Healthcare organization policy recommendations for the governance of surgical innovation: review of NHS policies.

BACKGROUND: The governance for introducing innovative surgical procedures/devices differs from the research requirements needed for new drugs. New invasive procedures/devices may be offered to patients outside of research protocols with local organization oversight alone. Such institutional arrangements exist in many countries and written policies provide guidance for their use, but little is known about their scope or standards. METHODS: One hundred and fifty acute NHS trusts in England and seven health boards in Wales were systematically approached for information about their policies. A modified framework approach was used to analyse when policies considered new procedures/devices to be within local organization remit and/or requiring research ethics committee (REC) approval. RESULTS: Of 113 policies obtained, 109 and 34 described when local organization and REC approval was required, respectively. Procedures/devices being used for the first time in the organization (n = 69) or by a clinician (n = 67) were commonly within local remit, and only 36 stated that evidence was required. Others stated limited evidence as a rationale for needing REC approval (n = 13). External guidance categorizing procedures as 'research only' was the most common reason for gaining REC approval (n = 15). Procedures/devices with uncertain outcomes (n = 28), requiring additional training (n = 26), and not previously used (n = 6) were within the remit of policies, while others recommended REC application in these situations (n = 5, 2 and 7, respectively). CONCLUSION: This study on NHS policies for surgical innovation shows variability in the introduction of procedures/devices in terms of local oversight and/or need for REC approval. Current NHS standards allow untested innovations to occur without the safety of research oversight and thus a standard approach is urgently needed.

The behavioural and social sciences as hidden curriculum in UK dental education: A qualitative study.

INTRODUCTION: The behavioural and social sciences (BeSS) are an integral part of dental curricula, helping students become holistic, patient-centred practitioners. Nevertheless, UK studies document that dental undergraduates struggle to see the relevance of BeSS to their training. Using the concept of hidden curriculum, this study explored dental students’ perceptions of and attitudes towards BeSS in one dental school in the UK. MATERIAL AND METHODS: Six focus groups were conducted with 37 dental students from years 1 to 5. Thematic analysis was conducted revealing five themes: student attitudes towards BeSS, teaching culture, learning culture, curricular issues and student culture. RESULTS: Many students recognised how BeSS contributed to their communication and patient management skills. Nevertheless, the study revealed a dental student cohort who have a strained relationship with BeSS. This negative attitude became more apparent from year 3 onwards, when the clinical phase of studies begins. It was perpetuated and legitimated by the existence of a strong student culture that openly critiqued BeSS among and between student year groups. DISCUSSION AND CONCLUSION(S): In UK dental education there is a hidden curriculum related to BeSS. By underestimating the utility of BeSS, students are failing to recognise the biopsychosocial dimensions relevant to oral health and dental practice. All UK dental schools should review their relationship with BeSS and assess whether they are perpetuating a hidden curriculum about BeSS within their curricula.

Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative study in primary care.

BACKGROUND: Physical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression. AIM: To explore engagement with an e-cycling intervention conducted with adults with T2DM. DESIGN & SETTING: Prospective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care. METHOD: Interviews were conducted with 20 individuals with T2DM (42-70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken. RESULTS: Participants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA. CONCLUSION: E-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.