Patterns of sickness absence from a secondary hospital in Melbourne: A 10-year longitudinal study

Background/aims: There has been significant concern in recent years regarding increases in absenteeism in the healthcare sector, leading to lost productivity and projected workforce shortages. This study aimed to identify patterns of sickness absence over a 10-year period in a single-site secondary hospital in Melbourne, Australia. Methods: Data regarding sickness absences were extracted from anonymised payroll records from 2007 to 2016. The patterns of sickness absence analysed included seasonality, amount of leave and category of leave. These were explored both for individuals and in the aggregate. Results: Compared to the Australian average of 9.7 days, this cohort of employees took less sick leave, averaging at 8.81 days each. As a group, a consistent proportion of staff took no sick leave, 1–3 days, 4–6 days, or 7–9 days each year in the 10-year timespan. Only a small proportion took more than 9 days of sickness leave per year. Conclusions: The pattern of leave-taking was consistent for the group as a whole, however, individual leave patterns vary

Patients\u27 attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: A theory of planned behaviour analysis

Purpose: A key component of effective diabetes care is understanding patients’ perceptions about diabetes management. Patients’ attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants’ attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control. Methods: A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants’ clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI. Results: Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow. Conclusions: Patients’ individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets

Can doctors improve the patient experience by rearranging the furniture and equipment in their office? A video recorded simulation

The design of this study is a video-recorded simulated consultation. Its aim is to evaluate the effect of changing seating arrangements and stethoscope visibility on patient enablement and non-verbal behaviour. Twelve simulated consultations with six actor-patients and a ‘real’ doctor were video recorded. Either the ‘real’ doctor or actor-patient, blind to the hypothesis sat in large executive office chair during the consult. The patient entered the room afresh for each consult. Consultation quality and outcomes were independently evaluated on three measures: The Patient Enablement Index (PEI), the Leicester Assessment Package (LAP); Non-Verbal Communication (NVC). Both expert reviewers were also blind to the study aim. The results: the doctor’s performance was consistent on the LAP score (P \u3e 0.05). There was a significant improvement in patient enablement (p=0.03) and non-verbal communication (p=0.003) when the actor-patients occupied the executive chair. The visibility of the stethoscope did not have a measurable effect on these measures. There was evidence that when patients occupy the larger chair in the consulting room there is significant objective improvement in the measures of patient experience of the meeting

Globular Domain of the Prion Protein Needs to Be Unlocked by Domain Swapping to Support Prion Protein Conversion*

Prion diseases are fatal transmissible neurodegenerative diseases affecting many mammalian species. The normal prion protein (PrP) converts into a pathological aggregated form, PrPSc, which is enriched in the β-sheet structure. Although the high resolution structure of the normal PrP was determined, the structure of the converted form of PrP remains inaccessible to high resolution techniques. To map the PrP conversion process we introduced disulfide bridges into different positions within the globular domain of PrP, tethering selected secondary structure elements. The majority of tethered PrP mutants exhibited increased thermodynamic stability, nevertheless, they converted efficiently. Only the disulfides that tether subdomain B1-H1-B2 to subdomain H2-H3 prevented PrP conversion in vitro and in prion-infected cell cultures. Reduction of disulfides recovered the ability of these mutants to convert, demonstrating that the separation of subdomains is an essential step in conversion. Formation of disulfide-linked proteinase K-resistant dimers in fibrils composed of a pair of single cysteine mutants supports the model based on domain-swapped dimers as the building blocks of prion fibrils. In contrast to previously proposed structural models of PrPSc suggesting conversion of large secondary structural segments, we provide evidence for the conservation of secondary structural elements of the globular domain upon PrP conversion. Previous studies already showed that dimerization is the rate-limiting step in PrP conversion. We show that separation and swapping of subdomains of the globular domain is necessary for conversion. Therefore, we propose that the domain-swapped dimer of PrP precedes amyloid formation and represents a potential target for therapeutic intervention