Developing change management skills: a resource for health care professionals and managers

Developing Change Management Skills is the first of the NHS Service Delivery and Organisation (SDO) Programmes resources aimed primarily at development. Five realistically complex case studies, made up of factual incidents woven into a fictional whole, provide the settings that allow readers to reason on behalf of characters within them. In the process they learn about: 1) The strengths and limitations of different change management approaches in different situations 2) How to group the approaches together to increase their usefulness 3) The importance of applying them rigorously, perceptively and creatively 4) How different results arise when they are used by people with different world views. The cases reflect the range of organisations within the NHS, being set in primary care, mental health and acute services trusts, as well as a strategic health authority. Key players within them include an individual team member, a service leader, and executive and non-executive board members. Readers are encouraged to take opportunities to apply the tools before comparing their thinking with that of the authors. In doing so they will develop skills they can apply within their own settings. It will be of interest to anyone in the NHS trying to initiate change, whether they hold formal leadership positions or not. It will also be of interest to developers and trainers

Direct evidence for the magnetic ordering of Nd ions in NdFeAsO by high resolution inelastic neutron scattering

We investigated the low energy excitations in the parent compound NdFeAsO of the Fe-pnictide superconductor in the $\mu$eV range by a back scattering neutron spectrometer. The energy scans on a powder NdFeAsO sample revealed inelastic peaks at E = 1.600 $\pm 0.003 \mu$eV at T = 0.055 K on both energy gain and energy loss sides. The inelastic peaks move gradually towards lower energy with increasing temperature and finally merge with the elastic peak at about 6 K. We interpret the inelastic peaks to be due to the transition between hyperfine-split nuclear level of the $^{143}$Nd and $^{145}$Nd isotopes with spin $I = 7/2$. The hyperfine field is produced by the ordering of the electronic magnetic moment of Nd at low temperature and thus the present investigation gives direct evidence of the ordering of the Nd magnetic sublattice of NdFeAsO at low temperature

Making informed decisions on change: key points for health care managers and professionals

A booklet, drawing on 'Organisational Change: A review for health care managers, professionals and researchers' (NSCCSDO, 2001), which aims to encourage managers and professionals to reflect on and share what helps and hinders successful change to improve the quality of services

Monitoring the CMS strip tracker readout system

The CMS Silicon Strip Tracker at the LHC comprises a sensitive area of approximately 200 m2 and 10 million readout channels. Its data acquisition system is based around a custom analogue front-end chip. Both the control and the readout of the front-end electronics are performed by off-detector VME boards in the counting room, which digitise the raw event data and perform zero-suppression and formatting. The data acquisition system uses the CMS online software framework to configure, control and monitor the hardware components and steer the data acquisition. The first data analysis is performed online within the official CMS reconstruction framework, which provides many services, such as distributed analysis, access to geometry and conditions data, and a Data Quality Monitoring tool based on the online physics reconstruction. The data acquisition monitoring of the Strip Tracker uses both the data acquisition and the reconstruction software frameworks in order to provide real-time feedback to shifters on the operational state of the detector, archiving for later analysis and possibly trigger automatic recovery actions in case of errors. Here we review the proposed architecture of the monitoring system and we describe its software components, which are already in place, the various monitoring streams available, and our experiences of operating and monitoring a large-scale system

Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research

Objective: This paper aimed to report the current status of research in the field of post-traumatic stress disorder following childbirth (PTSD FC), and to update the findings of an earlier 2008 paper. Background: A group of international researchers, clinicians and service users met in 2006 to establish the state of clinical and academic knowledge relating to PTSD FC. A paper identified four key areas of research knowledge at that time. Methods: Fourteen clinicians and researchers met in Oxford, UK to update the previously published paper relating to PTSD FC. The first part of the meeting focused on updating the four key areas identified previously, and the second part on discussing new and emerging areas of research within the field. Results: A number of advances have been made in research within the area of PTSD FC. Prevalence is well established within mothers, several intervention studies have been published, and there is growing interest in new areas: staff and pathways; prevention and early intervention; impact on families and children; special populations; and post-traumatic growth. Conclusion: Despite progress, significant gaps remain within the PTSD FC knowledge base. Further research continues to be needed across all areas identified in 2006, and five areas were identified which can be seen as ‘new and emerging’. All of these new areas require further extensive research. Relatively little is still known about PTSD FC

A pragmatic cluster randomised trial evaluating three implementation interventions

Background Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. Methods A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients' experiences, and stakeholders' experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. Results Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. Conclusions This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions' impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. Trial registration ISRCTN18046709 - Peri-operative Implementation Study Evaluation (POISE

Geography and Sentencing: Does Country of Citizenship Influence Sentence Longevity?

Contentious debates on immigrants in the United States has led to growing interest in their treatment in the criminal justice system. Much of what is known, however, springs from research that treats immigrants as a homogeneous group. The lumping of all immigrants into one category potentially mask variances in sentencing based on national origins. The current study disaggregates federal sentencing data to explore whether length of sentence differs by the defendants' geographical region of citizenship. After controlling for a number of legal and extra-legal factors, sentences imposed upon Mexican citizens were found to be longer than sentences meted out to defendants who are citizens of other countries. Evidence suggesting that national origin has a stronger influence on sentence length than race/ethnicity and legal status was also detected. Implications of the findings and directions for future research are discussed

Association of MC1R Variants and host phenotypes with melanoma risk in CDKN2A mutation carriers: a GenoMEL study

<p><b>Background</b> Carrying the cyclin-dependent kinase inhibitor 2A (CDKN2A) germline mutations is associated with a high risk for melanoma. Penetrance of CDKN2A mutations is modified by pigmentation characteristics, nevus phenotypes, and some variants of the melanocortin-1 receptor gene (MC1R), which is known to have a role in the pigmentation process. However, investigation of the associations of both MC1R variants and host phenotypes with melanoma risk has been limited.</p> <p><b>Methods</b> We included 815 CDKN2A mutation carriers (473 affected, and 342 unaffected, with melanoma) from 186 families from 15 centers in Europe, North America, and Australia who participated in the Melanoma Genetics Consortium. In this family-based study, we assessed the associations of the four most frequent MC1R variants (V60L, V92M, R151C, and R160W) and the number of variants (1, ≥2 variants), alone or jointly with the host phenotypes (hair color, propensity to sunburn, and number of nevi), with melanoma risk in CDKN2A mutation carriers. These associations were estimated and tested using generalized estimating equations. All statistical tests were two-sided.</p> <p><b>Results</b> Carrying any one of the four most frequent MC1R variants (V60L, V92M, R151C, R160W) in CDKN2A mutation carriers was associated with a statistically significantly increased risk for melanoma across all continents (1.24 × 10−6 ≤ P ≤ .0007). A consistent pattern of increase in melanoma risk was also associated with increase in number of MC1R variants. The risk of melanoma associated with at least two MC1R variants was 2.6-fold higher than the risk associated with only one variant (odds ratio = 5.83 [95% confidence interval = 3.60 to 9.46] vs 2.25 [95% confidence interval = 1.44 to 3.52]; Ptrend = 1.86 × 10−8). The joint analysis of MC1R variants and host phenotypes showed statistically significant associations of melanoma risk, together with MC1R variants (.0001 ≤ P ≤ .04), hair color (.006 ≤ P ≤ .06), and number of nevi (6.9 × 10−6 ≤ P ≤ .02).</p> <p><b>Conclusion</b> Results show that MC1R variants, hair color, and number of nevi were jointly associated with melanoma risk in CDKN2A mutation carriers. This joint association may have important consequences for risk assessments in familial settings.</p&gt