scholarly journals 606 How can we deliver timely and high quality diagnosis for children with possible autism in the UK: a rapid realist review of autism service delivery literature

2021 ◽  
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
William Farr ◽  
Ian Male ◽  
Jeremy Parr ◽  
...  
Keyword(s):  
Service Delivery ◽  
Realist Review ◽  
High Quality ◽  
The Uk ◽  
Quality Diagnosis ◽  
Rapid Realist Review

scholarly journals Realist evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Findings from a rapid realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051241
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
Patricia M Wilson ◽  
William Farr ◽  
Venkat Reddy ◽  
...  
Keyword(s):  
Service Delivery ◽  
Grey Literature ◽  
Realist Review ◽  
Current Evidence ◽  
Diagnostic Model ◽  
High Quality ◽  
Current Evidence Base ◽  
The Uk ◽  
Diagnostic Pathways ◽  
Rapid Realist Review

ObjectivesWaiting times in the UK for an autism diagnostic assessment have increased rapidly in the last 5 years. This review explored research (including ‘grey’ literature) to uncover the current evidence base about autism diagnostic pathways and what works best, for whom and in what circumstances, to deliver high quality and timely diagnosis.DesignWe performed a Rapid Realist Review consistent with recognised standards for realist syntheses. We collected 129 grey literature and policy/guidelines and 220 articles from seven databases (January 2011–December 2019). We developed programme theories of how, why and in what contexts an intervention worked, based on cross comparison and synthesis of evidence. The focus was on identifying factors that contributed to a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within specific parameters (Autism diagnostic services in Paediatric and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group, including representatives from local parent forums, national advocacy groups and clinicians, was integral to the process.ResultsBased on 45 relevant articles, we identified 7 programme theories that were integral to the process of diagnostic service delivery. Four were related to the clinical pathway: initial recognition of possible autism; referral and triaging; diagnostic model; and providing feedback to parents. Three programme theories were pertinent to all stages of the referral and diagnostic process: working in partnership with families; interagency working; and training, service evaluation and development.ConclusionsThis theory informed review of childhood autism diagnostic pathways identified important aspects that may contribute to efficient, high quality and family-friendly service delivery. The programme theories will be further tested through a national survey of current practice and in-depth longitudinal case studies of exemplar services.Trial registration numberNCT04422483.

scholarly journals Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037846
Author(s):  
Vanessa Abrahamson ◽  
Wenjing Zhang ◽  
Patricia Wilson ◽  
William Farr ◽  
Ian Male
Keyword(s):  
Service Delivery ◽  
Research Question ◽  
Waiting Times ◽  
Realist Review ◽  
Realist Evaluation ◽  
High Quality ◽  
Wide Range ◽  
Diagnostic Pathways ◽  
Rapid Realist Review

IntroductionThe National Health Service (NHS) Long-Term Plan (2019) acknowledges that children and young people with suspected autism wait too long for diagnostic assessment and sets out to reduce waiting times. However, diagnostic pathways vary with limited evidence on what model works best, for whom and in what circumstances. The National Autism Plan for Children (2003) recommended that assessment should be completed within 13 weeks but referral to diagnosis can take as long as 799 days.This Rapid Realist Review (RRR) is the first work package in a national programme of research: a Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD). We explore how particular approaches may deliver high-quality and timely autism diagnostic services for children with possible autism; high quality is defined as compliant with National Institute for Heath and Care Excellence (2011) guidelines, and timely as a pathway lasting no more than one calendar year, based on previous work.Methods and analysisRRR is a well-established approach to synthesising evidence within a compressed timeframe to identify models of service delivery leading to desired outcomes. RRR works backwards from intended outcomes, identified by NICE guidelines and the NHS England Long-Term Plan. The focus is a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within a particular set of parameters (Autism and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group consists of policymakers, content experts and knowledge users with a wide range of experience to supplement, tailor and expedite the process. The RRR is consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and includes identifying the research question, searching for information, quality appraisal, data extraction, synthesising the evidence, validation of findings with experts and dissemination.Ethics and disseminationEthical approval not required. Findings will inform the wider RE-ASCeD evaluation and be reported to NHS England.Trial registration numberNCT04422483. This protocol relates to Pre-results.

scholarly journals Service innovations

2003 ◽  
Vol 27 (09) ◽  
pp. 346-348
Author(s):  
Chris Simpson ◽  
Prasanna De Silva
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Older People ◽  
High Quality ◽  
The Uk ◽  
Multi Disciplinary Team

The increase in older people in the UK will increase the need for mental health services to run efficient, high-quality services. Multi-disciplinary team assessments, although not new, provide a method of increasing the capacity to see referrals. Two similar systems of multi-disciplinary team assessments from North Yorkshire are reported with evidence of improvement in quality.

scholarly journals Rapid Realist Review of School-Based Physical Activity Interventions in 7- to 11-Year-Old Children

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 52
Author(s):  
Emmanuel Defever ◽  
Michelle Jones
Keyword(s):  
Physical Activity ◽  
School Leadership ◽  
School Environment ◽  
Meta Analysis ◽  
Implementation Fidelity ◽  
Realist Review ◽  
School Level ◽  
School Settings ◽  
Physical Activity Interventions ◽  
Rapid Realist Review

Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-years-old works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented.

scholarly journals NCOG-36. FIRST HEALTH UTILITIES OF GLIOBLASTOMA PATIENTS USING TTFIELDS TREATMENT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii137-ii137
Author(s):  
Gordon Chavez ◽  
Christina Proescholdt
Keyword(s):  
Population Sample ◽  
National Health System ◽  
Medical Decision ◽  
Economic Evaluations ◽  
Health State ◽  
High Quality ◽  
Health States ◽  
Tumor Treating Fields ◽  
Health State Utilities ◽  
The Uk

Abstract BACKGROUND Despite the importance of Health State Utilities for health policy and medical decision making, there are no publications that provide high quality utility values estimated from glioblastoma multiforme (GBM) patients. Published health economic evaluations for GBM treatments rely on utilities determined by Garside et al. (2007), which used the standard gamble method in healthy panel members of the UK National Health System. There are no published utilities for GBM estimated from a general population sample, and there are no utility estimates whatsoever for Tumor Treating Fields (TTFields) users. METHODS We designed a study to remedy this major deficit by eliciting utilities directly from GBM patients using the EuroQol 5-Dimension (EQ-5D) survey. The EQ-5D is a widely used and NICE-recommended tool for the estimation of health state utilities. The survey is composed of a questionnaire that asks patients to specify their health state along 5 dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Statistical models provided by EuroQol’s network of researchers convert this data into health state utility estimates. RESULTS The EQ-5D questionnaire is administered to active patients using TTFields treatment during the study duration, allowing the elicitation of health preference measures for different glioblastoma health states based on: progression status (progressed vs. non-progressed), current treatments (TTFields only vs. TTFields + others) and time-from-diagnosis (0-12 months vs. > 12 months) CONCLUSION These results are important for understanding the patient preferences using TTFields treatment and communicating these preferences to decision makers. This study is the first to provide direct, high quality utility measures in glioblastoma patients using TTFields treatment.

scholarly journals A Rapid Realist Review of Group Psychological First Aid for Humanitarian Workers and Volunteers

2021 ◽  
Vol 18 (4) ◽  
pp. 1452
Author(s):  
Julia Corey ◽  
Frédérique Vallières ◽  
Timothy Frawley ◽  
Aoife De Brún ◽  
Sarah Davidson ◽  
...  
Keyword(s):  
Research Question ◽  
Grey Literature ◽  
Age Groups ◽  
Integrated Design ◽  
Realist Review ◽  
First Aid ◽  
Psychological Consequences ◽  
Post Traumatic Stress ◽  
Psychological First Aid ◽  
Rapid Realist Review

Humanitarian workers are at an elevated risk of occupational trauma exposure and its associated psychological consequences, and experience increased levels of anxiety, depression, and post-traumatic stress disorder (PTSD) compared to the general population. Psychological first aid (PFA) aims to prevent acute distress reactions from developing into long-term distress by instilling feelings of safety, calmness, self- and community efficacy, connectedness and hope. Group PFA (GPFA) delivers PFA in a group or team setting. This research sought to understand ‘What works, for whom, in what context, and why for group psychological first aid for humanitarian workers, including volunteers?’ A rapid realist review (RRR) was conducted. Initial theories were generated to answer the question and were subsequently refined based on 15 documents identified through a systematic search of databases and grey literature, in addition to the inputs from a core reference panel and two external experts in GPFA. The findings generated seven programme theories that addressed the research question and offered consideration for the implementation of GPFA for the humanitarian workforce across contexts and age groups. GPFA enables individuals to understand their natural reactions, develop adaptive coping strategies, and build social connections that promote a sense of belonging and security. The integrated design of GPFA ensures that individuals are linked to additional supports and have their basic needs addressed. While the evidence is sparce on GPFA, its ability to provide support to humanitarian workers is promising.

scholarly journals Content online and the end of public media? The UK, a canary in the coal mine?

2011 ◽  
Vol 33 (8) ◽  
pp. 1202-1219 ◽  
Author(s):  
Richard Collins
Keyword(s):  
Business Model ◽  
Business Models ◽  
Direct Payment ◽  
Publicly Funded ◽  
High Quality ◽  
Online Delivery ◽  
Local Newspapers ◽  
Public Media ◽  
The Uk ◽  
Pervasive Access

Online delivery of content has changed media advertising markets, undermining the business model which has underpinned provision of ‘public media’. Three business models have sustained mass media: direct payment for content, payment for advertising and state subsidy, and the author argues, contrary to others’ claims, that advertising finance has made possible production and provision of high-quality, pluralistic and affordable public media. In consequence, substitution of the internet as an advertising medium has undermined the system of finance which, in the UK and societies like it, sustained public media. Global advertising revenues have both fallen and been redistributed, though to differing degrees in different countries, with particularly deleterious effects on local newspapers. Prices have risen, original content production has fallen and reversion to a direct payment-for-content business model is pervasive. And this despite the growth of new entrant online media and established publicly funded media (notably public service broadcasters) resulting in the likelihood of a continued general worsening of affordable and pervasive access to high-quality and diverse public media.

The effect of feeding different protein sources on intake, milk yield, milk composition and liveweight in high yielding Holstein cows

1998 ◽  
Vol 1998 ◽  
pp. 202-202
Author(s):  
R J Mansbridge ◽  
J S Blake
Keyword(s):  
Weight Loss ◽  
Public Awareness ◽  
Block Design ◽  
Milk Composition ◽  
Holstein Cows ◽  
High Quality ◽  
Protein Sources ◽  
Sufficient Energy ◽  
Soyabean Meal ◽  
The Uk

High yielding cows require high quality diets to sustain milk yields and to minimise weight loss, metabolic disorders and fertility problems. Traditionally, these diets have contained fishmeal and soyabean meal, both widely regarded as good sources of high quality, digestible undegraded protein (DUP). However, there is increasing concern over the sustainability of world fish stocks and the BSE scare has increased public awareness to the extent that feeding animal protein to herbivores may become unacceptable in me future. This in turn has driven up the price of high quality imported vegetable proteins, such as soyabean meal. The aim of this study was to investigate whether fishmeal and soyabean meal could be replaced in the diet of high yielding cows, with protein sources grown in the UKIn a 12 week randomised block design experiment, 60 muciparous Holstein cows, on average 28 days calved at the start of the study, were fed total mixed rations based on grass silage and one of five protein mixtures. These were either 0.5 kg DM fishmeal + 0.7 kg DM soya + 2.5 kg DM rapeseed (PC), 1.3 kg DM soyabean + 2.3 kg DM rapeseed (PI), 3.8 kg DM lupins + 2.3 kg DM heat treated rapeseed (P2), 3.6 kg DM linseed + 1.4 kg DM rapeseed (P3) or 5.8 kg DM rapeseed (P4). Each diet was formulated to supply sufficient energy and metabolisable protein for maintenance + 43 litres and 0.75kg/d weight loss and to contain similiar levels of DUP (AFRC, 1993).

scholarly journals Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews

2019 ◽  
Vol 7 (31) ◽  
pp. 1-216 ◽  
Author(s):  
Catrin Evans ◽  
Ritah Tweheyo ◽  
Julie McGarry ◽  
Jeanette Eldridge ◽  
Juliet Albert ◽  
...  
Keyword(s):  
Health Care ◽  
Service Delivery ◽  
Pregnant Women ◽  
Systematic Reviews ◽  
Female Genital Mutilation ◽  
Genital Mutilation ◽  
Women And Girls ◽  
The Uk ◽  
Experienced Female ◽  
Female Genital

Background In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery. Objectives To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2). Review methods The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts. Results Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up. Limitations Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs. Conclusions The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need. Future work Future research should evaluate the most-effective models of training and of service delivery. Study registration This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2). Funding The National Institute for Health Research Health Services and Delivery Research programme.

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