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Adopting a children’s rights perspective, a critique and analysis underpinned by documentary research methodology was undertaken in order to assess the extent to which the government’s Green Paper (Department of Health and Social Care and Department of Education, 2017. Transforming children and young people’s mental health provision: a green paper. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 7 December 2017)) addresses the mental health and well-being needs of refugee children and young people in England and Wales, identifying strengths, limitations and challenges for future policy and practice. Findings suggest that there is much of potential benefit to refugee children and young people’s future mental health and well-being. However, a paradigm shift, explicit in implications, scale and time frame, will be required, if the Green Paper is to achieve those changes in attitudes, practice and service delivery which it anticipates. We argue that this Green Paper’s overarching challenge is that it is premised on Western-centric models in its understanding of the experiences of refugee children and young people, and management of trauma and mental health. It fails to recognize the meanings and significance of culture, and of diversity and difference, and the need to invest in all communities in facilitating engagement and support for children and young people’s mental health issues.

Citation rates can be used as an indicator of the influence and relevance of scientific papers. The present study analyzed the 100 most-cited articles related to erosive tooth wear (ETW). The top 100 most-cited papers focusing on ETW topics were collected from the Web of Science database on November 11, 2020. The following bibliometric data were extracted from papers: title, authorship, institutions, countries, number of citations, year of publication, journal title, study design, topic, and keywords. Scopus and Google Scholar were searched to compare the number of citations. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations of the 100 most-cited papers ranged from 71 to 330 (average: 97.44). The papers were published between 1949 and 2015. Caries Research (28%) and The Journal of Dentistry (16%) presented the majority of papers. Laboratorial (44%) and observational studies (33%) were the most common study designs. The most studied topics were epidemiology (31%) and the erosive potential of substances (drinks, foods, or medicines) (22%). The countries with the highest number of most-cited papers were England (32%), Germany (18%), and Switzerland (10%). The University of Bern was the institution with the most papers (10%). Lussi A was the author with the highest number of papers in the top 100 (14%). The most common keyword was “dental erosion” with 64 occurrences. The top 100 most-cited papers related to ETW were composed mainly of laboratorial and observational studies focusing on epidemiology and the erosive potential of substances.

The Canadian physician Sir William Osler is a key figure in the history of modern medicine. He encouraged lifelong learning for doctors, starting with bedside teaching. Contemporary with Old World figures such as Pasteur in Paris and Virchow in Berlin, he played a major role in raising awareness among clinicians of the importance of the scientific basis for the practice of medicine. He championed a rational approach to treatment and did much to encourage avoidance of ‘unnecessary drugging’ by prescribers. He is credited with playing a key role in improving education of medical students and postgraduate education of doctors, with important benefits for the care of hospital patients. He also had a major influence on his medical colleagues through founding and leading medical societies. A century on from his death in December 1919, his specific contributions and how he achieved them are not well known. The aim of this article is to consider the evidence that Osler was an influential medical leader and to reflect on the extent to which the achievements which resulted from his leadership are relevant to modern clinical medicine. Questions of interest include his leadership style, what made for his success as a leader, his medical achievements both in North America and in England, his own insight into leadership and how he was viewed by his peers.

Primary care services in or alongside emergency\ud departments look and function differently and are\ud described using inconsistent terminology. Research to\ud determine effectiveness of these models is hampered by\ud outdated classification systems, limiting the opportunity\ud for data synthesis to draw conclusions and inform\ud decision-making and policy. We used findings from a\ud literature review, a national survey of Type 1 emergency\ud departments in England and Wales, staff interviews,\ud other routine data sources and discussions from\ud two stakeholder events to inform the taxonomy. We\ud categorised the forms inside or outside the emergency\ud department: inside primary care services may be\ud integrated with emergency department patient flow or\ud may run parallel to that activity; outside services may be\ud offered on site or off site. We then describe a conceptual\ud spectrum of integration: identifying constructs that\ud influence how the services function—from being closer\ud to an emergency medicine service or to usual primary\ud care. This taxonomy provides a basis for future evaluation\ud of service models that will comprise the evidence base\ud to inform policy-making in this domain. Commissioners\ud and service providers can consider these constructs in\ud characterising and designing services depending on local\ud circumstances and context.

Objective The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges. Methods Based on a scan of the literature five cases were selected: England (UK), Ireland, California (USA), Victoria and Queensland (Australia). Information was gathered via a review of the grey and peer-reviewed literature. Country experts were consulted for additional information and to review country reports. Results The focus of safe staffing policies varies: increasing transparency about staffing decisions (England), matching actual and required staffing levels based on patient acuity measurement (Ireland), mandated patient-to-nurse ratios at the level of the nurse (California) or the ward (Victoria, Queensland). Calibration of the number of patients by the number of nurses varies across cases. Nevertheless, positive effects on the nursing workforce (increased bedside staffing) and staff well-being (increased job satisfaction) have been consistently documented. The impact on patient outcomes is promising but less well evidenced. Conclusion Countries will have to set safe staffing policies to tackle challenges such as the ageing population and workforce shortages. Various approaches may prove effective, but need to be accompanied by a comprehensive policy that enhances bedside nurse staffing in an evidence-based, objective and transparent way.

Background Cardiovascular disorders (CVD) are the single greatest cause of mortality worldwide. In the UK, the National Health Service (NHS) has launched an initiative of health checks over and above current care to tackle CVD. However, the uptake of Health Checks is poor in disadvantaged communities. This protocol paper sets out a UK-based study (Sussex and Nottingham) aiming to co-produce a community delivered CVD risk assessment and coaching intervention to support community members to reduce their risk of CVD. The overall aim of the project is to implement a tailored-to-context community engagement (CE) intervention on awareness of CVD risks in vulnerable populations in high, middle and low-income countries. The specific objectives of the study are to enhance stakeholder’ engagement; to implement lifestyle interventions for cardiovascular primary prevention, in disadvantaged populations and motivate uptake of NHS health checks. Methods This study uses both qualitative and quantitative methods in three phases of evaluation, including pre-, per- and post-implementation. To ensure contextual appropriateness the ‘Scaling-up Packages of Interventions for Cardiovascular disease prevention in selected sites in Europe and Sub-Saharan Africa: An implementation research’ (SPICES) project will organize a multi-component community-engagement intervention. For the qualitative component, the pre-implementation phase will involve a contextual assessment and stakeholder mapping, exploring potentials for CVD risk profiling strategies and led by trained Community Health Volunteers (CHV) to identify accessibility and acceptability. The per-implementation phase will involve healthy lifestyle counselling provided by CHVs and evaluation of the outcome to identify fidelity and scalability. The post-implementation phase will involve developing sustainable community-based strategies for CVD risk reduction. All three components will include a process evaluation. A stepped wedge cluster randomised trial of the roll out will focus on implementation outcomes including uptake and engagement and changes in risk profiles. The quantitative component includes pre and post-intervention surveys. The theory of the socio-ecological framework will be applied to analyse the community engagement approach. Discussion Based on the results ultimately a sustainable community engagement-based strategy for the primary prevention of CVD risk will be developed to enhance the performance of NHS health care in the UK. The Trial Registration number is ISRCTN68334579.

In their letter to the Editor in this issue, Kolstoe and Carpenter challenge a core aspect of our recently published case study of research approvals [BMC Medical Ethics 20:7] by arguing that we conflate research ethics with governance and funding processes. Amongst the key concerns of the authors are: 1) that our paper exemplifies a typical conflation of concepts such as governance, integrity and ethics, with significant consequences for claims around the responsibility and accountability of the organisations involved; 2) that, as a consequence of this conflation, we misrepresent the ethics review process, including in fundamental aspects such as the ethics approval-opinion distinction; 3) that it is difficult to see scope for greater integration of processes such as applying for funding, research approvals, Patient and Public Involvement, etc., as suggested by us. Here we present an alternative point of view towards the concerns raised.

Post-refereed, pre-print version, de acuerdo con consent form. Publicado en: Religion and the Arts 19:1-2(2015). 144-145.DOI: https://doi.org/10.1163/15685292-01901011 Two important concepts underlie this collection of essays edited by Joseph Sterrett and Peter Thomas: sacred space, a place or places where man can find “what is real in the midst of the formless expanse”; and text, considered in its sacred character, as something given to and developed by man in order to guide his own spiritual life. While they seem to proceed from opposite directions, the opposition implicit in these concepts between concrete and spiritual is not so strong when we consider that (according to Helen Wilcox) sacred spaces are everywhere when considered in the general context of the spiritual life. The relations between sacred texts and sacred spaces presented in this volume are the result of research done at Cardiff University, and are limited to England and Wales. Due to the history of the these two countries it is easy for the reader to understand how these concepts are related with the evolution and transformation of religious belief and of society in general during the period under consideration. The book is divided into three temporal sections, focusing on the medieval era, the early modern period, and the nineteenth century. The twelve essays that make up the book look at sacred texts, at sacred spaces, and at both of them in very different ways: ...

Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.

The government has bought some time to find a sustainable solution The spring budget delivered £2bn of new funding for social care over three years from 2017‑18 and a commitment to publish a green paper outlining options for future funding. The government’s decision to find additional resources reflects the huge pressures facing social care in England, which the Care Quality Commission described as near “tipping point,”1 and the effect of these pressures on the NHS. These resources will go some way towards stabilising social care, even though they fall short of the sums independent commentators have argued are needed to bridge the expected funding gap by the end of this parliament.2 The announcement of a green paper, planned for the autumn, fulfils the prime minister’s commitment to explore ways of making the funding of social care sustainable. Several options are likely to be considered, including compulsory social insurance as used in countries such as Germany and Japan; acting on the recommendations of the Dilnot report to introduce a cap on care costs, which was included in the Care Act …

The development and provision of maternity services globally are continuing to receive much attention in order to improve care and safety for women and babies. In the UK national reviews of the maternity services have taken place, with local services taking forward specific pilot projects to support the implementations of policy recommendations. This paper argues that, in order to meet the requirements of change in maternity services, there also needs to be a prompt review of the education of student midwives in order to be confident that the workforce of the future is equipped to implement these changes successfully. Using changes to national policy in England, this paper raises the question of the need for flexible national education standards, to ensure a curriculum can meet the needs of the changing workforce without the need for constant revision of the curriculum.

IntroductionDevelopments in information and communication technologies have enabled electronic health and seen a huge expansion over the last decade. This has increased the possibility of self-management of health issues.PurposeTo assess the effectiveness of the Baby Buddy app on maternal self-efficacy and mental well-being three months post-birth in a sample of mothers recruited antenatally. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.MethodsWe will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings’ website.

Background\ud \ud The MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources.\ud \ud Methods\ud \ud MODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year.\ud \ud Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations.\ud \ud Discussion\ud \ud Modelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently.

A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence, which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the National Institute for Health and Care Excellence guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a series of questions about design and methods for future researchers who intend to further explore this complex relationship between nurse staffing levels and outcomes. These questions are intended to reflect on the potential added value of new research given what is already known, and to encourage those conducting research to take opportunities to produce research that fills gaps in the existing knowledge for practice. By doing this we hope that future studies can better quantify both the benefits and costs of changes in nurse staffing levels and, therefore, serve as a more useful tool for those delivering services.

Background A portfolio of supporting information (SI) reflecting a doctor’s entire medical practice is now a central aspect of UK appraisal for revalidation. Medical revalidation, introduced in 2012, is an assessment of a doctor’s competence and passing results in a five yearly license to practice medicine. It assesses of a doctor’s professional development, workplace performance and reflection and aims to provide assurance that doctors are up-to-date and fit to practice. The dominant assessment mechanism is a portfolio. The content of the revalidation portfolio has been increasingly prescribed and the assessment of the SI is a fundamental aspect of the appraisal process which ultimately allows Responsible Officers (ROs) to make recommendations on revalidation. ROs, themselves doctors, were the first to undergo UK revalidation. This qualitative study explored the perceptions of ROs and their appraisers about the use of this portfolio of evidence in a summative revalidation appraisal. Methods 28 purposefully sampled London ROs were interviewed following their revalidation appraisal and 17 of their appraisers participated in focus groups and interviews. Thematic analysis was used to identify commonalities and differences of experience. Results SI was mostly easy to provide but there were challenges in gathering certain aspects. ROs did not understand in what quantities they should supply SI or what it should look like. Appraisers were concerned about making robust judgements based on the evidence supplied. A lack of reflection from the process of collating SI and preparing for appraisal was noted and learning came more from the appraisal interview itself. Conclusions More explicit guidance must be available to both appraisee and appraiser about what SI is required, how much, how it should be used and, how it will be assessed. The role of SI in professional learning and revalidation must be clarified and further empirical research is required to examine how best to use this evidence to make judgments as part of this type of appraisal.

IntroductionEvidence suggests bowel scope screening (BSS) can significantly reduce an individual’s risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance.Methods and analysisA three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual’s GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual’s GP practice and a patient navigation call made on behalf of an individual’s GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation.Ethics and disseminationNHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Trial registration numberISRCTN16252122; Pre-results.