Job dissatisfaction and early retirement: a qualitative study of general practitioners in the Northern Deanery

Early retirement has become an important labour market trend for workers in professional occupations. General practitioners (GPs), however, are in short supply, and are being encouraged by the government to stay at work beyond the age of 60. In this study, which followed up a questionnaire survey of all general practitioners over 44 working in the Northern Deanery, 21 GPs took part in semi-structured interviews looking at their plans, reasons for, and feelings about, retirement. Interviews were taped, transcribed, and the text coded using themes from the interview schedule and those derived from the data. Findings are reported using a qualitative distinction between ‘happy’ and ‘unhappy’ doctors and on this basis just over two-fifths of those interviewed were ‘unhappy’, all of whom wanted to take early retirement. The major factor influencing these plans to retire was dissatisfaction with their role and none of this group would be persuaded to change their minds by various incentives such as ‘golden handcuffs’. ‘Happy’ doctors who wanted to stay in practice had found ways of accommodating themselves to change and factors outside of work provided no incentive or ‘pull’. This was not the case for ‘happy’ doctors who wanted to leave: they wanted to pursue hobbies and other interests whilst they were young enough to do so. The paper concludes that change is a major factor producing job dissatisfaction among GPs and that future generations of doctors need to be equipped with the means to cope with it, while governments need to consider the merits of stability and continuity

NURS 360: Nursing Practice and Moral Distress

Objectives: The purpose of the research was to find how many newly graduated nurses and currently practicing nurses experience moral distress and burnout and what strategies are used to minimize this distress. Background: In acute care settings it was been shown that there are high numbers of nurses that experience moral distress and burnout due to internal and external problems. Methods: In this study multiple steps were used to fully compare each intervention and its efficacy in addressing moral distress through literature review and analysis. Results: The Dudinski Moral Distress Map is more effective for clinicians in practice due to its structure and analysis. Conclusion: The Dudinski Moral Distress Map is more effective for clinicians in practice due to its structure and analysis. The process of the moral distress map leads the user through steps that identify the cause and the course of action needed to correct the nurse\u27s distress

Systematic reviews of occupational therapy interventions: summarizing research evidence and highlighting the gaps

As services are commissioned based on effectiveness, occupational therapists are under pressure to demonstrate the efficacy of their interventions. Occupational therapists also need to know that the interventions they are providing are effective. Robertson et al (2013) demonstrated that the occupational therapy literature is important for clinicians and is an essential part of their practice. However, as more research is published, it can be increasingly time-consuming and confusing for clinicians to keep abreast of the current literature. Occupational therapy-related research may be published in different forms, in a range of locations, and be of varying methodological quality. Furthermore, readily available published studies that investigate occupational therapy efficacy may not be sufficiently powered, or may lack external validity, when applied to different clinical settings. When well conducted, systematic reviews provide a useful way of synthesizing and evaluating the evidence on a particular topic and, to some extent, provide a solution to this problem. This paper focuses upon reviews of randomized controlled trials, as these provide the highest quality of evidence on the question of a particular intervention’s effectiveness. The merits of reviews of qualitative studies are also considered, together with the possibility of combining more than one type of review

Effect of partially-screened nuclei on fast-electron dynamics

We analyze the dynamics of fast electrons in plasmas containing partially ionized impurity atoms, where the screening effect of bound electrons must be included. We derive analytical expressions for the deflection and slowing-down frequencies, and show that they are increased significantly compared to the results obtained with complete screening, already at sub-relativistic electron energies. Furthermore, we show that the modifications to the deflection and slowing down frequencies are of equal importance in describing the runaway current evolution. Our results greatly affect fast-electron dynamics and have important implications, e.g. for the efficacy of mitigation strategies for runaway electrons in tokamak devices, and energy loss during relativistic breakdown in atmospheric discharges.Comment: 6 pages, 3 figures, fixed minor typo

Comparison of four analytic strategies for complex survey data: a case-study of Spanish data

Purpose: The aim of this secondary data analysis was to investigate the effect of four different analytical strategies: Model Based Analysis (MBA), Design Based Analysis (DBA), Multilevel Model Based Analysis (MMBA), and Multilevel Design Based Analysis (MDBA), on the model estimates for complex survey data. Methods: Using data from the World Health Survey-Spain explanatory models for the outcome Metabolic Equivalent of Task (METs) were calculated using MBA, DBA, MMBA, and MDBA. Regression coefficients, standard errors (SE) and the Akaike Information Criterion (AIC) from all the models were compared. Results: DBA showed highest estimates for most of the variables, including consistently higher SE than all other model - 20% to 48% higher than estimates for MBA, 10% to 37% for MMBA and 23% to 35% for MDBA. The SE for MDBA were 2.5% to 13% higher than estimates derived from MMBA in level 1 predictors, but SE in MMBA was higher by 18% for level 2 predictors. Values of AIC suggested the model derived by MDBA was the best fit and DBA the poorest fit of the four models. Conclusion: With minimum AIC, MDBA appeared to be the most appropriate approach to analyze complex survey data. To confirm the finding of present study a future work on a simulation data would be required

Keeping patients with cancer exercising in the age of COVID-19

The novel 2019 coronavirus disease (COVID-19) pandemic is a global public health emergency. To date, physical distancing and good personal hygiene have been the only effective measures to limit spread. The pandemic has altered routine cancer care, including allied health and supportive care interventions. Clinicians must adapt and find ways to continue to deliver optimal patient care at this time. The prescription of exercise to people with cancer has been demonstrated to have meaningful benefits for both physical and mental health and quality of life, and may even enhance survival. Such exercise interventions provide the largest benefit to patients when delivered in a supervised, group, clinic-based setting. In the age of COVID-19, group-based exercise in communal facilities presents risks for both aerosol and surface transmission of the virus among people exercising, necessitating a pivot from the usual methods of exercise delivery to home-based exercise programs. In this article, we discuss the challenges that need to be overcome in moving to a home-based program for patients with cancer while maintaining the benefits of targeted and high-fidelity exercise medicine. We provide practical recommendations for how home-based exercise can be supported and nurtured by qualified exercise professionals who treat people living with cancer, as well as pointing to resources that are available online to assist practitioners. Despite the challenges faced during this pandemic, we believe that it is important for people to continue to benefit from exercise in a safe environment with the support of exercise specialists

Patient information, education and self-management in bronchiectasis: facilitating improvements to optimise health outcomes

Background: Bronchiectasis is an incurable lung disease characterised by irreversible airway dilatation. It causes symptoms including chronic productive cough, dyspnoea, and recurrent respiratory infections often requiring hospital admission. Fatigue and reductions in quality of life are also reported in bronchiectasis. Patients often require multi-modal treatments that can be burdensome, leading to issues with adherence. In this article we review the provision of, and requirement for, education and information in bronchiectasis. Discussion: To date, little research has been undertaken to improve self-management in bronchiectasis in comparison to other chronic conditions, such as COPD, for which there has been a wealth of recent developments. Qualitative work has begun to establish that information deficit is one of the potential barriers to self-management, and that patients feel having credible information is fundamental when learning to live with and manage bronchiectasis. Emerging research offers some insights into ways of improving treatment adherence and approaches to self-management education; highlighting ways of addressing the specific unmet information needs of patients and their families who are living with bronchiectasis. Conclusions: We propose non-pharmacological recommendations to optimise patient self-management and symptom recognition; with the aim of facilitating measurable improvements in health outcomes for patients with bronchiectasis

Communication, trust and dental anxiety:a person-centred approach for dental attendance behaviours

Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental attendance behaviours using person-centred and socio-economic position factors. A secondary data analysis was conducted on a cross-sectional representative survey of a two-stage cluster sample of adults including England, Wales and Northern Ireland. Data were drawn from structured interview. Path analysis of proposed model was calculated following measurement development and confirmation of reliable constructs. The findings show model fit was good. Dental anxiety was predicted negatively by patient’s trust and positively by reported dentist communication. Patient’s shame was positively associated with dental anxiety, whereas self-reported dental attendance was negatively associated with dental anxiety. Both patient’s trust and dentist’s communication effects were moderated by social class. Manual classes were most sensitive to the reported dentist’s communications. Some evidence for the proposed model was found. The relationships reflected in the model were illuminated further when social class was introduced as moderator and indicated dentists should attend to communication processes carefully across different categories of patients.Publisher PDFPeer reviewe