A consultation-level intervention to improve care of frequently attending patients: a cluster randomised controlled feasibility trial

Background: Frequent attenders (FAs) to primary care receive considerable NHS resources without necessarily gaining benefit, and may even be harmed. Aim: To assess the feasibility of a consultation-level intervention to improve care and address service use of FAs. Design & setting: A cluster randomised controlled feasibility trial was undertaken. The study used a mixed-methods process evaluation and took place in six practices in England. Method: All practices screened the top 3% of all attending patients over the previous 12 months for eligibility. Following randomisation, intervention patients were matched with named GPs, trained to use the Background, Affect, Trouble, Handling, Empathy (BATHE) technique during consultations. Telephone consultations were encouraged. Feasibility outcomes assessed were recruitment, retention, data collection and completeness, implementation fidelity, and acceptability Results: A total of 599/1328 (45.1%) FAs were eligible. Four practices were randomised to the intervention (n = 451) and two to usual care (n = 148). A total of 96 (23.7%) patients were recruited to complete questionnaires. Retention and completeness of data were good; for example, 76% of those agreeing to complete questionnaires did so at the 12-month assessment point. Thirty-four GPs were trained and delivered BATHE ≥1 times to 50.1% of patients (n = 577 consultations). There were minimal increases in continuity and telephone consultations. Patients were positive about the intervention, but noticed little change in their care. Despite valuing BATHE, low adherence to training was indicated and GPs used it less than anticipated. Conclusion: It was feasible to identify FAs and collect trial data. GPs were keen to engage and there was evidence that the BATHE technique was taken into practice. Optimising training is likely to improve fidelity. The intervention was low cost and low risk

Using the Past to Predict the Future: The Public Land Survey, 19th Century Climate and the PalEON Project

<p>Presentation for the Yi-Fu Seminar at the University of Wisconsin-Madison's Department of Geography.  Presented on February 15th by Simon Goring.  The talk abstract is here:  </p> <p><strong>Using Historical Records to Help Predict the Future: The Public Land Survey, 19th Century Climate and the PalEON Project</strong></p> <p><em>Predicting the response of organisms to changing climates in the 21st century is a major conservation challenge. Standard practice uses the relationship between modern species ranges and climate to predict future distributions under various future climate scenarios. The widespread and significant land use conversion in North America, particularly in the upper Midwest, challenges the basic assumptions of this model. I use historical records of vegetation and climate to build a better understanding of the state of forests in the upper Midwest prior to European settlement. Pre-settlement forests show significantly different structure and composition than modern forests, and our interpretations of the kinds of climates that tree species can occupy is likely to be affected by the broad-scale changes brought about by agricultural conversion. This analysis forms part of the broader PalEON project, and I will highlight how the information we gain from historical data can inform and improve our estimates of future climate change, species distributions and, ultimately help inform conservation planning in the 21st century.</em></p

Effects of Euro-American settlement and historic climate variability on species-climate relationships and the co-occurance of domnant tree species

<p>Poster: American Geophysical Union, 2013</p> <p>To study shifts in forest composition and species-climate relationships we unite data from the Forest Inventory and Analysis Program (FIA) and the Public Land Survey System (PLSS; Liu et al., Ecol. Monograph, 2011) with climate records from the last 200+ years.  Differences in composition, taxon co-occurrence, richness and climate occupancy may have profound impacts on our ability to successfully model species distributions.  Modern forests are less diverse than pre-settlement forests and are compositionally dissimilar.  Changes in composition are not uniform across space. Tree genera in hotter drier climates in the Upper Midwest have seen greater range shifts than in the north.</p

Estimating pre-settlement vegetation in the American Midwest: Exploring climate relationships and links to proxy data for robust data assimilation

<p>A PDF presentation from the International Biogeography Society Meeting in Miami Florida (January, 2013)</p