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

Probabilistic abductive logic programming using Dirichlet priors

Probabilistic programming is an area of research that aims to develop general inference algorithms for probabilistic models expressed as probabilistic programs whose execution corresponds to inferring the parameters of those models. In this paper, we introduce a probabilistic programming language (PPL) based on abductive logic programming for performing inference in probabilistic models involving categorical distributions with Dirichlet priors. We encode these models as abductive logic programs enriched with probabilistic definitions and queries, and show how to execute and compile them to boolean formulas. Using the latter, we perform generalized inference using one of two proposed Markov Chain Monte Carlo (MCMC) sampling algorithms: an adaptation of uncollapsed Gibbs sampling from related work and a novel collapsed Gibbs sampling (CGS). We show that CGS converges faster than the uncollapsed version on a latent Dirichlet allocation (LDA) task using synthetic data. On similar data, we compare our PPL with LDA-specific algorithms and other PPLs. We find that all methods, except one, perform similarly and that the more expressive the PPL, the slower it is. We illustrate applications of our PPL on real data in two variants of LDA models (Seed and Cluster LDA), and in the repeated insertion model (RIM). In the latter, our PPL yields similar conclusions to inference with EM for Mallows models

Gambling Alone? A Study of Solitary and Social Gambling in America

In his acclaimed 2000 book Bowling Alone, Robert Putnam documents a disturbing social trend of the broadest kind. Putnam cites a wide variety of data that indicate that over the past fifty years, Americans have become increasingly socially disengaged. In developing this theme, Putnam specifically cites the increase in casino gambling (and especially machine gambling) as evidence in support of his argument. Building on the empirical and theoretical work of Putnam, this exploratory article examines the subphenomenon of gambling alone by exploring sample survey data on solitary and social gambling behavior among adults who reside in Las Vegas, Nevada. Specifically, to further understand these phenomena, a number of demographic, attitudinal, and behavioral variables are examined for their explanatory power in predicting solitary vs. social gambling behavior

A Survey of Selected Business Teachers and Business Students in Four Norfolk Public High Schools of Their Opinions of Various Aspects of the Phase Elective Program

It is hoped that in this study students\u27 and teachers\u27 opinions of the Phase Elective Program can be evaluated. The study examines the following questions: 1. Do teachers and students feel that the classroom instruction has improved in the nine-week phases? 2. Does the Phase Elective Program capitalize on teacher expertise? 3. Do teachers and students feel that the Phase Elective Program meets the students\u27 educational needs and interests better than the traditional program

Changing Traditions: Examining the Factors That Determine the Probability of Bidding to Host the Olympic Games Over Time

In September 2017, the International Olympic Committee (IOC) announced that, for the first time in its history, it would award the hosting of two different Olympic Games at the same time, giving the 2024 and 2028 Summer Olympic Games to Paris and Los Angeles respectively. As a result, the question is raised as to why the IOC broke tradition in its host city selection process. The break of tradition is presumably due to a lack of candidates to host the 2028 Summer Olympics. With prior host cities reporting astronomical costs and high debt balances associated with hosting, many cities have retracted their bids or have refused to submit candidature bids altogether. The Olympics are one of the largest, most economically impactful mega-events in modern culture. While hosting does provide a nation with the opportunity to show off its infrastructure and culture before millions of people worldwide, the costs to host the event have steadily risen as the Olympics have become a larger and larger spectacle. This study uses a logistic regression model to determine the relative factors that determine a city\u27s willingness to bid and uses the results to draw conclusions as to why the willingness to host has fluctuated across time. The results show a definite change in the probabilities of a potential city bidding to host the Olympic Games across time and also provide insight into the factors that determine these changes in probabilities. By determining these conclusions, this study hopes to provide insight into ways that hosting the Olympics can become accessible to all prospective host cities so that there is increased competition in the host city selection process

The Macroeconomics of Low Inflation

macroeconomics, low inflation

A Small Unassuming Man Walked up to Me, Shook My Hand and Told Me, “I Really Enjoyed Your Paper”

Dr. David Dickens, Professor of Sociology at the University of Nevada Las Vegas, wrote this memoir at the invitation of Dmitri Shalin and gave his approval for posting the present version in the Erving Goffman Archives

Analysis of Droplet Train/Moving Substrate Interactions in Ink-Jetting Processes

Ink-jetting technology has been applied to several processes in solid free-form fabrication (SFF) wherein droplets impinge onto a substrate to deposit the build material. Droplet impact behaviour on a surface has been the interest of many researchers; however, few studies have been undertaken to investigate the interaction of droplets with the moving substrate. This paper reports the impact behaviour of the droplets jetted at different frequencies onto a substrate moving over a range of velocities. The phenomena associated with the interaction were classified into three main regimes.Mechanical Engineerin