The Double Burden: Climate Change Challenges for Health Systems.

Climate change presents significant challenges to human health and health systems, and there is a critical need for health systems to adapt and become more resilient in order to effectively mediate the impacts of climate change on population health. This paper analyzes existing academic literature to identify key themes, trends, and research gaps at the intersection of climate change and health systems. Utilizing a scoping review of 179 studies, we explore how health systems can enhance their resilience through effective governance, sustainable financing, resource generation, and adaptive service delivery.

Impact of Chronic Pain on Patients' Quality of Life: A Comparative Mixed-Methods Study.

Background: Chronic pain has become a common problem within primary care and can negatively impact patients' lives.

Objective: To assess and explore the impact of chronic pain on patients' quality of life (QoL) using quantitative and qualitative data, respectively.

Methods: A convergent parallel mixed-methods design was used.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships.

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken.

Improving the management of pain from advanced cancer in the community: study protocol for a pragmatic multicentre randomised controlled trial.

Introduction: For patients with advanced cancer, research shows that pain is frequent, burdensome and undertreated. Evidence-based approaches to support cancer pain management have been developed but have not been implemented within the context of the UK National Health Service. This protocol is for a pragmatic multicentre randomised controlled trial (RCT) to assess feasibility, acceptability, effectiveness and cost-effectiveness for a multicomponent intervention for pain management in patients with advanced cancer.

Self-management toolkit and delivery strategy for end-of-life pain: the mixed-methods feasibility study.

Background: Pain affects most people approaching the end of life and can be severe for some. Opioid analgesia is effective, but evidence is needed about how best to support patients in managing these medicines.

Objectives: To develop a self-management support toolkit (SMST) and delivery strategy and to test the feasibility of evaluating this intervention in a future definitive trial.

The impact of transcatheter aortic valve implantation on quality of life: A mixed methods study.

Objective: To provide an in-depth understanding of patients' views about the impact of transcatheter aortic valve implantation on self-reported quality of life.

Background: Transcatheter aortic valve implantation is considered to be the gold standard of care for inoperable patients diagnosed with severe symptomatic aortic stenosis. Mid- to long-term clinical outcomes are favourable and questionnaire data indicates improvements in quality of life but an in-depth understanding of how quality of life is altered by the intervention is missing.

'Treated as a number, not treated as a person': a qualitative exploration of the perceived barriers to effective pain management of patients with chronic pain.

Objectives: To identify barriers to effective pain management encountered by patients with chronic pain within the UK's National Health Service (NHS).

Design: Secondary analysis of face-to-face, semistructured qualitative interviews using thematic analysis.

Setting: A community-based chronic pain clinic jointly managed by a nurse and pharmacist located in the North of England.

Feasibility of a staff training and support programme to improve pain assessment and management in people with dementia living in care homes.

Objectives: The objective of this study was to establish the feasibility and initial effectiveness of training and support intervention for care staff to improve pain management in people with dementia living in care homes (PAIN-Dem).

Methods: PAIN-Dem training was delivered to care staff from three care homes in South London, followed by intervention support and resources to encourage improved pain management by staff over 4 weeks. Feasibility was assessed through fidelity to intervention materials and qualitative approaches.

Using the MRC Framework for Complex Interventions to Develop Clinical Decision Support: A Case Study.

The Medical Research Council (MRC) framework for complex interventions provides useful guidance to assist with the development and evaluation of health technology interventions such as decision support. In this paper we briefly summarise a project that focused on designing a decision support intervention to assist with the recognition, assessment and management of pain in patients with dementia in an acute hospital setting. We reflect on our experience of using the MRC framework to guide our study design, and highlight the importance of considering decision support interventions as complex interventions.

A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England.

. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. .

Creating a better picture of chronic pain: improving pain pictogram designs through systematic evaluation of user responses.

This article discusses the challenges of visually representing pain qualities in pictogram design. An existing set of 12 pictograms designed for people with literacy problems was evaluated to understand more about misunderstandings of pictogram interpretation. Two sets of university students from different disciplines were asked to interpret the pictograms, and a novel classification system was developed to categorise answer types, as 'location', 'affective', temporal' or 'literal'.

The landscape of pain management in people with dementia living in care homes: a mixed methods study.

Objectives: The aim of this study is to explore the current landscape of pain management in people with dementia living in care home settings. Pain is extremely common in this patient group, yet there is very limited guidance for healthcare professionals.

Methods: Triangulation of stakeholder consultation and quality review of pain management guidance were performed.

Supporting self-management of pain by patients with advanced cancer: views of palliative care professionals.

Purpose: The aim of the study is to ascertain the views of specialist palliative care professionals on patient self-management of cancer pain in order to inform the development of a new educational intervention to support self-management.

Methods: This is a qualitative research study using focus group interviews.

Results: Participants viewed self-management of cancer pain as desirable and achievable but also as something that could be problematic.

The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective.

Background: Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigate how pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.

Exploring the Influence of Patient-Professional Partnerships on the Self-Management of Chronic Back Pain: A Qualitative Study.

Patients are encouraged to take an active role in self-managing their chronic back pain and functional problems. However, research suggests that patients do not self-manage, and they expect health professionals to fulfill a comprehensive role in managing pain. A partnership between patients and health professionals is called for, and self-management works best when they share knowledge and work together toward optimal goals.

The effects of patient-professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study.

Background: Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients' health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients' ability to self-manage their condition.

The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia.

Background: Assessment and management of pain in patients with dementia is known to be challenging, due to patients' cognitive and/or communication difficulties. In the UK, pain in hospital is managed through regular assessments, with the use of pain intensity scores as triggers for action. The aim of this study was to understand current pain assessment practices, in order to later inform the development of a decision support tool designed to improve the management of pain for people with dementia in hospital.

Ensuring rigour and trustworthiness of qualitative research in clinical pharmacy.

The use of qualitative research methodology is well established for data generation within healthcare research generally and clinical pharmacy research specifically. In the past, qualitative research methodology has been criticized for lacking rigour, transparency, justification of data collection and analysis methods being used, and hence the integrity of findings. Demonstrating rigour in qualitative studies is essential so that the research findings have the "integrity" to make an impact on practice, policy or both.

Applications of mixed-methods methodology in clinical pharmacy research.

Introduction Mixed-methods methodology, as the name suggests refers to mixing of elements of both qualitative and quantitative methodologies in a single study. In the past decade, mixed-methods methodology has gained popularity among healthcare researchers as it promises to bring together the strengths of both qualitative and quantitative approaches. Methodology A number of mixed-methods designs are available in the literature and the four most commonly used designs in healthcare research are: the convergent parallel design, the embedded design, the exploratory design, and the explanatory design.

Can pictorial images communicate the quality of pain successfully?

Chronic pain is common and difficult for patients to communicate to health professionals. It may include neuropathic elements which require specialised treatment. A little used approach to communicating the quality of pain is through the use of images.

Effectiveness of a community based nurse-pharmacist managed pain clinic: A mixed-methods study.

Background: Chronic pain is predominantly managed in primary care, although often ineffectively. There is growing evidence to support the potential role of nurses and pharmacists in the effective management of chronic pain.

Objectives: To evaluate the effectiveness of a pain clinic jointly managed by a nurse and pharmacist.

Using sense-making theory to aid understanding of the recognition, assessment and management of pain in patients with dementia in acute hospital settings.

Background: The recognition, assessment and management of pain in hospital settings is suboptimal, and is a particular challenge in patients with dementia. The existing process guiding pain assessment and management in clinical settings is based on the assumption that nurses follow a sequential linear approach to decision making. In this paper we re-evaluate this theoretical assumption drawing on findings from a study of pain recognition, assessment and management in patients with dementia.

Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study.

Background: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term prescribing of opioids for chronic, non-cancer pain.