'To bring the work to greater perfection': systematising governance in the Church of Scotland, 1696–1800

Following the confirmation of Presbyterian government in the Church of Scotland in 1690, a number of attempts were made to codify the governance practices that were to be followed in the various ruling bodies of the church. A review of these attempts indicates a distinctive approach to governance based on detailed record keeping and the monitoring of activities based on these records. While the church never managed to agree on a complete manual of procedure, a review of responses to the proposals suggests substantial conformance with their main precepts. Not only did these precepts contribute to the consolidation of the Presbyterian settlement of 1690, they also provided a legalistic and systemic cast to organisational structures and practices. This then shaped a distinctive ‘culture of organisation’ which, in conjunction with other institutions such as education, provided to-hand resources for the widely noted Scottish competence in administration. A focus on administrative practices in their cultural and social context provides a basis for assessing claims to Scottish distinctiveness and influence

Thrombin-anti-thrombin levels and patency of arterio-venous fistula in patients undergoing haemodialysis compared to healthy volunteers : a prospective analysis

Peer reviewedPublisher PD

Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines) and reviewing drafts (ten guidelines). More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training may strengthen these processes.Journal of Comorbidity 2015;5(1):122–13