reviews, economic studies or studies that reported on longer-term outcomes. The key themes identified were origin and location of CHs; their place in the continuum of care; services provided; effectiveness, efficiency and equity of CHs; and views of patients and staff. In general, there was a lack of robust evidence for the role of CHs, which is partly due to the ad hoc nature of their development and lack of clear strategic vision for their future. Evidence for the effectiveness and efficiency of the services provided was limited. Most people admitted to CHs appeared to be older, suggesting that admittance to CHs was age-related rather than condition-related. Conclusion: Overall the literature surveyed was long on opinion and short of robust studies on CHs. While lack of evidence on CHs does not imply lack of effect, there is an urgent need to develop a research agenda that addresses the key issues of health care delivery in the CH setting

Examining the role of Scotland’s telephone advice service (NHS 24) for managing health in the community : analysis of routinely collected NHS 24 data

Date of Acceptance: 15/06/2015 Funding This work was supported by the Chief Scientist Office, ScottishExecutive (grant no. CZH/4/692). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.Peer reviewedPublisher PD

Transnational comparison : A retrospective study on e-health in sparsely populated areas of the northern periphery

Peer reviewedPublisher PD

Causality in Political Networks

As the study of political networks becomes more common in political science, greater attention to questions of causality is warranted. This essay explores competing visions of causality in political networks. Independent essays address issues of statistical model specification, identification of multi-step personal influence, measurement error, causality in historical perspective, and the insights of field experiments. These essays do not agree entirely on the nature of causality in political networks, though they commonly take seriously concerns regarding homophily, time- consistency, and the uniqueness of political network data. Serious consideration of these methodological issues promises to enhance the value-added of network analysis in the study of politics

Malnutrition in healthcare settings and the role of gastrostomy feeding

Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes

Mass production of individual feedback

Learning to program is intrinsically difficult. In addition there is a trend towards increased student diversity and larger class sizes. Student diversity increases the need for individual attention for each student, while increased class sizes decreases the amount of time a lecturer has to provide this attention. This thesis investigates an approach to help provide each student with detailed individual feedback. This feedback is important where individual attention is lacking. We used two trials to determine the effectiveness of the system. The first of these trial runs was in Autumn 2002 and the system provided the facility to the tutors to give personal and detailed feedback to each student. There was a statistically significant improvement in the weaker students’ exam results for that Semester. The system was improved for the second trial. The tutors could provide feedback as before, but also this time the students could provide feedback on each other through peer-assessment and self-assessment. The system remained popular and useful. However for the second trial we were interested in making the peer assessment aspect a success. The thesis will discuss our limited success in this area. Eighty eight percent of the students were motivated to provide feedback through bonus marks and the incentive of getting feedback from others, but many students gave absolute minimum feedback

Combining transcranial ultrasound with intelligent communication methods to enhance the remote assessment and management of stroke patients : framework for a technology demonstrator

With over 150,000 strokes in the United Kingdom every year, and more than 1 million living survivors, stroke is the third most common cause of death and the leading cause of severe physical disability among adults. A major challenge in administering timely treatment is determining whether the stroke is due to vascular blockage (ischaemic) or haemorrhage. For patients with ischaemic stroke, thrombolysis (i.e. pharmacological 'clot-busting') can improve outcomes when delivered swiftly after onset, and current National Health Service Quality Improvement Scotland guidelines are for thrombolytic therapy to be provided to at least 80 per cent of eligible patients within 60 min of arrival at hospital. Thrombolysis in haemorrhagic stroke could severely compound the brain damage, so administration of thrombolytic therapy currently requires near-immediate care in a hospital, rapid consultation with a physician and access to imaging services (X-ray computed tomography or magnetic resonance imaging) and intensive care services. This is near impossible in remote and rural areas, and stroke mortality rates in Scotland are 50 per cent higher than in London. We here describe our current project developing a technology demonstrator with ultrasound imaging linked to an intelligent, multi-channel communication device - connecting to multiple 2G/3G/4G networks and/or satellites - in order to stream live ultrasound images, video and two-way audio streams to hospital-based specialists who can guide and advise ambulance clinicians regarding diagnosis. With portable ultrasound machines located in ambulances or general practices, use of such technology is not confined to stroke, although this is our current focus. Ultrasound assessment is useful in many other immediate care situations, suggesting potential wider applicability for this remote support system. Although our research programme is driven by rural need, the ideas are potentially applicable to urban areas where access to imaging and definitive treatment can be restricted by a range of operational factors

Epilithic biomass in a large gravel-bed river (the Garonne, France): a manifestation of eutrophication?

In order to evaluate the impact of outputs of the city of Toulouse (740 000 inhabitants) on the epilithic communities colonizing pebble banks in the river Garonne, a large gravel-bed river (eighth order), dry mass (DM), ash-free dry mass (AFDM) and chlorophyll-a (chla) epilithic biomass per unit area were measured and autotrophic index (AI) (i.e. ratio AFDM/chla) was calculated at four stations. This river is morphologically characterized by a succession of pools and riffles and by highly fluctuating hydraulic conditions. At the four stations studied (223 km apart), the means of AFDM values varied between 17.1 and 31.1 g m−2 of colonized surface and the chla concentration varied between 112 and 254 mg m−2. However, there were no significant differences in AFDM per unit area between the parts of the river upstream and downstream of the Toulouse area (Mann–Whitney U-test statistic), nor between the four stations (Kruskal–Wallis test statistic), and the AI did not allow the description of changes in periphyton communities between sampling locations. This study showed that epilithic biomass should be considered as the typical microbial community of the river rather than as a manifestation of eutrophication