Do patient surveys work? The influence of a national survey programme on local quality-improvement initiatives

Objectives: To assess current attitudes towards the national patient survey programme in England, establish the extent to which survey results are used and identify barriers and incentives for using them. Design: Qualitative interviews with hospital staff responsible for implementing the patient surveys (survey leads). Setting: National Health Service (NHS) hospital organisations (trusts) in England. Participants: Twenty-four patient survey leads for NHS trusts. Results: Perceptions of the patient surveys were mainly positive and were reported to be improving. Interviewees welcomed the surveys’ regular repetition and thought the questionnaires, survey methods and reporting of results, particularly inter-organisational benchmark charts, were of a good standard. The survey results were widely used in action planning and were thought to support organisational patient-centredness. There was variation in the extent to which trusts disseminated survey findings to patients, the public, staff and their board members. The most common barrier to using results was difficulty engaging clinicians because survey findings were not sufficiently specific to specialties, departments or wards. Limited statistical expertise and concerns that the surveys only covered a short time frame also contributed to some scepticism. Other perceived barriers included a lack of knowledge of effective interventions, and limited time and resources. Actual and potential incentives for using survey findings included giving the results higher weightings in the performance management system, financial targets, Payment by Results (PbR), Patient Choice, a patient-centred culture, leadership by senior members of the organisation, and boosting staff morale by disseminating positive survey findings. Conclusion: The national patient surveys are viewed positively, their repetition being an important factor in their success. The results could be used more effectively if they were more specific to smaller units

A Halomethane thermochemical network from iPEPICO experiments and quantum chemical calculations

Internal energy selected halomethane cations CH3Cl+, CH2Cl2+, CHCl3+, CH3F+, CH2F2+, CHClF2+ and CBrClF2+ were prepared by vacuum ultraviolet photoionization, and their lowest energy dissociation channel studied using imaging photoelectron photoion coincidence spectroscopy (iPEPICO). This channel involves hydrogen atom loss for CH3F+, CH2F2+ and CH3Cl+, chlorine atom loss for CH2Cl2+, CHCl3+ and CHClF2+, and bromine atom loss for CBrClF2+. Accurate 0 K appearance energies, in conjunction with ab initio isodesmic and halogen exchange reaction energies, establish a thermochemical network, which is optimized to update and confirm the enthalpies of formation of the sample molecules and their dissociative photoionization products. The ground electronic states of CHCl3+, CHClF2+ and CBrClF2+ do not confirm to the deep well assumption, and the experimental breakdown curve deviates from the deep well model at low energies. Breakdown curve analysis of such shallow well systems supplies a satisfactorily succinct route to the adiabatic ionization energy of the parent molecule, particularly if the threshold photoelectron spectrum is not resolved and a purely computational route is unfeasible. The ionization energies have been found to be 11.47 ± 0.01 eV, 12.30 ± 0.02 eV and 11.23 ± 0.03 eV for CHCl3, CHClF2 and CBrClF2, respectively. The updated 0 K enthalpies of formation, ∆fHo0K(g) for the ions CH2F+, CHF2+, CHCl2+, CCl3+, CCl2F+ and CClF2+ have been derived to be 844.4 ± 2.1, 601.6 ± 2.7, 890.3 ± 2.2, 849.8 ± 3.2, 701.2 ± 3.3 and 552.2 ± 3.4 kJ mol–1, respectively. The ∆fHo0K(g) values for the neutrals CCl4, CBrClF2, CClF3, CCl2F2 and CCl3F and have been determined to be –94.0 ± 3.2, –446.6 ± 2.7, –702.1 ± 3.5, –487.8 ± 3.4 and –285.2 ± 3.2 kJ mol–1, respectively

Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial

© Cuzick et al. Open Access article distributed under the terms of CC BY.http://dx.doi.org/10.1016/S1470-2045(14)71171-

Motivations, experiences and aspirations of trainee nursing associates in England: a qualitative study

Background The nursing associate role was developed in England in response to the ‘Shape of Caring’ review. It has been implemented to fulfil two aims; to bridge the gap between registered nurses and healthcare assistants, and to provide an alternative route into registered nursing in light of workforce shortages. Other high income countries deploy second level nurses within their healthcare systems, however the UK has a turbulent history with such roles. The previous state enrolled nurse was phased out in the 1990s, and more recently the assistant practitioner (AP) role has faced wide variation in titles, scope and pay. Little is known about those who have embarked on the new nursing associate training course and their experiences of the role. Methods An exploratory qualitative study was undertaken using focus groups of trainee nursing associates to generate in-depth discussion about their motivations, experiences of training, and career aspirations. Three focus groups (n = 15) took place in December 2018 using a purposive sample of trainee nursing associates registered at a University in the North of England. Two researchers facilitated each group discussion at a time and place convenient for participants. The discussions were audio recorded, transcribed and data was analysed thematically. Results This study found that trainee nursing associates are motivated by affordable, local, career development. During training they face challenges relating to clinical support, academic workload and uncertainty about future career opportunities. They experience role ambiguity both individually and across the wider organisation. Trainee nursing associates rely on broad support networks to build their occupational identity. Conclusions The barriers and facilitators of trainee nursing associate personal development have implications for policy and practice relating to recruitment and retention. The results increase our understanding of this emerging role, and have informed the development of a larger longitudinal cohort study. Further research is required to evaluate the impact of this new role

Teaching psychology to student nurses: the use of talking heads videos

Psychology is a central part of undergraduate nursing curricula in the UK.However, student nurses report difficulties recognising the relevance and value of psychology. We sought to strengthen first-year student nurses’ application of psychology by developing a set of digital stories based around ‘Talking Head’video clips where authentic patients relate their experiences of illness and nursing care. The aim of this article is to discuss the technological, organisational and pedagogical challenges, student and staff evaluations and our recommendations for the future of Talking Heads. First-year student nurses were shown a video clip of a patient talking about their illness experiences followed by a group learning situation linking main themes to psychology and nursing. Students and staff valued the authenticity of patient’s narrative, found the video clip easy to follow,reported a raised awareness of psychological concepts and improved empathetic understanding of chronic illness. Negative evaluations were related to a sanitised, untypical representation and limited internet access. This small-scale study highlighted how patient narrative may enhance students understanding of illness experience. It chronicles the development and evaluation of a Talking Head in a specific context but which may be useful across disciplines

Diagnosis and management of glutaric aciduria type I – revised recommendations

Glutaric aciduria type I (synonym, glutaric acidemia type I) is a rare organic aciduria. Untreated patients characteristically develop dystonia during infancy resulting in a high morbidity and mortality. The neuropathological correlate is striatal injury which results from encephalopathic crises precipitated by infectious diseases, immunizations and surgery during a finite period of brain development, or develops insidiously without clinically apparent crises. Glutaric aciduria type I is caused by inherited deficiency of glutaryl-CoA dehydrogenase which is involved in the catabolic pathways of L-lysine, L-hydroxylysine and L-tryptophan. This defect gives rise to elevated glutaric acid, 3-hydroxyglutaric acid, glutaconic acid, and glutarylcarnitine which can be detected by gas chromatography/mass spectrometry (organic acids) or tandem mass spectrometry (acylcarnitines). Glutaric aciduria type I is included in the panel of diseases that are identified by expanded newborn screening in some countries. It has been shown that in the majority of neonatally diagnosed patients striatal injury can be prevented by combined metabolic treatment. Metabolic treatment that includes a low lysine diet, carnitine supplementation and intensified emergency treatment during acute episodes of intercurrent illness should be introduced and monitored by an experienced interdisciplinary team. However, initiation of treatment after the onset of symptoms is generally not effective in preventing permanent damage. Secondary dystonia is often difficult to treat, and the efficacy of available drugs cannot be predicted precisely in individual patients. The major aim of this revision is to re-evaluate the previous diagnostic and therapeutic recommendations for patients with this disease and incorporate new research findings into the guideline