Bereaved relatives' experiences in relation to post mortem: a qualitative exploration in North East Scotland.

When a family is grieving the loss of a member the consideration of post mortem is an additional concern. This study set out to explore how relatives are supported to give authorisation and throughout the post mortem process. Thirteen relatives with varied experiences of a relative's death took part in interviews. Data analysis revealed the post mortem as part of the narrative of the death, with more significance for some than others. Important aspects for relatives were being able to say goodbye properly, and engagement with staff in hospital and procurator fiscal (public prosecution) services in more substantive communicative relationships, rather than only receiving basic information. Relatives valued receiving results they could understand. There may be opportunities, particularly in coroner or procurator fiscal services, for development of roles in liaison between relatives and pathology services, and support for relatives

Catch crop strategy and nitrate leaching following grazed grass-clover

Cultivation of grassland presents a high risk of nitrate leaching. This study aimed to determine if leaching could be reduced by growing spring barley (Hordeum vulgare L.) as a green crop for silage with undersown Italian ryegrass (Lolium multiflorum Lam.) compared with barley grown to maturity with or without an undersown conventional catch crop of perennial ryegrass (Lolium perenne L.). All treatments received 0,60 or 120 kg of ammonium-N ha-1 in cattle slurry. In spring 2003, two grass-clover fields (3 and 5 years old, respectively, with different management histories) were ploughed. The effects of the treatments on yield and nitrate leaching were determined in the first year, while the residual effects of the treatments were determined in the second year in a crop of spring barley⁄perennial ryegrass. Nitrate leaching was estimated in selected treatments using soil water samples from ceramic cups. The experiment showed that compared with treatments without catch crop, green barley⁄Italian ryegrass reduced leaching by 163–320 kg Nha-1, corresponding to 95–99%, and the perennial ryegrass reduced leaching to between 34 and 86 kg Nha-1, corresponding to a reduction of 80 and 66%. Also, in the second growing season, leaching following catchcrops was reduced compared with the bare soil treatment. It was concluded that the green barley⁄Italian ryegrass offers advantages not only for the environment but also for farmers, for whom it provides a fodder high in roughage and avoids the difficulties with clover fatigue increasingly experienced by Danish farmers

The impact of spousal bereavement on hospitalisations: evidence from the Scottish Longitudinal Study.

This paper estimates the impact of spousal bereavement on hospital inpatient use for the surviving bereaved by following the experience of 94,272 married Scottish individuals from 1991 until 2009 using a difference-in-difference model. We also consider the sample selection issues related to differences in survival between the bereaved and non-bereaved using a simple Cox Proportional-Hazard model. Before conducting these estimations, propensity score approaches are used to re-weight the non-bereaved to generate a more random-like comparison sample for the bereaved. We find that those bereaved who survive are both more likely to be admitted and to stay longer in hospital than a comparable non-bereaved cohort. Bereavement is estimated to induce on average an extra 0.24 (95% CI [0.15, 0.33]) hospital inpatient days per year. Similar to previous studies, we estimate the bereaved have a 19.2% (95% CI [12.5%, 26.3%]) higher mortality rate than the comparable non-bereaved cohort

The economic cost of bereavement in Scotland.

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around {pound}20 million. Cost of bereavement coded consultations in primary care was estimated at around {pound}2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement

A video life-world approach to consultation practice: The relevance of a socio-phenomenological approach

This article discusses the [development and] use of a video life-world schema to explore alternative orientations to the shared health consultation. It is anticipated that this schema can be used by practitioners and consumers alike to understand the dynamics of videoed health consultations, the role of the participants within it and the potential to consciously alter the outcome by altering behaviour during the process of interaction. The study examines health consultation participation and develops an interpretative method of analysis that includes image elicitation (via videos), phenomenology (to identify the components of the analytic framework), narrative (to depict the stories of interactions) and a reflexive mode (to develop shared meaning through a conceptual framework for analysis). The analytic framework is derived from a life-world conception of human mutual shared interaction which is presented here as a novel approach to understanding patient-centred care. The video materials used in this study were derived from consultations in a Walk-in Centre (WiC) in East London. The conceptual framework produced through the process of video analysis is comprised of different combinations of movement, knowledge and emotional conversations that are used to classify objective or engaged WiC health care interactions. The videoed interactions organise along an active or passive, facilitative or directive typical situation continuum illustrating different kinds of textual approaches to practice that are in tension or harmony. The schema demonstrates how practitioners and consumers interact to produce these outcomes and indicates the potential for both consumers and practitioners to be educated to develop practice dynamics that support patient-centred care and impact on health outcomes

Clinical peripherality: development of a peripherality index for rural health services

BACKGROUND: The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a "clinical peripherality" indicator that has potential application to remote and rural general practice communities for planning and research purposes. METHODS: Profiles of general practice communities in Scotland were created from a variety of public data sources. Four candidate variables were chosen that described demographic and geographic characteristics of each practice: population density, number of patients on the practice list, travel time to nearest specialist led hospital and travel time to Health Board administrative headquarters. A clinical peripherality index, based on these variables, was derived using factor analysis. Relationships between the clinical peripherality index and services offered by the practices and the staff profile of the practices were explored in a series of univariate analyses. RESULTS: Factor analysis on the four candidate variables yielded a robust one-factor solution explaining 75% variance with factor loadings ranging from 0.83 to 0.89. Rural and remote areas had higher median values and a greater scatter of clinical peripherality indices among their practices than an urban comparison area. The range of services offered and the profile of staffing of practices was associated with the peripherality index. CONCLUSION: Clinical peripherality is determined by the nature of the practice and its location relative to secondary care and administrative and educational facilities. It has features of both gravity model-based and travel time/accessibility indicators and has the potential to be applied to training of staff for rural and remote locations and to other aspects of health policy and planning. It may assist planners in conceptualising the effects on general practices of centralising specialist clinical services or administrative and educational facilities

An Evaluation of Parent Preference for Prompting Procedures

Parent participation in intervention can enhance intervention efficacy and promote generalization of skills across settings. Thus, parents should be trained to implement behavioral interventions. The purpose of the current investigation was to evaluate parent preference for and acceptability of 3 commonly used prompting procedures. We trained parents of children with disabilities to use 3 empirically validated prompting strategies (i.e., least‐to‐most, most‐to‐least, and a progressive‐prompt delay). Once the parent reached the mastery criteria with each prompting procedure, we evaluated his/her preference for each of the procedures using a concurrent‐chains arrangement. We also measured treatment acceptability of all procedures throughout the study. All participants met the mastery criteria for each of the prompting procedures and showed a preference for least‐to‐most prompting. Results suggest parents\u27 acceptability of procedures prior to training were different than posttraining/post‐child practice. In addition, acceptability rating scores obtained at the end of the investigation corresponded to preference of intervention during the concurrent‐chains arrangement. The results demonstrate the benefits of objective measures for studying preference for behavioral, skill‐acquisition procedures

The changing landscape of disaster volunteering: opportunities, responses and gaps in Australia

There is a growing expectation that volunteers will have a greater role in disaster management in the future compared to the past. This is driven largely by a growing focus on building resilience to disasters. At the same time, the wider landscape of volunteering is fundamentally changing in the twenty-first century. This paper considers implications of this changing landscape for the resilience agenda in disaster management, with a focus on Australia. It first reviews major forces and trends impacting on disaster volunteering, highlighting four key developments: the growth of more diverse and episodic volunteering styles, the impact of new communications technology, greater private sector involvement and growing government expectations of and intervention in the voluntary sector. It then examines opportunities in this changing landscape for the Australian emergency management sector across five key strategic areas and provides examples of Australian responses to these opportunities to date. The five areas of focus are: developing more flexible volunteering strategies, harnessing spontaneous volunteering, building capacity to engage digital (and digitally enabled) volunteers, tapping into the growth of employee and skills-based volunteering and co-producing community-based disaster risk reduction. Although there have been considerable steps taken in Australia in some of these areas, overall there is still a long way to go before the sector can take full advantage of emerging opportunities. The paper thus concludes by identifying important research and practice gaps in this area

How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making