Defining and Measuring The Creation of Quality Jobs

Our research is intended to support our peers in the Community Development Financial Institution (CDFI) industry who, through their financing, have served low-income and other disadvantaged communities for two decades.  While the CDFI industry has been instrumental in supporting job creation across the U.S., we believe that now is the time to focus greater attention on the quality of the jobs created in order to combat rising income and wealth inequality.Through a better understanding of what defines a quality job and a set of practical methods for measuring the quality of jobs created, we believe CDFIs and others in the impact investing community will be better positioned to make more effective investments that support good jobs for workers, businesses, and communities

Prostate specific antigen

The use of PSA as a screening test for prostate cancer remains controversial because no double blind, randomised controlled trial has shown that early detection reduces mortality.1,2 Despite this controversy, PSA provides valuable information for the general practitioner in everyday clinical practice, including monitoring of treated and untreated prostate cancer and prostatitis

New medical graduates: Can general practice help with training?

Medical student numbers in Australia have increased significantly in recent years. A resulting increase in medical graduates is inevitable and desirable. Western Australian medical graduates will double by 2012 and treble shortly afterward. Insufficient training positions in hospitals will likely require additional training opportunities to be provided by general practices. This article reviews innovative general practice training schemes for new medical graduates in Australia and overseas. It examines whether Australian general practice can play a role in training the rising numbers of new doctors

Screening for familial hypercholesterolaemia in primary care: Time for general practice to play its part

Fifty per cent of first-degree relatives of index cases with familial hypercholesterolemia (FH) inherit the disorder. Despite cascade screening being the most cost-effective method for detecting new cases, only a minority of individuals with FH are currently identified. Primary care is a key target area to increase identification of new index cases and initiate cascade screening, thereby finding close relatives of all probands. Increasing public and health professional awareness about FH is essential. In the United Kingdom and in Australia, most of the population are reviewed by a General Practitioner (GP) at least once over a three-year period, offering opportunities to check for FH as part of routine clinical consultations. Such opportunistic approaches can be supplemented by systematically searching electronic health records with information technology tools that identify high risk patients. GPs can help investigate and implement results of this data retrieval. Current evidence suggests that early detection of FH and cascade testing meet most of the criteria for a worthwhile screening program. Among heterozygous patients the long latent period before the expected onset of coronary artery disease provides an opportunity for initiating effective drug and lifestyle changes. The greatest challenge for primary care is to implement an efficacious model of care that incorporates sustainable identification and management pathways

Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service.

Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. A service evaluation of one-to-one therapy for patients with misophonia ( =19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures -tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds

What can acute medicine learn from qualitative methods?

Purpose of review: The contribution of qualitative methods to evidence-based medicine is growing, with qualitative studies increasingly used to examine patient experience and unsafe organizational cultures. The present review considers qualitative research recently conducted on teamwork and organizational culture in the ICU and also other acute domains. Recent findings: Qualitative studies have highlighted the importance of interpersonal and social aspects of healthcare on managing and responding to patient care needs. Clear/consistent communication, compassion, and trust underpin successful patient-physician interactions, with improved patient experiences linked to patient safety and clinical effectiveness across a wide range of measures and outcomes. Across multidisciplinary teams, good communication facilitates shared understanding, decision-making and coordinated action, reducing patient risk in the process. Summary: Qualitative methods highlight the complex nature of risk management in hospital wards, which is highly contextualized to the demands and resources available, and influenced by multilayered social contexts. In addition to augmenting quantitative research, qualitative investigations enable the investigation of questions on social behaviour that are beyond the scope of quantitative assessment alone. To develop improved patient-centred care, health professionals should therefore consider integrating qualitative procedures into their existing assessments of patient/staff satisfaction

Structural and biophysical analysis of the CLCA1 VWA domain suggests mode of TMEM16A engagement

The secreted protein calcium-activated chloride channel regulator 1 (CLCA1) utilizes a von Willebrand factor type A (VWA) domain to bind to and potentiate the calcium-activated chloride channel TMEM16A. To gain insight into this unique potentiation mechanism, we determined the 2.0-Å crystal structure of human CLCA1 VWA bound to C

Research capacity building in general practice: A new opportunity in Fremantle, WA

One of the great disappointments of primary care medicine has been the failure to develop a strong research tradition among general practitioners. This has happened despite the great legacy left by William Budd, James MacKenzie, and Will Pickles, and the clear acceptance that such research is necessary to improve patient care

A proof of concept study to identify familial hypercholesterolaemia in primary care

This study examines the feasibility (acceptability, usefulness, convenience and cost) of using a new method of detecting hypercholesterolaemia through GP clinics. If the condition is found following a fasting pathology test, close relatives will also be checked. This family tracing will identify new patients with the condition as they stand to benefit most from early treatment. The proposed new approach will allow the condition to be managThe research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy