GP perspectives on hospital discharge letters : an interview and focus group study

Background: Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs’ opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear. Aim: To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes. Design & setting: The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England. Method: Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques. Results Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding. Conclusion: GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients

Sex on TV: Content and Context

Part of a series that examines the nature and extent of sexual messages conveyed on American television. Focuses on references to contraception, safer sex, and waiting to have sex. Based on a sample of 1997-1998 programs

Young people who are being bullied – do they want general practice support?

Background: Childhood bullying is a major risk factor for health, education and social relationships, with effects persisting into adulthood. It affects half of all children at some point, with 10–14 % experiencing bullying that lasts for years. With the advent of cyberbullying, it can happen at all times and places. There have been calls for GPs to take a more active role in identifying and supporting young people who are being bullied. This paper explores young people’s and parents’ opinions about whether general practice should be involved in identifying and supporting young people who are being bullied. Methods: Two hundred six young people (85.9 % female, mean ± sd age 16.2 ± 3.2 years) and 44 parents were recruited through established bullying charity websites and their social media channels to complete an online questionnaire comprising multiple-choice questions and unlimited narrative responses. Questionnaire responses were analysed by age and gender using descriptive statistics. A descriptive analysis of the narrative responses was undertaken and key themes identified. Results: Young people (90.8 %) and parents (88.7 %) thought it was important for GPs to be better able to recognise and help young people who are being bullied. Most recognised the link between bullying and health. The doctor’s independence was seen as advantageous. Young people preferred completing a screening questionnaire to disclose experience of being bullied than being asked directly. They expressed concerns about how questions would be asked and whether information would be shared with parents/guardians. Parents were supportive of the use of a screening questionnaire, and most expected their child’s disclosure to be shared with them. Conclusion: Young people and parents recruited through anti-bullying websites and social media would welcome greater GP involvement in identifying and supporting young people who are being bullied and their families, provided it is offered in a caring, compassionate and confidential manner

The discharge communication study : research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample

Background: Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient’s General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care. Methods: The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be “matched” to the discharge letter sample, so forming multiple-perspective “quartet” cases. These “quartets” allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis. Discussion: This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations

Renegotiating father’s identity following stillbirth: what and who am I?

This study examines the experiences of men following stillbirth in particular the challenges they face in claiming their identity as a father of an absent child. Fathers felt diminished when concerns about how they were coping were directed only to the women. Contrary to the notion that father’s experience suggests men suffer less distress, this research shows that men also deal with loss at an emotional level. This investigation into men’s accounts of loss forms part of a larger study in which 28 men and women participated in interviews and focus groups about their experiences of perinatal death. By listening to narrative accounts of loss, the passage to parenthood for bereaved men represents a disruption and re-evaluation of who they are, what they knew about the world as they negotiate the incomprehensibility of the death itself. Narratives by bereaved men also reveal how their sense of self and identity is mediated by the social and cultural milieu to which they belong and are largely disenfranchising experiences when friends, family and others, at times, fail to acknowledge the enormity of their loss. The findings suggest that recognition of the death of baby who is stillborn as well as the impact of the death for father’s is intertwined with personal identity. Men in this study needed to receive recognition as fathers, both at the time of their loss and after. In examining the reproductive and bereavement journey of men, several domains occurred to illuminate the experience of men including; men as support partners; the impact of the death; parenting an absent child [advocate, protector]. The findings from this study will offer insight into the experiences of men that will resonate for others including practitioners who support individuals going through similar experiences. Ethical approval for the study was granted by the University of Bristol Ethics Committee as part of doctoral research. Written informed consent was obtained by all study participants. No formal recruitment was obtained through the National Health Service or Government Institution and was entirely voluntary

National Institute for Rocket Propulsion Systems 2012 Annual Report: A Year of Progress and Challenge

The National Institute for Rocket Propulsion Systems (NIRPS) maintains and advances U.S. leadership in all aspects of rocket propulsion for defense, civil, and commercial uses. The Institute's creation is in response to widely acknowledged concerns about the U.S. rocket propulsion base dating back more than a decade. U.S. leadership in rocket and missile propulsion is threatened by long-term industry downsizing, a shortage of new solid and liquid propulsion programs, limited ability to attract and retain fresh talent, and discretionary federal budget pressures. Numerous trade and independent studies cite erosion of this capability as a threat to national security and the U.S. economy resulting in a loss of global competitiveness for the U.S. propulsion industry. This report covers the period between May 2011 and December 2012, which includes the creation and transition to operations of NIRPS. All subsequent reports will be annual. The year 2012 has been an eventful one for NIRPS. In its first full year, the new team overcame many obstacles and explored opportunities to ensure the institute has a firm foundation for the future. NIRPS is now an active organization making contributions to the development, sustainment, and strategy of the rocket propulsion industry in the United States. This report describes the actions taken by the NIRPS team to determine the strategy, organizational structure, and goals of the Institute. It also highlights key accomplishments, collaborations with other organizations, and the strategic framework for the Institute

Gamma Rays from Star Formation in Clusters of Galaxies

Star formation in galaxies is observed to be associated with gamma-ray emission. The detection of gamma rays from star-forming galaxies by the Fermi Large Area Telescope (LAT) has allowed the determination of a functional relationship between star formation rate and gamma-ray luminosity (Ackermann et. al. 2012). Since star formation is known to scale with total infrared (8-1000 micrometers) and radio (1.4 GHz) luminosity, the observed infrared and radio emission from a star-forming galaxy can be used to quantitatively infer the galaxy's gamma-ray luminosity. Similarly, star forming galaxies within galaxy clusters allow us to derive lower limits on the gamma-ray emission from clusters, which have not yet been conclusively detected in gamma rays. In this study we apply the relationships between gamma-ray luminosity and radio and IR luminosities derived in Ackermann et. al. 2012 to a sample of galaxy clusters from Ackermann et. al. 2010 in order to place lower limits on the gamma-ray emission associated with star formation in galaxy clusters. We find that several clusters have predicted lower limits on gamma-ray emission that are within an order of magnitude of the upper limits derived in Ackermann et. al. 2010 based on non-detection by Fermi-LAT. Given the current gamma-ray limits, star formation likely plays a significant role in the gamma-ray emission in some clusters, especially those with cool cores. We predict that both Fermi-LAT over the course of its lifetime and the future Cherenkov Telescope Array will be able to detect gamma-ray emission from star-forming galaxies in clusters.Comment: 17 pages, 2 figures, 2 tables. Minor revisions made to match version accepted to Ap

Exploring the perceived usefulness and ease of use of a personalized web-based resource (care companion) to support informal caring : qualitative descriptive study

Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers' resilience. It aims to provide personalized access to information and resources that are responsive to individuals' caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. [Abstract copyright: ©Amadea Turk, Emma Fairclough, Gillian Grason Smith, Benjamin Lond, Veronica Nanton, Jeremy Dale. Originally published in JMIR Aging (http://aging.jmir.org), 20.08.2019.

Amorphous and Crystalline H20 Ice at Rhea's Inktomi Crater

We present the analysis of Cassini spectral data from spectral mapping of Saturnian icy moons Dione and Rhea, to investigate possible effects of impact crater formation on the relative abundances of crystalline and amorphous water ice in the moons' ice crusts. Both moons display morphologically young ray craters as well as older craters. Possible changes in ice properties due to crater formation are conjectured to be more visible in younger craters, and as such Rhea's well imaged ray crater Inktomi is analysed, as are older craters for comparison. We used data from Cassini's Visual and Infrared Mapping Spectrometer (VIMS). For each pixel in the VIMS maps, spectral data were extracted in the near-infrared range (1.75 micrometers less than lambda less than 2.45 micrometers). Analysis was begun by fitting a single Gaussian to the peak in absorption at 2.0 micrometers, which was then subtracted from the data, leaving residuals with a minimum on either side of the original 2.0-micrometers band. The spectra of the individual spatial pixels were then clustered by the differences between these minima, which are sensitive to changes in both ice grain size and crystallinity. This yielded preliminary maps which approximated the physical characteristics of the landscape and were used to identify candidates for further analysis. Spectra were then clustered by the properties of the 1.5-micrometers band, to divide the map into regions based on inferred grain size. For each region, the predicted differences in minima from the Gaussian residuals, over a range of crystallinities, were calculated based on the found grain sizes. This model was used to find the crystallinity of each pixel via grain size and characteristics of the residual function. Preliminary results show a greater degree of crystallization of young crater interiors, particularly in Rhea's ray crater Inktomi, where ice showed crystalline ice abundances between 33 percent and 61 percent. These patterns in ice crystallization are possibly attributable to increased heat generated during crater formation

Structures of RecBCD in complex with phage-encoded inhibitor proteins reveal distinctive strategies for evasion of a bacterial immunity hub

Following infection of bacterial cells, bacteriophage modulate double-stranded DNA break repair pathways to protect themselves from host immunity systems and prioritise their own recombinases. Here, we present biochemical and structural analysis of two phage proteins, gp5.9 and Abc2, which target the DNA break resection complex RecBCD. These exemplify two contrasting mechanisms for control of DNA break repair in which the RecBCD complex is either inhibited or co-opted for the benefit of the invading phage. Gp5.9 completely inhibits RecBCD by preventing it from binding to DNA. The RecBCD-gp5.9 structure shows that gp5.9 acts by substrate mimicry, binding predominantly to the RecB arm domain and competing sterically for the DNA binding site. Gp5.9 adopts a parallel coiled-coil architecture that is unprecedented for a natural DNA mimic protein. In contrast, binding of Abc2 does not substantially affect the biochemical activities of isolated RecBCD. The RecBCD-Abc2 structure shows that Abc2 binds to the Chi-recognition domains of the RecC subunit in a position that might enable it to mediate the loading of phage recombinases onto its single-stranded DNA products