bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrated care pilots in England revisited
Authors: Lewis Richard Q. , Ling Tom 
Published: September 2019

Purpose
The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy.

Design/methodology/approach
This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England.

Findings
The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate.

Research limitations/implications
This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years.

Originality/value
This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced.
The actor-network theory as a method in the analysis of Samarco disaster in Brazil
Authors: Bussular Camilla Zanon , Burtet Cecília Gerhardt , Antonello Cláudia Simone 
Published: September 2019

Purpose
The actor-network theory (ANT) has been understood as a method, as a way of engaging in the social world and also transform it. The purpose of this paper is to show the ANT methodological aspects, provide an empirical demonstration of this approach as a method, and promote a debate about the implications and importance of understanding it as a method and not just as a theory.

Design/methodology/approach
By analyzing the criticisms of ANT seminal concepts and its repercussions, the authors have offered an understanding of its methodological aspects and its implications for the practice of research. An empirical study conducted in Brazil is presented to exemplify the use of ANT as a method.

Findings
The methodological reflection of this approach starts from the recognition that the methods are part of the social world that they research; they are totally imbued with theoretical representations of this world; they are social because they also help to constitute this social world. As a method, ANT seeks to understand the process of stabilizing practices, negotiations and controversies that are established when such practices are in the process of being. In that sense, following the relational disputes that build a practice before their stabilization is the task to be accomplished for the researcher in the field.

Research limitations/implications
The paper offers relevant contributions to the understanding of ANT as a method. The authors encourage other researchers to venture into the development of this approach in future studies that further explore its methodological character.

Originality/value
There are not many studies on ANT as a method. If ANT is also a method, can we apply it to any research? The authors hope to bring this matter to discussion, understanding and questioning the use of this theoretical-methodological approach in the research fields.
Narcissism and Empowerment: How Narcissism Influences the Trickle‐Down Effects of Organizational Empowerment Climate on Performance
Authors: Han Joo Hun , Liao Hui , Kim Seongsu , Han Jian 
Published: September 2019

AbstractThe present study proposes a trickle‐down model of employee empowerment in which empowerment climate at the organization level is positively related to the empowering leadership of team leaders and ultimately to individual task performance. Importantly, we hypothesize that team leaders’ and members’ narcissism can respectively inhibit and enable the cross‐level empowerment process by affecting the intended distribution of decision‐making authority and resources between team leaders and members. The analysis of data from 834 team members of 189 teams in 46 organizations reveals that organizational empowerment climate is positively related to team leaders’ empowering leadership when they are less narcissistic. Empowering leadership is positively related to individual task performance when team members are highly narcissistic. Finally, we observe that the combination of less narcissistic leaders and more narcissistic members is a condition under which the indirect effect of organizational empowerment climate on individual task performance through empowering leadership is positive.
Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta‐analysis of randomized controlled trials
Authors: Ma Chak Fai , Chan Sherry Kit Wa , Chien Wai Tong , Bressington Daniel , Mui Esther Yee Wai , Lee Edwin Ho Ming , Chen Eric Yu Hai 
Published: September 2019

Accessible SummaryWhat is known on the subject?

Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence‐based interventions, but they are practically difficult to be implemented in many clinical settings.

The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice.

A few individual studies reported the effectiveness of CBFI, but no systematic review and meta‐analysis have been conducted.

What the paper adds to existing knowledge

CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention.

Compared to CBTp, the intervention seems to be more effective to reduce delusions.

What are the implications for practice?

The results of this review suggest that the brief CBFI is an effective family‐inclusive intervention that could be integrated into clinical practice.

Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families.

AbstractIntroductionCognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI.AimThis review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families.MethodEligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random‐effects models.ResultsFour studies consisting of 524 participants were included. The risk of bias was low–unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post‐treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal.DiscussionThe findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention.Implications for PracticeMental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse‐led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.
Mid‐Term Follow‐Up of Acetabular Revision Arthroplasty Using Jumbo Cups
Authors: Zhang Ji , Huang Yong , Zhou Baochun , Zhou Yixin 
Published: September 2019

ObjectiveTo evaluate the mid‐term clinical and radiographic results of revision total hip arthroplasty (THA) using jumbo cups in Chinese patients.MethodsWe retrospectively studied 61 patients (63 hips; 29 men [30 hips], 32 women [33 hips]) who underwent acetabular revision with jumbo cups between January 2001 and April 2016 at our institution. The mean age at the index operation was 59.4 ± 11.4 years. The mean body mass index of the patients was 24.9 ± 3.8 kg/m2. Clinical evaluation was determined using the Harris hip score preoperatively and at follow up. Major complications (including instability, sepsis, and revision of the femoral or acetabular component) were recorded. Radiographic measurements included inclination and anteversion angles of the acetabular components, and the vertical and horizontal distances of the centers of rotation (V‐COR and H‐COR, respectively). In the 42 patients with normal contralateral hip joints, the postoperative V‐COR and H‐COR were compared between right and left sides. Their improvement in leg‐length discrepancy (LLD) after revision THA was also evaluated. Cup survival was evaluated using the Kaplan–Meier analysis. Clinical and radiographic outcomes were analyzed.ResultsMean follow up was 5.7 years (2–16 years). At the latest follow‐up, the average Harris hip score (preoperative vs postoperative values) had improved from 46 to 83 (P < 0.001). No acetabular component was radiographically defined as loosened. Four hips (6.3%) had major complications: one hip was revised because of periprosthetic infection (at 3 months); one underwent femoral open reduction and internal fixation (with implant retention) because of a periprosthetic femoral fracture (at 13 months); one operated hip developed a deep infection (at 2.5 years), which was treated with antibiotics; one hip experienced recurrent dislocation (at 4.5 years). The average cup inclination angle was 40.8° ± 6.8° and the average anteversion angle was 14.9° ± 6.6°. Average V‐COR decreased from 29.7 ± 10.4 mm to 22.3 ± 7.6 mm (P < 0.001). The average postoperative H‐COR was 29.5 ± 3.7 mm compared with 30.8 ± 6.6 mm preoperatively (P = 0.145). Among the 42 patients with normal contralateral hips, the average postoperative V‐COR were 22.2 ± 8.3 mm (operated side) and 14.0 ± 3.7 mm (contralateral side) (P < 0.001). LLD improved from −16.8 ± 17.1 mm to −5.6 ± 11.8 mm (P < 0.001). When failure was defined as any reoperation involving the hip, the mean 16‐year hip survival was 96.8% (95% confidence interval [CI] 87.9%–99.2%). When defined as any hip reoperation or major complication, it was 92.7% (95%CI 81.2%–97.2%).ConclusionUse of jumbo cups for revision THA resulted in excellent mid‐term cup survival and helped restore the COR.
Effect of reimbursement restriction policy on the use of benzodiazepines in the Netherlands: an interrupted time series analysis
Authors: Stoker Lennart Jan , Heerdink Eibert Roelof , Janssen Richard , Egberts Toine C G 
Published: September 2019

ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use.DesignInterrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis.SettingA 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015.Participants2 500 800 benzodiazepine prescriptions from 128 603 patients were included.InterventionReimbursement restriction policy from January 2009 onwards.Outcome measuresChanges in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuation rates of benzodiazepines.ResultsThe volume of dispensed prescriptions and doses decreased by 12.5% (95% CI 9.0% to 15.9%) and 15.1% (95% CI 11.4% to 17.3%) respectively in January 2009 compared with December 2008. A clear initial effect on the overall incidence (−14.7%; 95% CI −19.8% to 9.6%) and the prevalence of incidental (−17.8%; 95% CI −23.9% to 11.7%), regular (−20.0%; 95% CI −26.1% to 13.9%) and chronic (−16.0%; 95% CI −23.1% to 8.9%) use was observed. A statistically significant reduction in the monthly trend per 1000 medication users was observed for the overall incidence (−0.017; 95% CI −0.031 to 0.003) and the prevalence of incidental (−3.624; 95% CI −4.996 to 2.252) but not for regular (−0.304; 95% CI −1.204 to 0.596) and chronic (0.136; 95% CI −0.858 to 1.130) use. Patients who started treatment before policy had a slightly higher probability of discontinuation (HR=1.013; 95% CI 1.004 to 1.022).ConclusionsThe reimbursement policy had a significant initial effect on the volume, incidence and prevalence of benzodiazepine use. In addition, there is a statistically significant reduction in the monthly trend of overall incidence and of the prevalence of incidental use. No statistically significant reduction in the monthly trend of chronic use, the main purpose of the reimbursement restriction, could be demonstrated.
PP14 Soiled airway tracheal intubation and the effectiveness of decontamination (SATIATED) by paramedics: a randomised controlled manikin study
Authors: Pilbery Richard , Dawn Teare M 
Published: September 2019

BackgroundIn more than one-in-five cases of out-of-hospital cardiac arrest, the patient’s airway is soiled by vomit and blood. If a paramedic cannot clear the airway, the patient will die. A new method of clearing the airway called suction assisted laryngoscopy and airway decontamination (SALAD) has been developed, but it’s not known whether the method can assist paramedics to intubate. This study aims to determine whether paramedics can intubate a simulated soiled airway more often on their first attempt, using SALAD.MethodsA modified airway manikin, with the oesophagus connected to a reservoir of ‘vomit’ that was propelled up the oesophagus by a pump, was used to simulate a soiled airway. The intervention consisted of a brief SALAD training session with a demonstration and opportunity to practice. Participants were randomly allocated into two groups: AAB who made two pre-training intubation attempts and one post-training attempt, and ABB, who made one pre-training and two post-training attempts, to adjust for improvement in performance due to repetition.Results164 paramedics took part in the study. First-pass intubation success with and without SALAD was 90.2% and 53.7% respectively, a significant difference of 36.6% (95%CI 24–49.1%, p<0.001). The mean successful intubation time for each attempt and patient group (AAB and ABB) was as follows: 61.8 (95%CI 55.8–67.8) and 59.4 (95%CI 53.6–65.1) seconds on the first attempt, 50.8 (95%CI 45.7–55.9) and 51.5 (95%CI 48.6–54.4) seconds on the second attempt and 53.5 (95%CI 50.4–56.6) and 46.6 (95%CI 44.0–49.1) seconds on the third attempt. There was no significant difference in success rates on the third attempt between AAB and ABB 89% vs 86.6% respectively, a difference of 2.4% (95%CI 7.6–12.4%, p=0.63).ConclusionsIn this study, paramedics were able to intubate a simulated soiled airway on their first attempt, significantly more often when using the SALAD technique.
02 ‘Have you had the surgery?’: A survey of transgender and non-binary patients’ experiences of interacting with the ambulance service
Authors: Barley Chloé , Tooms Alec 
Published: September 2019

BackgroundPre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients.This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues.MethodAn online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled questions were used. Advertisement on social media was tailored to target TNB individuals who have had patient contact with the ambulance service. All respondents were anonymous and voluntary. This survey was conducted by TNB individuals in a personal capacity, without funding.Results72% of the 25 respondents rated their experience as satisfactory or above. 40% reported that identifying as TNB affected the way they were treated and 40% reported that they were asked about their gender by the ambulance crew.In free text answers, the main themes identified were the misidentification of gender, the use of incorrect pronouns, hospital handovers, intrusive/irrelevant questioning and the need for training.ConclusionsThe responses suggest that TNB patients feel that being asked about their gender is important however ambulance staff sometimes struggled to address this sensitively. Positive experiences included having gender and pronouns addressed in hospital handover which can form a recommendation for best practice. Negative experiences were associated with being misgendered, using incorrect pronouns and intrusive/irrelevant questioning. Survey responses led to practical recommendations for ambulance staff interacting with TNB patients, including the authors creating a training session which has received positive feedback from clinicians. Limitations include small sample size, potential for response bias due to survey being self-selecting and missing demographic data. Recommendations for further research are to provide a more in-depth exploration of TNB experience and of ambulance staff views.
PP21 Non-technical skills in the out-of-hospital cardiac arrest – identification for future practice
Authors: Cormack Stef , Scott Steve , Stedmon Alex 
Published: September 2019

BackgroundThe use and assessment of non-technical skills (NTS) in healthcare has gained recognition in recent years. Mainly adopted from aviation key NTS have enabled specific teams such as surgical and anaesthetics, to improve leadership, communication and situational awareness. Paramedic NTS have been identified but in the out-of-hospital cardiac arrest (OHCA) there is limited evidence. This study aims to identify NTS in the OHCA to inform the design of an assessment tool to improve overall management of an OHCA.MethodsA review of the literature including NTS in the OHCA and existing behavioural marker tools was completed using online databases (Medline, PubMed, AMED, PsycINFO, PsycARTICLES and CINAHL) and MeSH terms (out-of-hospital, prehospital, paramedic, ambulance, EMS, non-technical skills, soft skills, human factors and behavioural marker systems). Key NTS were taken from the literature and explored by three focus groups (numbers 5, 6, 6). Focus groups comments were transcribed and thematic analysis used to identify noteworthy NTS that could be used to design a tool for assessing NTS in a simulated OHCA. Participants were also asked to rank the most important NTS relevant to an OHCA.ResultsThe literature review revealed limited evidence for NTS in the OHCA but identified existing behavioural marker systems in healthcare, although not for the OHCA. Focus groups explored NTS relevant to the OHCA and ranked in order the most important. Situational awareness, communication, leadership, followership and decision making including knowledge and procedures were identified as the most important NTS relevant to an OHCA.ConclusionsThere is no existing assessment or behavioural marker tool for assessing NTS in the OHCA. Focus groups identified key NTS relevant to the OHCA which could be used to design an assessment/behavioural marker tool to assess individuals in a simulated OHCA.
PP22 Box randomisation- a novel method for allocation in pre-hospital randomised controlled trials: the ACUTE study experience
Authors: McKenzie Thomas , Keating Samuel , Goodacre Steve , Fuller Gordon 
Published: September 2019

BackgroundAllocation concealment is essential to avoid selection bias in randomised trials. The ACUTE pilot trial compared the effectiveness of pre-hospital CPAP vs standard oxygen therapy for acute respiratory failure (ARF). The randomisation schedule was implemented, and treatment allocation concealed, with a novel method using identical boxes.MethodsInvestigation of allocation concealment in the ACUTE trial proceeded in 4 stages. Firstly, the characteristics of recruited ACUTE trial patients were compared across arms. Secondly, the findings of a weekly trial box audit log were examined. Thirdly, allocation concealment was explored in paramedic focus groups and survey. Finally, a convenience sample of West Midlands and Yorkshire Ambulance Service paramedics were presented with a random pair of ACUTE boxes from each trial arm, and asked to identify any differences. If a difference was noted, they were asked to indicate which box contained CPAP and why.ResultsThe ACUTE study enrolled 77 participants (42 CPAP, 35 control). Baseline characteristics were similar, although patients in the CPAP arm appeared to have slightly more severe ARF. In week 10, audit of trial boxes revealed that intervention arm boxes were ‘rattling’, secondary to deflation of CPAP masks packaged under tension. All boxes were consequently re-packaged and resupplied. No comments in the paramedic survey, but a focus group participant stated that one box had appeared different when shaken. 278 paramedics participated in the observational study. 115 participants (41.4%) felt they were able to tell which box contained CPAP, predominantly due to weight difference. Of these, 81 paramedics (70%, p<0.05) were correct.ConclusionsAlthough the majority of paramedics were unable to determine box contents, a significant minority correctly determined the CPAP arm. Taken together with the development of a ‘rattle’ during the trial, and slight baseline imbalance in characteristics of trial participants, loss of allocation concealment cannot be excluded.