Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator

Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care

Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

A Fuzzy Logic Based Controller for the Automated Alignment of a Laser-beam-smoothing Spatial Filter

A fuzzy logic based controller for a laser-beam-smoothing spatial filter is described. It is demonstrated that a human operator's alignment actions can easily be described by a system of fuzzy rules of inference. The final configuration uses inexpensive, off-the-shelf hardware and allows for a compact, readily implemented embedded control system

Temperature-stable Gunn-diode oscillator

Oscillator consisting of Gunn diode embedded in coaxial circuit has excellent temperature stability and low fabrication costs as compared with automatic-frequency-control crystal oscillators

Unsung heroes: Constituency election agents in British general elections

Despite their central role in the electoral process, constituency agents have been largely overlooked by political scientists and this article seeks to rectify the omission. It sketches the origins and development of the role of agent from the late 19th century and suggests that a serious rethink of the role took place in the 1990s. Survey-based evidence about the social characteristics of agents is presented confirming that they are largely middle-aged, middle-class, well-educated men. They are also becoming more experienced, offer realistic assessments of the impact of constituency campaigning and, arguably, many take a long-term view of how their party's support can be maximised

GRIDCC: Real-time workflow system

The Grid is a concept which allows the sharing of resources between distributed communities, allowing each to progress towards potentially different goals. As adoption of the Grid increases so are the activities that people wish to conduct through it. The GRIDCC project is a European Union funded project addressing the issues of integrating instruments into the Grid. This increases the requirement of workflows and Quality of Service upon these workflows as many of these instruments have real-time requirements. In this paper we present the workflow management service within the GRIDCC project which is tasked with optimising the workflows and ensuring that they meet the pre-defined QoS requirements specified upon them

Modulation of LAT1 (SLC7A5) transporter activity and stability by membrane cholesterol.

LAT1 (SLC7A5) is a transporter for both the uptake of large neutral amino acids and a number of pharmaceutical drugs. It is expressed in numerous cell types including T-cells, cancer cells and brain endothelial cells. However, mechanistic knowledge of how it functions and its interactions with lipids are unknown or limited due to inability of obtaining stable purified protein in sufficient quantities. Our data show that depleting cellular cholesterol reduced the Vmax but not the Km of the LAT1 mediated uptake of a model substrate into cells (L-DOPA). A soluble cholesterol analogue was required for the stable purification of the LAT1 with its chaperon CD98 (4F2hc,SLC3A2) and that this stabilised complex retained the ability to interact with a substrate. We propose cholesterol interacts with the conserved regions in the LAT1 transporter that have been shown to bind to cholesterol/CHS in Drosophila melanogaster dopamine transporter. In conclusion, LAT1 is modulated by cholesterol impacting on its stability and transporter activity. This novel finding has implications for other SLC7 family members and additional eukaryotic transporters that contain the LeuT fold

Variation in ambulance call rates for care homes in Torbay, UK

Emergency ambulance calls represent one of the routes of emergency hospital admissions from care homes. We aimed to describe the pattern of ambulance call rates from care homes and identify factors predicting those homes calling for an ambulance most frequently. We obtained data from South Western Ambulance Service NHS Foundation Trust on 3138 ambulance calls relating to people aged 65 and over from care homes in the Torbay region between 1/4/12 and 31/7/13. We supplemented this with data from the Care Quality Commission (CQC) website on home characteristics and outcomes of CQC inspections. We used descriptive statistics to identify variation in ambulance call rates for residential and nursing homes and fitted negative binomial regression models to determine if call rates were predicted by home type (nursing versus residential), the five standards in the CQC reports, dementia care status or travel time to hospital. One hundred and forty-six homes (119 residential and 27 nursing) were included in the analysis. The number of calls made ranged from 1 to 99. The median number (IQR; range) of calls per resident per year was 0.51 (0.21 to 0.89; 0.03 to 2.45). Nursing homes had a lower call rate than residential homes (adjusted rate ratio (ARR) 0.29; 95% CI: 0.22 to 0.40 ; p<0.001); care homes failing the quality and suitability of management standard had a lower call rate compared to those who passed (ARR 0.67; 95% CI: 0.50 to 0.90; p=0.006); and homes specialising in dementia had a higher call rate compared to those not specialising (ARR 1.56; 95% CI: 1.23 to 1.96; p<0.001). These findings require replication in other regions to establish their generalisability and further investigation is required to determine the extent to which callrate variability reflects the different needs of resident populations or differences in care home policies and practice