What patients do and their impact on implementation.

Purpose: The potential for including patients in implementation processes has received limited attention in the literature. The purpose of this paper is to explore the different roles adopted by 63 patients that emerged during and after four participatory quality improvement interventions, and the nature of their impact upon implementation processes and outcomes.

Design/methodology/approach: A cross-case ethnographic comparison of Experience-based Co-design in two clinical pathways in two UK NHS Trusts.

A medical director's perspective on healthcare leadership.

Healthcare leadership needs doctors in particular to step forward, despite the pressures, lack of recognition and challenges to bring their talents to aid improvement for patients and staff. There is clear evidence worldwide of the power of clinical, particularly medical leadership and its benefits are currently underutilised in the UK; now is the opportunity for major change. Focusing on the patient first ('what matters to you?') will be a necessary change.

Using a national archive of patient experience narratives to promote local patient-centered quality improvement: an ethnographic process evaluation of 'accelerated' experience-based co-design.

Objectives: To evaluate an accelerated form of experience-based co-design (EBCD), a type of participatory action research in which patients and staff work together to improve quality; to observe how acceleration affected the process and outcomes of the intervention.

Methods: An ethnographic process evaluation of an adapted form of EBCD was conducted, including observations, interviews, questionnaires and documentary analysis. Whilst retaining all components of EBCD, the adapted approach replaced local patient interviews with secondary analysis of a national archive of patient experience narratives to create national trigger films; shortened the timeframe; and employed local improvement facilitators.

An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence In Acutely Ill Patients (SOAP) study.

Objective: To define the frequency and prognostic implications of SIRS criteria in critically ill patients hospitalized in European ICUs.

Design And Setting: Cohort, multicentre, observational study of 198 ICUs in 24 European countries.

Patients And Interventions: All 3,147 new adult admissions to participating ICUs between 1 and 15 May 2002 were included.

Systemic capillary leak syndrome after granulocyte colony-stimulating factor (G-CSF).

Capillary leak syndrome (CLS) commonly occurs in the intensive care setting. CLS is seen in conditions such as septic shock or may result from conditions such as multitrauma and pancreatitis, which result in the systemic inflammatory response syndrome (SIRS). We present two cases in which both patients suffered with CLS, which we believe was caused following administration of granulocyte colony-stimulating factor, to our knowledge not described in the intensive care patient previously.