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Purpose The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children’s services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers’ accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children’s birth families there were more mixed and negative impressions. Originality/value Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised.

Background: Physician Associate and Physician Associate comparable (PA/PA-comparable) professions are classified by the 2012 International Labour Classification of Occupations within ISCO group 2240 paramedical practitioners. However, to date, there is no single global framework that categorize and/or describe their scopes of practice, or a single unifying occupational group name. In 2022, the World Health Organization (WHO) published its Global Competency and Outcomes Framework for Universal Health Coverage which focuses on the practice activities for health workers with a pre-service training pathway of 12-48 months, thus including many PA/PA-comparable roles. This is an exploratory study to describe the similarities and differences between the SOP documents for PA/PA-comparable professions with a pre-service pathway of 12-48 months, thus excluding any extra-training and specializations, from 25 countries using the WHO Framework as a frame of reference. Methods: SOP documents were collected from 25 countries and mapped to the WHO Framework by 3 independent reviewers. We used descriptive statistics to examine the percent agreement between the WHO Framework and SOP documents by country, as well as the ubiquity of each WHO practice activity across the examined documents. To test the hypothesis that country-specific economic indicators and healthcare workforce metrics may be linked to the presence or absence of specific SOP elements, we utilized bivariate logistic regression analyses to examine the associations between World Bank economic indicators and country specific healthcare workforce metrics and presence/absence of specific WHO Framework practice activities within each SOP. Results: The study found significant heterogeneity between the WHO practice activities reported in the 25 SOP documents, particularly related to the provision of individual health services, indicating an equivalent SOP across these areas. However, the study did find variation with regards three practice activities within the SOP documents relating to population health and management and organization practice activities. These were inversely associated with specific health expenditure and health workforce variables. 1) “assessing community health needs” (OR: 0.42, 95% CI: 0.20, 0.89 for every per unit increase in medical doctors; OR: 0.78, 95% CI: 0.61, 0.98 for nursing; OR: 0.57, 95% CI: 0.33, 0.97 for every 1000 USD increase in health expenditure) 2) and “planning and delivering community health programmes,” (OR: 0.36, 95% CI: 0.17, 0.78 for every per unit increase in medical doctors; OR: 0.80, 95% CI: 0.66, 0.97 for nursing, OR: 0.53, 95% CI: 0.32, 0.89 for health expenditure)and 3) “managing physical resources,” (OR 0.51, 95% CI: 0.29, 0.92 for medical doctors; OR: 0.70, 95% CI: 0.50, 0.99 for health expenditure. This study suggests that these SOP practice activities are more common in lower income countries and countries with a smaller per-capita health workforce. Conclusions: The WHO practice activities provide an effective framework to catalogue and compare the responsibilities of PA/PA-comparable professions recorded by country specific SOP documents. This approach could also be used to compare different occupational SOPs within a country, as well as SOPs between countries. The authors propose that additional information relating to the types of procedures and the level of supervision or autonomy would enable a more comprehensive comparison of SOPs, going beyond the granularity offered by the WHO framework. At that level, the evaluation can then be used to inform gap analysis for training needs in the context of migration, or to better understand the health team skills mixes in different countries. The study also offers reflections on the importance of clarity of intended meaning within the SOP documents.

This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.

BackgroundCompetency frameworks are being taken up by a growing number of sectors and for a broad range of applications. However, the topic of competency frameworks is characterised by conceptual ambiguity, misunderstanding and debate. Lack of consistency in the conceptualisation and use of key terminology creates a barrier to research and development, consensus, communication and collaboration, limiting the potential that competency frameworks have to deal with real workforce challenges. This paper aims to advance the field by conducting a detailed review of the literature to understand the underlying causes of conceptual differences and divergent views and proposing a re-conceptualisation of competency framework terminology for use by the health sector.MethodsA broad scoping review of literature was conducted to identify publications relating to the conceptualisation of competency frameworks and key terms, examine how they are conceptualised and determine how this evolved. In addition, a purposive sample of health-related competency frameworks was chosen to illustrate how the terms and concepts are currently being applied in the health context.ResultsOf the 4 155 records identified, 623 underwent text searches and broad quantitative analysis, and 70 were included for qualitative analysis. Quantitative analysis identified 26 key terms, which were coded under six thematic headings. Qualitative analysis using the thematic areas revealed two distinct conceptualisations of competency frameworks and their terminology emerging concurrently in the education and employment sectors, with different underpinnings and purposes. As competency frameworks have developed, these two conceptualisations intertwined, resulting in the same terms being used to convey different concepts. Examination of health-related frameworks showed that this merging of concepts is prominent, with lack of consistency in definitions and use of key terms even within a single organisation.Discussion and conclusionsBuilding on previous efforts to address the lack of conceptual clarity surrounding competency frameworks, this paper proposes a re-conceptualisation of the terminology that encompasses two distinct competency framework interpretations, using a glossary of mutually exclusive terms to differentiate concepts. The re-conceptualisation holds relevance for multiple competency framework applications within health, enabling harmonisation, clear communication, consensus-building and effective implementation of competency frameworks.

Introduction Thyroid lobectomy is recommended with total laryngectomy in the National Comprehensive Cancer Network guidelines. However, it is associated with a 32% to 89% risk of hypothyroidism, which is a problem for patients without access to thyroid hormone monitoring and replacement. A number of studies have reported a low incidence of thyroid gland involvement and recommended preserving the thyroid gland in favorable cases. Yet there are no studies that report whether thyroid preserving laryngectomy for laryngeal cancer adversely affects oncologic outcomes compared to patients who have undergone thyroid lobectomy. Objectives To determine whether patients who underwent thyroid gland preserving laryngectomy had higher local recurrence rates or poorer disease-free survival. Method A retrospective folder review of patients who underwent a total laryngectomy over a 12-year period was conducted. Local recurrence and disease-free survival were determined for patients who had both their thyroid lobes preserved and compared with those who had a thyroid lobectomy. Results Sixty-nine patients had thyroid preserving laryngectomy and 73 patients had a thyroid lobectomy. The duration of follow-up was 18 to 132 months (median, 30; IQR, 30). There was no significant difference in local recurrence rates (P = .76) or survival curves between the two groups. Conclusion Thyroid preserving laryngectomy in selected patients with advanced laryngeal carcinoma does not increase local recurrence rates, nor does it negatively affect disease-free survival. Thyroid preservation is appropriate when intraoperative inspection of the larynx shows no extralaryngeal extension or when paratracheal nodal metastases are not a concern. Level of evidence Level 4 Laryngoscope, 130:1465-1469, 2020.

Although general principles of pressure wound management begin with optimisation of patient and wound factors to promote healing, refractory cases may require surgical intervention. Compared with other areas, ischial tuberosity (IT) wounds tend to occur in wheelchair-bound patients and may respond well to surgical debridement and flap reconstruction where added tissue bulk is preventative for further pressure ulcer formation. IT ulcers may occur in patients with some degree of ambulatory potential or those who have a temporary impairment. While the most commonly used flap for typical IT ulcers is the musculocutaneous hamstring flap, for these patients, this is not suitable due to the sacrifice of muscle function. We designed a combined posterior thigh flap with pedicled gracilis to provide robust coverage and vascularised muscle bulk, while preserving hamstring function and potential for re-advancement in ulcer recurrence. Patients were selected for their grade of ulcer, compliance with physiotherapy, and their need to preserve muscle function. Each underwent surgical debridement and reconstruction using the combination flap. End-points included wound coverage, post-operative mobility, and complications. Follow-up was 3 months post-surgery. All patients achieved complete coverage of their wound. In the follow-up period, there were no wound complications or ulcer recurrence. We describe a novel reconstruction method for IT pressure ulcers that maintains patient mobility. This combination perforator-based fasciocutaneous and gracilis flap is a superior reconstructive option that has reduced donor site morbidity and relatively simple operative technique and can be reutilised in ulcer recurrence. Level of Evidence: Level V, therapeutic study.

Millions of children worldwide will not reach their potential in terms of education and development. However, it is widely known that investment in high-quality early childhood development (ECD) pays rich dividends throughout the lifespan of an individual, impacting their own lives, families, and communities in a positive way. Further evidence points to the importance of ECD in delivering the United Nations’ Sustainable Development Goals (SDGs). The multi-sectoral, integrated provision of ECD services is ideally placed to facilitate holistic positive change and enhance social cohesion in some of the most inequitable and vulnerable contexts. The LINKS project brings together an international network of researchers, who work in strategic partnership with United Nations Children’s Fund (UNICEF) and Early Years the Organisation for Young Children in Northern Ireland to support the development, implementation, and evaluation of ECD programs in low- and middle-income countries impacted by divisions and conflict. The project is designed to contribute to the international evidence base on ECD for social cohesion and sustaining peace to make a real difference in the lives of children, caregivers, and communities.

Adolescent depression is the fourth leading cause of illness and disability among young people globally (WHO, 2020). This is concerning, given the formative nature of adolescence: experiencing depr...

BACKGROUND Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey–36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. OBJECTIVE The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. METHODS Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke’s 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. RESULTS Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. CONCLUSIONS This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM.

The Australasian Students' Surgical Association (ASSA) is a not-for-profit, student-run organization supporting the 26 student surgical societies across Australia and New Zealand. It fosters interest in surgery through positive surgical experiences, insight into surgical careers and by developing technical and non-technical skills. Further background about the history and activities of ASSA are detailed elsewhere.1 The year 2020 has seen many societal challenges, notably the COVID-19 crisis, declared a pandemic by the World Health Organization on 11 March 2020.2 There have been significant downstream ramifications for medical students as learning opportunities in the operating theatre, at the bedside and in formal institutional settings become limited.3 In addition, travel restrictions and social distancing recommendations have led to the cancellation or postponement of many face-to-face courses and conferences.3 ASSA has responded to these changes to provide surgically inclined students with opportunities to learn about surgery, in turn serving as models of organizational adaptability in rapidly evolving times.

Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people's mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people's mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people's mental health in the future.

Protein C circulates in human plasma to regulate inflammation and coagulation. It has shown a crucial role in wound healing in animals, and low plasma levels predict the presence of a wound in diabetic patients. However, no detailed study has measured protein C levels in patients with severe burns over the course of a hospital admission. A severe burn is associated with dysfunction of inflammation and coagulation as well as a significant risk of morbidity and mortality. The current methods of burn assessment have shortcomings in reliability and have limited prognostic value. The discovery of a biomarker that estimates burn severity and predicts clinical events with greater accuracy than current methods may improve management, resource allocation and patient counseling. This is the first study to assess the potential role of protein C as a biomarker of burn severity. We measured the plasma protein C levels of 86 patients immediately following a severe burn, then every three days over the first three weeks of a hospital admission. We also analysed the relationships between burn characteristics, blood test results including plasma protein C levels and clinical events. We used a primary composite outcome of increased support utilisation defined as: a mean intravenous fluid administration volume of five litres or more per day over the first 72 h of admission, a length of stay in the intensive care unit of more than four days, or greater than four surgical procedures during admission. The hypothesis was that low protein C levels would be negatively associated with increased support utilisation. At presentation to hospital after a severe burn, the mean plasma protein C level was 76 ± 20% with a range of 34–130% compared to the normal range of 70–180%. The initial low can be plausibly explained by impaired synthesis, increased degradation and excessive consumption of protein C following a burn. Levels increased gradually over six days then remained at a steady-state until the end of the inpatient study period, day 21. A multivariable regression model (Nagelkerke’s R2 = 0.83) showed that the plasma protein C level on admission contributed the most to the ability of the model to predict increased support utilisation (OR = 0.825 (95% CI = 0.698-0.977), P = 0.025), followed by burn size (OR = 1.252 (95% CI = 1.025–1.530), P = 0.027), burn depth (partial thickness was used as the reference, full thickness OR = 80.499 (1.569–4129.248), P = 0.029), and neutrophil count on admission (OR = 1.532 (95% CI = 0.950–2.473), P = 0.08). Together, these four variables predicted increased support utilisation with 93.2% accuracy, 83.3% sensitivity and 97.6% specificity. However if protein C values were disregarded, only 49.5% of the variance was explained, with 82% accuracy, 63% sensitivity and 91.5% specificity. Thus, protein C may be a useful biomarker of burn severity and study replication will enable validation of these novel findings.

Background Educating doctors is expensive and poor performance by future graduates can literally cost lives. Whilst the practice of medicine is highly evidence based, medical education is much less so. Research on medical school selection, undergraduate progression, Fitness to Practise (FtP) and postgraduate careers has been hampered across the globe by the challenges of uniting the data required. This paper describes the creation, structure and access arrangements for the first UK-wide attempt to do so. Overview A collaborative approach has created a research database commencing with all entrants to UK medical schools in 2007 and 2008 (UKMED Phase 1). Here the content is outlined, governance arrangements considered, system access explained, and the potential implications of this new resource discussed. The data currently include achievements prior to medical school entry, admissions tests, graduation point information and also all subsequent data collected by the General Medical Council, including FtP, career progression, annual National Training Survey (NTS) responses, career choice and postgraduate exam performance data. UKMED has grown since the pilot phase with additional datasets; all subsequent years of students/trainees and stronger governance processes. The inclusion of future cohorts and additional information such as admissions scores or bespoke surveys or assessments is now being piloted. Thus, for instance, new scrutiny can be applied to selection techniques and the effectiveness of educational interventions. Data are available free of charge for approved studies from suitable research groups worldwide. Conclusion It is anticipated that UKMED will continue on a rolling basis. This has the potential to radically change the volume and types of research that can be envisaged and, therefore, to improve standards, facilitate workforce planning and support the regulation of medical education and training. This paper aspires to encourage proposals to utilise this exciting resource.

This essay examines five historic structures two mills, a library, a custom house and a retirement community that have been converted to serve as museums. Each case study looks at the building loca...

OBJECTIVE: This study examined the association between body mass index (BMI), physical activity and cardiorespiratory fitness levels on work performance with and without neck pain in habitual computer users. METHODS: Forty participants with and without neck pain were recruited and completed a battery of measures: body composition (BMI), physical activity levels (International Physical Activity Questionnaire), cardiorespiratory fitness (Chester Step Test) and work performance (Health and Work Performance Questionnaire). MAIN RESULTS: Body mass index, physical fitness and cardiorespiratory fitness were not significantly associated with the three domains of workplace performance; absenteeism, presenteeism and critical incidents. However, a significant association was found between neck disability and the incidence of headaches/migraines and fatigue/sleep disturbance. CONCLUSION: Mild neck pain in habitual computer users does not significantly influence work performance, although the association between the co-morbidities (headaches/migraine and fatigue/sleep disturbance) should be considered in those presenting for treatment with mild neck pain.

Understanding the impact of research on policy is a vital, and often overlooked, element of policy-making. A systematic literature review was conducted to examine methods for evaluating the impact of research on policy outcomes. The review focused in particular on strategic policy levels (rather than implementation) and waste, environment and pollution policy. The review draws on an international literature, although it is limited to English language publications. The findings identify the different methods used, the advantages and disadvantages of different approaches and the methods that are most effective (particularly in terms of cost). The field of research impact evaluation is currently experiencing rapid development, and there is scope to develop and apply new conceptual frameworks and innovative methods for evaluation, and to conduct and publish more research impact evaluations. Copyright , Beech Tree Publishing.

This article reports on the development and systematic evaluation of an innovative early years programme aimed at encouraging young children to respect differences within a deeply divided society that is emerging out of a prolonged period of violent conflict. The programme, the Media Initiative for Children—Northern Ireland, has been the product of a partnership between a US‐based organization (the Peace Initiatives Institute) and NIPPA—The Early Years Organisation, and has been supported by academic research and the efforts of a range of voluntary and statutory organizations. It has attempted to encourage young children to value diversity and be more inclusive of those who are different from themselves through the use of short cartoons designed for and broadcast on television as well as specially prepared curricular materials for use in pre‐school settings. To date the programme has been delivered through 200 settings to approximately 3500 pre‐school children across Northern Ireland. This article describ...

This cross-border action research project involved parents and communities in diverse rural communities on both sides of the border in identifying and addressing their childcare needs. Initiated as...

Siobhan Fitzpatrick and Paul O’Neill outline the changes to selection into the foundation programme for 2013