Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study

Background: An understanding of stakeholders’ views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. Methods: This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. Results: We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. Conclusions: This study provides insight into rural professionals’ perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems

Crescimento inicial de plantas de Cryptocaria aschersoniana Mez. submetidas a níveis de radiação solar Early growth of plants of Cryptocaria aschersoniana Mez. submitted to radiation solar levels

O plantio de essências nativas, seja com finalidade econômica ou conservacionista, requer uma série de cuidados que dependem do conhecimento prévio de suas características fisiológicas e exigências ecológicas nas diversas etapas de seu ciclo vital. O estudo do crescimento e desenvolvimento de uma planta, em diferentes condições ambientais, oferece ao pesquisador bom indício sobre quais as melhores condições para se cultivar determinada espécie. Objetivou-se avaliar o crescimento inicial e as concentrações de clorofilas em plantas jovens de Cryptocaria aschersoniana Mez. (Canela-Batalha), submetidas a níveis de redução da radiação solar: 0% (Pleno Sol), 30%, 50% e 70%. Os resultados demonstram que o teor de clorofila total foi maior nas plantas cultivadas em 70% de sombreamento, o mesmo ocorrendo com a razão clorofila a/b. A maior altura foi apresentada pelas plantas cultivadas em 50% de sombreamento. Do ponto de vista de acúmulo de matéria seca total e matéria seca de raízes, a melhor performance foi observada nas plantas em 30% de sombreamento e o maior acúmulo de matéria seca de folhas verificado nas plantas cultivadas em 30 e 50% de sombreamento. Conclui-se que as melhores condições de cultivo para mudas de Cryptocaria aschersoniana Mez. (Canela-Batalha) foram os níveis de 30 e 50% de redução da radiação solar incidente.<br>The cultivation of native essences with economical or conservacionist purpose needs a serie of cares that need some previous knowledgment of the physiological and ecologic characteristics of the diverses phases of the life cycle. The study of the growth and development of a plant under different environmental conditions offers to the researcher a good clue on which the best conditions to grow a particular species. It was aimed at to evaluate the initial growth and the concentration of chlorophylls in young plants of Cryptocaria aschersoniana Mez. (Canela-Batalha) submitted to levels of reduction of solar radiation: 0% (full sunlight), or 30, or 50 or 70%. The results demonstrate that the concentration of total chlorophyll was larger in the plants grown under 70% of shading, the same happened with the ratio of chlorophyll a/b. The greatest plant height was observed in the plants grown in 50% of shading. From the standpoint of total biomass accumulated and root dry matter, the best performance was observed in the plants under 30% of shading and the higher leaves dry matter accumulation was verified in the plants grown under 30 and 50% shading. It is ended that the best ones growing conditions for seedlings of Cryptocaria aschersoniana Mez. (Canela-Batalha) were the levels of 30 and 50% of reduction of the incident solar radiation