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Re-inventing the book : challenges from the past for the publishing industryBook Review: Re-inventing the book: challenges from the past for the publishing industry, C. Banou.
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The end of wisdom? The future of libraries in the digital ageBook Review: The end of wisdom? The future of libraries in the digital age, D. Baker and W. Evans (eds).
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The National Joint Registry Data Quality Audit of elbow arthroplastyAims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow. Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them. Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties. Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research.
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Are e-cigarettes a safer alternative to smoking?Smokers appear to be using electronic cigarettes in attempts to quit but the products are currently unregulated. This article explores evidence regarding electronic nicotine delivery devices--usually known as e-cigarettes--and how this relates to clinical practice. It also discusses secondary care smoking cessation services in the light of NICE guidance.
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Measuring the impact of information skills training : a survey of health libraries in EnglandBackground: The lack of robust research measuring the impact of NHS based information skills training prompted the West Midlands Regional Trainers' Forum to conduct a post-training survey. Methods: This is a multi-centred study which collected data from over 60 separate organisations. Survey questionnaires were completed by learners a few weeks after the training event. Results: Five hundred and thirty-four responses were received. 82% of information skills training recipients indicated that they had implemented learning or changed practice as a result of the training. 70% of recipients indicated there had been an impact on patient care. Discussion: The beneficial results from information skills training manifest in a multitude of ways. The results of this study indicate that the learning from information skills training is being used to reduce problems and address the key issues in modern health care. Conclusion: The results clearly demonstrate the value of information skills training and its beneficial impact on patient care, lifelong learning and other key NHS functions. This study shows information skills training as an important activity which supports the information literacy agenda, and has a positive impact across the four key functions of library and knowledge services within the NHS.
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Developing a generic tool to routinely measure the impact of health librariesBackground: Health libraries contribute to many activities of a health care organisation. Impact assessment needs to capture that range of contributions. Objectives: To develop and pilot a generic impact questionnaire that: (1) could be used routinely across all English NHS libraries; (2) built on previous impact surveys; and (3) was reliable and robust. Methods: This collaborative project involved: (1) literature search; (2) analysis of current best practice and baseline survey of use of current tools and requirements; (3) drafting and piloting the questionnaire; and (4) analysis of the results, revision and plans for roll out. Findings: The framework selected was the International Standard Methods And Procedures For Assessing The Impact Of Libraries (ISO 16439). The baseline survey (n = 136 library managers) showed that existing tools were not used, and impact assessment was variable. The generic questionnaire developed used a Critical Incident Technique. Analysis of the findings (n = 214 health staff and students), plus comparisons with previous impact studies indicated that the questionnaire should capture the impact for all types of health libraries. Conclusions: The collaborative project successfully piloted a generic impact questionnaire that, subject to further validation, should apply to many types of health library and information services.
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Health-care process improvement decisions : a systems perspectivePurpose: The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. Design/methodology/approach: A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. Findings: The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. Practical implications: Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. Originality/value: Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.
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Why do patients volunteer to take part in medical student final examinations, what is their experience like and how can their experience be improved?Medical education relies on volunteer patients to allow students to demonstrate competency in examinations however literature regarding volunteers’ involvement in final exams is lacking. This research investigated motivations of volunteers, explored their experiences, sought to understand which factors facilitated a good experience, and led to changes where needed to ensure continued engagement. Research participants were patient volunteers at final examinations in one Hospital. Methods included questionnaires a year apart and semi-structured focus groups in stage 1. Questionnaire response were 67% stage 1, 63% in stage 2, and 20% of participants attended focus groups. Questionnaire responses were generally positive with several improvements suggested e.g., adding extra information to leaflets and ensuring the volunteers role was made more explicit and focus groups added the volunteer’s perspective. Improvements were addressed before the questionnaire was administered in stage 2. Thematic content analysis of focus group data demonstrated inconsistency in examiners behaviour and perceived variation in instructions, which were addressed in examiner briefing the following year. Results in stage two suggested improvements had been successful. Volunteers were motivated to take part in exams to ensure the patient’s perspective is given; give back to the NHS and help future doctors. Practice points are suggested for consideration.
