Open Access Books - Health Science - 2022

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Now showing 1 - 5 of 39
  • Publication
    KCNQ2- and KCNQ3- Associated Epilepsy
    ( 2022)
    Edited by Sarah Weckhuysen, Alfred L. George, Jr
    KCNQ2 and KCNQ3 encode subunits (KV7.2, KV7.3) that combine to form a voltage-gated potassium ion (K+) channel responsible for generating an ionic current (M-current) important for controlling activity in the nervous system. Pathogenic variants in both genes are associated with a spectrum of genetic neurological disorders that feature epilepsy of variable severity and can be accompanied by debilitating impaired neurodevelopment. These two genes were among the first discovered causes of monogenic epilepsy, and are frequently identified in persons with early-life epilepsy. This Element provides a comprehensive review of the clinical features, genetic basis, pathophysiology, pharmacology and treatment of these prototypical neurological disorders accompanied by perspectives shared by affected families and scientists who have made seminal contributions to the field
  • Publication
    The Positive Deviance Approach
    ( 2022)
    Ruth Baxter, Rebecca Lawton
    Positive deviance is an asset-based improvement approach. At its core is the belief that solutions to problems already exist within communities, and that identifying, understanding, and sharing these solutions enables improvements at scale. Originating in the field of international public health in the 1960s, positive deviance is now, with some adaptations, seeing growing application in healthcare. We present examples of how positive deviance has been used to support healthcare improvement. We draw on an emerging view of safety, known as Safety II, to explain why positive deviance has drawn the interest of researchers and improvers alike. In doing so, we identify a set of fundamental values associated with the positive deviance approach and consider how far they align with current use. Throughout, we consider the untapped potential of the approach, reflect on its limitations, and offer insights into the possible challenges of using it in practice.
  • Publication
    Collaboration-Based Approaches
    ( 2022)
    Graham Martin, Mary Dixon-Woods
    Collaboration-based approaches to healthcare improvement attract much attention. They involve networks of people coming together to cooperate around a common interest, with shared goals of improving care and mutual learning. Longstanding examples of collaborative approaches have been associated with some success in improving outcomes and reducing harm. The evidence for their effectiveness and cost-effectiveness, however, remains inconsistent and contingent on the circumstances in which they are deployed and how they are used for what purpose. Several models for collaboration have been developed, varying in structure, format, and balance between internal leadership and external control. The authors focus on two approaches: quality improvement collaboratives and communities of practice. They explore evidence of their impact on health outcomes, and evidence about how best to organise and implement collaboration-based approaches. Using examples of more and less successful collaborations, they offer guidance on the key challenges involved in using collaboration-based approaches to improve healthcare.
  • Publication
    Co-Producing and Co-Designing
    ( 2022)
    Glenn Robert, Louise Locock, Oli Williams, Jocelyn Cornwell, Sara Donetto, Joanna Goodrich
    Many healthcare improvement approaches originated in manufacturing, where end users are framed as consumers. But in healthcare, greater recognition of the complexity of relationships between patients, staff, and services (beyond a provider-consumer exchange) is generating new insights and approaches to healthcare improvement informed directly by patient and staff experience. Co-production sees patients as active contributors to their own health and explores how interactions with staff and services can best be supported. Co-design is a related but distinct creative process, where patients and staff work in partnership to improve services or develop interventions. Both approaches are promoted for their technocratic benefits (better experiences, more effective and safer services) and democratic rationales (enabling inclusivity and equity), but the evidence base remains limited. This Element explores the origins of co-production and co-design, the development of approaches in healthcare, and associated challenges; in reviewing the evidence, it highlights the implications for practice and research.
  • Publication
    Making Culture Change Happen
    ( 2022)
    Russell Mannion
    Healthcare policy frequently invokes notions of cultural change as a means of achieving improvement and good-quality care. This Element unpacks what is meant by organisational culture and explores the evidence for linking culture to healthcare quality and performance. It considers the origins of interest in managing culture within healthcare, conceptual frameworks for understanding culture change, and approaches and tools for measuring the impact of culture on quality and performance. It considers potential facilitators of successful culture change and looks forward towards an emerging research agenda. As the evidence base to support culture change is rather thin, a more realistic assessment of the task of cultural transformation in healthcare is warranted. Simplistic attempts to manage or engineer culture change from above are unlikely to bear fruit; rather, efforts should be sensitive to the complexity and highly stratified nature of culture in an organisation as vast and diffuse as the NHS.