Improving access to health care in a rural regional hospital in South Africa: Why do patients miss their appointments?

Background: Access to health services is one of the Batho Pele (‘people first’) values and principles of the South African government since 1997. This necessitated some changes around public service systems, procedures, attitudes and behaviour. The challenges of providing health care to rural geographically spread populations include variations in socio-economic status, transport opportunities, access to appointment information and patient perceptions of costs and benefits of seeking health care. George hospital, situated in a rural area, serves 5000 outpatient visits monthly, with non-attendance rates of up to 40%. Objectives: The aim of this research was to gain a greater understanding of the reasons behind non-attendance of outpatient department clinics to allow locally driven, targeted interventions. Methods: This was a descriptive study. We attempted to phone all patients who missed appointments over a 1-month period (n = 574). Only 20% were contactable with one person declining consent. Twenty-nine percent had no telephone number on hospital systems, 7% had incorrect numbers, 2% had died and 42% did not respond to three attempts. Results: The main reasons for non-attendance included unaware of appointment date (16%), out of area (11%), confusion over date (11%), sick or admitted to hospital (10%), family member sick or died (7%), appointment should have been cancelled by clerical staff (6%) and transport (6%). Only 9% chose to miss their appointment. The other 24% had various reasons. Conclusions: Improved patient awareness of appointments, adjustments in referral systems and enabling appointment cancellation if indicated would directly improve over two-thirds of reasons for non-attendance. Understanding the underlying causes will help appointment planning, reduce wasted costs and have a significant impact on patient care

Low grade Ductal Carcinoma in situ (DCIS): how best to describe it?

BACKGROUND: In the absence of definitive data about the natural history of DCIS the appropriateness of describing DCIS as cancer is controversial. METHODS: We conducted a survey amongst British Breast Group (BBG) members, to determine which descriptions of DCIS were deemed most accurate and appropriate. RESULTS: 54/73 (74%) attendees completed the survey: A majority (34/54; 63%) said they would be comfortable using the description that explained DCIS as abnormal cells in the milk ducts that had not spread into other breast tissue and which did not need urgent treatment as if it was breast cancer and this description was overall the most preferred (24/54; 44%). CONCLUSIONS: Little consensus exists regarding how best to explain low grade DCIS to patients

Modern languages and mentoring: Lessons from digital learning in Wales

This article considers the role that mentoring, and in particular online mentoring, can play in tackling the decline in modern language learning at GCSE level in Wales. • It evaluates Digi-Languages, a blended learning experience that pairs university student linguists with secondary school learners of languages to improve MFL uptake at GCSE. • This article examines the conception, design and early outcomes of DigiLanguages. • The article evaluates the experiential learning of the mentees (Year 9 learners) and explores the ethos underpinning resource development and the project’s key messaging around culture and languages. • The article provides recommendations for the expansion of Digi-Languages to support broader language policy objectives in Wales, including the Welsh Government’s policy of one million Welsh speakers by 2050. • The article concludes with suggestions for the extension of Digi-Languages to other regions of the UK and overseas and its potential as a model for stimulating inter-cultural conversations on the lifelong value of languages

The Distribution of Nearby Stars in Velocity Space Inferred from Hipparcos Data

(abridged) The velocity distribution f(v) of nearby stars is estimated, via a maximum- likelihood algorithm, from the positions and tangential velocities of a kinematically unbiased sample of 14369 stars observed by the HIPPARCOS satellite. f(v) shows rich structure in the radial and azimuthal motions, v_R and v_phi, but not in the vertical velocity, v_z: there are four prominent and many smaller maxima, many of which correspond to well known moving groups. While samples of early-type stars are dominated by these maxima, also up to 25% of red main-sequence stars are associated with them. These moving groups are responsible for the vertex deviation measured even for samples of late-type stars; they appear more frequently for ever redder samples; and as a whole they follow an asymmetric-drift relation, in the sense that those only present in red samples predominantly have large |v_R| and lag in v_phi w.r.t. the local standard of rest (LSR). The question arise, how these old moving groups got on their eccentric orbits. A plausible mechanism, known from solar system dynamics, which is able to manage a shift in orbit space involves locking into an orbital resonance. Apart from these moving groups, there is a smooth background distribution, akin to Schwarzschild's ellipsoidal model, with axis ratio of about 1:0.6:0.35 in v_R, v_phi, and v_z. The contours are aligned with the $v_r$ direction, but not w.r.t. the v_phi and v_z axes: the mean v_z increases for stars rotating faster than the LSR. This effect can be explained by the stellar warp of the Galactic disk. If this explanation is correct, the warp's inner edge must not be within the solar circle, while its pattern rotates with frequency of about 13 km/s/kpc or more retrograde w.r.t. the stellar orbits.Comment: 16 pages LaTeX (aas2pp4.sty), 6 figures, accepted by A

Accountability and Transparency of Entrepreneurial Journalism: Unresolved ethical issues in crowdfunded journalism projects

Crowdfunding is a new business model in which journalists rely—and depend—on (micro-) payments by a large number of supporters to finance their reporting. In this form of entrepreneurial journalism the roles of publisher, fundraiser and journalist often overlap. This raises questions about conflicts of interest, accountability and transparency. The article presents the results of selected case studies in four different European countries—Germany (Krautreporter), Italy (Occhidellaguerra), the United Kingdom (Contributoria) and the Netherlands (De Correspondent)—as well as one US example (Kickstarter). The study used a two-step methodological approach: first a content analysis of the websites and the Twitter accounts with regard to practices of media accountability, transparency and user participation was undertaken. The aim was to investigate how far ethical challenges in crowdfunded entrepreneurial journalism are accounted for. Second, we present findings from semi-structured interviews with journalists from each crowdfunding. The study provides evidence about the ethical issues in this area, particularly in relation to production transparency and responsiveness. The study also shows that in some cases of crowdfunding (platforms), accountability is outsourced and implemented only through the audience participation

Patients’ and partners’ views of care and treatment provided for metastatic castrate resistant prostate cancer in the UK

Objective Documentations of the experiences of patients with advanced prostate cancer and their partners are sparse. Views of care and treatment received for metastatic castrate resistant prostate cancer (mCRPC) are presented here. Methods Structured interviews conducted within 14 days of a systemic therapy for mCRPC starting and 3 months later explored: treatment decisions, information provision, perceived benefits and harms of treatment, and effects of these on patients’ and partners’ lives. Results Thirty-seven patients and 33 partners recruited from UK cancer centres participated. The majority of patients (46%) reported pain was their worst symptom and many wanted to discuss its management (baseline-50%; 3 months-33%). Patients and partners believed treatment would: delay progression (>75%), improve wellbeing (33%), alleviate pain (≈12%) and extend life (15% -patients, 36% -partners). At 3 months most men (42%) said fatigue was the worst treatment-related side effect (SE), 27% experienced unexpected SEs, and 54% needed help with SEs. Most patients received SE information (85% written; 75% verbally); many additionally searched the internet (33%-patients; 55%-partners). Only 54% of patients said nurse support was accessible. Conclusion Pain and other symptom management is not optimal. Increased specialist nurse provision and earlier palliative care links are needed. Dedicated clinics may be justified