975 research outputs found
Research & physician associates – building the evidence base and the physician associate researchers
No full textIn this presentation Vari Drennan gives an over view of the funded research she has led investigating the contribution of physician associates in England since 2009. She will present key findings from the recently finished NIHR study investigating the contribution in secondary care in England . She will talk through how physician associates can be involved in research , including clinical research and build research careers – pointing out resources available in the UK to support clinical academic careers
Out of hours and unscheduled primary care making it safer: report of the joint conference hosted by the Medical Protection Society, National Patient Safety Agency and MPS Risk Solutions
No full textIn April 2010, the Medical Protection Society, the National Patient Safety Agency (NPSA) and MPS Risk Solutions hosted a joint conference on Out of Hours and Unscheduled Primary Care.
The conference attracted over 130 delegates from across the UK and Ireland including people directly involved in the provision of OOH care, decision makers and commissioners of OOH services.
Professor Vari Drennan, Professor of Health Policy & Service Delivery, Faculty of Health & Social Sciences, Kingston University and St George’s University of London, was commissioned to produce an independent report on the conference in order to cover the key issues raised during the day
sj-pdf-1-hsr-10.1177_13558196211036727 - Supplemental material for Are advanced clinical practice roles in England’s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives
No full textSupplemental material, sj-pdf-1-hsr-10.1177_13558196211036727 for Are advanced clinical practice roles in England’s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives by Vari M Drennan, Linda Collins, Helen Allan, Neil Brimblecombe, Mary Halter and Francesca Taylor in Journal of Health Services Research & Policy</p
Sustaining innovation in the health care workforce: a case study of community nurse consultant posts in England
No full textBACKGROUND:
Recruiting, retaining and meeting increasing demand for experienced, qualified nurses is an issue of concern for all health care systems. The UK has been creating clinical career structures for nurses that include innovative posts known as nurse consultants. While the numbers overall appear to have grown over the last eleven years, there is evidence that in some specialities and regions the numbers are decreasing. This paper considers the factors that sustain or curtail workforce innovations through the case example of a cohort of nurse consultants established in one community health service in England.
METHODS:
A mixed method case study evaluation was undertaken over three years, using interviews, observations, documentary analysis and questionnaires. The final element of data collection was obtained three years later. Data was anonymised, analysed using a framework method and then integrated using a narrative synthesis.
RESULTS:
Ten nurse consultant posts were created over a period of two years (2002-2004). Within two years only five posts remained and within five years (2009) only two part time posts, with the original appointees, remained. When the nurse consultants left their posts, these were not replaced. In exploring the interaction between the innovation (the nurse consultant posts), the adoptees (the senior staff in the organisation) and the context (the immediate service colleagues, the service organisation and commissioners as well as the broader NHS policy context) three key factors were identified as influential in the demise of the posts. These were: a) the extent to which there was support for individual nurses rather than the post, b) the extent to which there was an unambiguous and uncontested clinical service requirement for a nurse consultant and c) the extent to which finances for the post were judged as being used to best effect in a service setting.
CONCLUSIONS:
This case study example demonstrates how tantalisingly close the nurse consultant initiative came to achieving a clinical career pathway for nurses in community services but more work was required to normalise clinician and managers' beliefs in the relevance and need for the role. Those looking to embed these types of nursing workforce innovations should pay due regard to these issues
Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review
No full textAbstract
ABSTRACT:
BACKGROUND: Dementia is a distressing and disabling illness with worldwide estimates of increased numbers of people with the condition. Two thirds of people with dementia live at home and policies in many countries seek to support more people for longer in this setting. Incontinence both contributes to carer burden and is also a significant factor in the decision to move into care homes. A review was conducted for evidence of effectiveness for conservative interventions, which are non-pharmacological and non-surgical interventions, for the prevention or management of incontinence in community dwelling people with dementia.
METHOD:
Fourteen electronic databases were searched, including MEDLINE, EMBASE and CINAHL (from inception to 2012). Assessments of risk of bias were made. Meta-analysis was inappropriate due to the heterogeneity of the interventions and outcome measurements. A narrative analysis was undertaken.
RESULTS:
From 427 identified abstracts, 56 studies were examined but only three met the inclusion criteria, all more than a decade old. All three focused on urinary incontinence. Two studies were exploratory or pilot studies. All had a control arm. The interventions were of advice for the carer to implement. Two included toileting education of prompted voiding or an individualised toileting schedule. There was insufficient evidence to support or rule out effectiveness of any of these interventions. Some interventions were unacceptable for some carers. None specifically reported the perspective of the person with dementia.
CONCLUSIONS:
There was insufficient evidence from any studies to recommend any strategies. There remains an urgent need for both research and also clinical guidance for health professionals tailored to community settings where the majority of people with dementia live
Appendix - Supplemental material for Moving upstream in health promoting policies for older people with early frailty in England? A policy analysis
No full textSupplemental material, Appendix for Moving upstream in health promoting policies
for older people with early frailty in England? A policy analysis by Vari
Drennan, Kate Walters, Christina Avgerinou, Benjamin Gardner, Claire Goodman,
Rachael Frost, Kalpa Kharicha, Steve Iliffe and Jill Manthorpe in Journal of
Health Services Research & Policy</p
Continence care for people with dementia at home.
No full textThe majority of people with dementia live in their own homes. Difficulties with using the toilet and incontinence can lead to them moving into care homes. This report summarises a systematic review by Drennan et al (2012) that investigated the evidence for conservative interventions for the prevention or management of incontinence in people with dementia living at home
Vari disegni de arghitettura ornati de porte /
No full textEngraved throughout. Title, leaf [1]. Coat of arms of Cardinal Borghese, leaf [2], the dedication to whom appears on leaf [3].Mode of access: Internet.Binding: later marbled paper, backed in vellum. Title & author written on spine.Bound with: Disegni varii di depositi / Bernardino Radi (Rome, 1619).In Getty copy the upright of the G in title word "arghitettura" effaced to make a C
Assessing the contribution of prescribing in primary care by nurses and professionals allied to medicine: a systematic review of literature
No full textBackground
Safe and timely access to effective and appropriate medication through primary care settings is a major concern for all countries addressing both acute and chronic disease burdens. Legislation for nurses and other professionals allied to medicine to prescribe exists in a minority of countries, with more considering introducing legislation. Although there is variation in the range of medicines permitted to be prescribed, questions remain as to the contribution prescribing by nurses and professionals allied to medicine makes to the care of patients in primary care and what is the evidence on which clinicians, commissioners of services and policy makers can consider this innovation.
Methods
An integrative review of literature on non-medical prescribing in primary care was undertaken guided by dimensions of health care quality: effectiveness, acceptability, efficiency and access.
Results
19 papers of 17 empirical studies were identified which provided evidence of patient outcome of non medical prescribing in primary care settings. The majority were undertaken in the UK with only one each from the USA, Canada, Botswana and Zimbabwe. Only two studies investigated clinical outcomes of non-medical prescribing. Seven papers reported on qualitative designs and four of these had fewer than ten participants. Most studies reported that non medical prescribing was widely accepted and viewed positively by patients and professionals.
Conclusions
Primary health care is the setting where timely access to safe and appropriate medicines is most critical for the well-being of any population. The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of non-medical prescribing is based on the perceived value to the health care system as a whole. Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena. We suggest that future studies of non-medical prescribing in primary care focus on the broad range of patient and health service outcomes and include economic dimensions
Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis
No full textINTRODUCTION:
Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes.
METHODS AND ANALYSIS:
A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1.
ETHICS AND DISSEMINATION:
The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research
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