Fat

Arlene and Pappy spill out at the usual booth

A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK

Background: The Quality and Outcomes Framework (QOF) is an incentive scheme for general practice, which was introduced across the UK in 2004. The Quality and Outcomes Framework is one of the biggest pay for performance (P4P) scheme in the world, worth £691 million in 2016/17. We now know that P4P is good at driving some kinds of improvement but not others. In some areas, it also generated moral controversy, which in turn created conflicts of interest for providers. We aimed to undertake a meta-synthesis of 18 qualitative studies of the QOF to identify themes on the impact of the QOF on individual practitioners and other staff. Methods: We searched 5 electronic databases, Medline, Embase, Healthstar, CINAHL and Web of Science, for qualitative studies of the QOF from the providers’ perspective in primary care, published in UK between 2004 and 2018. Data was analysed using the Schwartz Value Theory as a theoretical framework to analyse the published papers through the conceptual lens of Professionalism. A line of argument synthesis was undertaken to express the synthesis. Results: We included 18 qualitative studies that where on the providers’ perspective. Four themes were identified; 1) Loss of autonomy, control and ownership; 2) Incentivised conformity; 3) Continuity of care, holism and the caring role of practitioners’ in primary care; and 4) Structural and organisational changes. Our synthesis found, the Values that were enhanced by the QOF were power, achievement, conformity, security, and radition. The findings indicated that P4P schemes should aim to support Values such as benevolence, self-direction, stimulation, hedonism and universalism, which professionals ranked highly and have shown to have positive implications for Professionalism and efficiency of health systems. Conclusions: Understanding how practitioners experience the complexities of P4P is crucial to designing and delivering schemes to enhance and not compromise the values of professionals. Future P4P schemes should aim to permit professionals with competing high priority values to be part of P4P or other quality improvement initiatives and for them to take on an ‘influencer role’ rather than being ‘responsive agents’. Through understanding the underlying Values and not just explicit concerns of professionals, may ensure higher levels of acceptance and enduring success for P4P schemes

Group Theoretical Investigation of Octahedral and Cuboctahedral Bonding

The behavior of electrons in molecules is governed by quantum mechanical laws – insofar as we can tell. A quantitative check has proved impossible for all except the simplest systems, such as the H2+ and H2 molecules. Generally, severe approximations have to be made. The procedure that is supported by spectral measurements is the molecular orbital method. Indeed, energy levels of many systems can be classified in molecular orbital configurations, while a similar explanation is not possible in terms of valence-bond or hybridization description. In the work reported here, group theoretical methods have been used to obtain symmetry orbitals that are molecular orbital candidates. The symmetric structures considered include an octahedral B6 cage, octahedral Ta6C12+2, and a cuboctahedral B12 cage. The biggest problem arose in combining the symmetry orbitals from multiply occurring irreducible representations to get functions belonging to the same column. Finally, energy levels were found and expressed in parametric form

What Information Technology Asks of Business Higher Education Institutions: The Case of Rhode Island

Using data from Rhode Island, this research examines the relationships among certifications, skills, educational levels and the level of compensation across the IT field and attempts to discriminate between ten major job functions. It assesses the significance of skills and certifications to specific IT worker categories. The level of education was found to predict success. Certification and skills vary across job functions, and did not necessarily differentiate across IT job functions. Suggestions on the development of curricula are proposed

Incentivizing preventive services in primary care: perspectives on Local Enhanced Services

Background: General practitioners in the UK play a key role in prevention but provision of preventive services is variable. The 2004 General Medical Services contract allows Primary Care Trusts (PCTs) to address health needs through providing locally agreed payments for Local Enhanced Services (LESs). This study identifies how this contractual flexibility is used for preventive services and explores its perceived effectiveness. Methods: Semi-structured interviews were carried out (2008–09) in 10 purposively selected case study sites in England. Details of LESs for these sites were collected (2009) through Freedom of Information requests or local contacts. A national on-line survey of PCTs (2009) provided a national context for case study findings. Results: LESs were considered to be effective in incentivizing preventive activity. However, specifications and performance management were often weak, awareness of how to optimize incentives was low and, as optional services, LESs were perceived to be at risk in a financial downturn. Conclusions: Using LESs for preventive services highlights gaps in ‘core’ primary care responsibilities and in the national pay-for-performance framework. Current incentive arrangements are complex, could increase inequalities and provide only a partial, short-term solution to developing a proactive approach to prevention in primary care

Inverted appendix mistaken for a polyp during colonoscopy and leading to intussusception

AbstractA spectrum of appendiceal diseases, ranging from simple mucous distension to acute perforated appendicitis, are seen in patients with CF. We report a 6 year old boy with CF and recurrent periumbilical pain. During colonoscopy, a fleshy pedunculated mass at the junction of the ascending colon and caecum was mistaken for a polyp and excised. However, histopathological examination suggested it was a segment of inverted appendix. The remnant of the inverted appendix was subsequently found to be associated with an intussusception