2,095 research outputs found

    Impact on maternity professionals of novel approaches to clinical audit feedback

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    We compared three approaches to feedback of clinical audit findings relating to miscarriage in 15 Scottish maternity services (printed report alone; report plus Action Planning Letter; report plus face-to-face Facilitated Action Planning). We surveyed clinicians to measure Theory of Planned Behaviour constructs (in the context of two audit criteria) before and after feedback (n=253) and assessed perceptions of the audit through in-depth interviews (n=17). Pre-feedback, clinicians had positive attitudes and strong subjective norms and intentions to comply, although perceived behavioural control was lower. Generally, positive attitudes, subjective norms and intentions increased after feedback but for one of the two criteria (providing a 7-day miscarriage service), perceived behavioural control decreased. No changes over time reached statistical significance and analysis of covariance (adjusting for pre-feedback scores) showed no consistent relationships between method of feedback and post-feedback construct scores. Interviews revealed positive perceptions of audit but frustration at lack of capacity to implement changes. While interventions which increased intensity of feedback proved feasible and acceptable to clinicians, we were unable to demonstrate that they increased intention to comply with audit criteria.This study was funded by NHS Quality Improvement Scotland

    Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

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    Objective: To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design: Cross-sectional survey and qualitative interviews. Setting: Scotland and North West England. Participants: Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods: Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results: Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions: Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required

    Comparison of copper and tungsten carbide calibration spheres

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    Author Posting. Ā© Acoustical Society of America, 1984. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 75 (1984): 612-616, doi:10.1121/1.390489.The properties of calibration spheres made from electricalā€grade copper, denoted Cu, and tungsten carbide with 6% cobalt binder, denoted WC, are examined theoretically. Effects of variations in material, medium, and equipment parameters are determined for spheres intended to calibrate 38ā€kHz echo sounders when a target strength of order āˆ’41.5 dB is required. The derived 30.4ā€mmā€diam Cu sphere and selected 38.1ā€mmā€diam WC ball bearing show different dependences on the varied parameters. Changes in the material and equipment parameters within wide ranges will not upset a precision calibration with expected Ā±0.1ā€dB accuracy. Adjustment of the calibration value of ā€‰backscattering cross section with changing temperature is generally necessary for elastic spheres. This is the case for the present WC sphere, but not for the Cu sphere by virtue of its optimization with respect to temperature. Greater hardness is found to be insufficient for choosing between the two; the particular application must be considered. Pragmatic criteria for sphere selection are discussed

    Public acceptability of financial incentives for smoking cessation in pregnancy and breastfeeding

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    Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Design Cross-sectional survey. Setting and participants British general public. Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Results Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to Ā£40/month vouchers for behaviour change were acceptable (>85%). Conclusions Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic groups are required prior to implementing incentive interventions

    Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)

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    Funding The project was funded by the National Institute for Health Research Health Technology Assessment Programme (Project Number 07/60/18). The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Acknowledgements The authors wish to thank the women who participated in the PROSPECT study. We also thank Margaret MacNeil for her secretarial support and data management; Dawn McRae and Lynda Constable for their trial management support; the programming team in CHaRT, led by Gladys McPherson; members of the Project Management Group for their ongoing advice and support of the study; and the staff at the recruitment sites who facilitated the recruitment, treatment and follow up of study participants.Peer reviewedPublisher PD

    Front propagation into unstable and metastable states in Smectic C* liquid crystals: linear and nonlinear marginal stability analysis

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    We discuss the front propagation in ferroelectric chiral smectics (SmC*) subjected to electric and magnetic fields applied parallel to smectic layers. The reversal of the electric field induces the motion of domain walls or fronts that propagate into either an unstable or a metastable state. In both regimes, the front velocity is calculated exactly. Depending on the field, the speed of a front propagating into the unstable state is given either by the so-called linear marginal stability velocity or by the nonlinear marginal stability expression. The cross-over between these two regimes can be tuned by a magnetic field. The influence of initial conditions on the velocity selection problem can also be studied in such experiments. SmCāˆ—^* therefore offers a unique opportunity to study different aspects of front propagation in an experimental system
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