Understanding quit decisions in primary care: a qualitative study of older GPs

This is the final version of the article. Available from the publisher via the DOI in this record.OBJECTIVE: To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50-60 years. DESIGN AND SETTING: Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. PARTICIPANTS: 23 GPs aged 50-60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. RESULTS: The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs' decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. CONCLUSIONS: This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs' views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs' own health; improving confidence in the future of general practice; and improving GP morale.This study was funded by the South West Academic Health Science Network (grant number: SWAHSN 4.21.019) and the University of Exeter Medical School

'I can still swing a spade': a qualitative exploratory study of gardening groups for people with dementia

This exploratory qualitative study aimed to evidence how community-based gardening groups can be used to support the psychological, physical and social health of those living with dementia. The views of people living with dementia in the community, care partners and group leaders were sought to better understand the benefits gained from gardening groups, as well as the features of gardening groups that are cited as enabling positive outcomes. Going beyond the existing single-group studies in this area, this research aimed to identify common themes across multiple gardening groups. Semi-structured interviews were conducted with six group leaders, three people living with dementia and ten care partners from seven gardening groups, either in person or remotely. Thematic analysis of the interview transcripts highlighted broad enablers - 'the garden setting', 'features of activities' and 'organisational components' - that were cited as facilitating a range of positive wellbeing outcomes, creating an environment that provides 'physical and cognitive benefits', 'affirmation of identity', 'social connection' and 'benefits for care partners and others'. The wide-ranging benefits and enablers cited by participants within this research support the use of gardening groups as community-based interventions to reinforce positive psychological, physical and social outcomes for people with dementia. Themes also provide a clear framework for the design, implementation and evaluation of future gardening groups

Estimating everyday portion size using a 'method of constant stimuli': in a student sample, portion size is predicted by gender, dietary behaviour, and hunger, but not BMI

This paper (i) explores the proposition that body weight is associated with large portion sizes and (ii) introduces a new technique for measuring everyday portion size. In our paradigm, the participant is shown a picture of a food portion and is asked to indicate whether it is larger or smaller than their usual portion. After responding to a range of different portions an estimate of everyday portion size is calculated using probit analysis. Importantly, this estimate is likely to be robust because it is based on many responses. First-year undergraduate students (N=151) completed our procedure for 12 commonly consumed foods. As expected, portion sizes were predicted by gender and by a measure of dieting and dietary restraint. Furthermore, consistent with reports of hungry supermarket shoppers, portion-size estimates tended to be higher in hungry individuals. However, we found no evidence for a relationship between BMI and portion size in any of the test foods. We consider reasons why this finding should be anticipated. In particular, we suggest that the difference in total energy expenditure of individuals with a higher and lower BMI is too small to be detected as a concomitant difference in portion size (at least in our sample)

Community-based Rehabilitation Training after stroke: Protocol of a pilot randomised controlled trial (ReTrain)

Introduction: The Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost-effectiveness of ReTrain, which is based on Action for Rehabilitation from Neurological Injury (ARNI). The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. Methods and analysis: A 2-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed-methods process evaluation and economic evaluation. 48 participants discharged from clinical rehabilitation despite residual physical disability will be individually randomised 1:1 to ReTrain (25 sessions) or control (exercise advice booklet). Outcome assessment at baseline, 6 and 9 months include Rivermead Mobility Index; Timed Up and Go Test; modified Patient-Specific Functional Scale; 7-day accelerometry; Stroke Self-efficacy Questionnaire, exercise diary, Fatigue Assessment Scale, exercise beliefs and self-efficacy questionnaires, SF-12, EQ-5D-5L, Stroke Quality of Life, Carer Burden Index and Service Receipt Inventory. Feasibility, acceptability and process outcomes include recruitment and retention rates; with measurement burden and trial experiences being explored in qualitative interviews (20 participants, 3 intervention providers). Analyses include descriptive statistics, with 95% CI where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. Ethics and dissemination: National Health Service (NHS) National Research Ethics Service approval granted in April 2015; recruitment started in June. Preliminary studies suggested low risk of serious adverse events; however (minor) falls, transitory muscle soreness and high levels of postexercise fatigue are expected. Outputs include pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised Trainer and Intervention Delivery manuals for multicentre replication of ReTrain; presentations at conferences, public involvement events; internationally recognised peer-reviewed journal publications, open access sources and media releases

Investigating the sustainability of careers in academic primary care: a UK survey.

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.The UK National Health Service (NHS) is undergoing institutional reorganisation due to the Health and Social Care Act-2012 with a continued restriction on funding within the NHS and clinically focused academic institutions. The UK Society for Academic Primary Care (SAPC) is examining the sustainability of academic primary care careers within this climate and preliminary qualitative work has highlighted individual and organisational barriers. This study seeks to quantify the current situation for academics within primary care.UK Society for Academic Primary CareNIHR SPCR Fellowshi

Measurement of Shared Social Identity in Singing Groups for People With Aphasia

This is the final version. Available on open access from Frontiers Media via the DOI in this recordData Availability Statement: The datasets presented in this article are not readily available because participants did not consent for datasets to be stored or accessed outside of the research team. Requests to access the datasets should be directed to MT, [email protected] groups are commonly used as a mode of delivery of interventions for promoting health and well-being. Research has demonstrated that developing a sense of shared social identity with other group members is a key mechanism through which the health benefits of group membership are realized. However, there is little understanding of how shared social identity emerges within these therapeutic settings. Understanding the emergence of shared social identity may help researchers optimize interventions and improve health outcomes. Group-based singing activities encourage coordination and a shared experience, and are a potential platform for the development of shared social identity. We use the “Singing for People with Aphasia” (SPA) group intervention to explore whether group cohesiveness, as a behavioral proxy for shared social identity, can be observed and tracked across the intervention. Video recordings of group sessions from three separate programmes were rated according to the degree of cohesiveness exhibited by the group. For all treatment groups, the final group session evidenced reliably higher levels of cohesiveness than the first session (t values ranged from 4.27 to 7.07; all p values < 0.003). As well as providing confidence in the design and fidelity of this group-based singing intervention in terms of its capacity to build shared social identity, this evaluation highlighted the value of observational methods for the analysis of shared social identity in the context of group-based singing interventions.Stroke AssociationNational Institute for Health Research (NIHR

The effectiveness and usability of online, group-based interventions for people with severe obesity: Systematic review protocol

No embargo required.Background: Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the United Kingdom adult population is currently considered clinically obese (typically Body Mass Index ≥35kg/m2). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity. Objective: The purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Population, Intervention, Comparator, and Outcome frameworks were used to structure this review. The review will systematically search seven databases: Medline, Embase, the Cumulative Index of Nursing and Allied Health Literature, American Psychological Association PsycNet, Web of Science, the Cochrane Library, and the ProQuest Dissertations and Theses databases. Two authors will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias tool and a descriptive analysis will be used to evaluate effectiveness and usability. Results: The systematic review has not yet been started. It is expected to be completed and submitted for publication by May 2021. Conclusions: This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity

Physical activity, sleep, and fatigue in community dwelling Stroke Survivors

Stroke can lead to physiological and psychological impairments and impact individuals’ physical activity (PA), fatigue and sleep patterns. We analysed wrist-worn accelerometry data and the Fatigue Assessment Scale from 41 stroke survivors following a physical rehabilitation programme, to examine relationships between PA levels, fatigue and sleep. Validated acceleration thresholds were used to quantify time spent in each PA intensity/sleep category. Stroke survivors performed less moderate to vigorous PA (MVPA) in 10 minute bouts than the National Stroke guidelines recommend. Regression analysis revealed associations at baseline between light PA and fatigue (p = 0.02) and MVPA and sleep efficiency (p = 0.04). Light PA was positively associated with fatigue at 6 months (p = 0.03), whilst sleep efficiency and fatigue were associated at 9 months (p = 0.02). No other effects were shown at baseline, 6 or 9 months. The magnitude of these associations were small and are unlikely to be clinically meaningful. Larger trials need to examine the efficacy and utility of accelerometry to assess PA and sleep in stroke survivorsStroke Association for funding this research (TSA – 2014-03) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trus

Singing for people with aphasia (SPA): Results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility

This is the final version. Available on open access from BMJ Publishing Group via the DOI in this recordObjectives: Pilot feasibility randomised controlled trial (RCT) for the ‘Singing groups for People with Aphasia’ (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved. Design: A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Setting: Three community-based cohorts in the South-West of England. Participants: Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control. Intervention: The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack. Outcome measures: Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews. Results: Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, Control=21); 36 participants (SPA=17, Control=19) completed 3-month follow-up, 34 (SPA=18, Control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified. Conclusions: The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable.Stroke Associatio

Age- Matched Comparison of Children Hospitalized for 2009 Pandemic H1N1 Influenza with Those Hospitalized for Seasonal H1N1 and H3N2

BACKGROUND: A wide spectrum of clinical manifestation ranging from deaths to a mild course of disease has been reported in children infected with the 2009 pandemic H1N1 (pH1N1) influenza. METHODOLOGY/MAJOR FINDINGS: We conducted an age-matched control study comparing children hospitalized for pH1N1 with historic controls infected with seasonal H1N1 and H3N2 influenza to correct for the effect of age on disease susceptibility and clinical manifestations. We also compared children with pH1N1 to children concurrently admitted for seasonal influenza during the pandemic period to adjust for differences in health-seeking behavior during the pandemic or other potential bias associated with historic controls. There was no death or intensive care admission. Children with pH1N1 were more likely to have at least one risk condition for influenza, an underlying chronic pulmonary condition, more likely to have asthma exacerbation and to be treated with oseltamivir. There was no difference in other aspects of the clinical course or outcome. CONCLUSION: Disease manifestation of children hospitalized for pH1N1 infection was mild in our patient population