| 1. |
- Ness, A. R., et al.
(författare)
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Centralization of cleft care in the UK. Part 6 : a tale of two studies
- 2015
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Ingår i: Orthod Craniofac Res. - 1601-6343 (Electronic) 1601-6335 (Linking) ; 18 Suppl 2, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG). SETTING AND SAMPLE POPULATION: A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007. MATERIALS AND METHODS: We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies. RESULTS: We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure. CONCLUSIONS: Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
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| 2. |
- Persson, Martin, 1971-, et al.
(författare)
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A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate : the Cleft Care UK study. Part 1
- 2015
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Ingår i: Orthod Craniofac Res. - 1601-6343 (Electronic) 1601-6335 (Linking) ; 18 Suppl 2, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. SETTING AND SAMPLE POPULATION: This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. MATERIALS AND METHODS: Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. CONCLUSIONS: Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.
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| 3. |
- Sandy, J, et al.
(författare)
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Why are multi-centre clinical observational studies still so difficult to run?
- 2011
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Ingår i: British Dental Journal. - 0007-0610 .- 1476-5373. ; 211:2, s. 59-61
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Tidskriftsartikel (refereegranskat)abstract
- Despite the introduction of IRAS, obtaining R&D approvals for multicentre studies is a major rate limiting step. Our experience with cleft research demonstrates that this approvals process must be drastically and rapidly improved if we wish to continue attract clinical research to the UK.
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| 4. |
- Norman, A., et al.
(författare)
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The effectiveness of psychosocial intervention for individuals with cleft lip and/or palate
- 2015
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 52:3, s. 301-10
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this review was to assess the effectiveness of different psychological interventions for children and adults with cleft lip and/or palate and their parents. DESIGN: We searched six databases including MEDLINE and EMBASE to June 2013 and checked bibliographies. We included research that evaluated any psychological intervention in studies in which at least 90% of the participants had cleft lip and/or palate or were parents of those with cleft lip and/or palate. Studies containing less than 90% were excluded unless they reported results separately for those with cleft lip and/or palate, or raw data were available upon request from the authors. Inclusion assessment, data extraction, and risk of bias assessment were carried out independently by two reviewers. RESULTS: Seven studies were identified as inclusions, with only two studies being included in the full data analysis (one of which failed to meet the full inclusion criteria). The five remaining studies were included only in a narrative synthesis because data were available for people or parents of those with cleft lip and/or palate only. This highlights a distinct dearth of research into psychological intervention within the field of cleft lip and/or palate. CONCLUSIONS: The review found no evidence to support any specific intervention. Key uncertainties need to be identified and addressed. Adequately powered, methodologically rigorous randomized controlled trials are needed to provide a secure evidence base for psychological intervention techniques in participants with cleft lip and/or palate and their parents.
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| 5. |
- Waylen, A., et al.
(författare)
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Cleft Care UK study. Part 5 : child psychosocial outcomes and satisfaction with cleft services
- 2015
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Ingår i: Orthod Craniofac Res. - 1601-6343 (Electronic) 1601-6335 (Linking) ; 18 Suppl 2, s. 47-55
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe the impact of cleft service centralization on parental perceptions of child outcomes and satisfaction with care from the Cleft Care UK (CCUK) study and compare them to the Clinical Standards Advisory Group (CSAG) study that took place 15 years earlier. SETTING AND SAMPLE POPULATION: A subgroup of respondents from a UK multicentre cross-sectional study (CCUK) of 5-year-olds born with non-syndromic unilateral cleft lip and palate. MATERIALS AND METHODS: Data on parents' perceptions of child self-confidence and their satisfaction with treatment outcomes and service provision were collected via self-report questionnaires. Data were compared with findings from the 1998 CSAG study. RESULTS: Fewer parents in the CCUK study perceived their children as having poor self-confidence than in the 1998 CSAG study (8 and 19%, respectively). At least 81% of parents report satisfaction with the child's facial features after surgery and 98% report being satisfied with the care received. These results are similar to those reported in 1998. There is no evidence of an adverse impact on families' ability to attend appointments at the cleft clinic following centralization. Levels of reported problems (around 30%) with attendance were similar to those reported by CSAG. CONCLUSION: Centralization of cleft services appears to have improved parental perceptions of some child outcomes but has made little difference to already high levels of parental satisfaction with cleft care services. Centralization is not associated with an increase in the proportion of families who find it difficult to attend appointments.
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| 6. |
- Hughes, C, et al.
(författare)
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An evaluation of current services available for people diagnosed with head and neck cancer in the UK (2009-2010).
- 2012
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Ingår i: Clinical Oncology. - 0936-6555 .- 1433-2981. ; 24:10, s. e187-92
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To evaluate current care and service provision for people with head and neck cancer in the UK.MATERIALS AND METHODS: Self-report questionnaires for cancer networks, clinical leads of oncology units and leads for multidisciplinary teams (MDTs) were designed. These questionnaires were based on a previous survey. Questionnaires were sent out between 2009 and 2010.RESULTS: Questionnaires were received from all networks (n = 37), most oncology units (48 of 53) and most MDTs (51 of 63). Care for people with head and neck cancer is increasingly being provided by a centralised MDT. The membership of these teams varies; facilities available for team meetings are fit for purpose in most cases. MDTs are meeting frequently (weekly meetings in 96%) and discussing on average 18 cases at each meeting (95% confidence interval 15-21 cases). Most oncologists have access to all common anti-cancer drugs and most have access to all forms of radiotherapy. Intensity-modulated radiotherapy is not yet available in some oncology units (28%). A small number of units have only one oncologist (13%). Despite audit and research being part of the rationale for MDT working, regular discussion of morbidity and mortality is unusual (40%) and use of a database to record decisions is not universal. Only seven centres record decisions into the Data for Head and Neck Oncology database. Reported recruitment to studies is generally low (<2% of cases enrolled in studies in 62%).CONCLUSIONS: Head and neck cancer care is increasingly provided through a centralised MDT. Increased resources and further changes in practice are required to implement current National Health Service cancer policy. Teams need to improve recording of their decision-making, discuss morbidity and mortality and support recruitment to clinical studies.
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| 7. |
- Oteros-Rozas, Elisa, et al.
(författare)
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Participatory scenario planning in place-based social-ecological research : insights and experiences from 23 case studies
- 2015
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Ingår i: Ecology and Society. - 1708-3087. ; 20:4
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Tidskriftsartikel (refereegranskat)abstract
- Participatory scenario planning (PSP) is an increasingly popular tool in place-based environmental research for evaluating alternative futures of social-ecological systems. Although a range of guidelines on PSP methods are available in the scientific and grey literature, there is a need to reflect on existing practices and their appropriate application for different objectives and contexts at the local scale, as well as on their potential perceived outcomes. We contribute to theoretical and empirical frameworks by analyzing how and why researchers assess social-ecological systems using place-based PSP, hence facilitating the appropriate uptake of such scenario tools in the future. We analyzed 23 PSP case studies conducted by the authors in a wide range of social-ecological settings by exploring seven aspects: (1) the context; (2) the original motivations and objectives; (3) the methodological approach; (4) the process; (5) the content of the scenarios; (6) the outputs of the research; and (7) the monitoring and evaluation of the PSP process. This was complemented by a reflection on strengths and weaknesses of using PSP for the place-based social-ecological research. We conclude that the application of PSP, particularly when tailored to shared objectives between local people and researchers, has enriched environmental management and scientific research through building common understanding and fostering learning about future planning of social-ecological systems. However, PSP still requires greater systematic monitoring and evaluation to assess its impact on the promotion of collective action for transitions to sustainability and the adaptation to global environmental change and its challenges.
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| 8. |
- Sandy, J, et al.
(författare)
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Using service rationalisation to build a research network : lessons from the centralisation of UK services for children with cleft lip and palate
- 2012
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Ingår i: British Dental Journal. - 0007-0610 .- 1476-5373. ; 212:11, s. 553-5
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Tidskriftsartikel (refereegranskat)abstract
- In the UK around a thousand children are born annually with a cleft lip and/or palate that requires treatment. In the last decade services have been centralised in the UK reducing the 57 centres operating on these children in 1998, down to 11 centres or managed clinical networks in 2011. While the rationale for centralisation was to improve the standard of care (and in so doing the outcome) for children born with cleft lip and/or palate, research was central to this process. We illustrate how research informed and shaped this service rationalisation and how it facilitated the emergence of a research culture within the newly configured teams. We also describe how these changes in service provision were linked to the development of a national research strategy and to the identification of the resources necessary to support this strategy.
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| 9. |
- Scott, J. K., et al.
(författare)
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Centralization of services for children born with orofacial clefts in the United kingdom : a cross-sectional survey
- 2014
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 51:5, s. e102-9
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Tidskriftsartikel (refereegranskat)abstract
- Objective : To examine current provision of cleft lip and/or palate services in the U.K. and compliance with recommendations made by the Clinical Standards Advisory Group (CSAG) in 1998. Design : Cross-sectional questionnaire survey. Setting : All 11 services within the U.K. providing care for children born with a cleft lip and palate. Participants : Members from each healthcare specialty in each U.K. cleft team. Interventions : Self-administered postal questionnaires enquired about the provision of cleft services. Data were collected about the overall cleft service, team coordination, hearing, orthodontics, pediatric dentistry, primary cleft surgery, psychology, restorative dentistry, secondary surgery, specialist cleft nursing, and speech and language therapy. Results : Questionnaires were returned from members of 130/150 cleft teams (87%) and these showed that U.K. cleft services have been restructured to 11 centralized services with 17 primary operative sites and 61 peripheral sites. All services provide care through a multidisciplinary (MDT) model, but the composition of each team varies. Primary cleft surgery and orthodontics were the only specialties that were represented in all cleft teams. Specialties may be represented in a team but their attendance at MDT clinics is variable. Only one team met all of the CSAG recommendations. Conclusions : Our survey shows that cleft services have centralized over the last 10 years, and an MDT model of care has been adopted. Further research is needed to show how this has influenced outcomes and to see whether some models of centralized care are associated with better outcomes.
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| 10. |
- Scott, J. K., et al.
(författare)
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Perceptions of team members working in cleft services in the United Kingdom : a pilot study
- 2015
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Ingår i: Cleft Palate Craniofac J. - 1545-1569 (Electronic) 1055-6656 (Linking) ; 52:1, s. e1-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cleft care provision in the United Kingdom has been centralized over the past 15 years to improve outcomes for children born with cleft lip and palate. However, to date, there have been no investigations to examine how well these multidisciplinary teams are performing. METHODS: In this pilot study, a cross-sectional questionnaire surveyed members of all health care specialties working to provide cleft care in 11 services across the United Kingdom. Team members were asked to complete the Team Work Assessment (TWA) to investigate perceptions of team working in cleft services. The TWA comprises 55 items measuring seven constructs: team foundation, function, performance and skills, team climate and atmosphere, team leadership, and team identity; individual constructs were also aggregated to provide an overall TWA score. Items were measured using five-point Likert-type scales and were converted into percentage agreement for analysis. RESULTS: Responses were received from members of every cleft team. Ninety-nine of 138 cleft team questionnaires (71.7%) were returned and analyzed. The median (interquartile range) percentage of maximum possible score across teams was 75.5% (70.8, 88.2) for the sum of all items. Team performance and team identity were viewed most positively, with 82.0% (75.0, 88.2) and 88.4% (82.2, 91.4), respectively. Team foundation and leadership were viewed least positively with 79.0% (72.6, 84.6) and 76.6% (70.6, 85.4), respectively. CONCLUSIONS: Cleft team members perceive that their teams work well, but there are variations in response according to construct.
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