'The big buzz': a qualitative study of how safe care is perceived, understood and improved in general practice

Background: Exploring frontline staff perceptions of patient safety is important, because they largely determine how improvement interventions are understood and implemented. However, research evidence in this area is very limited. This study therefore: explores participants’ understanding of patient safety as a concept; describes the factors thought to contribute to patient safety incidents (PSIs); and identifies existing improvement actions and potential opportunities for future interventions to help mitigate risks. Methods: A total of 34 semi-structured interviews were conducted with 11 general practitioners, 12 practice nurses and 11 practice managers in the West of Scotland. The data were thematically analysed. Results: Patient safety was considered an important and integral part of routine practice. Participants perceived a proportion of PSIs as being inevitable and therefore not preventable. However, there was consensus that most factors contributing to PSIs are amenable to improvement efforts and acknolwedgement that the potential exists for further enhancements in care procedures and systems. Most were aware of, or already using, a wide range of safety improvement tools for this purpose. While the vast majority was able to identify specific, safety-critical areas requiring further action, this was counter-balanced by the reality that additional resources were a decisive requirment. Conclusion: The perceptions of participants in this study are comparable with the international patient safety literature: frontline staff and clinicians are aware of and potentially able to address a wide range of safety threats. However, they require additional resources and support to do so

Airflow limitation or static hyperinflation: which is more closely related to dyspnea with activities of daily living in patients with COPD?

<p>Abstract</p> <p>Background</p> <p>Dyspnea while performing the activities of daily living has been suggested to be a better measurement than peak dyspnea during exercise. Furthermore, the inspiratory capacity (IC) has been shown to be more closely related to exercise tolerance and dyspnea than the FEV₁, because dynamic hyperinflation is the main cause of shortness of breath in patients with COPD. However, breathlessness during exercise is measured in most studies to evaluate this relationship.</p> <p>Purpose</p> <p>To evaluate the correlation between breathlessness during daily activities and airflow limitation or static hyperinflation in COPD.</p> <p>Methods</p> <p>We examined 167 consecutive outpatients with stable COPD. The Baseline Dyspnea Index (BDI) was used to evaluate dyspnea with activities of daily living. The relationship between the BDI score and the clinical measurements of pulmonary function was then investigated.</p> <p>Results</p> <p>The Spearman rank correlation coefficients (Rs) between the BDI score and the FEV₁(L), FEV₁(%pred) and FEV₁/FVC were 0.60, 0.56 and 0.56, respectively. On the other hand, the BDI score also correlated with the IC, IC/predicted total lung capacity (TLC) and IC/TLC (Rs = 0.45, 0.46 and 0.47, respectively). Although all of the relationships studied were strongly correlated, the correlation coefficients were better between dyspnea and airflow limitation than between dyspnea and static hyperinflation. In stepwise multiple regression analyses, the BDI score was most significantly explained by the FEV₁(R²= 26.2%) and the diffusion capacity for carbon monoxide (R²= 14.4%) (Cumulative R²= 40.6%). Static hyperinflation was not a significant factor for clinical dyspnea on the stepwise multiple regression analysis.</p> <p>Conclusion</p> <p>Both static hyperinflation and airflow limitation contributed greatly to dyspnea in COPD patients.</p

Using air quality monitoring to reduce second-hand smoke exposure in homes : the AFRESH feasibility study

ACKNOWLEDGEMENTS This research was supported by a grant from the Medical Research Council’s Public Health Intervention Development scheme. The research team would like to thank Christine Foster and the staff and volunteers of Healthy Valleys, Lanarkshire, for their support in carrying out this work, and Beverley Scheepers and Joanne Buchan of ASH Scotland for their assistance in developing training material. FUNDING Medical Research Council PHIND Grant MR/M026159/1.Peer reviewedPublisher PD

Effects of combined tiotropium/olodaterol on inspiratory capacity and exercise endurance in COPD.

Two replicate, double-blind, 6-week, incomplete-crossover studies (MORACTO 1 and 2) assessed the effects of tiotropium/olodaterol on inspiratory capacity and exercise endurance time in patients with moderate to severe chronic obstructive pulmonary disease.For each patient, four of five treatments were administered once daily for 6 weeks, with a 21-day washout between treatments: tiotropium/olodaterol 2.5/5 µg or 5/5 µg, tiotropium 5 µg, olodaterol 5 µg or placebo, all via the Respimat inhaler. Primary outcomes were inspiratory capacity prior to exercise and exercise endurance time during constant work-rate cycle ergometry to symptom limitation at 75% of peak incremental work rate after 6 weeks (2 h post-dose).295 and 291 patients were treated in MORACTO 1 and 2, respectively. Tiotropium/olodaterol 2.5/5 and 5/5 µg provided significant improvements in inspiratory capacity versus placebo and monotherapies (p&lt;0.0001), and significant improvements in exercise endurance time versus placebo (p&lt;0.0001). Intensity of breathing discomfort was reduced following both doses of tiotropium/olodaterol versus placebo (p&lt;0.0001).Once-daily tiotropium/olodaterol yielded improvements in lung hyperinflation versus placebo and statistically significant improvements versus monotherapies. Tiotropium/olodaterol also showed improvements in dyspnoea and exercise tolerance versus placebo but not consistently versus monotherapies

Site multiplicity of rare earth ions in III-nitrides

This presentation reviews recent lattice location studies of RE ions in GaN by electron emission channelling (EC) and X-ray absorption fine structure (XAFS) techniques. These studies agree that RE ions at low concentrations (whether they are incorporated during growth or introduced later by ion implantation) predominantly occupy Ga substitutional sites, as expected from considerations of charge equivalence. We combine this result with some examples of the welldocumented richness of optical spectra of GaN:RE3+ to suggest that the luminescence of these materials may be ascribed to a family of rather similar sites, all of which feature the REGa defect

Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

Objectives: Patient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting. Design: Qualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT). Setting: Scottish general practice. Participants: We conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland. Results: We identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants’ involvement; (3) the characteristics of the reviewers—implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful. Conclusions: This study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors

Charmless B Decays to Final States with Radially Excited Vector Mesons

We consider the weak decays of a B meson to final states that contain a S-wave radially excited vector meson. We consider vector-pseudoscalar final states and calculate ratios of the type $B \to \rho^{\prime} \pi/B \to \rho \pi$, $B \to \omega^{\prime} \pi/B \to \omega \pi$ and $B \to \phi^{\prime} \pi/B \to \phi \pi$ where $\rho^{\prime}$, $\omega^{\prime}$ and $\phi^{\prime}$ are higher $\rho$, $\omega$ and $\phi$ S-wave radial excitations. We find such decays to have larger or similar branching ratios compared to decays where the final state $\rho$, $\omega$ and $\phi$ are in the ground state. We also study the effect of radial mixing in the vector system generated from hyperfine interaction and the annihilation term.Comment: Latex, 12 pages, one figur

Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions