Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption

OBJECTIVES: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN: The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken. PARTICIPANTS: Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad. RESULTS: Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence. CONCLUSIONS: Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation

A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics.

INTRODUCTION: Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). METHODS AND ANALYSIS: A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. ETHICS AND DISSEMINATION: The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations

Understanding Predictors of Nutrient Management Practice Diversity in Midwestern Agriculture

Agriculture\u27s negative effect on water quality has become increasingly well documented. Farmers have a range of conservation practices available, yet rate of adoption is not optimal. Extension and other agricultural stakeholders play a key role in promotion of conservation practice adoption. We used survey data to examine relationships between farmers\u27 integration in agricultural social networks and diversity of conservation practices used. Farmers who were more engaged in agricultural organizations and social networks tended to report greater diversity in nutrient best management practices. Conversely, less connected farmers reported less management practice diversity. Opportunities for Extension to engage with both groups exist

The Absorption Spectra of Derivatives of Phthalic Anhydride

The organic qualitative reagent 3-nitrophthalic anhydride has been found useful in the characterization of alcohols and mercaptans. It is of particular interest to note that in the products formed by the reaction of this reagent with alcohols the ester group is uniformly ortho to the nitro group rather than meta. Similarly it has been noted that the reaction of quinolinic anhydride with methyl alcohol likewise gives the a-methyl ester (Kirpal, 1907). On the other hand, the reaction between methyl alcohol and 4-nitrophthalic anhydride or cinchomeronic anhydride results in the formation of derivatives in which the ester group is para to the nitro group or to the heterocyclic nitrogen (Wegscheider and v. Dubrav, 1903; Goldschmiedt and Strache, 1889)

Understanding Predictors of Nutrient Management Practice Diversity in Midwestern Agriculture

Agriculture\u27s negative effect on water quality has become increasingly well documented. Farmers have a range of conservation practices available, yet rate of adoption is not optimal. Extension and other agricultural stakeholders play a key role in promotion of conservation practice adoption. We used survey data to examine relationships between farmers\u27 integration in agricultural social networks and diversity of conservation practices used. Farmers who were more engaged in agricultural organizations and social networks tended to report greater diversity in nutrient best management practices. Conversely, less connected farmers reported less management practice diversity. Opportunities for Extension to engage with both groups exist

Request for Initial Allotment to Establish a Water Resources Research Institute for the State of Ohio to Director, Office of Water Resources Research, the United States Department of Interior

(print) 140 p.The Water Resources Center of The Ohio State University hereby respectfully submits its request for an initial allotment of $75,000.00 for the fiscal year 1964-65 to continue operations of a Water Resources research facility serving the State of Ohio. It is intended that the allotment will be utilized to provide assistance in conducting basic and applied water resources research as designated under Public Law 88-379. The accompanying request evidences the various requirements for program participation in accordance with part 502 of the Office of Water Resources Notice of Proposed Rules and Regulations, as published in the Federal Register, Volume 29, Number 212, October 29, 1964. The request further documents the water research and development needs in the State of Ohio, and sets forth an integrated and comprehensive long range program to achieve the intended goals. The detailed program included under the initial allotment request will provide assistance for completing links in and providing an integrated coordination of existing programs, will initiate new programs, and will bolster the necessary cooperation with other agencies and groups active in the water resources fieldRequesting Institution -- Responsibility for Accounting and Reporting -- Institutional Qualifications -- Participation by Other Colleges or Universities -- Institutional Capabilities -- External Cooperation -- Development Rights Agreement -- Financial Plan -- Notice of Research Project -- Appendix A - Designation and Appointments -- Appendix B - Research Activities -- Appendix C - Biographies -- Appendix D - Notices of Research Project