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  1. Article ; Online: Constructing public–private partnerships to undermine the public interest

    Mary Madden / Andrew Bartlett / Jim McCambridge

    Globalization and Health, Vol 19, Iss 1, Pp 1-

    critical discourse analysis of Working Together published by the International Alliance for Responsible Drinking

    2023  Volume 15

    Abstract: Abstract Background The global burden of alcohol harm has increased and is forecast to grow further without effective policy implementation. Public–private partnerships aiming to address global health, and other societal challenges, are a burgeoning ... ...

    Abstract Abstract Background The global burden of alcohol harm has increased and is forecast to grow further without effective policy implementation. Public–private partnerships aiming to address global health, and other societal challenges, are a burgeoning feature of neoliberal governance. Rhetorically distancing themselves from tobacco, the major alcohol companies are committed to tackling ‘harmful drinking’ and have created a distinct type of public relations organization for this purpose. The activities of such organizations are increasingly recognized as an impediment to the implementation of policies to reduce alcohol harm, including in low- and middle-income countries where markets are expanding. Methods The approach of critical discourse analysis is used to examine the discursive tactics and strategies used in Working Together; a ‘toolkit’ published by the key global level alcohol industry public relations organization, the International Alliance for Responsible Drinking (IARD). This study considers how it works discursively to set the terms of, and overcome skepticism about partnerships, to define aims and position various actors by constructing their roles. The construction of prospective partners provides insights into the alcohol industry itself. Results The toolkit operates as an ideological resource for forming public–private partnerships across the world based on the accumulated know-how of the major companies through IARD. This allows the largest alcohol companies to exercise leadership of the industry, while remaining off-stage. The toolkit relies on a form of rhetorical work which creates distance from obvious corporate interests and the harms caused to population health and society. This is accomplished by working against evidence-informed population level approaches, and thus avoiding policies that will make any significant difference to overall alcohol harm. Unspecific “complexity” affords opportunity for preferred types of “actions”, and “partnership” provides opportunity to gain credibility by ...
    Keywords Alcohol Industry ; Commercial Determinants of Health ; Corporate Social Responsibility ; Global Health ; Alcohol Policy ; Public–Private Partnerships ; Public aspects of medicine ; RA1-1270
    Subject code 306
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Alcohol marketing versus public health

    Mary Madden / Jim McCambridge

    Globalization and Health, Vol 17, Iss 1, Pp 1-

    David and Goliath?

    2021  Volume 6

    Abstract: Abstract Background Alcohol harms are rising globally, and alcohol policies, where they exist, are weak or under-developed. Limited progress has been made since the formulation of the World Health Organisation (WHO) Global Strategy in 2010. WHO is ... ...

    Abstract Abstract Background Alcohol harms are rising globally, and alcohol policies, where they exist, are weak or under-developed. Limited progress has been made since the formulation of the World Health Organisation (WHO) Global Strategy in 2010. WHO is seeking to accelerate progress in implementing international efforts to reduce the harmful use of alcohol. The threat to global health posed by tobacco is well understood by policy communities and populations globally; by contrast alcohol is much less so, despite available evidence. The competition for epistemic authority Global alcohol corporations have sought to become trusted sources of advice for policy makers and consumers, while continuing to grow their markets. Evidence-informed public health messaging faces formidable competition from transnational corporations as the worlds of corporate and political communications, social and mainstream media become increasingly linked, presenting new opportunities for corporate actors to shape global health governance. Alcohol messaging that uses means of persuasion tied to industry agendas does not tell a clear story about commercial determinants of health, and does not contribute to health improvement. On the contrary, the basic tenets of an evidence-informed population-based approach are denied and the policy measures supported by high quality evidence are being opposed, because they are inimical to commercial interests. A David and Goliath metaphor for this state of affairs, which seems to fit at first glance, may unwittingly reinforce the status quo. Conclusion Public opinion on alcohol and policy issues varies across time and place and can be influenced by dedicated public health interventions. Alcohol marketing dominates people’s thinking about alcohol because we currently allow this to happen. Greater ambition is needed in developing countermarketing and other interventions to promote evidence-informed ideas with the public. Alcohol policies need to be further developed, and implemented more widely, in order to ...
    Keywords Commercial determinants of health ; Alcohol ; Public health ; Alcohol marketing ; Alcohol industry ; Alcohol policy ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Alcohol, the overlooked drug

    Mary Madden / Duncan Stewart / Thomas Mills / Jim McCambridge

    Addiction Science & Clinical Practice, Vol 18, Iss 1, Pp 1-

    clinical pharmacist perspectives on addressing alcohol in primary care

    2023  Volume 10

    Abstract: Abstract Background Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical ... ...

    Abstract Abstract Background Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists’ experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient’s health conditions and medicines, rather than a separated ‘healthy living’ issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. Methods Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. Results When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. Conclusions Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing ...
    Keywords Alcohol ; Clinical pharmacy ; Medication review ; Brief intervention ; Qualitative research ; Medicine (General) ; R5-920 ; Social pathology. Social and public welfare. Criminology ; HV1-9960
    Subject code 360
    Language English
    Publishing date 2023-03-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Consultation skills development in general practice

    Jim McCambridge / Duncan Stewart / Thomas Mills / Mary Madden

    BMJ Open, Vol 13, Iss

    findings from a qualitative study of newly recruited and more experienced clinical pharmacists during the COVID-19 pandemic

    2023  Volume 4

    Abstract: Objective The new structured medication review (SMR) service was introduced into the National Health Service in England during the COVID-19 pandemic, following a major expansion of clinical pharmacists within new formations known as primary care networks ...

    Abstract Objective The new structured medication review (SMR) service was introduced into the National Health Service in England during the COVID-19 pandemic, following a major expansion of clinical pharmacists within new formations known as primary care networks (PCNs). The aim of the SMR is to tackle problematic polypharmacy through comprehensive, personalised medication reviews involving shared decision-making. Investigation of clinical pharmacists’ perceptions of training needs and skills acquisition issues for person-centred consultation practice will help better understand their readiness for these new roles.Design A longitudinal interview and observational study in general practice.Setting and participants A longitudinal study of 10 newly recruited clinical pharmacists interviewed three times, plus a single interview with 10 pharmacists recruited earlier and already established in general practice, across 20 newly forming PCNs in England. Observation of a compulsory 2-day history taking and consultation skills workshop.Analysis A modified framework method supported a constructionist thematic analysis.Results Remote working during the pandemic limited opportunities for patient-facing contact. Pharmacists new to their role in general practice were predominantly concerned with improving clinical knowledge and competence. Most said they already practiced person-centred care, using this terminology to describe transactional medicines-focused practice. Pharmacists rarely received direct feedback on consultation practice to calibrate perceptions of their own competence in person-centred communication, including shared decision-making skills. Training thus provided knowledge delivery with limited opportunities for actual skills acquisition. Pharmacists had difficulty translating abstract consultation principles into specific consultation practices.Conclusion SMRs were introduced when the dedicated workforce was largely new and being trained. Addressing problematic polypharmacy requires structural and organisational ...
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2023-04-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Integration of a clinical pharmacist workforce into newly forming primary care networks

    Jim McCambridge / Duncan Stewart / Thomas Mills / Mary Madden / Brendan Gough

    BMJ Open, Vol 12, Iss

    a qualitatively driven, complex systems analysis

    2022  Volume 11

    Abstract: Objective The introduction of a new clinical pharmacist workforce via Primary Care Networks (PCNs) is a recent national policy development in the National Health Service in England. This study elicits the perspectives of people with responsibility for ... ...

    Abstract Objective The introduction of a new clinical pharmacist workforce via Primary Care Networks (PCNs) is a recent national policy development in the National Health Service in England. This study elicits the perspectives of people with responsibility for local implementation of this national policy package. Attention to local delivery is necessary to understand the contextual factors shaping the integration of the new clinical pharmacy workforce, and thus can be expected to influence future role development.Design A qualitative, interview studySetting and participants PCN Clinical Directors and senior pharmacists across 17 PCNs in England (n=28)Analysis Interviews were transcribed, coded and organised using the framework method. Thematic analysis and complex systems modelling were then undertaken iteratively to develop the themes.Results Findings were organised into two overarching themes: (1) local organisational innovations of a national policy under conditions of uncertainty; and (2) local multiprofessional decision-making on clinical pharmacy workforce integration and initial task assignment. Although a phased implementation of the PCN package was planned, the findings suggest that processes of PCN formation and clinical pharmacist workforce integration were closely intertwined, with underpinning decisions taking place under conditions of considerable uncertainty and workforce pressures.Conclusions National policy decisions that required General Practitioners to form PCNs at the same time as they integrated a new workforce risked undermining the potential of both PCNs and the new workforce. PCNs require time and support to fully form and integrate clinical pharmacists if successful role development is to occur. Efforts to incentivise delivery of PCN pharmacy services in future must be responsive to local capacity.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2022-11-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Optimization and validation of a cost‐effective protocol for biosurveillance of invasive alien species

    Yoamel Milián‐García / Robert Young / Mary Madden / Erin Bullas‐Appleton / Robert H. Hanner

    Ecology and Evolution, Vol 11, Iss 5, Pp 1999-

    2021  Volume 2014

    Abstract: Abstract Environmental DNA (eDNA) metabarcoding has revolutionized biodiversity monitoring and invasive pest biosurveillance programs. The introduction of insect pests considered invasive alien species (IAS) into a non‐native range poses a threat to ... ...

    Abstract Abstract Environmental DNA (eDNA) metabarcoding has revolutionized biodiversity monitoring and invasive pest biosurveillance programs. The introduction of insect pests considered invasive alien species (IAS) into a non‐native range poses a threat to native plant health. The early detection of IAS can allow for prompt actions by regulating authorities, thereby mitigating their impacts. In the present study, we optimized and validated a fast and cost‐effective eDNA metabarcoding protocol for biosurveillance of IAS and characterization of insect and microorganism diversity. Forty‐eight traps were placed, following the CFIA's annual forest insect trapping survey, at four locations in southern Ontario that are high risk for forest IAS. We collected insects and eDNA samples using Lindgren funnel traps that contained a saturated salt (NaCl) solution in the collection jar. Using cytochrome c oxidase I (COI) as a molecular marker, a modified Illumina protocol effectively identified 2,535 Barcode Index Numbers (BINs). BINs were distributed among 57 Orders and 304 Families, with the vast majority being arthropods. Two IAS (Agrilus planipennis and Lymantria dispar) are regulated by the Canadian Food Inspection Agency (CFIA) as plant health pests, are known to occur in the study area, and were identified through eDNA in collected traps. Similarly, using 16S ribosomal RNA and nuclear ribosomal internal transcribed spacer (ITS), five bacterial and three fungal genera, which contain species of regulatory concern across several Canadian jurisdictions, were recovered from all sampling locations. Our study results reaffirm the effectiveness and importance of integrating eDNA metabarcoding as part of identification protocols in biosurveillance programs.
    Keywords 16S ; biomonitoring ; biosurveillance ; COI ; eDNA metabarcoding ; invasive alien species ; Ecology ; QH540-549.5
    Subject code 580
    Language English
    Publishing date 2021-03-01T00:00:00Z
    Publisher Wiley
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Producing co‐production

    Mary Madden / Steph Morris / Margaret Ogden / David Lewis / Duncan Stewart / Jim McCambridge

    Health Expectations, Vol 23, Iss 3, Pp 659-

    Reflections on the development of a complex intervention

    2020  Volume 669

    Abstract: Abstract Background Patient and public involvement and co‐production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they are, how they might be undertaken and how they relate to each ... ...

    Abstract Abstract Background Patient and public involvement and co‐production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they are, how they might be undertaken and how they relate to each other. There are distinct challenges and particular gaps in public involvement in alcohol research, especially when the study focus is on health matters other than alcohol dependence. Objective To explore how patient and public involvement and co‐production have been interpreted and applied within a multi‐disciplinary research programme in the development of a complex intervention on alcohol and medicine use in community pharmacies. Design The paper presents the authors' critical reflection on a grounded example of how public involvement concepts have been translated into practice in the intervention development phase of a publicly funded research programme, noting its impact on the programme to date. Discussion Co‐production adds another layer of complexity in the development of a complex intervention. The research planning requirements for publicly funded research circumscribe the possibilities for co‐production, including impacting on the possibility of stability and continuity over time.
    Keywords alcohol ; community pharmacy ; complex interventions ; co‐production ; medicines review ; patient and public involvement ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
    Subject code 306
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher Wiley
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: What happens after James Lind Alliance Priority Setting Partnerships? A qualitative study of contexts, processes and impacts

    Kristina Staley / Sally Crowe / Joanna C. Crocker / Mary Madden / Trisha Greenhalgh

    Research Involvement and Engagement, Vol 6, Iss 1, Pp 1-

    2020  Volume 10

    Abstract: Abstract Background The James Lind Alliance (JLA) supports priority setting partnerships (PSPs) in which patients, carers and health professionals collaborate to identify a Top 10 list of research priorities. Few studies have examined how partnerships ... ...

    Abstract Abstract Background The James Lind Alliance (JLA) supports priority setting partnerships (PSPs) in which patients, carers and health professionals collaborate to identify a Top 10 list of research priorities. Few studies have examined how partnerships plan for the post-prioritisation phase, or how context and post-PSP processes influence the fortunes of priorities. This evaluation aimed to explore these questions. Methods We selected a diverse sample of 20 interviewees who had knowledge of 25 PSPs. Thirteen interviewees had led a PSP, either from a university, patient organisation or charity. Three were patients who had taken part in a PSP workshop. Four others, three researchers and one funder, had worked with JLA PSP priorities to develop research proposals. We analysed the data thematically, exploring how success was understood and achieved. Results The JLA PSPs had different histories, funding sources, goals and stakeholders. Whilst their focus was on generating priority research topics, PSPs’ wider impacts included enhanced status and greater confidence for individuals, as well as relationship-building and network strengthening for the organisations involved. To follow through on a Top 10, additional work was needed to refine broad priority topics into research questions and match them with appropriate funding sources. Commitment to post-PSP action from partners appeared to increase the chance that priority topics would be followed through to funded studies. Academic publications could alert researchers to a PSP’s outputs, but not all PSPs had the capacity to produce them. A Top 10 list potentially influences funding decisions through direct funding, themed calls or as a prompt in open calls. Influence on funders appears to depend on alignment between a priority and the funder’s remit, culture and values. Conclusion The history and context of a JLA PSP have a major influence on its impact. Our findings suggest that there is no universal formula for success, but that greater resource and attention should be ...
    Keywords Patient and public involvement ; James Lind Alliance ; Priority setting partnerships ; Research priorities ; Medicine ; R ; Medicine (General) ; R5-920
    Subject code 306
    Language English
    Publishing date 2020-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Conceptualising alcohol consumption in relation to long-term health conditions

    Mary Madden / Stephanie Morris / Duncan Stewart / Karl Atkin / Brendan Gough / Jim McCambridge

    PLoS ONE, Vol 14, Iss 11, p e

    Exploring risk in interviewee accounts of drinking and taking medications.

    2019  Volume 0224706

    Abstract: Background Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who ... ...

    Abstract Background Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who take multiple medications, experience and understand their alcohol use. The study objective is to explore how people conceptualise the risks posed to their own health from their concurrent alcohol and medicines use. Methods and findings Semi-structured interviews were conducted with a sample of 24 people in the North of England taking medication for long term conditions who drank alcohol twice a week or more often. Transcripts were analysed using a modified framework method with a constructionist thematic analysis. Alcohol was consumed recreationally and to aid with symptoms of sleeplessness, stress and pain. Interviewees were concerned about the felt effects of concurrent alcohol and medicines use and sought ways to minimise the negative effects. Interviewees associated their own drinking with short-term reward, pleasure and relief. Risky drinking was located elsewhere, in the drinking of others. People made experiential, embodied sense of health harms and did not seem aware of, or convinced by, (or in some cases appeared resigned to) future harms to their own health from alcohol use. The study has limitations common to exploratory qualitative studies. Conclusions Health risk communication should be better informed about how people with long-term health conditions perceive health outcomes over time, and how they adopt experience-based safety strategies in contexts in which alcohol consumption is heavily promoted and weakly regulated, whilst medicines adherence is expected. Supporting people to make active and informed connections between medicines, alcohol and potential personal health harms requires more than a one-way style of risk communication if it is to be perceived as opening up rather than restricting choice.
    Keywords Medicine ; R ; Science ; Q
    Subject code 360
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Addressing complex pharmacy consultations

    Jim McCambridge / Karl Atkin / Ranjita Dhital / Brent Foster / Brendan Gough / Mary Madden / Stephanie Morris / Ronan O’Carroll / Margaret Ogden / Anne Van Dongen / Sue White / Cate Whittlesea / Duncan Stewart

    Addiction Science & Clinical Practice, Vol 16, Iss 1, Pp 1-

    methods used to develop a person-centred intervention to highlight alcohol within pharmacist reviews of medications

    2021  Volume 9

    Abstract: Abstract Background Alcohol is challenging to discuss, and patients may be reluctant to disclose drinking partly because of concern about being judged. This report presents an overview of the development of a medications review intervention co-produced ... ...

    Abstract Abstract Background Alcohol is challenging to discuss, and patients may be reluctant to disclose drinking partly because of concern about being judged. This report presents an overview of the development of a medications review intervention co-produced with the pharmacy profession and with patients, which breaks new ground by seeking to give appropriate attention to alcohol within these consultations. Methods This intervention was developed in a series of stages and refined through conceptual discussion, literature review, observational and interview studies, and consultations with advisory groups. In this study we reflect on this process, paying particular attention to the methods used, where lessons may inform innovations in other complex clinical consultations. Results Early work with patients and pharmacists infused the entire process with a heightened sense of the complexity of consultations in everyday practice, prompting careful deliberation on the implications for intervention development. This required the research team to be highly responsive to both co-production inputs and data gathered in formally conducted studies, and to be committed to working through the implications for intervention design. The intervention thus evolved significantly over time, with the greatest transformations resulting from patient and pharmacist co-design workshops in the second stage of the process, where pharmacists elaborated on the nature of the need for training in particular. The original research plans provided a helpful structure, and unanticipated issues for investigation emerged throughout the process. This underscored the need to engage dynamically with changing contexts and contents and to avoid rigid adherence to any early prescribed plan. Conclusions Alcohol interventions are complex and require careful developmental research. This can be a messy enterprise, which can nonetheless shed new insights into the challenges involved in optimising interventions, and how to meet them, if embraced with an attitude of ...
    Keywords Alcohol ; Complex interventions ; Pharmacist ; Brief intervention ; Person-centred ; Medications review ; Medicine (General) ; R5-920 ; Social pathology. Social and public welfare. Criminology ; HV1-9960
    Subject code 360
    Language English
    Publishing date 2021-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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