BESTFACT Best Practice Handbook 3

The Best Practice Handbook (BPH) gives an overview about current concepts, strategies and actions in freight transport all over Europe. It is disseminating information on successful projects and practices to increase awareness and share experiences. It is enabling knowledge transfer and supporting transferability for best practices. The third and last Best Practice Handbook focuses on the work done over the entire project, with 157 inventory cases and 60 in-depth analyses. After four years of case collection a wide field of solutions is available. The main findings of the BESTFACT cases are cross-checked and summarised for each of the cluster topics. The consistent form of collection and information provision broadens the structural understanding of best practice cases. The synthesis of cases per topic shows that under consideration of barriers and framework conditions replicable impacts are achievable. Main editors are Martin Ruesch & Simon Bohne (Rapptrans) and Jacques Leonardi (UoW). Project leader is Marcel Huschebeck (PTV)

Dignity and Narrative Medicine

Critiques of the dehumanising aspects of contemporary medical practice have generated increasing interest in the ways in which health care can foster a holistic sense of wellbeing. We examine the relationship between two areas of this humanistic endeavour: narrative and dignity. This paper makes two simple arguments that are intuitive but have not yet been explored in detail: that narrative competence of carers is required for maintaining or recreating dignity, and that dignity promotion in health care practice is primarily narrative in form. The multiple meanings that dignity has in a person’s life are what give the concept power and can only be captured by narrative. This has implications for health care practice where narrative work will be increasingly required to support patient dignity in under-resourced and over-subscribed health care system

The pathway to consultation for rheumatoid arthritis:Exploring anticipated actions between the onset of symptoms and face-to-face encounter with a healthcare professional

Background: When people first experience symptoms of rheumatoid arthritis (RA) they often delay seeking medical attention resulting in delayed diagnosis and treatment. This research assesses behaviours people might engage in prior to, or instead of, seeking medical attention and compares these with behaviours related to illnesses which are better publicised. Methods: Thirty-one qualitative interviews with members of the general public explored intended actions in relation to two hypothetical RA vignettes (with and without joint swelling) and two non-RA vignettes (bowel cancer and angina). The interviews were audio-recorded and transcribed. Analysis focused on intended information gathering and other self-management behaviours in the interval between symptom onset and help-seeking. Results: Participants were more likely to envision self-managing symptoms when confronted with the symptoms of RA compared to the other vignettes. Participants would look for information to share responsibility for decision making and get advice and reassurance. Others saw no need for information seeking, perceived the information available as untrustworthy or, particularly in the case of bowel cancer and angina, would not want to delay seeking medical attention. Participants further anticipated choosing not to self-manage the symptoms; actively monitoring the symptoms (angina/ bowel cancer) or engaging in self-treatment of symptom(s). Discussion: These results help define targets for interventions to increase appropriate help-seeking behaviour for people experiencing the initial symptoms of RA, such as educational interventions directed at allied healthcare professionals from whom new patients may seek information on self-management techniques, or the development of authoritative and accessible informational resources for the general public