Community hospitals – the place of local service provision in a modernising NHS: an integrative thematic literature review

Background: Recent developments within the United Kingdom's (UK) health care system have reawakened interest in community hospitals (CHs) and their role in the provision of health care. This integrative literature review sought to identify and assess the current evidence base for CHs. Methods: A range of electronic reference databases were searched from January 1984 to either December 2004 or February 2005: Medline, Embase, Web of Knowledge, BNI, CINAHL, HMIC, ASSIA, PsychInfo, SIGLE, Dissertation Abstracts, Cochrane Library, Kings Fund website, using both keywords and text words. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying unifying concepts and discrepant issues. Results: The search strategy identified over 16,000 international references. We included papers of any study design focussing on hospitals in which care was led principally by general practitioners or nurses. Papers from developing countries were excluded. A review of titles revealed 641 potentially relevant references; abstract appraisal identified 161 references for review. During data extraction, a further 48 papers were excluded, leaving 113 papers in the final review. The most common methodological approaches were cross-sectional/descriptive studies, commentaries and expert opinion. There were few experimental studies, systematic reviews, economic studies or studies that reported on longer-term outcomes. The key themes identified were origin and location of CHs; their place in the continuum of care; services provided; effectiveness, efficiency and equity of CHs; and views of patients and staff. In general, there was a lack of robust evidence for the role of CHs, which is partly due to the ad hoc nature of their development and lack of clear strategic vision for their future. Evidence for the effectiveness and efficiency of the services provided was limited. Most people admitted to CHs appeared to be older, suggesting that admittance to CHs was age-related rather than condition-related. Conclusion: Overall the literature surveyed was long on opinion and short of robust studies on CHs. While lack of evidence on CHs does not imply lack of effect, there is an urgent need to develop a research agenda that addresses the key issues of health care delivery in the CH setting

Consensus on occupational health competencies for UK first contact physiotherapists

Background: Patients at risk of preventable sickness absence frequently attend at primary care. First contact physiotherapists (FCP) may provide an optimal way of reducing this risk; however, there is significant variability in clinical practice, limited research directing best practice and this work and health role is traditionally seen as outside of the ‘therapeutic relationship’. If FCP's training and development in this area is considered, FCP's will be able to effectively conduct fitness for work and sickness absence certification within UK primary care settings. Aims: This study aimed to reach expert consensus for work-related competencies for FCP practice for patients at risk of preventable sickness absence. Methods: A modified Delphi technique involved a UK-wide FCP expert panel completing three rounds of an online questionnaire. The initial 30-competency questionnaire, based on two separate Nominal Group Techniques in a FCP and Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE) physiotherapist cohort and Health Education England's published Roadmap to Practice, covered occupational health specific items (knowledge and skills) related to the topic. Consensus threshold was set a priori at 70% level of group agreement. Items not reaching consensus were modified and new items added based on themes from qualitative data from the open-ended free text questions present in each section. Items that reached values greater than or equal to 70% of agreement among experts were considered definitive for the competency items. Items between 51% and 69% of agreement were included for the next round and those items with less than or equal to 50% of agreement were considered unnecessary and were excluded. In the third round, the occupational health (OH) specific contents for primary care were classified according to the degree of consensus as follows: strong (≥70% of agreement), moderate (51–69% of agreement) and weak (50% of agreement) based on the maximum consensus reached. Results: Of the 30 initial competencies, 20 (67%) reached a strong degree of consensus and 2 (7%) reached a moderate degree of consensus and 8 (27%) competencies were not recommended (≤50% of agreement). 20 OH specific competencies reached a priori consensus level of agreement to provide the final group list. Conclusions: This paper provides an empirically derived list of OH competencies for FCP education in primary care ‘first point of care’ physiotherapy with a high level of expert agreement and high retention rate between rounds. Contribution of the paper: • The role of certifying sickness absence and providing fitness for work advice within primary care settings has normally been conducted by General Practitioners, largely due to the legislative aspects that require a ‘Fit Note’. • FCPs may be ideally suited in ensuring that work is considered at an early stage to help support and prompt conversations about work. • Most individual's health needs are addressed within Primary Care (first point of contact in the NHS). • There is a lack of empirical evidence on the competencies needed for the new ‘first point of contact role’ whereby FCPs manage undiagnosed and undifferentiated musculoskeletal (MSK) conditions.</p

Synthesis and characterisation of transition metal fluorides

This thesis reports exploratory studies on the synthesis of new vanadium and copper-containing compounds, with a particular emphasis on preparing new magnetically-active materials with S = ½ spin configurations. Eighteen crystal structures are reported, sixteen of which represent new compounds. These materials were studied for magnetic behaviour where appropriate. The sixteen vanadium-containing compounds were prepared using either the hydrothermal, Solvothermal or ionothermal synthesis methods at temperatures ranging from 60 °C to 200 °C. Inorganic cations and organic moieties were used as templating agents to direct the structures, often targeting potentially frustrated lattices based on triangular motifs by using ‘triangular’ templating molecules such as guanidine. Solvent choices, as well as reactant ratios were all varied in order to produce the new oxide, fluoride and oxyfluoride compounds of vanadium. Three families of vanadium compounds were prepared from these methods; a family of 1D vanadium (IV) oxyfluoride ladder compounds of general formula AVOF₃ (A=K⁺, Rb⁺, Cs⁺ or NH₄⁺), and a family of 1D vanadium fluoride chain compounds of general formula A₂VF₅ (A=K⁺ or NH₄⁺). The third family is comprised of three vanadium-containing compounds of varying dimensionality that share guanidine as the common organic moiety. Several miscellaneous compounds of vanadium such as clusters and a new V (IV) layer were synthesized, and are reported. The two copper compounds containing compounds, analogous to the pseudo-kagome compound, Cu₃Bi(SeO₃)₂O₂Br, were prepared via solid-state techniques. A detailed neutron diffraction study was carried out on the two compounds to measure the evolution of the magnetic properties from room temperature down to 2.5 K. Representational analysis was utilised in order to provide a detailed magnetic model of the compounds

A Lexical Approach to Collective Personality Using Nongroup Members as Raters

The construct of personality exhibits utility in predicting group outcomes. However, quantifying a group personality construct has almost exclusively been accomplished by aggregating individual group member five-factor personality scores to derive the group personality score. This type of operationalizing rests on the assumption that collective personality exists and has a five-factor structure, makes results context specific, and limits cross-comparison of different types of groups. The purpose of this quantitative study was to apply a lexical approach and exploratory factor analysis to explore personality structure of a group at a group level. The research question focused on identifying if a construct of collective personality operationalized at the group level through use of a lexical approach would yield a five-factor structure. Exploratory factor analysis was applied to data collected from an anonymous on-line survey administered to a convenience sample of 11 staff at residential treatment facilities for children. Data were not able to be subjected to tests for sampling adequacy before primary component and factor extraction due to the low sample size and the resulting factors did not rotate in 25 iterations. Despite these limitations, results suggest the lexical approach can be applied to quantifying the construct of collective personality. Results also provide support for a collective personality structure that may differ from the five-factor model of individual personality structure. These findings inform on a possible new way of quantifying and studying group characteristics which could lead to social change through better ways of understanding, predicting, and changing group behavior in a wide variety of domains

Scoping biological indicators of soil quality Phase II. Defra Final Contract Report SP0534

This report presents results from a field assessment of a limited suite of potential biological indicators of soil quality to investigate their suitability for national-scale soil monitoring

Promoting the achievement of looked after children and young people in South Tyneside

As of March 2016, there were 70,440 children and young people in care in England. The number of looked after children has continued to increase steadily over the last eight years. Sixty per cent of these children are in care because of abuse or neglect and three-quarters are placed in foster care arrangements. Children and young people who are in or have experienced care remain one of the lowest performing groups in terms of educational outcomes. Last year, 14% of looked after children achieved five or more A*–C GCSEs or equivalent, including English and mathematics. As a consequence, they also experience poorer employment and health outcomes after leaving school compared to their peers. They are over-represented amongst the offender population and those who experience homelessness. However, research is emerging to show that children and young people in care can have very positive experiences of school and are supported effectively to reach their full potential academically and socially. The purpose of this report is to share practice in selected South Tyneside schools that is contributing to improved outcomes and school experiences for children and young people in care. In July 2015, the South Tyneside Virtual School (VS) collaborated with UCL Institute of Education to run their Promoting the Achievement of Looked After Children (PALAC) programme with seven schools in the local authority (LA). This report presents an account of the programme, including the activities undertaken by the participants and the outcomes of the programme to date for students in care and staff in the participating school

The interaction of age and gender in illness narratives

Recognition of the greater capacity of older women to draw on supportive social networks has now supplemented an earlier focus of research into gender and ageing which portrayed older men as a 'privileged gerontocracy' because of their greater access to financial resources and spousal care. This study of the experiences of cancer among people of three different age groups conducted a comparative keyword analysis of their narratives to consider the gender differentiation of a third resource: access to medical information and personnel. The analysed narratives were sampled from a large archive of research interviews. It was found that older men with cancer demonstrated a greater involvement with medicine as an expert system than younger men or women or older women. This stemmed from their social confidence when interacting with doctors and their interest in treating their illness as a 'problem' to be fixed with medico-scientific solutions. Compared with younger men and women of all ages, older men were less likely to draw on informal social and family networks for support, or to discuss in a direct style the emotional dimension of illness experience. Our findings contrast with other studies that have reported linguistic disadvantage in older people in elderly care settings, which underlines the importance of context for linguistic studies. © 2008 Cambridge University Press

Bone tissue engineering

Medical advances have led to a welcome increase in life expectancy. However, accompanying longevity introduces new challenges: increases in age-related diseases and associated reductions in quality of life. The loss of skeletal tissue that can accompany trauma, injury, disease or advancing years can result in significant morbidity and significant socio-economic cost and emphasise the need for new, more reliable skeletal regeneration strategies. To address the unmet need for bone augmentation, tissue engineering and regenerative medicine have come to the fore in recent years with new approaches for de novo skeletal tissue formation. Typically, these approaches seek to harness stem cells, innovative scaffolds and biological factors that promise enhanced and more reliable bone formation strategies to improve the quality of life for many. This review provides an overview of recent developments in bone tissue engineering focusing on skeletal stem cells, vascular development, bone formation and the translation from preclinical in vivo models to clinical delivery