A portfolio of theory, practice and research in a primary care setting

Counselling is a growth area in primary care. Difficulties providing a psychologically based serviced within the medical domain of the surgery have been documented, in particular the difficulties when two professionals from differing backgrounds come together to provide a service to patients. This piece of research aims to explore (both qualitatively and quantitatively) the perceptions and experiences of GPs of primary care counselling. A second aim is to compare GP's perceptions and experiences to those of primary care counsellors themselves. The objective being to help understand these difficulties (from the perspective of both professionals) as well as the factors involved in shaping a GP's perception of primary care counselling. The study focuses on the GP-counsellor relationship, GP satisfaction with the service, GPs' perceptions of counselling and the role of the counsellor in the practice. The research aims are addressed through using three different formats and combining qualitative and quantitative methods of analysis. A small group of GPs were interviewed on their experiences of a counselling service. These findings helped to shape the development of a survey looking at perceptions and experiences of primary care counselling. The survey was sent to a larger group of GPs and also to primary care counsellors. The third stage of the study involved meeting with a group of GPs to hear their views on primary care counselling services. The results obtained from the study suggest that overall GPs value their counselling service but they seem to view counselling as a passive process. There is no consensus among GPs or among counsellors as to what counselling is. The role of the counsellor within the practice does not appear to be clear to the GP and there are differences between the counsellors' perceptions of their role and the GPs' perceptions. Issues of GP power emerge from the study and many GPs believe they offer counselling to their patients. These results are developed into a model showing the factors involved in a GP's perception of primary care counselling and what factors might lead a GP to form a negative or unhelpful perception of practice based counselling. From this model interventions are suggested aimed at changing unhelpful/negative perceptions that GPs may hold and interventions designed to promote good collaborative practice. These interventions are aimed at both GPs and primary care counsellors. The study has implications for the training of both GPs and primary care counsellors as well as implications for service users. The study highlights the importance of collaborative working and the GP-counsellor relationship. Such research can help increase our understanding of inter-professional relationships

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

A portfolio of theory, practice and research in a primary care setting

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On weak shape equivalences

We prove that weak shape equivalences are monomorphisms in the shape category of uniformly pointed movable continua Sh(M). We use an example of Draper and Keesling to show that weak shape equivalences need not be monomorphisms in the shape category. We deduce that Sh(M) is not balanced. We give a characterization of weak dominations in the shape category of pointed continua, in the sense of Dydak (1979). We introduce the class of pointed movable triples (X,F,Y), for a shape morphism F:X --> Y, and we establish an infinite-dimensional Whitehead theorem in shape theory from which we obtain, as a corollary, that for every pointed movable pair of continua (Y,X) the embedding j: X --> Y is a shape equivalence iff it is a weak shape equivalence

Ultrametrics and infinite dimensional whitehead theorems in shape theory

We apply a Cantor completion process to construct a complete, non-Archimedean metric on the set of shape morphisms between pointed compacta. In the case of shape groups we obtain a canonical norm producing a complete, both left and right invariant ultrametric. On the other hand, we give a new characterization of movability and we use these spaces of shape morphisms and uniformly continuous maps between them, to prove an infinite-dimensional theorem from which we can show, in a short and elementary way, some known Whitehead type theorems in shape theory