Communication in Hong Kong accident and emergency departments: The clinicians’ perspectives

© The Author(s) 2015. In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patientcentered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and timeburdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice

The scaling limit of the incipient infinite cluster in high-dimensional percolation. II. Integrated super-Brownian excursion

For independent nearest-neighbour bond percolation on Z^d with d >> 6, we prove that the incipient infinite cluster's two-point function and three-point function converge to those of integrated super-Brownian excursion (ISE) in the scaling limit. The proof is based on an extension of the new expansion for percolation derived in a previous paper, and involves treating the magnetic field as a complex variable. A special case of our result for the two-point function implies that the probability that the cluster of the origin consists of n sites, at the critical point, is given by a multiple of n^{-3/2}, plus an error term of order n^{-3/2-\epsilon} with \epsilon >0. This is a strong statement that the critical exponent delta is given by delta =2.Comment: 56 pages, 3 Postscript figures, in AMS-LaTeX, with graphicx, epic, and xr package

The accuracy of caries risk assessment in children attending South Australian School Dental Service: a longitudinal study

Objectives: To determine the accuracy of the caries risk assessment system and performance of clinicians in their attempts to predict caries for children during routine practice. Design: Longitudinal study. Setting and participants Data on caries risk assessment conducted by clinicians during routine practice while providing care for children in the South Australian School Dental Service (SA SDS) were collected from electronic patient records. Baseline data on caries experience, clinicians’ ratings of caries risk status and child demographics were obtained for all SA SDS patients aged 5–15 years examined during 2002–2005. Outcome measure: Children’s caries incidence rate, calculated using examination data after a follow-up period of 6–48 months from baseline, was used as the gold standard to compute the sensitivity (Se) and specificity (Sp) of clinicians’ baseline ratings of caries risk. Multivariate binomial regression models were used to evaluate effects of children's baseline characteristics on Se and Sp. Results: A total of 133 clinicians rated caries risk status of 71 430 children during 2002–2005. The observed Se and Sp were 0.48 and 0.86, respectively (Se+Sp=1.34). Caries experience at baseline was the strongest factor influencing accuracy in multivariable regression model. Among children with no caries experience at baseline, overall accuracy (Se+Sp) was only 1.05, whereas it was 1.28 among children with at least one tooth surfaces with caries experience at baseline. Conclusions: Clinicians’ accuracy in predicting caries risk during routine practice was similar to levels reported in research settings that simulated patient care. Accuracy was acceptable in children who had prior caries experience at the baseline examination, while it was poor among children with no caries experience.Diep H Ha, A John Spencer, Gary D Slade, Andrew D Chartie

Kinetic growth walks on complex networks

Kinetically grown self-avoiding walks on various types of generalized random networks have been studied. Networks with short- and long-tailed degree distributions $P(k)$ were considered ($k$, degree or connectivity), including scale-free networks with $P(k) \sim k^{-\gamma}$. The long-range behaviour of self-avoiding walks on random networks is found to be determined by finite-size effects. The mean self-intersection length of non-reversal random walks, , scales as a power of the system size $N$: $ \sim N^{\beta}$, with an exponent $\beta = 0.5$ for short-tailed degree distributions and $\beta < 0.5$ for scale-free networks with $\gamma < 3$. The mean attrition length of kinetic growth walks, , scales as $\sim N^{\alpha}$, with an exponent $\alpha$ which depends on the lowest degree in the network. Results of approximate probabilistic calculations are supported by those derived from simulations of various kinds of networks. The efficiency of kinetic growth walks to explore networks is largely reduced by inhomogeneity in the degree distribution, as happens for scale-free networks.Comment: 10 pages, 8 figure

Neutral Evolution as Diffusion in phenotype space: reproduction with mutation but without selection

The process of `Evolutionary Diffusion', i.e. reproduction with local mutation but without selection in a biological population, resembles standard Diffusion in many ways. However, Evolutionary Diffusion allows the formation of local peaks with a characteristic width that undergo drift, even in the infinite population limit. We analytically calculate the mean peak width and the effective random walk step size, and obtain the distribution of the peak width which has a power law tail. We find that independent local mutations act as a diffusion of interacting particles with increased stepsize.Comment: 4 pages, 2 figures. Paper now representative of published articl

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial a training intervention for community mental health teams in recovery-oriented practice

Background: Recovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes. Methods: The mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18-75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data. Discussion: Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery

Perfectionism and achievement goals in young Finnish ice-hockey players aspiring to make the Under-16 national team

Research on perfectionism suggests that is it useful to differentiate between perfectionistic strivings and perfectionistic concerns. Regarding the 2 x 2 achievement goal framework, the usefulness of this differentiation was recently demonstrated in a study with university student athletes (Stoeber, Stoll, Pescheck, & Otto, 2008, Study 2), in which it was found that perfectionistic strivings were associated with mastery-approach and performance-approach goals and perfectionistic concerns with mastery-avoidance, performance-approach, and performance-avoidance goals. Because the study was largely exploratory and only used non-elite athletes, the aim of the present research was to replicate and extend these findings by investigating a sample of 138 young, elite ice-hockey players, while adding further measures of perfectionism and using structural equation modelling (SEM) to confirm the relationships between perfectionistic strivings, perfectionistic concerns,and the 2 x 2 achievement goals. The SEM results showed that, in elite athletes also, perfectionistic strivings are associated with mastery-approach and performance-approach goals, whereas perfectionistic concerns are associated with masteryavoidance, performance-approach, and performance-avoidance goals. Our findings corroborate the importance of differentiating between perfectionistic strivings and perfectionistic concerns when studying perfectionism in sports, because only perfectionistic concerns (and not perfectionistic strivings) are associated with maladaptive patterns of achievement goals

A typology of modifications to peer support work for adults with mental health problems:systematic review

© The Authors 2020. Background Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects. Aims To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems. Method We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications. Results A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues. Conclusions Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings. Declaration of interest None