Steering Groups Research Articles

Luton, a Marmot town – using a whole-system approach to tackle health equity

Abstract Issue Luton has high deprivation and health inequalities. We have a borough-wide vision that no one should live in poverty by 2040, and have become a health equity town - committed to Marmot policy objectives and recommendations across all we do. Description Luton is 70th most deprived local authority in England, with stark health inequalities. To deliver the 2040 ambition, 5 pillars have been established, including tackling health inequalities. Luton has become the first Marmot Town in the UK, working with the Institute of Health Equity to develop recommendations and actions relating to the Marmot Policy objectives. Cross-sector system partnership has been key -NHS, businesses, housing, voluntary sector, university. Year 1: we mapped the Marmot recommendations to existing workstreams; completed a mixed-methods evaluation to understand system views of the approach and establish our impact measures. We established steering groups: Children and young people; Housing; Employment and skills; Net zero, they continue to embed recommendations using logic models. We have an overarching strategic approach, alongside smaller scale programmes, to create a movement. Including: grant funding; regular newsletter; training; case studies repository and annual celebration event. Results We have established 15 impact measures across Marmot policy areas to review annually. Qualitative evaluation findings built into work plans include: improved governance and accountability; workforce development across the system; use of logic models; Learning from best practice; sharing knowledge and learning. Lessons The wider agenda of Luton 2040 has enabled health inequalities to be embedded into strategic discussions; improved evidence base and clear narrative to support priorities is helpful; clear focused recommendations helps move work forwards; shared understanding of how we will measure long term impact is vital, communicating to the system is key, and long-term ism challenging. Speakers/Panelists Lee Watson East of England Public Health Training Programme, Luton, UK Ramya Ravindrane East of England Public Health Training Programme, Luton, UK Chimeme Egbutah Luton Borough Council, Luton, UK Nasreen Ali University of Bedfordshire, Luton, UK

Building sustainable capacity to adopt, adapt or develop child health guidelines, Malawi, Nigeria and South Africa.

Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.

Improving tobacco cessation interventions in hospitals: Pre-post evaluation of an innovative health systems intervention in Catalonia (Spain).

This study measured changes in healthcare professionals' (HCPs) performance in tobacco cessation intervention before and 6 months after a health system intervention. The intervention involved exposure to online training for staff and the implementation of a structured organizational change-level practice model that included some strategies, comprising establishing tobacco cessation steering groups with champions in each hospital, developing tailored protocols and guidelines within each organization, conducting on-site workshops for clinicians, and creating posters and pocket materials summarizing the intervention. Pre-post evaluation in four hospitals in Barcelona province (Catalonia, Spain). We assessed the knowledge, attitudes, behaviors, and organizational factors (KABO) and the performance of each of the components of the 5As Model for Treating Tobacco Use according to a scale from 0 ("Never") to 10 ("Always") among HCPs. We performed Wilcoxon signed-rank tests for paired samples and assessed changes in performance by performing linear regression. A total of 255 HCPs completed the pre-post evaluation. All components of the 5As Model increased, with "Assist" and "Arrange a follow-up" showing the greatest improvement. Several KABO dimensions significantly increased, including individual skills (mean score: 3.3-5.7, P < .001), attitudes and beliefs (4.8-5.4, P < .001), individual commitment (5.9-6.6, P < .001), and perception of having positive organizational support (4.3-4.7, P < .001). An increase in each point in individual skills and support of the organization was associated with increased rates of 5As delivery, with the greatest associations found for "Assist" (0.60 and 0.17, respectively) and "Arrange a follow-up" (0.71 and 0.18, respectively). The intervention was successful in increasing HCPs individual skills, attitudes and beliefs, individual commitment, and perception of having positive organizational support and the performance of all components of the 5As. Future research should focus on strategies that promote organizational support, a dimension that is essential to increasing Assist and Arrange, which were less implemented at baseline.

The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives.

Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision. The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities. Qualitative descriptive. Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected. Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop. Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions. Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace. This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care. The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed. Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria

BackgroundSub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach.MethodsWe followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed.ResultsBased on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.ConclusionsThrough dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

The use of injectable orthobiologics for knee osteoarthritis: A European ESSKA-ORBIT consensus. Part 1-Blood-derived products (platelet-rich plasma).

The aim of this European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus is to provide recommendations based on evidence and expert opinion to improve indications, decision-makingand administration-related aspects when using blood-derived orthobiologics (for simplicity indicated as PRP-platelet-rich plasma-with PRP being the most common product) for the management of knee osteoarthritis (OA). Leading European expert clinicians and scientists were divided into a steering group, a rating group and a peer review group. The steering group prepared 28 question-statement sets divided into three sections: PRP rationale and indications, PRP preparation and characterisationand PRP protocol. The quality of the statements received grades of recommendation ranging from A (high-level scientific support)to B (scientific presumption), C (low-level scientific support) or D (expert opinion). The question-statement sets were then evaluated by the rating group, and the statements scored from 1 to 9 based on their degree of agreement with the statements produced by the steering group. Once a general consensus was reached between the steering and rating groups, the document was submitted to the peer review group who evaluated the geographic adaptability and approved the document. A final combined meeting of all the members of the consensus was held to produce the official document. The literature review on the use of blood-derived products for knee OA revealed that 9 of 28 questions/statements had the support of high-level scientific literature, while the other 19 were supported by a medium-low scientific quality. Three of the 28 recommendations were grade A recommendations: (1) There is enough preclinical and clinical evidence to support the use of PRP in knee OA. This recommendation was considered appropriate with a strong agreement (mean: 8). (2) Clinical evidence has shown the effectiveness of PRP in patients for mild to moderate degrees of knee OA (KL ≤ 3). This recommendation was considered appropriate with a strong agreement (mean: 8.1). (3) PRP injections have been shown to provide a longer effect in comparison to the short-term effect of CS injections. They also seem to provide a safer use profile with less potential related complications. This recommendation was considered appropriate with a very strong agreement (mean: 8.7). Six statements were grade B recommendations, 7 were grade C and 12 were grade D. The mean rating score was 8.2 ± 0.3. The consensus group reached a high level of agreement on all the questions/statements despite the lack of clear evidence for some questions. According to the results from this consensus group, given the large body of existing literature and expert opinions, PRP was regarded as a valid treatment option for knee OAand as a possible first-line injectable treatment option for nonoperative management of knee OA, mainly for KL grades 1-3. Level II.

The COVID guidelines India project: A rapid living evidence synthesis during a pandemic in a LMIC setting

BackgroundCOVID-19 has had an unprecedented impact worldwide. Evidence for management interventions emerged rapidly but was difficult for clinicians and others to assess and decide how to use. Our team in India set up a national and international collaboration preparing guidance in real time to help guide clinical practice in the country during a pandemic setting. We describe our methods and the product in this paper. MethodsSpecialized groups comprising core, steering, methodology, evidence synthesis, dissemination and intervention expert working groups were formed. A Cochrane Rapid Review approach was used for prioritized questions in areas of clinical equipoise in management of COVID-19. GRADE methodology was incorporated into this process and expert working groups tailored guidelines for India using the WHO Evidence to Decision framework. This was then disseminated on a widely accessible platform: indiacovidguidelines.org. A questionnaire was then used to obtain end-user feedback on the guidelines. ResultsSince May 2021, a total of 20 guidelines have been developed spanning pharmacological, respiratory and other supportive interventions for management of COVID-19, with over 83,600 unique page views up to December 2023. Results from a pilot survey suggest usefulness of the guidelines, but also highlighted areas for improvement. A key output was adoption of our anticoagulation recommendation in state level COVID-19 guidelines (Kerala, India). National and institutional capacity for evidence synthesis and guidelines was strengthened. ConclusionsThe COVID Guidelines India project successfully developed contextually relevant, nationally applicable, evidence-based guidelines in a timely manner, and disseminated these freely through a dedicated website while successfully building capacity amongst Indian clinicians for evidence-based guideline development. Throughout the ongoing COVID Guidelines India project, the team has maintained a 'living' approach, continuously updating and refining recommendations in response to emerging evidence during the ever-evolving pandemic landscape.

Hearing the Older Adults and Caregivers Voice in Medication Optimization Initiatives

AbstractBackgroundEngaging older adults, caregivers and family is necessary to produce relevant and meaningful evidence. Patient‐centered‐outcomes research (PCOR) engages these individuals as research partners. For instance, the process of shared decision‐making about deprescribing (reducing or stopping potentially inappropriate medications) between people living with dementia and their carers (consumers), and clinicians, is complex.MethodVarious tactics were employed by the Elder Care Medicine Network (ECMN) and stakeholder steering groups from USA and Australia. These initiatives describes efforts to increase capacity of local communities – older adults, their caregivers, healthcare providers and researchers – to participate in medication related PCOR as well as the development of a tool (PRIME) to help with deprescribing medications for individuals with dementia.ResultThere are over 120 active participants in the ECMN. After they shared their PCOR training needs, trainings were held as Discussion sessions where Council members and network participants shared their medication experiences and talked about participating on a PCOR research team. Network participants also identified what they felt were meaningful research questions on medication‐related PCOR (video). Additionally the PRIME tool was developed via an iterative process utilizing one‐to‐one semi‐structured interviews and a focus group session with 39 participants (people living with dementia, carers, and clinicians) to determine the usability and comprehensibility of the PRIME tool. Iterative changes were made to improve the content and layout of the tool.ConclusionThese two initiatives illustrate the importance of co‐design and incorporating the older adults and caregivers voice in medication optimization efforts in individuals with dementia.

A theoretical framework for developing a health impact assessment implementation model in Ireland

Abstract Background A Health Research Board (HRB) four-year research study, which commenced in January 2023, seeks to explore the process of carrying out Health Impact Assessments (HIAs) with a view embedding the approach as normal practice in local and national policy development in Ireland. Methods A theoretical framework has been constructed to develop an HIA implementation model. The framework is based on the all-island Institute of Public Health Ireland's HIA guidance. The theoretical framework will examine factors affecting HIA implementation, using both the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT). An action research methodological approach will be used to gather data on the experiences that participants will reflect on while doing the HIA. Participants included in the study will be the members of the two HIA Steering Groups created for each HIA (12 participants in each HIA) and policy end-users of the HIA evidence from the city council and government ministries (20 participants for each HIA). Results The theoretical framework will be applied to two HIAs, in order to generate data in creating the HIA implementation model. HIA 1, commencing October 2023, will be conducted on the local government Cork City Development Plan. HIA 2, commencing January 2025, will be carried out on the Irish Government's Climate Action Plan. Preliminary results on the application of the theoretical framework to HIA 1 will be presented, as well as reflections for the planned HIA 2. Conclusions For the first time in Ireland and beyond, a theoretical framework has been developed employing innovative methodological approaches to building a contextualised HIA implementation model. Using action research in assessing the implementation of HIA, with a view to analysing the lived experience of Steering Group members as they conduct the HIAs, and policy end-users, will ensure an enhanced HIA implementation model. Key messages • The development of an innovative theoretical framework for the study of HIA. • The building of HIA capacity in Ireland using the newly revised Institute of Public Health guidance.

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus: part II—surgical strategy

PurposeThe aim of this ESSKA consensus is to give recommendations based on scientific evidence and expert opinion to improve the diagnosis, preoperative planning, indication and surgical strategy in Anterior Cruciate Ligament revision.MethodsPart 2, presented herein, followed exactly the same methodology as Part 1: the so-called ESSKA formal consensus derived from the Delphi method. Eighteen questions were ultimately asked. The quality of the answers received the following grades of recommendation: Grade A (high level scientific support), Grade B (scientific presumption), Grade C (low level scientific support) or Grade D (expert opinion). All answers were scored from 1 to 9 by the raters. Once a general consensus had been reached between the steering and rating groups, the question–answer sets were submitted to the peer-review group. A final combined meeting of all the members of the consensus was then held to ratify the document.ResultsThe review of the literature revealed a rather low scientific quality of studies examining the surgical strategy in cases of ACL reconstruction failure. Of the 18 questions, only 1 received a Grade A rating; 5, a Grade B rating; and 9, grades of C or D. The three remaining complex questions received further evaluations for each portion of the question and were looked at in more detail for the following grades: B and D; A, C and D; or A, B, C and D. The mean rating of all questions by the rating group was 8.0 + − 1.1. The questions and recommendations are listed in the article.ConclusionACL revision surgery, especially the surgical strategy, is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardization. Therefore, this international European consensus project is of great importance and clinical relevance for guiding the management of ACL revision in adults.Level of evidenceLevel II.

187 Improving adherence to anaesthetic room preoperative shaving: A surgical site infection quality improvement project

Abstract Introduction The correlation between hair removal and surgical site infection (SSI) remains debated but the limited guidance suggests when hair removal is necessary it should take place in the anaesthetic room. Our local policy is for preoperative hair removal to be performed in the anaesthetic room. We completed a quality improvement project after auditing our practice. Methods Location of preoperative shaving in emergency and trauma theatres were recorded for 7 days. Results were presented to surgical leadership teams and SSI steering groups, and information was disseminated to surgical and anaesthetic teams. Posters specifying the appropriate location of hair removal were created. Results were re-audited after six weeks. Results Pre-intervention, 15 cases required preoperative hair removal. This included 9 general surgery cases, 2 urology, 1 gynaecology and 4 trauma and orthopaedics. Overall, 6/15 (40%) cases were shaved in the anaesthetic room. The rates of hair shaving in the anaesthetic room were 2/9 (22%) general surgery, 1/2 (50%) urology, 1/1 (100%) gynaecology, and 2/4 (50%) trauma. Post-intervention, 9/12 (75%) cases were shaved in the anaesthetic room. This included 7/9 (78%) general surgery, 1/2 (50%) urology, 0/0 gynaecology and 1/1 (100%) trauma and orthopaedics. Conclusion The rate of appropriate preoperative hair shaving in the anaesthetic room increased as a result of initial audit and intervention. Notable change was observed in general surgery in emergency theatres. Future studies should record the rate of surgical site infection, to determine the overall effect this can have on patients and should extend the assessment to elective theatre.

Perceiving the organisation through a coding scheme

Abstract In contemporary organisations, managerial expertise is increasingly viewed as an ability to reflect on activities, processes and human relations within organisational life in order to gain a systemic understanding of the workings of the organisation. This article examines the interactional practices of a consultant-led management training where steering groups of an organisation have a task of gaining such expertise. The article investigates how managerial expertise is constructed and negotiated in training interaction as the groups categorise their managerial actions through a specific coding scheme. The analysis shows that the use of the coding scheme is contingent on being able to display access to organisational processes and activities, connecting general managerial knowledge to specific, local knowledge of the organisation and moving from ‘knowing-that’ to ‘knowing-how’ type of knowledge.

Integrated working in local authority decision-making about air quality: a qualitative study in Southwest England.

Exposure to poor air quality is one of the most significant environmental public health challenges. In the UK, local authorities (LAs) are responsible for monitoring and managing air quality. This article explores the need and mechanisms for cross-departmental working in LAs to make decisions about air quality issues. Semi-structured qualitative interviews with public health, environmental health and transport staff from LAs within the Southwest of UK. Interviews were conducted between April and August 2021 and analysed using a thematic approach. In sum, 24 staff from 7 LAs participated. Local authority staff in public health, environmental health and transport teams recognized that managing air quality was a cross-departmental issue. To enable effective integrated working staff described four successful mechanisms: (i) policy commitments and political support; (ii) dedicated air quality steering groups; (iii) existing governance and oversight groups; and (iv) networking and relationships. This study has identified mechanisms that LA staff have found support cross-departmental and integrated working on air quality issues. These are mechanisms that have helped environmental health staff work towards achieving compliance with pollution limits, and that have helped public health staff get air quality considerations recognized as a wider health issue.

Evaluation of the implementation of the Care Network for People with Disabilities in the Brazilian Unified National Health System: a multiple case study

The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine.

The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. Consensus statement. This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part I-diagnostics and preoperative planning.

The aim of this ESSKA consensus is to give recommendations based on evidence and expert opinion to improve diagnosis, preoperative planning, indication and surgical strategy in ACL revision. The European expert surgeons and scientists were divided into four groups to participate in this consensus. A "literature group" (four surgeons); "steering group" (14 surgeons and scientists); "rating group" (19 surgeons) and finally "peer review group" (51 representatives of the ESSKA-affiliated national societies from 27 countries). The steering group prepared eighteen question-answer sets. The quality of the answers received grades of recommendation ranging from A (high-level scientific support), to B (scientific presumption), C (low level scientific support) or D (expert opinion). These question-answer sets were then evaluated by the rating group. All answers were scored from 1 to 9. The comments of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the question-answer sets were submitted to the peer review group. A final combined meeting of all the members of the consensus was held to ratify the document. The literature review for the diagnosis and preoperative planning of ACL revision revealed a rather low scientific quality. None of the 18 questions was graded A and six received a grade B. The mean rating of all the questions by the rating group was 8.4 ± 0.3. The questions and recommendations are listed below. ACL revision surgery is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardisation. Therefore, this international consensus project is of great importance. II.

Engaging the less-often-heard in public health research grant writing: a case study of co-production involving underserved migrant mothers in the UK

BackgroundIn the UK, one-in-three births are to a non-UK born woman. A gap exists in co-produced research to understand their experiences. The UK National Institute for Health and Care Research (NIHR) defines co-production as “an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility”. This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less-often-heard in grant writing. MethodsAn expert by experience, an underserved migrant woman who had given birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women and two were multi-disciplinary. 26 underserved migrant women attended the online engagement workshops. NIHR INVOLVE guidance was consulted. FindingsWomen said they were often asked about negative experiences that felt disempowering, and rarely asked about solutions. Thus, our proposal will focus on co-designing solutions. Women felt that having an expert by experience co-host workshops encouraged engagement, so we integrated an expert into our methods. Women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We plan to engage mostly online as women preferred this method to enable flexibility with childcare. The lead expert by experience helped to form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding. InterpretationThe findings from this project are limited and not fully representative of all migrant groups, as only migrant women who have given birth in the UK were engaged. However, the work has highlighted the immense potential for co-production in public health research, and the value of adapting how investigators plan research to maximise the voices of the less-often-heard. FundingNational Institute for Health and Care Research Design Service London Public Involvement Fund.

Co-production in public health research grant writing: engaging underserved migrant mothers in the UK

Abstract Background In the UK, one in three births is to a non-UK born woman, but there is a gap in co-produced research to explore their experiences. The National Institute for Health and Care Research (NIHR) defines co-production as ‘an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility'. This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less often heard in grant writing. Methods An expert by experience, an underserved migrant woman who gave birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women, two were multi-disciplinary. 26 underserved migrant women attended. NIHR INVOLVE public involvement guidance was consulted. Results Women said they were often asked about negative experiences which felt disempowering, and rarely asked about solutions. Thus, we shifted the focus of our work to co-designing solutions. Women said that having an expert by experience co-host workshops encouraged engagement, so we integrated this into our methods. Some women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We will engage mostly online as women preferred this to enable flexibility with childcare. The lead expert by experience helped form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding. Conclusions This project highlights the immense potential for co-production in public health research, and the value of adapting research planning to maximise the voices of the less often heard. Key messages • Engaging experts by experiences in public health research planning is key to ensuring our work addresses the needs of underserved communities. • Co-Production of research requires determination to involve those whose voices are less often heard from the beginning of the research process, and to commit to joined working throughout.

Exploring the link between cancer policies and cancer survival: a comparison of seven countries

Abstract Background Disparity in cancer survival across countries has been linked to variation in cancer policy delivery but there is lack of empirical evidence for this association. We traced the evolution of cancer policies in 20 jurisdictions in Australia, Canada, Denmark, Ireland, Norway, New Zealand and the UK since 1995 and present the findings of an exploratory analysis linking cancer policy consistency to cancer survival. Methods We systematically searched and analysed national/regional cancer plans and strategies, mapping timelines of cancer policy evolution. For 10 jurisdictions, evidence was synthesised into five categories: oversight function; cancer plan; implementation plan; budget for plan implementation; and evaluation. We assigned scores evaluating whether a category was present or absent, and weighted scores for consistency. Summed scores were correlated with trends in survival from seven cancers between 1995-2014. Results All ten jurisdictions had implemented a high-level structure overseeing, steering or delivering cancer control policies (1995 - 2014); all had also published at least one major cancer plan. There was great variation in oversight mechanisms, ranging from institutionalising cancer control (New South Wales, Ontario) to cancer steering groups or taskforces (Denmark, Northern Ireland, Wales). Frequency and consistency of cancer plans also varied, from a succession of plans that build on each other (Denmark, New South Wales, Ontario) to the publication of isolated plans (New Zealand, Northern Ireland). We found a positive, albeit weak, correlation of cancer policy consistency and improvements in survival over time for six of the seven cancers. Conclusions Jurisdictions that have implemented consistent cancer control policies over time tended to be more successful in improving survival for a wide range of cancers. Our findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes. Key messages • Sustained and consistent strategic cancer planning and investment are crucial for ensuring better patient outcomes, and this requires strong and sustained commitment at all levels. • The findings can help guide policymakers seeking approaches and frameworks to improve cancer services and, ultimately, cancer outcomes.

The emotional landscape of curriculum making

AbstractOur aim with this study was to gain a better understanding of the emotional landscape of curriculum making by exploring the variety of emotions embedded in shared sense‐making about the national curriculum reform implementation at the district level. Focus group interview data were collected from 12 curriculum reform steering groups around Finland, that were responsible for orchestrating curriculum reform work at the district level. The data were qualitatively content analysed. The results showed that the local steering group members experienced a wide range of emotions in shared sense‐making. Positive emotions were described slightly more often than negative emotions. The emotional landscape of the sense‐making strategies applied in curriculum reform work varied depending on the strategy applied.