Partners At Care Transitions (PACT). Exploring older peoples’ experiences of transitioning from hospital to home in the UK: protocol for an observation and interview study of older people and their families to understand patient experience and involvement in care at transitions

Introduction: Lengths of hospital inpatient stays have reduced. This benefits patients, who prefer to be at home, and hospitals, which can treat more people when stays are shorter. Patients may, however, leave hospital sicker, with ongoing care needs. The transition period from hospital to home, can be risky, particularly for older patients with complex health and social needs. Improving patient experience, especially through greater patient involvement, may improve outcomes for patients and is a key indicator of care quality and safety. In this research we aim to: capture the experiences of older patients and their families during the transition from hospital to home; and identify opportunities for greater patient involvement in care, particularly where this contributes to greater individual- and organisational-level resilience. Methods and Analysis: A ‘focused ethnography’ comprising observations, ‘Go-Along’ and semi-structured interviews will be used to capture patient and carer experiences during different points in the care transition from admission to 90 days after discharge. We will recruit 30 patients and their carers from six hospital departments across two NHS Trusts. Analysis of observations and interviews will use a Framework approach to identify themes to understand the experience of transitions and generate ideas about how patients could be more actively involved in their care. This will include exploring what ‘good’ care at transitions look like and seeking out examples of success, as well as recommendations for improvement. Ethics and dissemination: Ethical approval was received from the NHS Research Ethics Committee in Wales. The research findings will add to a growing body of knowledge about patient experience of transitions, in particular providing insight into the experiences of patients and carers throughout the transitions process, in ‘real time’. Importantly, the data will be used to inform the development of a patient-centred intervention to improve the quality and safety of transitions

Динамические тенденции в становлении предмета лингвоэкологии

Экологизация всех сфер общественной жизни и самого человека широко обсуждается во многих наука, а также и в области языка. Во многих работах лингвистов экология языка определяется как наука о взаимоотношениях между языком и его окружением, так как язык существует не только в сознании говорящих на нем и функционирует только при взаимоотношениях с другими коммуникантами и с их социальным и природным окружением. В этом контексте понятие «языковое сознание» представляет собой специфическую картину взаимосвязи культуры и общественной жизни социума, которая определяет его психологическое своеобразие и специфические черты данного языка

Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care : a qualitative study

BACKGROUND: There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. METHODS: We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. RESULTS: Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. CONCLUSIONS: The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations

Climate change effects on agriculture: Economic responses to biophysical shocks

Agricultural production is sensitive to weather and thus directly affected by climate change. Plausible estimates of these climate change impacts require combined use of climate, crop, and economic models. Results from previous studies vary substantially due to differences in models, scenarios, and data. This paper is part of a collective effort to systematically integrate these three types of models. We focus on the economic component of the assessment, investigating how nine global economic models of agriculture represent endogenous responses to seven standardized climate change scenarios produced by two climate and five crop models. These responses include adjustments in yields, area, consumption, and international trade. We apply biophysical shocks derived from the Intergovernmental Panel on Climate Change's representative concentration pathway with end-of-century radiative forcing of 8.5 W/m2. The mean biophysical yield effect with no incremental CO2 fertilization is a 17% reduction globally by 2050 relative to a scenario with unchanging climate. Endogenous economic responses reduce yield loss to 11%, increase area of major crops by 11%, and reduce consumption by 3%. Agricultural production, cropland area, trade, and prices show the greatest degree of variability in response to climate change, and consumption the lowest. The sources of these differences include model structure and specification; in particular, model assumptions about ease of land use conversion, intensification, and trade. This study identifies where models disagree on the relative responses to climate shocks and highlights research activities needed to improve the representation of agricultural adaptation responses to climate change

Non-technical Skills in Healthcare

AbstractNon-technical Skills (NTS) are a set of generic cognitive and social skills, exhibited by individuals and teams, that support technical skills when performing complex tasks. Typical NTS training topics include performance shaping factors, planning and preparation for complex tasks, situation awareness, perception of risk, decision-making, communication, teamwork and leadership. This chapter provides a framework for understanding these skills in theory and practice, how they interact, and how they have been applied in healthcare, as well as avenues for future research

Patient involvement in diagnosing cancer in primary care: a systematic review of current interventions

Background: Patients can play a role in achieving an earlier diagnosis of cancer by monitoring and re-appraising symptoms after initially presenting to primary care. It is not clear what interventions exist, or what the components of an intervention to engage patients at this diagnostic stage are. Aim The review had two aims: 1) to identify interventions that involve patients, and 2) to establish key components for engaging patients in the diagnosis of cancer in primary care at the post-presentation stage. Design and setting: Empirical studies and non-empirical articles were identified searching Ovid MEDLINE, PsycINFO, and Embase databases, relevant journals, and available key author publication lists. Method: Abstracts and titles were screened against inclusion and exclusion criteria. Qualitative synthesis of empirical research and current opinion from across all articles was used to select, organise, and interpret findings. Results: No interventions were found. Sixteen articles provided suggestions for potential interventions and components important at the post-presentation stage. Factors contributing to patients not always being engaged in assisting with diagnosis, strategies to foster patient involvement, and moderators and benefits to patients and health services (proximal and distal outcomes) were captured in a logic model. Conclusion: There is an absence of interventions involving patients during the post-presentation stage of the diagnostic process. Limited literature was drawn upon to identify potential barriers and facilitators for engaging patients at this diagnostic stage, and to establish possible mechanisms of change and measurable outcomes. Findings can direct future research and the development of interventions

Exploring the Impact of Primary Care Physician Burnout and Well-Being on Patient Care: A Focus Group Study

Objectives The aims of the study were (1) to explore whether primary care physicians (general practitioners [GPs]) perceive burnout and well-being to impact on the quality and safety of patient care and (2) to determine potential mechanisms behind these associations. Method Five focus groups with 25 practicing GPs were conducted in England, either in the participants’ practice or in a private meeting room outside of their workplace. An interview schedule with prompts was followed with questions asking how participants perceive GP burnout and poor well-being could impact on patient care delivery. Audio recordings were transcribed verbatim and analyzed using thematic analysis. Results General practitioners believed that poor well-being and burnout affect the quality of care patients receive through reducing doctors’ abilities to empathize, to display positive attitudes and listening skills, and by increasing the number of inappropriate referrals made. Participants also voiced that burnout and poor well-being can have negative consequences for patient safety, through a variety of mechanisms including reduced cognitive functioning and decision-making abilities, a lack of headspace, and fatigue. Furthermore, it was suggested that the relationship between well-being/burnout and mistakes is likely to be circular. Conclusions Further research is needed to ascertain the validity of these perceptions. If found, physicians, healthcare organizations, and policy makers should examine how they can improve physician well-being and prevent burnout, because this may be a route to ensure high-quality and safe patient care

Strategies to improve general practitioner well-being: findings from a focus group study

Background: Primary care physicians are particularly prone to high levels of burnout and poor wellbeing. Despite this, no qualitative studies have specifically investigated the best ways to improve wellbeing and prevent burnout in primary care physicians. Previous interventions within primary care have been person-oriented and mainly focused on mindfulness, but there has been no prior research on whether general practitioners (GPs) deem this to be the best approach. Objectives: To explore strategies that could improve GP wellbeing and reduce or prevent burnout, based on GP perceptions of the workplace factors that affect their levels of wellbeing and burnout. Methods: Five focus groups were conducted, with 25 GPs (locums, salaried, trainees, and partners) in the UK, between September 2015 and February 2016. Focus groups took place in GP practices and private meeting rooms. Discussions were centered on the workplace factors that they perceived to influence their wellbeing, along with strategies that they use either personally, or as a practice, to try and prevent burnout. Furthermore, strategies that could feasibly be implemented by individuals and practices to improve wellbeing, as well as changes that are needed by groups or organizations that are external to their practice (e.g. the government) to improve the working conditions, were explored. Thematic analysis was conducted on the transcripts. Results: Based on the contributors to burnout and workplace wellbeing that the participants identified, the following feasible strategies were suggested: compulsory daily coffee breaks, increasing self and organizational awareness of the risks of burnout, and mentoring/buddy systems. System-level organizational changes were voiced as vital, however, to improve the wellbeing of all primary care physicians. Increasing resources seemed to be the ideal solution, to allow for more administrative staff and GPs. Conclusion: These strategies merit further consideration by researchers, physicians, healthcare organizations, and policy makers both in the UK and beyond. Failure to do so may result in healthcare staff becoming even more burnt-out, potentially leading to a loss of doctors from the workforce

The Shared Safety Net Action Plan (SSNAP): a co-designed intervention to reduce delays in cancer diagnosis

Background: Safety netting in primary care may help diagnose cancer earlier, but it is unclear what the format and content of an acceptable safety-netting intervention would be. This project aimed to co-design a safety-netting intervention with and for primary care patients and staff. Aim: This work sought to address how a safety-netting intervention would be implemented in practice; and, if and how a safety-netting intervention would be acceptable to all stakeholders. Design and setting: Patient representatives, GPs, and nurse practitioners were invited to a series of co-design workshops. Patients who had and had not received a diagnosis of cancer and primary care practices took part in separate focus groups. Method: Three workshops using creative co-design processes developed the format and content of the intervention prototype. The COM-B Framework underpinned five focus groups to establish views on capability, opportunity, and motivation to use the intervention to assist with prototype refinement. Results: Workshops and focus groups suggested the intervention format and content should incorporate visual and written communication specifying clear timelines for monitoring symptoms and when to present back; be available in paper and electronic forms linked to existing computer systems; and be able to be delivered within a 10-minute consultation. Intervention use themes included ‘building confidence through partnership’, ‘using familiar and current procedures and systems’, and ‘seeing value’. Conclusion: The Shared Safety Net Action Plan (SSNAP) — a safety-netting intervention to assist the timely diagnosis of cancer in primary care, was successfully co-designed with and for patients and primary care staff