3,238 research outputs found

    GPAQ-R: development and psychometric properties of a version of the general practice assessment questionnaire for use for revalidation by general practitioners in the UK.

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    BACKGROUND: The General Practice Assessment Questionnaire (GPAQ) has been widely used to assess patient experience in general practice in the UK since 2004. In 2013, new regulations were introduced by the General Medical Council (GMC) requiring UK doctors to undertake periodic revalidation, which includes assessment of patient experience for individual doctors. We describe the development of a new version of GPAQ - GPAQ-R which addresses the GMC's requirements for revalidation as well as additional NHS requirements for surveys that GPs may need to carry out in their own practices. METHODS: Questionnaires were given out by doctors or practice staff after routine consultations in line with the guidance given by the General Medical Council for surveys to be used for revalidation. Data analysis and practice reports were provided independently. RESULTS: Data were analysed for questionnaires from 7258 patients relating to 164 GPs in 29 general practices. Levels of missing data were generally low (typically 4.5-6%). The number of returned questionnaires required to achieve reliability of 0.7 were around 35 for individual doctor communication items and 29 for a composite score based on doctor communication items. This suggests that the responses to GPAQ-R had similar reliability to the GMC's own questionnaire and we recommend 30 completed GPAQ-R questionnaires are sufficient for revalidation purposes. However, where an initial screen raises concern, the survey might be repeated with 50 completed questionnaires in order to increase reliability. CONCLUSIONS: GPAQ-R is a development of a well-established patient experience questionnaire used in general practice in the UK since 2004. This new version can be recommended for use in order to meet the UK General Medical Council's requirements for surveys to be used in revalidation of doctors. It also meets the needs of GPs to ask about patient experience relating to aspects of practice care that are not specific to individual general practitioners (e.g. receptionists, telephone access) which meet other survey requirements of the National Health Service in England. Use of GPAQ-R has the potential to reduce the number of surveys that GPs need to carry out in their practices to meet the various regulatory requirements which they face

    A Richness Study of 14 Distant X-ray Clusters From the 160 Square Degree Survey

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    We have measured the surface density of galaxies toward 14 X-ray-selected cluster candidates at redshifts greater than z=0.46, and we show that they are associated with rich galaxy concentrations. We find that the clusters range between Abell richness classes 0-2, and have a most probable richness class of one. We compare the richness distribution of our distant clusters to those for three samples of nearby clusters with similar X-ray luminosities. We find that the nearby and distant samples have similar richness distributions, which shows that clusters have apparently not evolved substantially in richness since redshift z =0.5. We compare the distribution of distant X-ray clusters in the L_x--richness plane to the distribution of optically-selected clusters from the Palomar Distant Cluster Survey. The optically-selected clusters appear overly rich for their X-ray luminosities when compared to X-ray-selected clusters. Apparently, X-ray and optical surveys do not necessarily sample identical mass concentrations at large redshifts. This may indicate the existence of a population of optically rich clusters with anomalously low X-ray emission. More likely, however, it reflects the tendency for optical surveys to select unvirialized mass concentrations, as might be expected when peering along large-scale filaments.Comment: The abstract has been abridged. Accepted for publication in the Astrophysical Journa

    Age, Metallicity and Star Formation History of Cluster Galaxies at z~0.3 F

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    We investigate the color-magnitude distribution in the rich cluster AC 118 at z=0.31. The sample is selected by the photometric redshift technique, allowing to study a wide range of properties of stellar populations, and is complete in the K-band, allowing to study these properties up to a given galaxy mass. We use galaxy templates based on population synthesis models to translate the physical properties of the stellar populations - formation epoch, time-scale of star formation, and metallicity - into observed magnitudes and colors. In this way we show that a sharp luminosity-metallicity relation is inferred without any assumption on the galaxy formation scenario (either monolithic or hierarchical). Our data exclude significant differences in star formation histories along the color-magnitude relation, and therefore confirm a pure metallicity interpretation for its origin, with an early (z~5) formation epoch for the bulk of stellar populations. The dispersion in the color-magnitude diagram implies that fainter galaxies in our sample (K~18) ceased to form stars as late as z~0.5, in agreement with the picture that these galaxies were recently accreted into the cluster environment. The trend with redshift of the total stellar mass shows that half of the luminous mass in AC 118 was already formed at $z~2, but also that 20% of the stars formed at z<1.Comment: 16 pages, 10 figures. ApJ in pres

    The Color-Magnitude Relation in Coma: Clues to the Age and Metallicity of Cluster Populations

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    We have observed three fields of the Coma cluster of galaxies with a narrow band (modified Stromgren) filter system. Observed galaxies include 31 in the vicinity of NGC 4889, 48 near NGC 4874, and 60 near NGC 4839 complete to M_5500=-18 in all three subclusters. Spectrophotometric classification finds all three subclusters of Coma to be dominated by red, E type (ellipticals/S0's) galaxies with a mean blue fraction, f_B, of 0.10. The blue fraction increases to fainter luminosities, possible remnants of dwarf starburst population or the effects of dynamical friction removing bright, blue galaxies from the cluster population by mergers. We find the color-magnitude (CM) relation to be well defined and linear over the range of M_5500=-13 to -22. After calibration to multi-metallicity models, bright ellipticals are found to have luminosity weighted mean [Fe/H] values between -0.5 and +0.5, whereas low luminosity ellipticals have [Fe/H] values ranging from -2 to solar. The lack of CM relation in our continuum color suggests that a systematic age effect cancels the metallicity effects in this bandpass. This is confirmed with our age index which finds a weak correlation between luminosity and mean stellar age in ellipticals such that the stellar populations of bright ellipticals are 2 to 3 Gyrs younger than low luminosity ellipticals.Comment: 26 pages AAS LaTeX, 6 figures, accepted for publication in A

    The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation

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    BACKGROUND: Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involves polypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the 'Universal Medication Schedule' (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings. METHODS: Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data. RESULTS: Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient's care was a key theme. CONCLUSIONS: The UMS chart provides consolidated medicines information that might help to improve patients' knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence
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