Clinician views on optimism and empathy in primary care consultations.

BACKGROUND: Practitioner expressions of optimism and empathy may improve treatment engagement, adherence and patient satisfaction but are not delivered consistently amidst the challenges of everyday clinical practice. AIMS: To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify behavioural, attitudinal and/or contextual issues likely to encourage or deter PCPs from practising such communication. DESIGN & SETTING: Qualitative interview study with 20 PCPs (General Practitioners, Practice Nurses, Primary Care Physiotherapists). METHOD: Semi-structured telephone interviews with 20 PCPs. Data was analysed thematically. RESULTS: A conceptual mismatch between optimism and patient expectations became apparent; when asked how PCPs communicate about the likely effects of a treatment answers were focussed around managing patient expectations. When prompted, it became clear PCPs were open to communicating optimistically with patients, but emphasised the need for realism. Concerns arose that patients may not be receptive to optimistic messages, especially when holding negative expectations. PCPs felt that expressing empathy is fundamental to all clinical consultations, noting that it can be challenging. Some PCPs worried that increasing expressions of empathy might increase their risk of clinician burnout and felt guilty about (appropriately) communicating empathy whilst maintaining some emotional distance. CONCLUSION: PCPs agreed expressing realistic optimism during consultations could aid communication and would constitute a novel change to practice. PCPs strive for clinical empathy but can struggle to manage emotional self-protection. Specific training to help PCPs express realistic optimism and empathy, and better utilise efficient non-verbal skills could help these issues

Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography.

OBJECTIVE: To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS: We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS: Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION: Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS: Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations

Learning in disrupted projects: on the nature of corporate and personal learning

The majority of large, complex projects suffer disruptions. These can have unexpected and significant impacts on a project, resulting in excessive time and cost overruns. Disrupted projects therefore require careful management in order to minimize the impact of a disruption. One element of a project for which disruptions will have a particular impact is on any anticipated learning gains. Loss of learning from disruptions can often be very significant. This lost learning may be from individual workers (personal) or by the organization (corporate). An understanding of the impact of a particular disruption on learning is required to enable effective management of that disruption. This paper argues that improved management of learning in disrupted projects may come from the disaggregation of personal and corporate learning from the typically used aggregated learning curve presumptions. The literature is reviewed to explore whether a method of disaggregation can be determined from existing propositions about the behaviour of learning curves. The explorations demonstrate that the disaggregation of a learning curve is complex. The contribution of this paper derives from developing an understanding of the role of asymptotes in constructing learning curves, and the nature of the interaction between personal and corporate learning. These two aspects are argued to be crucial aspects in managing the impact of disruptions on learning. The main motivation for this work is to provide managers with an understanding of the disaggregation process, in order that they can think through the impact of a disruption on learning in their own projects

Resistance of Scots pine (Pinus sylvestris L.) wood modified with functionalized commercial silicone emulsions against subterranean termites

Scots pine (Pinus sylvestris L.) sapwood was treated with quat-silicone micro-emulsion (<40 nm), amino-silicone macro-emulsion (110 nm), alkyl-modified silicone macro-emulsion (740 nm) and solutions of inorganic water glass. Three treatment concentrations of 5, 15 and 30% (w/w) were used for the impregnation of the test specimens. Termite resistance was assessed following a 16-week field trial conducted in northern Queensland, Australia. Two different field sites were chosen for exposure to feeding by Coptotermes acinaciformis (Froggatt) and Mastotermes darwiniensis (Froggatt). Following exposure, the test and feeder specimens were inspected and assessed for termite damage using a visual rating system (from 10 sound to 0 completely destroyed) and individual mass losses. The specimens treated with quat- and amino-silicone emulsions resisted damage by both termite species, even at less than 15% weight percent gains (WPGs). Alkyl-modified silicone macro-emulsion and water glass treatment induced somewhat less resistance to termite damage, but imparted protection at higher WPGs