James Barlow

Property, bureaucracy and culture : middle-class formation in contemporary Britain

Preface: Why we wrote this book 1. Are the Middle Classes Social Classes? 2. The Dynamics of Service Class Formation 3. The Historical Formation of the British Middle Classes 4. The Contemporary Restructuring of the Middle Classes 5. The Housing Market and the Middle Classes: Class Tenure and Capital Accumulation 6. Culture, Consumption and Lifestyle 7. Social Mobility and Household Formation 8. Regional Context and Spatial Mobility 9. Class Formation and Political Change, Appendix 1: What is Class Analysis? Appendix 2: Socio-Economic Groups, Appendix 3: The British Market Research Bureaus Classification of Occupations, Footnotes, References

A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions

We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect.

Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study

BackgroundTelehealth (TH) and telecare (TC) interventions are increasingly valued for supporting self-care in ageing populations; however, evaluation studies often report high rates of non-participation that are not well understood. This paper reports from a qualitative study nested within a large randomised controlled trial in the UK: the Whole System Demonstrator (WSD) project. It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial.MethodsQualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention (n = 19), or who withdrew from the intervention arm (n = 3). Participants were recruited from the four trial groups (with diabetes, chronic obstructive pulmonary disease, heart failure, or social care needs); and all came from the three trial areas (Cornwall, Kent, east London). Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home. Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes.ResultsBarriers to adoption of TH and TC associated with non-participation and withdrawal from the trial were identified within the following themes: requirements for technical competence and operation of equipment; threats to identity, independence and self-care; expectations and experiences of disruption to services. Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderstandings. Respondents’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance, and views that interventions could undermine self-care and coping. Finally, participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued.ConclusionsThese findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake. These insights have implications for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction. It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation.

Innovation and learning in complex offshore construction projects

Abstract Concern about the poor performance of the construction industry, in the UK and elsewhere, is coming at a time when its customers are demanding more and projects are becoming increasingly complex. Many of the industrys performance problems stem from inadequate inter-organisational co-operation. The paper explores the problems and solutions in aligning the construction industry more closely to its customers in CoPS-type projects. Using the example of a high value, high complexity offshore oilfield construction project, the paper examines the use of ‘partnering’ as a tool for stimulating performance gains at the project level and innovation and learning benefits at the organisational level.

Technologies for global health

Institute for Global Health Innovation (L Conteh PhD, Prof A Darzi FRCS, P Howitt MA, K Kerr PhD, Prof S Matlin DSc, R Merrifi eld PhD, Prof G-Z Yang PhD), Centre for Environmental Policy (E Wilson MSc), Centre for Health Policy (D King MRCS, M Kulendran MRCS, Prof P C Smith BA), Department of Bioengineering (Prof A M J Bull PhD, Prof R A Malkin PhD, Prof M M Stevens PhD), Department of Civil and Environmental Engineering (M R Templeton PhD), Department of Infectious Diseases (G S Cooke PhD, N Ford PhD, S D Reid PhD), Department of Infectious Disease Epidemiology (S A J Gregson PhD), Department of Materials (Prof M M Stevens), Department of Medicine (A Blakemore PhD), Department of Primary Care & Public Health (Prof A Majeed MD), Department of Surgery and Cancer (H Ashrafi an MRCS, Prof C Vincent PhD), Faculty of Medicine (Prof R Atun FRCP), Global eHealth Unit (J Car PhD), Imperial College Business School (Prof R Atun FRCP, Prof J Barlow PhD), and Imperial Innovations (HA Penfold PhD), Imperial College London, London, UK Technologies for global health

Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial

Objective To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. Design A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively. Setting Provision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems. Participants Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009. Main outcome measures Generic, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). Results In the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth v usual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696). Conclusions Second generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients. Trial Registration ISRCTN43002091.

Organisational learning and inter‐firm “partnering” in the UK construction industry

The paper explores the role of construction industry “partnering” ‐ the development of closer collaborative links between firms ‐ in stimulating organisational learning. Drawing on case studies of partnering relationships involving large clients (British Petroleum, NatWest Bank, McDonald’s, Selfridges, Safeway) and over 40 of their contractors and suppliers, discusses the factors which influence the transfer of knowledge between organisations, the different levels at which learning takes place (e.g. individual, team, organisational) and the extent to which double‐loop learning can be observed.

An innovative supply chain strategy for customized housing

There has recently been considerable interest in construction research in paradigms developed for the manufacturing sector. Using lean thinking and agile production as examples of innovative organizational and business process design, this paper explores their commonalities and differences. In this way, it is possible to judge which paradigm is the most appropriate for given market conditions. By presenting action research outputs from a project on the UK house‐building industry, the paper indicates the potential application of both lean and agile construction from a supply chain perspective. The paper concludes that house‐building supply chains have to be engineered according to whether the market objectives are low cost, flexibility or a combination of the two.

A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the Whole Systems Demonstrator cluster randomised trial

BackgroundIt is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There is significant interest in the potential for technology to reduce utilisation of health services in these patient populations, including telecare (the remote, automatic and passive monitoring of changes in an individuals condition or lifestyle) and telehealth (the remote exchange of data between a patient and health care professional). The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact.Methods/DesignWe are conducting a large scale, multi-site study of the implementation, impact and acceptability of these new technologies. A major part of the evaluation is a cluster-randomised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs. The trial involves a number of outcomes, including health care utilisation and quality of life. We describe the broad evaluation and the methods of the cluster randomised trialDiscussionIf telehealth and telecare technology proves effective, it will provide additional options for health services worldwide to deliver care for populations with high levels of need.Trial RegistrationCurrent Controlled Trials ISRCTN43002091

Guidelines and the adoption of ‘lipid rescue’ therapy for local anaesthetic toxicity

Gathering evidence from animal experiments, an editorial in this journal and published human case reports culminated in the Association of Anaesthetists of Great Britain and Ireland recommending in August 2007 that lipid emulsion be immediately available to all patients given potentially cardiotoxic doses of local anaesthetic drugs. This development offered an opportunity to track the adoption of an innovation by anaesthetists in the UK and to gauge the effects of guidelines. Two surveys, each of 66 NHS hospitals delivering acute care within London and its penumbra, examined the adoption of lipid emulsion therapy. After the publication of the editorial in autumn 2006, the spread of ‘lipid rescue’ was rapid. The timing of the adoption and the impetus for innovation varied substantially between the sampled hospitals. When the formal guidelines were published, approximately half of the hospitals surveyed did not have lipid rescue. Of those that subsequently adopted it, half attributed their decision to the guidelines. At the end of 2007, there remained a small number of hospitals that had yet to adopt lipid rescue. Lipid rescue’s adoption by anaesthetists in the UK offers a rare example of swift uptake of an innovation. National guidelines accelerated the adoption of innovation by some hospitals.