nhs

NHS
  • 文章类型: Journal Article
    员工疾病缺勤和出勤(身体不适时参加工作)会给NHS带来高昂的成本,与患者不良结局相关,并因COVID-19大流行而加剧。主要原因是精神和肌肉骨骼疾病,心血管危险因素常见。
    进行一项可行性研究,以告知设计一项确定的随机对照试验,以了解健康筛查诊所在减少国家卫生服务人员中的旷工和出勤率方面的有效性和成本效益。
    与常规护理相比,工作人员健康筛查诊所的个人随机对照试点试验,包括定性过程评估。
    来自两个城市和一个农村信托的四个英国国家卫生服务医院。
    以前没有在伯明翰伊丽莎白女王医院参加过试点健康检查诊所的医院雇员。
    护士领导的员工健康筛查诊所,评估肌肉骨骼健康(STarT肌肉骨骼;STarTBack),心理健康(患者健康问卷-9;广泛性焦虑症问卷-7)和心血管健康(NHS健康检查,如果年龄≥40岁,生活方式检查,如果<40岁)。根据英国指南,为屏幕阳性提供建议和/或转介服务。
    三个共同结果是招募,转介和出席转介服务。当一起考虑时,这些形成了停/走标准。如果这些值中的任何一个落入“琥珀色”区域,那么审判将需要修改才能进行全面审判。如果所有的都是红色的,那么审判将被认为是不可行的。为最终随机对照试验的设计而收集的次要结果包括:普遍性,筛选结果,需要/参加的个人转介,健康行为,工艺的可接受性/可行性,污染和成本的指示。与最终试验相关的结果包括自我报告和员工旷工记录以及原因。过程评估包括与参与者的访谈,干预交付人员和服务提供商。提出了描述性统计数据,并对定性数据进行了框架分析。由于COVID-19大流行,结果仅在6个月内被捕获.
    三百十四个参与者同意(236随机),大多数在4个月内。邀请的314/3788(8.3%)的招聘率低于预期(符合此标准的红色),但是筛查发现,随机分组的57/118(48.3%)符合转诊至全科医生(81%),心理健康(18%)和/或物理治疗服务(30%)(绿色)。早日结束审判排除了确定出庭作证的可能性,但31.6%的合资格人士报告打算出席(琥珀色)。在计划进行的80次定性访谈中,有51次(63.75%)进行了定性访谈。过程评估的定量和定性数据表明,电子数据库驱动的筛查干预和数据收集是有效的,促进良好的保真度,虽然有时需要更多的个性化。招募和交付全面审判将受益于更长的开发期,以更好地了解当地情况,制定有效的战略,与服务不足的群体接触,提供更长的培训,并与转介服务更好地整合。由于COVID-19对工作人员调动的影响,试点的交付受到限制,COVID研究优先考虑和减少社区和内部转诊服务的可用性。虽然招聘迅速,它没有完全代表少数族裔群体,并且由于资金限制而导致的随访中断,无法对推荐服务的出勤率和次要结局进行全面评估.
    这个国家卫生服务人员的健康筛查诊所既有临床需求(48%的筛查合格转诊证明),也有感知的益处(来自定性访谈的数据)。三个停/走标准是红色的,绿色和琥珀色;因此,审判监督委员会建议进行全面审判,但要进行修改,以适应当地情况,并采用更好地与服务不足的社区接触的程序。
    本试验注册为ISRCTN10237475。
    该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:17/42/42)资助,并在《健康与社会护理提供研究》中全文发表。12号23.有关更多奖项信息,请参阅NIHR资助和奖励网站。
    疾病缺勤和出勤(生病时出勤,工作表现不佳)是NHS中的主要问题,并与较差的患者医疗保健有关。NHS员工缺勤和出勤的最常见原因是肌肉不适和精神疾病。不良的生活方式和与心脏病相关的疾病也是重要因素。员工健康检查可能会改善NHS员工的健康状况,但是没有研究包括筛查测试来解决员工健康状况不佳的最常见原因。这项初步研究测试了是否有可能对NHS员工健康筛查诊所进行随机对照试验,有些人得到筛查检查,而另一些人没有(随机选择,就像掷硬币一样)。我们使用电子数据库来捕获所有数据。参与者在家中或工作中完成了初始问卷,然后参加了面对面的筛查诊所,使用公认的筛查问卷和测试来检测肌肉问题,精神或心脏健康。我们考虑了NHS员工和医疗机构如何希望筛查诊所和试验运行,如何最好地接触各种各样的NHS工作人员,可能需要邀请多少员工,以及他们的医疗保健需求。这项研究在COVID-19大流行期间在英国的四家NHS医院进行。136名NHS工作人员参加了会议,但由于大流行而导致的早期试验结束意味着一些结果无法获得.对于主要的可行性结果,尽管约8%的招聘率低于预期,一半接受筛查的工作人员需要转诊以接受进一步的医疗保健,三分之一的工作人员报告打算参加。工作人员认为该诊所解决了重要的健康需求。审判监督委员会建议进行全面审判,但要修改以解决程序评估的结果,包括鼓励更广泛的NHS员工参加的方法。
    UNASSIGNED: Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common.
    UNASSIGNED: To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff.
    UNASSIGNED: Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation.
    UNASSIGNED: Four United Kingdom National Health Service hospitals from two urban and one rural Trust.
    UNASSIGNED: Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham.
    UNASSIGNED: Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines.
    UNASSIGNED: The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the \'amber\' zone, then the trial would require modifications to proceed to full trial. If all were \'red\', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only.
    UNASSIGNED: Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes.
    UNASSIGNED: There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities.
    UNASSIGNED: This trial is registered as ISRCTN10237475.
    UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.
    Sickness absenteeism and presenteeism (attendance at work while ill, with poor work performance) are major problems in the NHS and associated with worse patient health care. The most common causes of NHS staff sickness absenteeism and presenteeism are muscular complaints and mental ill health. Poor lifestyle and illnesses associated with heart disease are also important factors. Staff health checks might improve the health of NHS staff, but no studies have included screening tests to address the most common causes of poor staff health. This pilot study tested whether it would be possible to deliver a randomised controlled trial of an NHS staff health screening clinic, where some people get the screening check and others do not (chosen at random, like flipping a coin). We used an electronic database to capture all data. Participants completed initial questionnaires either at home or at work, then attended a face-to-face screening clinic using recognised screening questionnaires and tests to detect problems with muscular, mental or heart health. We considered how NHS staff and healthcare organisations would want the screening clinic and trial to run, how a diverse range of NHS staff could best be approached, how many staff might need to be invited and what their healthcare needs would be. The study ran in four UK NHS hospitals during the COVID-19 pandemic. Two hundred and thirty-six NHS staff participated, but early trial closure due to the pandemic meant that some results were unavailable. For the primary feasibility outcomes, although recruitment rates of around 8% were lower than anticipated, half of staff screened needed referral for further health care and one-third reported intending to attend. Staff felt that the clinic addressed an important health need. The Trial Oversight Committee recommended proceeding to a full-scale trial but with modifications to address findings from the process evaluation, including ways to encourage a wider group of NHS staff to take part.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目的:目前对精神分裂症反复发作及相关疾病患者的推荐治疗是抗精神病药物治疗。然而,许多抗精神病药物使用者仍然功能受损,并经历严重的身体和精神副作用。本研究旨在评估逐步减少和停用抗精神病药物的成本效益,与24个月的心理健康服务维持治疗相比,健康和社会护理,和社会观点。
    方法:19项精神健康信托基金招募患者参加RADAR随机对照试验。根据患者报告的EQ-5D-5L计算质量调整生命年(QALYs),根据患者报告的ICACAP-A计算出的全部能力年数(YFC)。从医疗记录中收集精神卫生服务的使用和药物。其他资源使用和生产率损失是使用自填问卷收集的。成本是从公布的来源计算出来的。
    结果:253名参与者被随机分配:126名被分配到抗精神病药物剂量减少和127名被分配到维持。从任何角度来看,武器之间的总成本没有显着差异。QALYs没有显着差异(-0.035;95%CI:-0.123至0.052),而与维持组相比,减少组的YFCs显著较低(基线校正差值:-0.103;95%CI:-0.192~-0.014).减少策略以维护所有分析为主,不太可能具有成本效益。
    结论:对于长期服用抗精神病药物的精神分裂症和其他复发性精神病患者,与维持两年相比,逐步减少和停用抗精神病药物的策略不太可能具有成本效益。
    OBJECTIVE: The current recommended treatment for patients with recurrent episodes of schizophrenia and related conditions is antipsychotic medication. However, many antipsychotic users remain functionally impaired and experience serious physical and mental side effects. This study aims to assess the cost-effectiveness of a gradual antipsychotic reduction and discontinuation strategy compared to maintenance treatment over 24 months from a mental health services, health and social care, and societal perspectives.
    METHODS: Nineteen mental health trusts recruited patients to the RADAR randomised controlled trial. Quality adjusted life years (QALYs) were calculated from patient-reported EQ-5D-5L, with years of full capability (YFCs) calculated from the patient-reported ICECAP-A. Mental health services use and medication was collected from medical records. Other resource use and productivity loss was collected using self-completed questionnaires. Costs were calculated from published sources.
    RESULTS: 253 participants were randomised: 126 assigned to antipsychotic dose reduction and 127 to maintenance. There were no significant differences between arms in total costs for any perspectives. There were no significant difference in QALYs (-0.035; 95% CI: -0.123 to 0.052), whereas YFCs were significantly lower in the reduction arm compared to the maintenance arm (baseline-adjusted difference: -0.103; 95% CI: -0.192 to -0.014). The reduction strategy was dominated by maintenance for all analyses and was not likely to be cost-effective.
    CONCLUSIONS: It is unlikely that gradual antipsychotic reduction and discontinuation strategy is cost-effective compared with maintenance over two-years for patients with schizophrenia and other recurrent psychotic disorders who are on long-term antipsychotics.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    在医疗保健行业内,越来越多的证据表明,员工调查可能会伤害参与该过程的个人,一个组织的文化和服务的交付。
    本文详细介绍了由NHS威尔士组织开发的一项干预措施,该措施旨在通过在整个组织范围内推广“最后手段”方法来减少其员工调查的数量,并引入了“可避免的员工伤害”的概念。制定了一系列相关的改进措施,以支持负责确定是否应启动员工调查的人员的行为改变。
    在13个月的时间里,组织记录显示,干预后调查案件每年减少71%,估计每年可避免3,308个病假日,估计每年可节省738,133英镑(基于直接节省和避免的成本)。这表明该组织已经开始采用“最后手段”的方法来使用员工调查来解决工作场所问题。该计划得到了对负责调试和领导组织员工调查的人员的培训的支持。对参加培训讲习班以支持该方案的人的调查数据进行的分析表明,参与者对讲习班后的员工调查过程的认识有所提高,对可避免的员工伤害的概念也有所了解。
    该计划与健康医疗保健概念一致,正如这项研究说明了其实践和流程如何对员工产生有益的影响,以及潜在的患者。这项研究突出了需要考虑的更广泛的问题,包括:(1)人力资源(HR)的作用,(2)采取多学科的方法,(3)文化与实践,(4)更广泛的HR职业的责任。
    UNASSIGNED: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization\'s culture and the delivery of its services.
    UNASSIGNED: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a \'last resort\' approach and introduced the concept of \'avoidable employee harm\'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated.
    UNASSIGNED: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the \"last resort\" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization\'s employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm.
    UNASSIGNED: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:英国医学教育体系面临着专业培训选择和竞争加剧的复杂局面。影响英国医学生专业培训偏好的因素(FAST)研究解决了需要了解影响英国医学生专业选择的因素,在医疗保健劳动力规划面临越来越多挑战的背景下。
    目的:FAST研究的主要目标是探索英国医学生的首选专业和影响这些选择的因素。次要目标是评估学生对确保他们选择的专业的信心,了解人口统计和学术背景如何影响他们的决定,并检查不同英国医学院的专业偏好和信心水平如何变化。
    方法:将使用横断面调查设计来收集英国医学生的数据。调查,包括17个问题,使用李克特音阶,多项选择格式,和自由文本输入,以捕捉对专业选择因素的细微见解。方法论,改编自英国医学生职业意向确定(AIMS)研究,纳入基于文献综述的调整,临床工作人员的反馈,和试点小组的见解。这种方法确保了全面和非指导性的提问。数据分析将包括描述性统计,以建立基本模式,用于组比较的方差分析,用于结果建模的逻辑回归,和专业偏好分析的离散选择模型。
    结果:该研究于2023年12月4日在全国范围内启动。数据收集预计将于2024年3月1日结束,此后开始数据分析。结果预计将在2024年晚些时候公布。
    结论:FAST研究代表了理解影响英国医学生职业道路的因素的重要一步。通过整合跨年度小组和医学院的不同学生观点,这项研究旨在提供对专业动态的关键见解,或居住权,选择。这些发现预计将为政策和教育战略提供信息,旨在使培训机会与未来医务人员不断变化的需求和愿望保持一致。最终,获得的见解可能会指导平衡专业分布的举措,改善职业指导,并提高国家卫生服务内学生的整体满意度,有助于建立更稳定和有效的医疗保健系统。
    DERR1-10.2196/55155。
    BACKGROUND: The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students\' specialty choices, against a backdrop of increasing challenges in health care workforce planning.
    OBJECTIVE: The primary objectives of the FAST study are to explore UK medical students\' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students\' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools.
    METHODS: A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis.
    RESULTS: The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024.
    CONCLUSIONS: The FAST study represents an important step in understanding the factors influencing UK medical students\' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system.
    UNASSIGNED: DERR1-10.2196/55155.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    异染性脑白质营养不良(MLD)是一种致命的遗传性溶酶体贮积病,可通过新生儿血斑筛查检测到。筛选试验的可行性和筛选MLD的临床原理先前已被证明,因此,本研究的目的是确定在英国常规新生儿筛查计划中增加MLD筛查是否具有成本效益地使用国家卫生服务(NHS)资源.基于每个MLD亚型的决策树框架,从NHS和个人社会服务的角度进行了健康经济分析,使用从先前提出的分区生存和马尔可夫经济模型得出的长期结果。流行病学相关参数的建模输入,测试特性,筛查和治疗费用是基于来自英国三大专业MLD医院的数据,结构化的专家意见和已发表的文献。寿命成本和质量调整寿命年(QALYs)以1.5%的折扣来考虑时间偏好。使用敏感性分析探索与参数输入相关的不确定性。这项健康经济分析表明,使用符合疾病严重程度的支付意愿阈值,对MLD进行新生儿筛查是对NHS资源的一种具有成本效益的使用;并支持将MLD纳入英国的常规新生儿筛查计划。
    Metachromatic leukodystrophy (MLD) is a fatal inherited lysosomal storage disease that can be detected through newborn bloodspot screening. The feasibility of the screening assay and the clinical rationale for screening for MLD have been previously demonstrated, so the aim of this study is to determine whether the addition of screening for MLD to the routine newborn screening program in the UK is a cost-effective use of National Health Service (NHS) resources. A health economic analysis from the perspective of the NHS and Personal Social Services was developed based on a decision-tree framework for each MLD subtype using long-term outcomes derived from a previously presented partitioned survival and Markov economic model. Modelling inputs for parameters related to epidemiology, test characteristics, screening and treatment costs were based on data from three major UK specialist MLD hospitals, structured expert opinion and published literature. Lifetime costs and quality-adjusted life years (QALYs) were discounted at 1.5% to account for time preference. Uncertainty associated with the parameter inputs was explored using sensitivity analyses. This health economic analysis demonstrates that newborn screening for MLD is a cost-effective use of NHS resources using a willingness-to-pay threshold appropriate to the severity of the disease; and supports the inclusion of MLD into the routine newborn screening programme in the UK.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:随着改善阿尔茨海默病(AD)的治疗方法的出现,有人担心,即使是高收入国家也缺乏及时准确识别合格患者的诊断能力。
    目的:我们分析了NHS英格兰在AD专家的能力上需要投资多少,使用PET扫描或CSF测试和MRI扫描进行生物标志物测试,以达到G7平均水平,并评估对诊断过程中等待时间的影响。
    方法:成本和容量数据的案头研究和专家访谈。马尔可夫模型来估计等待时间。
    方法:NHS英格兰。
    方法:AD专家,G7国家的人均PET和MRI扫描仪,以及不同投资情景下英国的等待时间。
    结果:在七国集团国家中,英国的PET和MRI扫描仪数量最少,人均AD专家数量排名第二。需要在十年内投资140亿英镑才能达到G7的平均水平,其中31%,22%,10%,37%将用于内存评估服务的容量,PET扫描,CSF分析,和核磁共振扫描,分别。这项投资将使2023年至2032年间的平均等待时间减少约87%。
    结论:英国NHS在AD诊断能力方面存在很大差距。如果没有大量投资,英格兰的AD患者将经历大量的等待时间和可避免的疾病进展。
    BACKGROUND: As disease-modifying Alzheimer\'s (AD) treatments are becoming available, concerns have been raised that even high-income countries lack the diagnostic capacity to accurately identify eligible patients in a timely manner.
    OBJECTIVE: We analyze how much NHS England would have to invest in capacity for AD specialists, biomarker testing with PET scans or CSF testing and MRI scans to reach G7 average levels and estimate the effect on wait times in the diagnostic process.
    METHODS: Desk research and expert interviews for cost and capacity data. Markov model to estimate wait times.
    METHODS: NHS England.
    METHODS: AD specialists, and PET and MRI scanners per capita in G7 countries and wait times in England under different investment scenarios.
    RESULTS: England has the lowest number of PET and MRI scanners and the second-lowest of AD specialists per capita among the G7 countries. An investment of GBP 14 billion over ten years would be needed to reach G7 average levels, of which 31%, 22%, 10%, 37% would be devoted to capacity for memory assessment services, PET scanning, CSF analysis, and MRI scanning, respectively. This investment would reduce estimated average wait times by around 87% between 2023 and 2032.
    CONCLUSIONS: The NHS England has large gaps in diagnostic capacity for AD. Without substantial investments, AD patients in England would experience substantial wait times and avoidable disease progression.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    目的:本文调查了与私营公司合作的英国国家卫生服务(NHS)组织,一种通常被称为公私伙伴关系(PPP)的形式。历届政府都将购买力平价作为改善医疗保健提供的一种方式,充分利用这两个部门带来的不同技能/经验。然而,使这些关系在地面上工作的任务通常落在个人领导者/从业者(“边界扳手”),他们的角色在这种类型的伙伴关系中被研究不足。
    方法:本文选择了比较三个案例研究方法,包括对代表参与管理合伙企业的中高级管理人员的员工进行的13次半结构化访谈和问卷调查。这些数据得到了文献分析的补充,包括分钟,内部流程和新闻稿的描述。
    结果:本文通过创建一个称为“边界墙”的框架来提供概念和经验见解,该框架表明组织之间边界的不同元素如何影响角色和活动。边界跨越者(伙伴关系的管理者)。
    结论:这是一个研究不足的领域的初步框架,因此,在未来的研究中,需要进一步测试和应用到其他案例研究网站。
    结论:该文件包括对实践和政策的影响。
    结论:虽然我们对边界扳手在公共伙伴关系中的作用越来越了解,本文通过在公共部门和私营部门之间的关系的背景下探索这些概念,做出了独特的贡献。
    OBJECTIVE: The paper investigates English National Health Service (NHS) organisations partnering with private companies, a form commonly known as a Public-Private Partnership (PPP). Successive governments have promoted PPPs as a way of improving the delivery of health care, making the best of the different skills/experience which both sectors bring. However, the task of making these relationships work on the ground often falls to individual leaders/practitioners (\"boundary spanners\") whose role has been under-researched in this type of partnership.
    METHODS: The paper opted for a comparative three case study approach, including 13 semi-structured interviews and questionnaires with employees representing middle and senior management involved in managing the partnerships. The data were complemented by documentary analysis, including minutes, descriptions of internal processes and press releases.
    RESULTS: The paper provides conceptual and empirical insights by creating a framework called the \"boundary wall\" that indicates the ways in which different elements of the boundaries between organisations influence the role and activities of boundary spanners (managers of the partnership).
    CONCLUSIONS: This is an initial framework in an under-researched area, so will need further testing and application to other case study sites in future research.
    CONCLUSIONS: The paper includes implications for both practice and policy.
    CONCLUSIONS: While we know an increasing amount about the role of boundary spanners in public partnerships, the paper makes a unique contribution by exploring these concepts in the context of relationships between the public and private sectors.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Case Reports
    化疗引起的恶心和呕吐(CINV)是癌症治疗的一种使人衰弱的副作用,影响许多患者。大麻素激动剂,例如纳比酮和Δ9-四氢大麻酚(THC),大麻的主要精神活性成分,已显示出作为止吐药的功效。这里,我们报道了迈克尔·罗伯茨(MR)的病例,我们认为,他是英国国家卫生服务(NHS)为管理CINV的药用大麻花费用报销的第一位英国患者。医疗数据来自NHS记录和个人资助请求(IFR)表格。使用经过验证的问卷收集患者报告的结果指标(PROM),作为开始处方药用大麻的专业私人诊所的护理标准的一部分。患者表现为直肠乙状结肠腺癌伴肺转移。他收到了FOLFIRI(亚叶酸,氟尿嘧啶,和伊立替康)化疗,并接受了紧急哈特曼手术,随后进行了二线FOLFOX(亚叶酸,氟尿嘧啶,和奥沙利铂)化疗和肺消融。MR报告与初始FOLFIRI治疗相关的严重恶心和呕吐。止吐药甲氧氯普胺和阿瑞吡坦显示出适度的疗效。止吐药昂丹司琼,左甲丙嗪,和纳比隆与不能容忍的副作用有关。吸入以THC为主的大麻花与标准药物改善CINV相关,焦虑,睡眠质量,食欲,整体情绪,和生活质量。我们的结果增加了现有证据,表明药用大麻花可能在癌症姑息治疗与标准治疗肿瘤治疗相结合中提供有价值的支持。在这种情况下,成功的个人资助请求证明了其他患者获得这些治疗的途径。倡导在国家医疗保健服务中更广泛地认识和整合大麻基医药产品。
    Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of cancer treatment, affecting many patients. Cannabinoid agonists, such as nabilone and Δ9-tetrahydrocannabinol (THC), the main psychoactive component of Cannabis sativa L., have shown efficacy as antiemetics. Here, we report the case of Michael Roberts (MR), who we believe is the first British patient reimbursed by the National Health Service (NHS) England for the cost of medicinal cannabis flowers to manage CINV. Medical data were obtained from NHS records and individual funding request (IFR) forms. Patient-reported outcome measures (PROMs) were collected using validated questionnaires as part of the standard of care at the specialized private clinics where the prescription of medicinal cannabis was initiated. The patient presented with rectosigmoid adenocarcinoma with lung metastases. He received FOLFIRI (folinic acid, fluorouracil, and irinotecan) chemotherapy and underwent an emergency Hartmann\'s procedure with subsequent second-line FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy and lung ablation. MR reported severe nausea and vomiting associated with the initial FOLFIRI treatment. Antiemetics metoclopramide and aprepitant demonstrated moderated efficacy. Antiemetics ondansetron, levomepromazine, and nabilone were associated with intolerable side effects. Inhalation of THC-predominant cannabis flowers in association with standard medication improved CINV, anxiety, sleep quality, appetite, overall mood, and quality of life. Our results add to the available evidence suggesting that medicinal cannabis flowers may offer valuable support in cancer palliative care integrated with standard-of-care oncology treatment. The successful individual funding request in this case demonstrates a pathway for other patients to gain access to these treatments, advocating for broader awareness and integration of cannabis-based medicinal products in national healthcare services.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    目的:分析泌尿外科专业的诉讼趋势和索赔原因,在英国国家卫生服务(NHS)内,超过16年。
    方法:根据2000年《信息自由法》,从NHS决议中要求提供数据。这包括泌尿外科的索赔总数,成功(结算或关闭)的数量,以及2006年至2022年每个财政年度支付的损害赔偿费用。还收集了按主要原因分列的成功索赔。这些被编码为以下类别:\“非手术\”,\'术中\',\'术后\',和\'其他\'。
    结果:在2006年至2022年期间,共提出了4124项诉讼索赔,其中60.9%(2511/4124)的诉讼成功。总之,支付了1.45亿英镑(英镑)的赔偿金。从这16年的开始到结束,成功的索赔数量增加了2.9倍,支付的损害赔偿成本增加了10倍。关于成功索赔的主要原因,治疗失败或延误(20.9%,525/2511),诊断失败或延迟(14.5%,364/2511),术中问题(9.1%,229/2511)所占比例最高。总的来说,成功索赔的非手术原因占73.3%(1840/2511),术中20.1%(504/2511),术后为3.9%(98/2511)。
    结论:成功的泌尿外科诉讼索赔的数量,他们的相关成本正在上升。大多数是由于非手术原因,这可能部分解释为NHS等待名单以及2019年冠状病毒病(COVID-19)大流行的影响。
    OBJECTIVE: To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period.
    METHODS: Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: \'non-operative\', \'intraoperative\', \'postoperative\', and \'other\'.
    RESULTS: A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511).
    CONCLUSIONS: The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    本文探讨了“患者安全的时刻”-2000年左右的时期,当时患者安全成为英国国家卫生服务(NHS)的主要政策关注,和其他医疗保健系统。虽然医疗造成的伤害(医源性损伤)早已得到临床医生和科学家的认可,从2000年开始,NHS中出现了一种新的系统的患者安全语言,促进了对患者伤害的新型管理和监管方法.这种语言反映了国家在调节医疗保健方面的作用越来越大,以及医疗自主权的侵蚀和新的官僚管理形式的兴起。承认一个跨国公司,对患者安全的政策兴趣上升背后的知识背景——例如,工业安全科学见解的应用-本文考察了国内文化因素所起的作用,如医疗过失诉讼和医疗丑闻,帮助定义英国的新语言。
    This article explores the \'the moment of patient safety\'-the period around 2000 when patient safety became a key policy concern of the British National Health Service (NHS), and other healthcare systems. While harm caused by medical care (iatrogenic injury) had long been acknowledged by clinicians and scientists, from 2000 a new systemic language of patient safety emerged in the NHS that promoted novel managerial and regulatory approaches to patient harm. This language reflected the state\'s increasing role in regulating healthcare, as well as the erosion of medical autonomy and the rise of new forms of bureaucratic management. Acknowledging a transnational, intellectual context behind the rise of policy interest in patient safety-for example, the application of insights from the industrial safety sciences-this article examines the role played by domestic cultural factors, such as medical negligence litigation and healthcare scandals, in helping to define the new language in Britain.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号