How current law and policy supports providers of NHS healthcare in England to respond to patient harm: A scoping review protocol.

INTRODUCTION: Harm arising from National Health Service (NHS) healthcare results in significant human cost for the patient, those who care for them, and the medical staff involved. Furthermore, patient harm results in substantial financial costs to the public purse. Improving how NHS providers in England respond to patient harm could reduce the number of claims for clinical negligence brought against NHS. Doing so will ensure those affected receive the justice they deserve and protect the public purse. Law and policy are key to supporting providers of NHS healthcare to respond to patient harm but are not necessarily understood and therefore can be challenging to apply to practice. Research exploring how law and policy supports this understanding is limited. The purpose of this scoping review is to address this knowledge gap and improve understanding by critically evaluating how law and policy supports providers of NHS healthcare in England to respond to patient harm. METHODS AND ANALYSIS: The review will use the methodological framework proposed by Arskey and O'Malley, Levac et al and the Joanna Briggs Institute. Search strategies will be developed using selected key words and index terms. MEDLINE, CINAHL, and Westlaw and reference lists of relevant publications will be searched to identify relevant grey literature. Two reviewers will independently assess the extracted data against the eligibility criteria. All studies identified will be charted and the results presented as a narrative synthesis.

The lived experiences of UK physiotherapists involved in Cauda Equina Syndrome litigation. A qualitative study.

BACKGROUND: Cauda Equina Syndrome is a serious spinal pathology, which can have life changing physical and psychological consequences and is highly litigious. Litigation can have negative personal and professional effects on the healthcare professionals cited in a clinical negligence claim. There is an absence of research looking at the experience of the physiotherapist and as such, it is unknown the impact litigation is having on them. This study explored the lived experiences of UK physiotherapists in relation to Cauda Equina Syndrome litigation. METHODS: A qualitative design, informed by Gadamerian hermeneutic phenomenology, using semi-structured interviews was used to explore participants' lived experiences of litigation. Interviews were audio-recorded and transcribed verbatim. Findings were analysed using an inductive thematic analysis framework. Nvivo software was used to facilitate analysis. The study is reported in accordance with the consolidated criteria for reporting qualitative (COREQ) research. RESULTS: 40 interviews took place online or over the phone, with physiotherapists and stakeholders. Four themes were found; 'litigation effects', 'it feels personal', 'learning from litigation' and 'support and training'. CONCLUSION: This is the first study to investigate the lived experiences of litigation in UK physiotherapists. Involvement in clinical negligence affected physiotherapists' physical and mental wellbeing and impacted their clinical practice. Most physiotherapists felt litigation was a personal attack on them and their ability to do their job. Physiotherapists highlighted perceptions of a 'blame culture' and perceived stigma associated with the claim, which often led to a lack of sharing and learning from litigation. Physiotherapists emphasised the need for emotional support for those going through a legal claim and that training was needed to understand the process of litigation and range of potential outcomes.

Medico-legal litigation of UK physiotherapists in relation to cauda equina syndrome: a multimethods study.

OBJECTIVE: The aim was to investigate the extent of cauda equina syndrome (CES) litigation and explore the process of medico-legal litigation in relation to physiotherapy in the UK. DESIGN: A multimethods inquiry that followed on from a previously conducted scoping literature review was undertaken to address the aim. This included freedom of information requests and direct communication with relevant stakeholders and organisations. RESULTS: A total of 2496 CES claims were found in the UK between 2012 and 2020. 51 of these were attributed to physiotherapists. There was little information available to physiotherapists regarding the legal process of litigation and much of this information was not from a physiotherapist's perspective. CONCLUSION: This is the first study that has investigated the extent and process of CES litigation in physiotherapy in the UK. The extent of CES litigation appears to be high considering CES is a rare spinal condition. Furthermore, the extent of CES litigation is suspected to be considerably higher than the data reported in this study due to the issues identified in how CES claims are recorded. Finally, there is no clearly articulated, easily accessible information describing the process and support available for physiotherapists in receipt of a legal claim.

Defensive medicine: A symptom of uncertainty?

Defensive medicine is a well-documented phenomenon and refers to the practice of over-cautious management of patients, leading to excessive clinical activity such as over-investigation, unnecessary appointments and additional interventions. Adopting this approach is not in the best interest of patients and can lead to clinical reasoning being replaced by lists, guidelines and algorithms which do not consider the complexity of a patients presentation or the reasoning inherent in good clinical judgement. The drivers of defensive medicine are varied and include a high level of uncertainty alongside other factors including clinical experience with past cases, system pressures and patient expectations. This paper explores these drivers and considers strategies on how best to avoid a defensive medicine approach. It reinforces the need to adopt a patient centred focus and use sound clinical reasoning to support the management of patients.

A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists.

INTRODUCTION: Cauda equina syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially devastating effects. There is a high number of litigation cases linked with CES given it is a relatively rare condition. This scoping review protocol proposes to explore the extent and process of CES litigation in UK healthcare context cases amongst UK physiotherapists. METHODS AND ANALYSIS: The methodological framework recommended by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute will be used throughout this review to aid reporting and transparency. A patient and public involvement (PPI) group meeting was convened at the beginning of the review process in order to provide knowledge exchange to inform the search strategy and propose resources to be used during the scoping review. Two reviewers will independently review the literature in order to apply the inclusion and exclusion criteria. Once the studies to be included have been identified, the data from these studies will be extracted and charted. Results will show quantitative data of the studies included in the review and a narrative synthesis of the literature. DISSEMINATION: This scoping review will evaluate the existing knowledge relating to CES and litigation and will map the key concepts around this topic. Results will be disseminated to practitioners and policy-makers through peer-reviewed publications, conferences, reports and social media. This method may prove helpful to others who are investigating extent and processes relating to medicolegal cases involving healthcare practitioners. REGISTRATION: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/MP6Y3).

A scoping review: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists.

INTRODUCTION: Cauda Equina Syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially life changing devastating effects. This paper reviews the extent and process of CES litigation amongst UK physiotherapists. METHODS: A well-established framework by Arksey and O'Malley was followed when completing the current scoping review. Records were identified via a comprehensive search of three databases as well as website and grey literature searching. Data was extracted and a descriptive analysis and thematic summary were formed. RESULTS AND DISCUSSION: A total of N = 1639 records were identified, following removal of duplicates and screening of titles and abstracts N = 211 full text records were screened and N = 39 were included for full analysis. CONCLUSIONS: This study is the first to investigate the extent and process of CES litigation for physiotherapists in the UK. Our data suggest that between 2009 and 2021 there were 15 CES claims recorded against physiotherapists which is 0.7% of all CES claims recorded in the UK. In terms of the legal process for CES claims, there is currently limited information for physiotherapists and what steps they would need to take once they receive notification they are being sued. REGISTRATION: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/6FCXN).

Inside ILSI: How Coca-Cola, Working through Its Scientific Nonprofit, Created a Global Science of Exercise for Obesity and Got It Embedded in Chinese Policy (1995-2015).

CONTEXT: Industry influence on health science and policy is a critical issue of our day. In 2015 the New York Times revealed that Coca-Cola paid scientists to form a Global Energy Balance Network promoting the notion that exercise, not dietary restraint, is the solution to the obesity epidemic-a claim few accept. This article examines the organizational dynamics and policy process behind Coke's efforts to sway obesity policy-globally and in China, a critical market-during 1995-2015. METHODS: In-depth, qualitative research during 2013-18 involved 10 weeks of fieldwork in Beijing, interviews with 25 leading experts, analysis of newsletters documenting all major obesity-related activities in China, interviews with 10 Euro-American experts, and extensive internet research on all major actors. FINDINGS: This article tells two intertwined stories (institutional dynamics, science making and policy making) at global and local-Chinese levels. Coke succeeded in redirecting China's obesity science and policy to emphasize physical activity. Key to its success was the industry-funded global nonprofit International Life Sciences Institute (ILSI). Beneath ILSI's public narrative of unbiased science and no policy advocacy lay a maze of hidden channels companies used to advance their interests. Working through those channels, Coca-Cola influenced China's science making and policy making during every phase in the policy process, from framing the issues to drafting official policy. CONCLUSIONS: Though China is exceptional, ILSI promoted exercise globally, suggesting potentially significant impacts in other ILSI-branch countries.

International Framework for Red Flags for Potential Serious Spinal Pathologies.

SYNOPSIS: The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) led the development of a framework to help clinicians assess and manage people who may have serious spinal pathology. While rare, serious spinal pathology can have devastating and life-changing or life-limiting consequences, and must be identified early and managed appropriately. Red flags (signs and symptoms that might raise suspicion of serious spinal pathology) have historically been used by clinicians to identify serious spinal pathology. Currently, there is an absence of high-quality evidence for the diagnostic accuracy of most red flags. This framework is intended to provide a clinical-reasoning pathway to clarify the role of red flags. J Orthop Sports Phys Ther 2020;50(7):350-372. Epub 21 May 2020. doi:10.2519/jospt.2020.9971.

SHADES of grey - The challenge of 'grumbling' cauda equina symptoms in older adults with lumbar spinal stenosis.

Diagnosing cauda equina syndrome is challenging in older adults with lumbar spinal stenosis. Understanding these challenges is vital for clinicians who are faced with difficult decisions about when to refer for investigation or surgical management. This is a growing clinical issue because of the escalating prevalence of lumbar spinal stenosis in our ageing population, and increasing demands on healthcare services including imaging and surgical services. This professional issue explores the challenges and evidence gaps relating to cauda equina syndrome in older adults with lumbar spinal stenosis. The degenerative patho-anatomical changes in the lumbar spine that are responsible for lumbar spinal stenosis also have the potential to lead to a gradual compromise of the cauda equina nerve roots. The clinical presentation may be unclear. As a result, there is a risk that slow-onset 'grumbling' cauda equina symptoms may be overlooked or dismissed in older patients with lumbar spinal stenosis. Furthermore, a lack of standardised diagnostic criteria and management pathways add to the challenges for clinicians diagnosing and managing potential cauda equina compromise associated with lumbar spinal stenosis. We recommend careful assessment, appropriate safety netting, and ongoing clinical monitoring and vigilance when assessing and managing this potentially vulnerable patient group.

Science and Serendipity: Finding Coca-Cola in China.

Four years of wide-ranging anthropological research yielded a surprising discovery: the Coca-Cola Company, working through an industry-funded scientific nonprofit, had quietly reshaped China's obesity science and policy to align with Coke's position that exercise, not food and drink, is what matters-a view few experts accept. Hoping to get the results to the key audiences, the author submitted a capstone article to a series of high-impact medical journals that was repeatedly rejected. Eventually the article was published in a top journal, but not as "scientific research." This prompted reflection on the differences between the methods of anthropology and medical science. Anthropological research is distinguished by methodological openness, serendipity, narrative sense-making, and personalism. It is personalistic in that the body is a research tool, and a solo researcher at the center acts as data clearinghouse and marshals regional expertise to show how things make cultural sense. Using the Coke-in-China research, this article illustrates how this systematic yet self-consciously subjective approach was effective in breaching the walls of industry science and uncovering the social ties and institutional mechanisms that allowed corporate schemes to remain hidden while gaining such power. The author encourages readers in medicine and public health to think about the complex, human process by which they reach their own conclusions. A better understanding of how each science is human in its own way might open up space for greater dialogue and even more collaborative knowledge-making at the crossroads of anthropology and the health sciences.

Soda industry influence on obesity science and policy in China.

Soda industry efforts to manipulate obesity science and policy in the US are well documented, yet little is known about whether the industry has pursued similar efforts abroad. In-depth research in China-analyses of interviews with prominent Chinese obesity experts, and of trends in obesity-related activities documented in newsletters of China's lead organization on obesity, a branch of the International Life Sciences Institute (ILSI), a US-based, corporate-funded, global nonprofit strongly influenced by the Coca-Cola Company-showed that from 1999 to 2015, China's obesity science and policy shifted markedly toward physical activity as Coca-Cola's influence in China increased. This shift aligned with Coca-Cola's message that it is activity, not diet, that matters-a claim few public health scholars accept. These changes correlated with the growing importance of Coca-Cola's funding, ideas, and affiliated researchers via ILSI-China. In putting its massive resources behind only one side of the science, and with no other parties sufficiently resourced to champion more balanced solutions that included regulation of the food industry, the company, working through ILSI, re-directed China's chronic disease science, potentially compromising the public's health.

Neoliberal science, Chinese style: Making and managing the 'obesity epidemic'.

Science and Technology Studies has seen a growing interest in the commercialization of science. In this article, I track the role of corporations in the construction of the obesity epidemic, deemed one of the major public health threats of the century. Focusing on China, a rising superpower in the midst of rampant, state-directed neoliberalization, I unravel the process, mechanisms, and broad effects of the corporate invention of an obesity epidemic. Largely hidden from view, Western firms were central actors at every stage in the creation, definition, and governmental management of obesity as a Chinese disease. Two industry-funded global health entities and the exploitation of personal ties enabled actors to nudge the development of obesity science and policy along lines beneficial to large firms, while obscuring the nudging. From Big Pharma to Big Food and Big Soda, transnational companies have been profiting from the 'epidemic of Chinese obesity', while doing little to effectively treat or prevent it. The China case suggests how obesity might have been constituted an 'epidemic threat' in other parts of the world and underscores the need for global frameworks to guide the study of neoliberal science and policymaking.

Disordered Eating/Eating Disorder: Hidden Perils of the Nation's Fight against Fat.

The nation's fight against fat has not reduced obesity, but it has had other worrying effects. Mental health researchers have raised the possibility that the intense pressures to lose weight have heightened the risks of developing eating disorders, especially among the young. Medical anthropology can help connect the dots between the war on fat and disordered eating, identifying specific mechanisms, pathways, and contextual forces that may lie beyond the scope of biomedical and psychiatric research. This article develops a biocitizenship approach that focuses on the pathologization of heaviness, the necessity of having a thin, fit body to belonging to the category of worthy citizen, and the work of pervasive fat-talk in defining who can belong. Ethnographic narratives from California illuminate the dynamics in individual lives, while lending powerful support to the idea that the battle against fat is worsening disordered eating and eating disorders among vulnerable young people.

Why do patients with Simple Mechanical Back Pain seek Urgent Care?

OBJECTIVE: To explore why patients with simple mechanical back pain seek urgent care. DESIGN: Qualitative Exploratory Inquiry based on the principles of Grounded Theory. SETTING: Urgent Care. METHODS: Data collection by semi-structured interview. PARTICIPANTS: Eleven patients presenting to urgent care (Accident and emergency, Walk-in Centre and Out of hours service) with back pain. RESULTS: The study identified eight key motivators of patients with mechanical back pain seeking urgent care: (1) GP access, (2) Pain, (3) Function, (4) Something being different, (5) Something being wrong, (6) Desire for investigation, (7) Third Party Influence and (8) Repeat visits. CONCLUSION: This study provides some evidence to support the notion that patients are willing to use primary care services for the treatment of Simple Mechanical Back Pain but that access is frequently limited and untimely. The study concludes that inappropriate attendances at urgent care facilities are frequently a human response to perception of pain severity which is reinforced by functional loss, uncertainty, the need to provide care for others and the encouragement of others. While it is asserted that there is a clear need for mass education in this area, it is also speculated that attendance at urgent care may occur to overtly escalate the need for assistance and illustrate to sceptical significant others the severity of the condition.