Integrated out-of-hours care arrangements in England: observational study of progress towards single call access via NHS Direct and impact on the wider health system

Objectives: To assess the extent of service integration achieved within general practice cooperatives and NHS Direct sites participating in the Department of Health’s national “Exemplar Programme” for single call access to out-of-hours care via NHS Direct. To assess the impact of integrated out-of-hours care arrangements upon general practice cooperatives and the wider health system (use of emergency departments, 999 ambulance services, and minor injuries units). Design: Observational before and after study of demand, activity, and trends in the use of other health services. Setting: Thirty four English general practice cooperatives with NHS Direct partners (“exemplars”) of which four acted as “case exemplars”. Also 10 control cooperatives for comparison. Main Outcome Measures: Extent of integration achieved (defined as the proportion of hours and the proportion of general practice patients covered by integrated arrangements), patterns of general practice cooperative demand and activity and trends in use of the wider health system in the first year. Results: Of 31 distinct exemplars 21 (68%) integrated all out-of-hours call management by March 2004. Nine (29%) established single call access for all patients. In the only case exemplar where direct comparison was possible, cooperative nurse telephone triage before integration completed a higher proportion of calls with telephone advice than did NHS Direct afterwards (39% v 30%; p<0.0001). The proportion of calls completed by NHS Direct telephone advice at other sites was lower. There is evidence for transfer of demand from case exemplars to 999 ambulance services. A downturn in overall demand for care seen in two case exemplars was also seen in control sites. Conclusion: The new model of out-of-hours care was implemented in a variety of settings across England by new partnerships between general practice cooperatives and NHS Direct. Single call access was not widely implemented and most patients needed to make at least two telephone calls to contact the service. In the first year, integration may have produced some reduction in total demand, but this may have been accompanied by shifts from one part of the local health system to another. NHS Direct demonstrated capability in handling calls but may not currently have sufficient capacity to support national implementation

Right ventricular responses to CPAP therapy in obstructive sleep apnoea: CMR analysis of the MOSAIC randomised trial

Effects of continuous positive airway pressure (CPAP) on right ventricular (RV) function in patients with untreated mild-to-moderate obstructive sleep apnea (OSA) are unclear. In this exploratory analysis of cardiac magnetic resonance (CMR)-derived indices of RV function in patients with minimally symptomatic OSA from the MOSAIC randomized control trial we found no effect of CPAP on RV CMR parameters. In those with lower RV ejection fraction and higher RV end-diastolic volume (EDV) at baseline, CPAP treatment appeared to improve RV function with a significant reduction in both RV EDV and RV end-systolic volume although between-group effects were not observed. These data suggest potential merit in a larger randomized study of CPAP in patients with mild-to-moderate OSA and a greater breadth of RV dysfunction

How do family physicians communicate about cardiovascular risk? Frequencies and determinants of different communication formats

Background: Patients understand information about risk better if it is communicated in numerical or visual formats (e.g. graphs) compared to verbal qualifiers only. How frequently different communication formats are used in clinical primary care settings is unknown. Methods: We collected socioeconomic and patient understanding data using questionnaires and audio-recorded consultations about cardiovascular disease risk. The frequencies of the communication formats were calculated and multivariate regression analysis of associations between communication formats, patient and general practitioner characteristics, and patient subjective understanding was performed. Results: In 73% of 70 consultations, verbal qualifiers were used exclusively to communicate cardiovascular risk, compared to numerical (11%) and visual (16%) formats. Female GPs and female patient's gender were significantly associated with a higher use of verbal formats compared to visual formats (p = 0.001 and p = 0.039, respectively). Patient subjective understanding was significantly higher in visual counseling compared to verbal counseling (p = 0.001). Conclusions: Verbal qualifiers are the most often used communication format, though recommendations favor numerical and visual formats, with visual formats resulting in better understanding than others. Also, gender is associated with the choice of communication format. Barriers against numerical and visual communication formats among GPs and patients should be studied, including gender aspects. Adequate risk communication should be integrated into physicians' education

Development and testing of innovative patient resources for the management of coronary heart disease (CHD): a descriptive study

BACKGROUND: Although heart disease is a major cause of morbidity and mortality the majority of patients do not access existing rehabilitation programs and patient resources are not designed to facilitate patient choice and decision-making. The objective of this study was to develop and test a series of risk factor modules and corresponding patient information leaflets for secondary prevention of CHD. METHODS: In phase one, a series of risk factor modules and management options were developed following analysis of literature and interviews with health professionals. In phase two, module information leaflets were developed using published guidelines and interviews of people with CHD. In phase three, the leaflets were tested for quality (DISCERN), readability (Flesch) and suitability (SAM) and were compared to the existing cardiac rehabilitation (CR) information leaflet. Finally, the patients assessed the leaflets for content and relevance. RESULTS: Four key risk factors identified were cholesterol, blood pressure, smoking and physical inactivity. Choice management options were selected for each risk factor and included medical consultation, intensive health professional led program, home program and self direction. Patient information needs were then identified and leaflets were developed. DISCERN quality scores were high for cholesterol (62/80), blood pressure (59/80), smoking (62/80) and physical activity (62/80), all scoring 4/5 for overall rating. The mean Flesch readability score was 75, representing "fairly easy to read", all leaflets scored in the superior category for suitability and were reported to be easy to understand, useful and motivating by persons with CHD risk factors. The developed leaflets scored higher on each assessment than the existing CR leaflets. CONCLUSION: Using a progressive three phase approach, a series of risk factor modules and information leaflets were successfully developed and tested. The leaflets will contribute to shared-decision making and empowerment for persons with CHD

Understanding the rise of faculty-student coaching: an academic capitalism perspective

We examine the rise of coaching within management education to support student learning. We question the assumption that faculty-student coaching (FSC) is beneficial and propose that there may be some limitations in the use of FSC that have yet to be adequately acknowledged and discussed in the literature. In particular, we propose that there is currently insufficient evidence to conclude that coaching can produce knowledge acquisition and therefore ask why we persist in the use of FSC when we have limited evidence of its efficacy in delivering a core education outcome. We suggest that the theory of academic capitalism provides a useful, critical lens through which to view the growing trend in FSC, identifying that FSC may be utilized as a method of increasing student satisfaction, perceptions of value for money and as a useful marketing tool for business schools competing for students. However, academic capitalism may also explain the use of coaching via its ability to enhance the skills and attitudes of students, providing outcomes that are valued by students, employers and governments. We conclude our essay by providing recommendations to mitigate these proposed dangers and consequently maximise the effectiveness of coaching as a development tool in management education

Practical considerations for implementing an evidence-based policing approach in police operations: a case study

Through the lens of a real operation carried out at Greater Manchester Police to protect the business community from burglaries over the Christmas and New Year period in 2017/2018, this paper highlights the practical considerations in implementing an evidence-based approach in policing operations where there is a perceived immediate threat, risk and harm. Operation Guard was a force-wide operation that ran for four months (1st December 2017–30th March 2018 inclusive) across seven districts and eleven wards in Greater Manchester (UK), with the primary mandate of reducing Greater Manchester Police’s (GMP) commercial burglary crime volume. With the operation carrying a second aim of tactical delivery through an evidence-based policing methodology, representing the first of its kind at this scale at GMP, this paper highlights key practical considerations and learning opportunities for future tactical deployment for both police strategic and tactical leaders, as well as policing academics

Electromagnetically induced transparency: Optics in coherent media

Coherent preparation by laser light of quantum states of atoms and molecules can lead to quantum interference in the amplitudes of optical transitions. In this way the optical properties of a medium can be dramatically modified, leading to electromagnetically induced transparency and related effects, which have placed gas-phase systems at the center of recent advances in the development of media with radically new optical properties. This article reviews these advances and the new possibilities they offer for nonlinear optics and quantum information science. As a basis for the theory of electromagnetically induced transparency the authors consider the atomic dynamics and the optical response of the medium to a continuous-wave laser. They then discuss pulse propagation and the adiabatic evolution of field-coupled states and show how coherently prepared media can be used to improve frequency conversion in nonlinear optical mixing experiments. The extension of these concepts to very weak optical fields in the few-photon limit is then examined. The review concludes with a discussion of future prospects and potential new applications