Naresuan University Journal
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Leadership for health commissioning in the new NHS: exploring the early development of clinical commissioning groups in England.
No full textPurpose To explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration towards a ‘clinically-led’ system is being realised. We investigate emerging leadership approaches within CCGs in light of the criterion for authorisation that calls for “great leaders”. Design/methodology/approach Qualitative research was carried out in eight case studies (CCGs) across England over a nine month period (September 2011 to May 2012) when CCGs were in their early development. We conducted a mix of interviews (with GPs and managers), observations (at CCG meetings) and examined associated documentation. Data were thematically analysed. Findings We found evidence of two identified approaches to leadership - positive deviancy and responsible guardianship - being undertaken by GPs and managers in the developing CCGs. Historical experiences and past ways of working appeared to be influencing current developments and a commonly emerging theme was a desire for the CCG to ‘do things differently’ to the previous commissioning bodies. We discuss how the current reorganisation threatens the guardianship approach to leadership and question if the new systems being implemented to monitor CCGs’ performance may make it difficult for CCGs to retain creativity and innovation, and thus the ability to foster the positive deviant approach to leadershi
Role substitution and extended scope of practice (ESP) in pharmacy: a policy analysis of the risks and opportunities of skill mix
No full textMethods for isolating atrial cells from large mammals and humans.
No full textThe identification of disturbances in the cellular structure, electrophysiology and calcium handling of atrial cardiomyocytes is crucial to the understanding of common pathologies such as atrial fibrillation. Human right atrial specimens can be obtained during routine cardiac surgery and may be used for isolation of atrial myocytes. These samples provide the unique opportunity to directly investigate the effects of human disease on atrial myocytes. However, atrial myocytes vary greatly between patients, there is little if any access to truly healthy controls and the challenges associated with assessing the in vivo effects of drugs or devices in man are considerable. These issues highlight the need for animal models. Large mammalian models are particularly suitable for this purpose as their cardiac structure and electrophysiology are comparable with humans. Here, we review techniques for obtaining atrial cardiomyocytes. We start with background information on solution composition. Agents shown to increase viable cell yield will then be explored followed by a discussion of the use of tissue-dissociating enzymes. Protocols are detailed for the perfusion method of cell isolation in large mammals and the chunk digest methods of cell isolation in humans
Older people and oral health: setting a patient-centred research agenda.
No full textOBJECTIVE: The aim of this pilot study was to provide the opportunity to enable older people to prioritise the research agenda to improve their own oral health. BACKGROUND: Little is known about the ageing population's views about their oral health from their perspective. Priority Setting Partnerships (PSPs) incorporate users' perspectives to prioritise research agendas and are based on a series of sequential steps to build consensus. This structured approach ensures their narrative and thoughts are heard and helps counter the 'top-down' medical model that can dominate healthcare services. MATERIALS AND METHODS: A PSP was undertaken with four key stakeholder groups: service users, carers, third sector and specialists. Six initial questions were posed to each group prior to a facilitated discussion led by one of the research team. Collective responses where then considered by a final consensus group. The views of the different groups were recorded, transcribed verbatim and underwent thematic analysis. RESULTS: The top three research priorities identified by the final group were to: (i) identify 'best practice' in the prevention and treatment of oral diseases for older people, (ii) identify the training needs for the dental profession and (iii) understand the key issues for older people from their perspective. Improving access to services, the importance of client appropriate information and the need for effective primary and secondary prevention were also articulated. CONCLUSION: Asking older people to prioritise the research agenda proved to be a positive experience. Key issues related to improving communication and the availability of appropriate evidence-based information on primary, secondary and tertiary prevention
“Unless everyone’s covert guerilla-like social justice practitioners…”: A preliminary study exploring social justice in UK counselling psychology.
No full textBackground: The discipline of applied psychology has begun to reflect more explicitly on the social justice values and practices of the profession. This paper presents the first stage of research in a larger project aiming to explore ‘social justice’ in applied psychology in the UK, and takes as its focus the branch of counselling psychology. Aim: To explore how members of the UK counselling psychology profession understand social justice, and act on their commitment to it. Method: Interviews were conducted with six individuals who had at least a moderate interest in and commitment to social justice, as assessed by the Social Issues Questionnaire. Data were analysed using techniques from the grounded theory approach. Findings: Themes included participants’ understandings of social justice both on a theoretical and a personal level, and the perceived fit between social justice and counselling psychology. Participants reported a perception of a lack of social justice action and reflected on potential difficulties associated with engaging in social justice action. Discussion: Implications for the international counselling psychology profession are reflected on. Directions for further research are outlined
Response to the Comment by Westaway et al. (Applied Energy, available online 20 March 2015) on the paper "Life cycle environmental impacts of UK shale gas" by Stamford and Azapagic (Applied Energy 134 (2014) 506-581)
No full textIn the recent Comment on our paper "Life cycle environmental impacts of UK shale gas" (Applied Energy 134 (2014) 506-518), Westaway et al. (Applied Energy, available online 20th March 2015) allege that we exaggerated the potential impacts of shale gas extraction in the UK. They first take an issue with our inclusion of worst case scenarios despite our clear declaration in several places in the paper that this is indicative of what could happen within the confines of a very ill-defined and highly variable future reality. Secondly, Westaway et al. claim that key assumptions in the modelling reflect illegal practices that would not occur, when in fact this is an exaggeration of the legal situation and these practices are still viable. This rebuttal addresses some of the claims made by Westaway et al. while welcoming further open and impartial discourse in this area
Pathophysiologic changes in extracellular pH modulate parathyroid calcium-sensing receptor activity and secretion via a histidine-independent mechanism
No full textThe calcium-sensing receptor (CaR) modulates renal calcium reabsorption and parathyroid hormone (PTH) secretion and is involved in the etiology of secondary hyperparathyroidism in CKD. Supraphysiologic changes in extracellular pH (pHo) modulate CaR responsiveness in HEK-293 (CaR-HEK) cells. Therefore, because acidosis and alkalosis are associated with altered PTH secretion in vivo, we examined whether pathophysiologic changes in pHo can significantly alter CaR responsiveness in both heterologous and endogenous expression systems and whether this affects PTH secretion. In both CaR-HEK and isolated bovine parathyroid cells, decreasing pHo from 7.4 to 7.2 rapidly inhibited CaR-induced intracellular calcium (Ca2+ i) mobilization, whereas raising pHo to 7.6 potentiated responsiveness to extracellular calcium (Ca2+ o). Similar pHo effects were observed for Ca2+ o-induced extracellular signal-regulated kinase phosphorylation and actin polymerization and for L-Phe-induced Ca2+ i mobilization. Intracellular pH was unaffected by acute 0.4-unit pHo changes, and the presence of physiologic albumin concentrations failed to attenuate the pHo-mediated effects. None of the individual point mutations created at histidine or cysteine residues in the extracellular domain of CaR attenuated pHo sensitivity. Finally, pathophysiologic pHo elevation reversibly suppressed PTH secretion from perifused human parathyroid cells, and acidosis transiently increased PTH secretion. Therefore, pathophysiologic pHo changes can modulate CaR responsiveness in HEK-293 and parathyroid cells independently of extracellular histidine residues. Specifically, pathophysiologic acidification inhibits CaR activity, thus permitting PTH secretion, whereas alkalinization potentiates CaR activity to suppress PTH secretion. These findings suggest that acid-base disturbances may affect the CaR-mediated control of parathyroid function and calcium metabolism in vivo
Integrated primary care for patients with mental and physical multimorbidity:cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease
No full textOBJECTIVE: To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions. DESIGN: Cluster randomised controlled trial. SETTING: 36 general practices in the north west of England. PARTICIPANTS: 387 patients with a record of diabetes or heart disease, or both, who had depressive symptoms (>/= 10 on patient health questionaire-9 (PHQ-9)) for at least two weeks. Mean age was 58.5 (SD 11.7). Participants reported a mean of 6.2 (SD 3.0) long term conditions other than diabetes or heart disease; 240 (62%) were men; 360 (90%) completed the trial. INTERVENTIONS: Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses. MAIN OUTCOME MEASURES: The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale (SCL-D13) at four months after baseline assessment. Secondary outcomes included anxiety symptoms (generalised anxiety disorder 7), self management (health education impact questionnaire), disability (Sheehan disability scale), and global quality of life (WHOQOL-BREF). RESULTS: 19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval -0.41 to -0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support. CONCLUSIONS: Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity. TRIAL REGISTRATION: ISRCTN80309252