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  • Using patient and public involvement to identify priorities for research in long-term conditions management

    Musgrove, Alison (2020)
    BACKGROUNDPatient and public involvement (PPI) is increasingly important in healthcare research. Although this is accepted at the level of individual research studies, it has been less well used in scoping fundamental research priorities. It has been suggested that patients with long-term conditions (LTCs) are well placed to influence research priorities in this area due to their accumulated experience of illness over time.AIMSTo obtain PPI in research-priority setting for a group with a special interest in LTC research.DISCUSSIONPPI representatives provided views on issues they thought required further research. The facilitators were able to move from the specifics of these ideas to identify cross-cutting research priorities.CONCLUSIONIt was possible to determine broad research themes despite PPI representatives initially articulating identified issues in very specific terms. Facilitating a better understanding of the research process for PPI representatives would allow their contribution to be more effective. Implications for practice PPI should be considered at the beginning of the process when broad research priorities are considered and before the study design. This is particularly so for broad, non-specialty-focused research themes such as LTCs. More work is required to ensure the views of harder-to-reach groups are included in this type of PPI.
  • Optimal healthcare delivery to care homes in the UK: A realist evaluation of what supports effective working to improve healthcare outcomes

    Dening, Tom; Schneider, Justine (2018)
    Introduction: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. Methods: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. Results: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. Conclusion: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.
  • Multi-agency care for people with alcohol-related long-term conditions

    Holmes, Mark (2017)
    In Nottinghamshire, a dedicated team cares for people with alcohol-related chronic ill health. This initiative won the award for Managing Long-term Conditions in the 2016 Nursing Times Awards
  • Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study

    Dening, Tom (2017)
    INTRODUCTIONCare home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents.METHODS AND ANALYSISRealist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories.ETHICS AND DISSEMINATIONThe PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination.TRIAL REGISTRATION NUMBERThe realist review has been registered on International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017062601).
  • Principles of service provision in old age psychiatry

    Dening, Tom (2013)
    The past decade has seen considerable changes in the shape of mental health services for older people. This has sometimes been so radical as to include the disappearance of the service as a separate entity, and yet this is at a time when the population of older people is growing and therefore it might be assumed that the demand for specialist services would also be increasing. How this can be so is the story of this chapter. There are two main strands to service provision to support mental health in older people. One is the general question of how mental health needs in this section of the population are to be met, and the other topic is the organization of specialist mental health services for older people. These strands are interwoven but also at risk of unwinding from each other. In this chapter, the focus is on the principles underlying services, rather than on much detail, partly because the situation will vary in different parts of the world but also partly because the way services are organized will continue to change, rendering anything too detailed obsolete in a short space of time. The chapter takes a largely UK, specifically England, focus. Many of the general issues are, however, global and also, as the UK has been one of the leaders in developing service models for old age psychiatry, it is likely that what happens there will be of interest to readers internationally. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Perspectives on ageing, later life and ethnicity: Ageing research in ethnic minority contexts

    Zubair, Maria (2015)
    This special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of ‘ethnicity’ (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of ‘otherness’ within the predominant existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic ‘difference’. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and ‘otherness’ is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly (re)produced, within (and through) research itself – for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à-vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants' ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.
  • Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample

    Wu, Mengjun (2015)
    OBJECTIVES: Health-related quality of life (HRQoL) measures have been increasingly used in economic evaluations for policy guidance. We investigate the impact of 11 self-reported long-standing health conditions on HRQoL using the EQ-5D in a UK sample.
  • Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs

    Jones, Rob G. (2013)
    Background: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission.
  • Severe and enduring mental illness

    Dening, Tom (2013)
    This chapter addresses the needs of people growing old with long-term, severe mental illness. These comprise mainly patients with schizophrenia and other psychotic mental illness, but also a smaller number with bipolar affective disorder and other diagnoses including obsessive compulsive disorder, personality disorders, and substance misuse. Much of the clinical research concerns patients with schizophrenia, but the service considerations also apply to those with other diagnoses. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • The optimal study: Describing the key components of optimal health care delivery to UK care home residents: a research protocol

    Dening, Tom; Zubair, Maria; Schneider, Justine (2014)
    Long-term institutional care in the United Kingdom is provided by care homes. Residents have prevalent cognitive impairment and disability, have multiple diagnoses, and are subject to polypharmacy. Prevailing models of health care provision (ad hoc, reactive, and coordinated by general practitioners) result in unacceptable variability of care. A number of innovative responses to improve health care for care homes have been commissioned. The organization of health and social care in the United Kingdom is such that it is unlikely that a single solution to the problem of providing quality health care for care homes will be identified that can be used nationwide. Realist evaluation is a methodology that uses both qualitative and quantitative data to establish an in-depth understanding of what works, for whom, and in what settings. In this article we describe a protocol for using realist evaluation to understand the context, mechanisms, and outcomes that shape effective health care delivery to care home residents in the United Kingdom. By describing this novel approach, we hope to inform international discourse about research methodologies in long-term care settings internationally. Copyright © 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
  • Mental capacity assessments and discharge decisions

    Bartlett, Peter (2005)
    Uncertainties and conflicts around ‘place of discharge’ have always been a feature of the care of older people. On one hand, placing a person by coercion or deceit in an institution where they stand little chance of leaving is a fundamental human rights infringement. On the other hand, letting someone go home with poor memory, impaired judgement and little appreciation of risk may be irresponsible or even negligent.
  • Review of The secret scripture

    Baker, Charley (2010)
    Reviews the book, The Secret Scripture by Sebastian Barry (2008). The book is a triumphant and demanding book, winner of the 2008 Costa Book of the Year award, this multilayered narrative not only focuses on the need to tell our own stories, but also on the demand for these stories to be heard, reflecting its own demand as a novel. The book reads with urgency to be heard and to be told. This novel contains and explores a number of crucial issues in both history and more specifically the history of psychiatry. It provides a critique of the then-absolute and unquestioned power of Catholicism in Ireland. Notions of abuse within institutional settings are explored. This novel is a mediation on memory -on who remembers and how, on the accuracy of aging memory and whether this actually matters; and on loneliness and loss. The novel can be reflected upon by clinicians as a mediation on story telling and story creating - on who we listen to, whose version of the story is given more credence, and on whose interpretation matters the most. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Examining the incremental impact of long-standing health conditions on subjective well-being alongside the EQ-5D

    Wu, Mengjun (2014)
    BACKGROUND: Generic preference-based measures such as the EQ-5D and SF-6D have been criticised for being narrowly focused on a sub-set of dimensions of health. Our study aims to explore whether long-standing health conditions have an incremental impact on subjective well-being alongside the EQ-5D.
  • Peer support interventions for family carers of adults with chronic mental or physical illness who are living at home

    Orrell, Martin (2016)
    Withdrawn. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of peer support interventions on health-related quality of life (i.e. mental and physical health) and wellbeing of family carers who care for an adult relative with a chronic mental or physical illness at home. Secondary objectives are: to assess whether different features within each peer support intervention impact on its effects. These features could include: the facilitator (peer, versus peer and professional co-facilitators); format, duration, intensity of intervention; and quality of peer training. to assess the effects of simple and multifaceted interventions (interventions with more than one component), and the particular features that are most effective. to assess the effects of peer support interventions across different types of illness. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.