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Age at type 2 diabetes diagnosis and prevalence of obesity, hypertension, anxiety, and depression: a retrospective observational study
No full textBackground and aims: We aimed to investigate associations between age at diagnosis of type 2 diabetes and the relative and absolute risk of four common comorbidities: obesity, hypertension, depression, and anxiety. Methods and results: We used primary and secondary care data from England to conduct a matched cross-sectional study of individuals aged 16–50 years (N = 108,061 with a new diagnosis of type 2 diabetes; 829,946 without type 2 diabetes). Morbidity risk was estimated using multivariable generalised linear models. Adjusted risk ratios (RRs) indicated a higher risk of all studied comorbidities in individuals with vs without type 2 diabetes at all diagnostic ages, with RRs progressively decreasing with older age at diagnosis (from 13.8 at 16–27 years to 5.7 at 48–50 years, for obesity; from 28.9 to 3.2, for hypertension; from 4.4 to 2.5, for depression; and from 4.3 to 2.2, for anxiety). The estimated total number of morbidities among individuals aged 16 years with vs without type 2 diabetes were 85.2 (95 % CI: 83.3–87.0) and 7.1 (95 % CI: 6.9–7.3) per 100 individuals, respectively. Corresponding estimates at 50 years of age were 92.0 (91.3–92.8) and 24.8 (24.6–25.0). Conclusion: The substantially higher burden of MLTCs in young individuals with vs without type 2 diabetes emphasises the need for multidisciplinary patient care and management in individuals diagnosed with type 2 diabetes in early adulthood
James Kelman and the Impossibility of Managerial Souls
Get PDFDiscusses James Kelman's portrayal of middle managers and their interactions with those they manage in "The Bevel' (1983), A Disaffection (1989), How Late It Was, How Late, (1994), and You Have to be Careful in the Land of the Free (2004), exploring their interactions with those they manage in terms of managerialism, management theories, and the U.K. government's New Public Management reforms
Adverse outcomes after surgery after a cerebrovascular accident or acute coronary syndrome: a retrospective observational cohort study
Get PDFBackgroundDelaying surgery after a major cardiovascular event might reduce adverse postoperative outcomes. The time interval represents a potentially modifiable risk factor but is not well studied.MethodsThis was a longitudinal retrospective population-based cohort study, linking data from Hospital Episode Statistics for NHS England and the Myocardial Ischaemia National Audit Project. Adults undergoing noncardiac, non-neurologic surgery in 2007–2018 were included. The time interval between a preoperative cardiovascular event and surgery was the main exposure. The outcomes of interest were acute coronary syndrome (ACS), acute myocardial infarction (AMI), cerebrovascular accident (CVA) within 1 year of surgery, unplanned readmission (at 30 days and 1 year), and prolonged length of stay. Multivariable logistic regression models with restricted cubic splines were used to estimate adjusted odds ratios (aORs; age, sex, socioeconomic deprivation, and comorbidities).ResultsIn total, 877 430 people had a previous cardiovascular event and 20 582 717 were without an event. CVA, ACS, and AMI in the year after elective surgery were more frequent after prior cardiovascular events (adjusted hazard ratio 2.12, 95% confidence interval [CI] 2.08–2.16). Prolonged hospital stay (aOR 1.36, 95% CI 1.35–1.38) and 30-day (aOR 1.28, 95% CI 1.25–1.30) and 1-yr (aOR 1.60, 95% CI 1.58–1.62) unplanned readmission were more common after major operations in those with a prior cardiovascular event. After adjusting for the time interval between preoperative events until surgery, elective operations within 37 months were associated with an increased risk of postoperative ACS or AMI. The risk of postoperative stroke plateaued after a 20-month interval until surgery, irrespective of surgical urgency.ConclusionsThese observational data suggest increased adverse outcomes after a recent cardiovascular event can occur for up to 37 months after a major cardiovascular event
“I want to get out… I’ve got a child at home”: intersubjectivity, reality disjunctures and distress in the care of people living with dementia in the acute hospital
Get PDFThe pivotal role of language in achieving and maintaining intersubjectivity in interaction creates particular problems where one party has a medical condition affecting language use. Dementia can have significant impact on language comprehension, expression and memory; this creates challenges not only for people living with dementia (PLWD) but also those who care for them. In UK hospitals approximately 25% of beds are occupied by PLWD (Alzheimer’s Society, 2009) and the need for improved care is widely acknowledged. One specific challenge is the issue of competing realities, where a PLWD may not be oriented to time or place, and may produce what appear to healthcare professionals (HCPs) to be inaccurate, untrue or even bizarre statements. As part of a wider UK-based study identifying ways to avoid, de-escalate or resolve distress for PLWD in the acute hospital setting, and prompted by their co-occurrence with distress, we used conversation analysis to examine interactions involving these ‘reality disjunctures’ (Pollner, 1975). We analysed 54 HCP/PLWD interactions collected across four acute wards in two large teaching hospitals. We found that responses to reality disjunctures fell into four categories across a continuum: challenging the competing reality expressed by the PLWD; diverting the interaction to an alternative aspect of reality that could be shared; finding a commonality in the PLWD's reality; and co-constructing the PLWD's reality. Our findings show similarities with Lindholm's (2015) analysis of ‘confabulation’ by a single PLWD in a day-care centre; however the range, distribution and detail of the practices differed in ways that reflected the contingencies of the acute care setting. Approaches in the middle of our continuum, which work to create some kind of shareable world or experience, are one way in which skilled staff support PLWD not only to manage distress, but also to maintain a social self rather than a subjective one. Identifying these approaches makes them available to others to improve patient care
Authors' Response to: Advocating for Focused Attention on Functional Neurological Disorder in the Undergraduate Medical School Curriculum
No full textThe role of corporate lean programmes in crisis response: a multi-case study of hospitals during the COVID-19 pandemic
Get PDFPurposeThis research aims to examine the role of established Corporate Lean Programmes (CLPs) in responding to extreme disruptions. While CLPs are often considered dynamic capabilities, their effectiveness during crises remains unclear. Given substantial investment in CLPs and increasing global uncertainty, evaluating their crisis management potential is crucial.Design/methodology/approachWe build on a longitudinal non-participant field study conducted in five English hospitals, which implemented the Virginia Mason Production System, which is a CLP. This research was expanded in March 2020 to examine its application during the COVID-19 pandemic. We investigated how CLPs were utilised and adapted to manage the crisis. Data collection (May–December 2020) included 20 h of non-participant observation at leadership meetings, 39 semi-structured interviews, and extensive document review.FindingsTo respond to the crisis, activities related to strategy and long-term planning were paused, and the CLP was adapted in three main ways: increased daily management practices for coordination, communication and teamwork; flexible deployment of specialist knowledge resources and simplified CLP routines for widespread, structured problem-solving. We develop a process model of adapting a CLP to respond to a crisis. The increased use and visibility of these practices enhanced the CLP’s perceived legitimacy, overcoming initial resistance to adoption.Originality/valueThis study offered a unique opportunity to deepen our understanding of how a CLP responded to extreme disruption. It also provides evidence that, despite arguments that lean approaches are only effective in stable environments, they can be adapted to work effectively in dynamic ones. This offers significant insights into the CLP’s sustained utility during extreme disruption
Exploring novice principals’ professional confidence: insights from a Swedish perspective
Get PDFThis study explores novice principals’ professional confidence within the context of Sweden’s National Principal Training Programme (NPTP). The significance of professional confidence, an area that has been relatively underexplored within educational leadership research, is elemental for fostering effective school leadership. This is particularly pertinent during the transitional phase from instructional to administrative positions. Using a qualitative case study design, data were collected from 256 novice principals via programme evaluations, including digital questionnaires and group discussions. Thematic analysis identified four key themes: building deeper knowledge, developing leadership capabilities, professional learning with peers, and role clarity. The findings highlight the transformative potential of the NPTP in fostering professional confidence through theoretical grounding, practical application, and peer collaboration. Principals reported increased confidence in school law, communication, management, and decision-making, linking these capabilities to leadership efficacy. Peer interactions and mentorship significantly contributed to professional growth, reinforcing identity and confidence. The study underscores the NPTP’s role as a model for context-sensitive leadership development, emphasising the importance of integrating knowledge, practice, and reflective learning in leadership preparation programmes. These findings have implications for designing leadership training that addresses the cognitive, relational, and contextual dimensions of professional development for school leaders
Reconceiving Domestic Burning Controls: Air Quality Alerts, Behavioural Responsive Regulation, and Designing for Compliance
Get PDFDomestic combustion emissions pose a growing risk to public health, especially in the UK. Existing responses are polarised, with government advocating use of lower emission fuels and stoves while clean air campaigners call for blanket bans on burning. However, each approach is limited in its ability to control these emissions. An alternative can be found in the U.S.A., where ‘burn alert’ systems require stove and fireplace users to avoid lighting during periods of actual or projected poor air quality. Given the effectiveness of these regimes, the current study designs and evaluates the effectiveness and acceptability of a burn alert system in the UK for the first time, drawing on the theoretical perspective of behavioural responsive regulation. Fifty participants were recruited to use the system over 2 weeks in winter. The findings illustrate that a voluntary burn alert system can dissuade burning among users. Of those in receipt of an alert, 74% reduced burning frequency or burned for a shorter duration. In total, the alert system prevented at least 178 hours of burning for this group. Qualitative findings show that the consistency of the behavioural response is influenced by technical, structural, and environmental factors, providing key insight into how UK-based burn alert systems could be modified to increase the consistency of compliance in future. The overall conclusion is that burn alerts could be introduced in the UK and beyond, as a means of reducing domestic combustion emissions and their associated public health risks
How can specialist investigation agencies inform system-wide learning for patient safety? A qualitative study of perspectives on the early years of the English healthcare safety investigation branch
Get PDFObjectivesSystem-wide learning for patient safety is a core challenge for the health care sector, despite the prevalence of localised reporting and learning approaches. There is growing interest in how health care services could emulate other safety-critical sectors with the introduction of specialist safety investigation agencies to inform sector-wide safety. This paper reports on a study of the introduction and early operation of one such agency in the English health and care system.MethodsThis was a qualitative interview study carried out between 2019 and 2021 and co-designed through a partnership between University researchers and the Executive Team from the Healthcare Safety Investigation Branch (HSIB) to explore the organisational development of this ‘first of type’ organisation. The study involved interviews with 33 internal and external stakeholders and documentary analysis of HSIB reports.ResultsThe study findings highlight the organisational competencies and developmental challenges experienced in the early years of HSIB operations focusing on (i) independence and fit within the wider system; (ii) the selection and scope of investigations; (iii) the methodology and investigation approach; and (iv) the skill and competencies of investigators.ConclusionsThis study offers practical learning to health care decision-makers about the importance of securing independence and integration, about the production of system-wide learning, the standardisation of robust methodologies and the support for a multidisciplinary specialist workforce
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