Exploring what patients with musculoskeletal conditions want from first point of contact health practitioners

Objectives This research was conducted to support the development of the Musculoskeletal (MSK) Health Capabilities Framework to ensure the framework reflected patients’ priorities. The aim of this study was to explore what patients with MSK problems want from their initial consultation with a first contact health practitioner and from the patient perspective what characterises a good first contact health practitioner. Methods Focus groups were held in four locations across England. Sixteen participants with a self-declared MSK condition aged 19 to 75 took part (11 female, five male). Participants discussed the questions they want answered when first going to see a health professional about a MSK problem and how they would describe a good first contact health provider. Results Participants wanted answers to questions about: the nature of the problem, the management of the problem, where to get information and support to help themselves, what activities they can do and what the future holds. Values and behaviours they expect and value from first contact health practitioners include: good communication skills, appreciation of impact, a willingness to discuss alternative and complementary therapies, shared decision making and an awareness of own limitations and when to refer. Conclusion The MSK core capabilities framework for first contact health practitioners aims to ensure a person-centred approach in the first stages of managing any MSK problem a person may present with. The focus groups enabled the developers of the framework to achieve a greater understanding of patient priorities, expectations and needs and allowed the patient perspective to be included in this national framework

Low back pain: a call for action.

Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3is a call for action on this global problem of low back pain

Ethnicity and the Writing of Medieval Scottish history

Historians have long tended to define medieval Scottish society in terms of interactions between ethnic groups. This approach was developed over the course of the long nineteenth century, a formative period for the study of medieval Scotland. At that time, many scholars based their analysis upon scientific principles, long since debunked, which held that medieval 'peoples' could only be understood in terms of 'full ethnic packages'. This approach was combined with a positivist historical narrative that defined Germanic Anglo-Saxons and Normans as the harbingers of advances of Civilisation. While the prejudices of that era have largely faded away, the modern discipline still relies all too often on a dualistic ethnic framework. This is particularly evident in a structure of periodisation that draws a clear line between the 'Celtic' eleventh century and the 'Norman' twelfth. Furthermore, dualistic oppositions based on ethnicity continue, particularly in discussions of the law, kingship, lordship and religion

Working with Chronic Musculoskeletal Disorders : Good Practice Advice Report

This report takes an in-depth look at working with chronic musculoskeletal disorders (MSDs) and makes a clear case for the benefits of enabling those with chronic conditions to remain in work. It highlights the importance of designing inclusive workplaces and sets out principles for managing chronic MSDs, with prevention, early intervention, and effective, participative rehabilitation and return-to-work planning being identified as key. Good practice examples detail a wide range of workplace adjustments made to accommodate individuals with MSDs, from offering flexitime to providing the right tools and ergonomic equipment. This comprehensive practical advice is complemented by broader recommendations for policy-makers

Judicial Review, Irrationality, and the Limits of Intervention by the Courts

When exercising judicial review, the courts, on occasions, have intervened in circumstances where administrative decisions were not irrational. However, these low standards of judicial intervention are arguably constitutional, especially since the enactment of the Human Rights Act 1998 (HRA). To this end, this article seeks to establish a zone of executive decision-making, for reasons of democracy, where the courts are clearly excluded. But it is unable to do so. Does this mean, therefore, that judicial intervention on the grounds of irrationality exists without limit? Assuming this to be the case, it is suggested that the courts should show greater respect to the administrative branch of the state where it has genuinely sought to engage with the legal process in arriving at its decisions

In search of the authentic nation: landscape and national identity in Canada and Switzerland

While the study of nationalism and national identity has flourished in the last decade, little attention has been devoted to the conditions under which natural environments acquire significance in definitions of nationhood. This article examines the identity-forming role of landscape depictions in two polyethnic nation-states: Canada and Switzerland. Two types of geographical national identity are identified. The first – what we call the ‘nationalisation of nature’– portrays zarticular landscapes as expressions of national authenticity. The second pattern – what we refer to as the ‘naturalisation of the nation’– rests upon a notion of geographical determinism that depicts specific landscapes as forces capable of determining national identity. The authors offer two reasons why the second pattern came to prevail in the cases under consideration: (1) the affinity between wild landscape and the Romantic ideal of pure, rugged nature, and (2) a divergence between the nationalist ideal of ethnic homogeneity and the polyethnic composition of the two societies under consideration

The ability of intermediate-band Stromgren photometry to correctly identify dwarf, subgiant, and giant stars and provide stellar metallicities and surface gravities

[Abridged] Several large scale photometric and spectroscopic surveys are being undertaken to provide a more detailed picture of the Milky Way. Given the necessity of generalisation in the determination of, e.g., stellar parameters when tens and hundred of thousands of stars are considered it remains important to provide independent, detailed studies to verify the methods used in the surveys. We evaluate available calibrations for deriving [M/H] from Stromgren photometry and develop the standard sequences for dwarf stars to reflect their metallicity dependence and test how well metallicities derived from ugriz photometry reproduce metallicities derived from the well-tested system of Stromgren photometry. We use a catalogue of dwarf stars with both Stromgren uvby photometry and spectroscopically determined iron abundances (in total 451 dwarf stars with 0.3<(b-y)_0<1.0). We also evaluate available calibrations that determine log g. A larger catalogue, in which metallicity is determined directly from uvby photometry, is used to trace metallicity-dependent standard sequences for dwarf stars. We derive new standard sequences in the c_1,0 versus (b-y)_0 plane and in the c_1,0 versus (v-y)_0 plane for dwarf stars with 0.40 < (b-y)_0 < 0.95 and 1.10 < (v-y)_0 < 2.38. We recommend the calibrations by Ramirez & Me'endez (2005) for deriving metallicities from Stromgren photometry and find that intermediate band photometry, such as Stromgren photometry, more accurately than broad band photometry reproduces spectroscopically determined [Fe/H]. Stromgren photometry is also better at differentiating between dwarf and giant stars. We conclude that additional investigations of the differences between metallicities derived from ugriz photometry and intermediate-band photometry, such as Stromgren photometry, are required.Comment: Accepted for publication in A&A, 34 pages, including on-line materia