Yes / Objectives To investigate the impact of radiographer advanced practice on patient outcomes and health service quality. Methods Using the World Health Organisation definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs and data were systematically extracted using electronic data extraction proforma. Results 407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n=7) focussing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The papers were generally considered to be of low to moderate quality with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No papers reported data relating to time to diagnosis, time to recovery or patient mortality. Conclusions Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited. Advances in knowledge This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality. Powered by

No / This paper presents a knowledge review on the career progression of Equality and Diversity professionals within the British National Health Service. Adopting a multidimensional methodological approach, the review involved examining literature of published and unpublished literature including scientific journals, statistics, and national and international reports to highlight research gaps, consultation with experts, and documentary analysis of job advertisements. Thematic analysis was utilized to examine and report patterns within data generated from the multiple data collection methods. The review identified the concept of career undergoing a fundamental shift in strategy and consequent overhaul of traditional organizational structures in all sectors. New boundaryless organizations have presented the possibility of boundaryless careers, resulting in the renegotiation of the psychological contract between employee and employer. The knowledge review has identified that more needs to be addressed, from both employee and employer perspectives, to ensure that conditions are in place for such competences to flourish.

Yes / To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.

Yes / This article considers how cuts in Government funding will affect continuing professional development and mentorship training for NHS staff

Yes / In October 2014, Simon Stevens, the chief executive of NHS England, committed the service to plugging £22 billion of the expected £30 billion gap in its finances by 2020 through productivity gains of 2–3% a year by 2020. Since that announcement, the Government promised to provide £8 billion by 2020. This may notionally have been received, but it has not alleviated the severity of these financial constraints (Barnes and Dunhill, 2015). With austerity measures biting even deeper into the budgets of NHS organisations, all staff are under pressure to make cost efficiencies and at the same time improve operational standards and patient outcomes. In this pressured change environment, there are hospitals and departments that have embraced the demand for change, creating innovative skills mix platforms from which to deliver services. But there are also those who have remained entrenched in operational protocols. In both scenarios, the overarching driver for service re-design has been operational efficiency guided by government targets.

Yes / Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A coordenaÃÃo dos cuidados pela atenÃÃo primÃria à saÃde (APS) ocupa uma posiÃÃo de destaque na agenda das polÃticas de saÃde de vÃrios paÃses. à uma alternativa possÃvel para o problema da segmentaÃÃo em sistemas de saÃde, que gera iniquidade e ineficiÃncia, desarticulaÃÃo da rede assistencial e prejuÃzo no acesso aos nÃveis de atenÃÃo mais complexos. O objetivo geral do estudo foi comparar a induÃÃo centralizada da coordenaÃÃo dos cuidados pela APS em dois sistemas de saÃde universais. Estudo de abordagem quanti-qualitativa, à classificado como exploratÃrio-descritivo, valendo-se de dados documentais e orÃamentÃrios e da realizaÃÃo de nove entrevistas semiestruturadas com sujeitos-chave correspondentes ao National Health Service (NHS), do Reino Unido, e ao Sistema Ãnico de SaÃde (SUS), do Brasil. Foi utilizada anÃlise de conteÃdo temÃtica, estatÃstica descritiva e anÃlise comparativa. A pesquisa obedeceu à ResoluÃÃo 196/96 do Conselho Nacional de SaÃde e obteve parecer favorÃvel (nÃmero 198.092). A pesquisa identificou que o fortalecimento da APS à a base inicial para viabilizar a coordenaÃÃo dos cuidados no Brasil. O MinistÃrio da SaÃde do Brasil vem desenvolvendo polÃticas nacionais que impactam indiretamente na coordenaÃÃo dos cuidados - PolÃtica Nacional de AtenÃÃo BÃsica, NÃcleos de Apoio à SaÃde da FamÃlia e Programa Nacional de Melhoria do Acesso e da Qualidade da AtenÃÃo BÃsica. A polÃtica de Redes de AtenÃÃo à SaÃde revelou-se fator limitante ao papel coordenador da APS. As Tecnologias de InformaÃÃo e ComunicaÃÃo surgiram com menos Ãnfase no Ãmbito federal. O incremento estrutural no TelessaÃde Brasil Redes e os Cadernos de AtenÃÃo BÃsica sobressaÃram por sua capacidade de induzir mudanÃas organizacionais nos serviÃos. O NHS estruturou a coordenaÃÃo dos cuidados pela APS a partir do contrato dos general practitioners e busca empoderÃ-los para gerir 60% do orÃamento do sistema. A pesquisa concluiu que o modelo de Estado federativo brasileiro dificulta a coordenaÃÃo dos cuidados pela APS, em comparaÃÃo ao Estado unitÃrio inglÃs. A municipalizaÃÃo e descentralizaÃÃo tornaram complexo o processo de coordenaÃÃo dos cuidados, cabendo ao MinistÃrio da SaÃde o papel de induzir, de forma vertical, e aos municÃpios, operar o sistema em cada ponto de atenÃÃo de forma horizontal, situaÃÃo que nÃo ficou bem alinhada e configurou um modelo oblÃquo, gerando uma contradiÃÃo no desenho federativo brasileiro e dificultando a coordenaÃÃo dos cuidados. / The coordination of care for the primary health care (PHC) occupies a prominent position on the agenda of the health policies of various countries. It is a possible alternative to the problem of segmentation of health systems, which generates inequity and inefficiency, disarticulation of the care network and impaired access to more complex levels of care. The general objective of this study was to compare the centralized induction of coordination of care by PHC in two universal health systems. This study has a quantitative and qualitative approach and it is classified as exploratory and descriptive, by using documental and budgetary data and performing nine semistructured interviews with key subjects corresponding to National Health Service (NHS), from the United Kingdom, and the Unified Health System (SUS) in Brazil. The thematic content analysis, descriptive statistics and e comparative analysis were used. The research followed the Resolution 196/96 of the National Health Council and obtained its assent under number 198 092. The research identified that the strengthening of PHC is the initial basis to facilitate the coordination of care in Brazil. The Ministry of Health of Brazil has been developing national policies which impact indirectly on coordination of care - National Policy for Primary Care, Centers of Support for Family Health and the National Program for Improving Access and Quality of Primary Care. The Politics of Health Care Networks proved to be limiting factor for coordinating role of the PHC. The Information and Communication Technologies have emerged with less emphasis on the federal level. The structural increase in BrazilÂs Telehealth Networks and Protocols Notebooks of Primary Care, stood by their ability to induce changes in the organizational processes of the services. The NHS structured care coordination by PHC from the contract of general practitioners and seeks to empower them to manage 60% of the budget system. The research concluded that the brazilian federal State model complicates the coordination of care by PHC, compared to the english unitary State. The municipalization and decentralization made the process of coordination of care more complex, leaving to the Ministry of Health the role of inducing vertically and, to the municipalities, operate the system at each point of care in a horizontal manner, a situation which was not well aligned and configured an oblique model, generating a contradiction in the brazilian federal design and bringing difficulties to the coordination of care.

The main of objective of this diploma thesis is to define health care as economic goods based on the theoretical definitions. The fact whether health care should be considered as private goods or public goods plays a vital role in this debate. The initial hypothesis presupposes that health care is (based on the basic economic criteria) private goods; however there is objective evidence demonstrating that health care should be understood in terms of public goods. The author defines the necessary terminology and theoretical concepts. According to several expert concepts the author concludes that based on the basic economic definitions health care could be understood as private goods, admitting that in the real world objective limitations exist, which prevent keeping health care exclusively in the economic sphere. The thesis also evaluates the role of individual health care sectors, including their drawbacks. The author demonstrates all concepts on the Czech health care system. In the analytic part of the thesis the author demonstrates discrepancies between theoretical concepts and practice on specific models, including the risks of exclusively private financing of health care. For this purpose three income groups has been defined. The author compares expenditures of these groups on selected medical services with different levels of their savings. The thesis also deals with methods of economical analysis and its limitations in health care system analysis.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Richard H. Mattson / Subjects of this research were 64 adolescents receiving treatment at two behavioral health service institutions located in an urban mid-western city. Both institutions provided horticultural therapy and non-horticultural therapy programs. Research subjects were adolescents with diverse treatment needs and their responses on research questions were inconsistent compared to other related studies with general population. Current research assessed the adolescents with horticultural therapy treatment and without horticultural therapy treatment in three aspects. First, the levels of psychological aspects of adolescents were assessed with the Rosenberg Self-Esteem Scale and Nowicki-Strickland Locus of Control Scale for Children. The levels of self-esteem and locus of control of adolescents with horticultural therapy treatment were not significantly different from those of adolescents without horticultural therapy treatment at both institutions. Based on the different level of worthiness and competence factors, it is recommended to design horticultural therapy programs focused on improving the worthiness factor of self-esteem. Second, the pastoralism disposition of the Children's Environmental Response Inventory was used to assess the level of environmental attitude of the adolescents with and without horticultural therapy treatment. Horticultural experience and environmental attitude had a positive relationship with most subjects. At one institution, the level of environmental attitude of the adolescents with horticultural therapy treatment was significantly higher than the adolescents without horticultural therapy treatment. The adolescents at the horticultural therapy program which was scheduled more frequently showed higher environmental attitude scores. To improve environmental attitude of adolescents, horticultural therapy program should provide diversity and abundant opportunities of horticultural experiences. Third, basic horticultural knowledge was tested with the Basic Horticultural Knowledge Questionnaire. Vegetable/fruit consumption and preference were described with the Vegetable and Fruit Preference and Consumption Survey. Basic horticultural knowledge scores of the horticultural therapy group were significantly higher than that of the non-horticultural therapy group at one institution, but the scores were similar between the two groups at the other institution. Basic horticultural knowledge of subjects was significantly correlated to their vegetable and fruit consumption. To increase vegetable/fruit consumption, horticultural therapy programs should set goals to incorporate nutrition education.

Avhandlingen, som är en kvalitativ studie, rör yrkesgruppen undersköterskor inom hälso- och sjukvården. Syftet med studien har varit att studera och bidra med ökad kunskap, dels om villkoren för lärande och kunskapsbildning i arbetslivet, dels mer specifikt om undersköterskors arbete, arbetsvillkor samt villkor för lärande och utveckling på arbetsplatsen. Avhandlingens teoretiska referensram utgår från tidigare forskning och teoribildning om arbetsrelaterat lärande som kunnat sammanfattas i en modell, i vilken fyra olika grupper av faktorer, som är betydelsefulla för lärande i och genom arbetet, beskrivs. De fyra är: 1) Arbetets och organisering 2) Formell och icke-formell utbildning 3) Sociala aspekter och 4) Individuella faktorer. Tre olika sjukvårdsenheter; en akutsjukvårdsenhet, en barnsjukvårdsenhet och en operationssjukvårdsenhet, samtliga vid ett större sjukhus, ingår i studien. 17 undersköterskor och 5 vårdenhetschefer har intervjuats. Avhandlingen visar att undersköterskor som verkar inom akut eller traumatisk sjukvård också har ett varierat och oförutsett arbete, vilket ger dem goda möjligheter till lärande och utveckling. Vidare har undersköterskor som arbetar med uppgifter inom vårdens kärnverksamhet möjlighet att lära i arbetet. Avgörande i sammanhanget är att dessa arbetsuppgifter uppfattas som intressanta, meningsfulla och stimulerande. Lärande underlättas för de undersköterskor som arbetar vid en vårdenhet där de görs delaktiga i vårdarbetet och arbetsgemenskapen. Undersköterskor som arbetar tillsammans med andra yrkesgrupper kan ha möjlighet att lära i arbetet. Även delegering av arbetsuppgifter har betydelse för möjligheterna att lära. Avhandlingen visar också att undersköterskor kan hindras från att lära i arbetet om den sjuksköterska som de arbetar närmast (i vårdpar eller i team) inte tillåter dem att utföra vissa arbetsuppgifter. Det framkommer också att undersköterskor som saknar intresse, eller ork hindras från att lära och utvecklas i arbetet. Undersköterskor har begränsade möjligheter att delta i, och utvecklas genom formella läraktiviteter. Kursutbudet är litet och en del av de kurser som erbjuds rör inte vårdens kärnverksamhet. / The dissertation, which is a qualitative study, concerns auxiliary nurses in the health care. The aim of the study has partly been to generate knowledge about the prerequisites for learning and knowledge development in working life and partly to specifically study the work of auxiliary nurses, their working conditions and the prerequisites for learning and development in the workplace. The dissertation’s theoretical frame of reference is based on previous research and theories of workplace learning and have been summarised in a model. Four different groups of factors that are significant for learning in and through the work are described. The four groups are: 1) Work and organisation 2) Formal and non-formal learning activities, 3) Social aspects and 4) Individual factors. Three different health care units – an emergency care unit, a children’s unit and an operating unit – in a large hospital were included in the study. 17 auxiliary nurses and 5 care unit managers were interviewed. The dissertation shows that the work of auxiliary nurses involved in emergency care or the treatment of trauma is varied and unpredictable, which creates good opportunities for learning and development. Further, auxiliary nurses who are involved in core care activities are able to learn on the job. What is crucial here is that these duties are perceived as interesting, meaningful and stimulating. Learning is facilitated for auxiliary nurses who work in a care unit where they are involved in both the work and the work community. Auxiliary nurses who collaborate with other professional groups may find it easier to learn on the job. The delegation of tasks also affects the possibilities to learn. The dissertation also shows that auxiliary nurses can be prevented from learning on the job if the nurse with whom they work (in a nursing pair or team) does not allow them to perform certain tasks. It is also clear that auxiliary nurses who lack interest or stamina are prevented from learning and developing. Auxiliary nurses have limited opportunities to take part in and develop through formal learning activities. Few courses are available for auxiliary nurses, and those offered are seldom dealing with core care work.