Realising benefits in primary healthcare infrastructures

Purpose: This paper focuses upon the requirements to manage change, tangible and intangible benefits in a joint approach to deliver outputs on time, to quality and cost without failing to realise the benefits of the change. The aim of the paper is to demonstrate the need for benefits driven programme/project management as well as the importance of identifying the stakeholders’ level of involvement and contribution throughout the process, and manage their expectations. Design/methodology/approach: The methodology used is based on an action research approach, combining findings from a literature review and case studies within UK’s primary healthcare sector. Findings: Findings demonstrate development of a Benefits Realisation (BeReal) approach in healthcare through looking at case studies taking place within UK’s primary and acute healthcare sector Research limitations/implications: The framework development is based upon theoretical evidence and further research is needed to test and validate its robustness. Originality/value: The application of Benefits Realisation and Management in developing and delivering primary healthcare facilities. Keywords: Benefits management, Benefits realisation, healthcare infrastructures, process and LIF

Musical training as a potential tool for improving speech perception in background noise

Understanding speech in background noise is a complex and challenging task that causes difficulty for many people, including young children and older adults. Musicians, on the other hand, appear to have an enhanced ability to perceive speech in noise. This has prompted suggestions that musical training could help people who struggle to communicate in complex auditory environments. The experiments presented in this thesis were designed to investigate if and how musical training could be used as an intervention for improving speech perception in noise. The aim of Experiment 1 was to identify specific musical skills which could be targeted for training. Musical beat perception was found to be strongly correlated with speech perception in noise. It was hypothesised that musical beat perception might enhance speech perception in noise by facilitating temporal orienting of attention to important parts of the signal. Experiments 2, 3 and 4 investigated this hypothesis using a rhythmic priming paradigm. Musical rhythm sequences were used to prime temporal expectations, with performance for on-beat targets predicted to be better than that for temporally displaced targets. Rhythmic priming benefits were observed for detection of pure-tone targets in noise and for identification of words in noise. For more complex rhythms, the priming effect was correlated with musical beat perception. Experiment 5 used the metric structure within a sentence context to prime temporal expectations for a target word. There was a significant benefit of rhythmic priming for both children and adults, but the effect was smaller for children. In Experiment 6, a musical beat training programme was devised and evaluated for a group of older adults. After four weeks of training, a small improvement in speech reception thresholds was observed. It was concluded that beat perception is a useful skill to target in a musical intervention for speech perception in noise

Musical training as a potential tool for improving speech perception in background noise

Understanding speech in background noise is a complex and challenging task that causes difficulty for many people, including young children and older adults. Musicians, on the other hand, appear to have an enhanced ability to perceive speech in noise. This has prompted suggestions that musical training could help people who struggle to communicate in complex auditory environments. The experiments presented in this thesis were designed to investigate if and how musical training could be used as an intervention for improving speech perception in noise. The aim of Experiment 1 was to identify specific musical skills which could be targeted for training. Musical beat perception was found to be strongly correlated with speech perception in noise. It was hypothesised that musical beat perception might enhance speech perception in noise by facilitating temporal orienting of attention to important parts of the signal. Experiments 2, 3 and 4 investigated this hypothesis using a rhythmic priming paradigm. Musical rhythm sequences were used to prime temporal expectations, with performance for on-beat targets predicted to be better than that for temporally displaced targets. Rhythmic priming benefits were observed for detection of pure-tone targets in noise and for identification of words in noise. For more complex rhythms, the priming effect was correlated with musical beat perception. Experiment 5 used the metric structure within a sentence context to prime temporal expectations for a target word. There was a significant benefit of rhythmic priming for both children and adults, but the effect was smaller for children. In Experiment 6, a musical beat training programme was devised and evaluated for a group of older adults. After four weeks of training, a small improvement in speech reception thresholds was observed. It was concluded that beat perception is a useful skill to target in a musical intervention for speech perception in noise

Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the Theoretical Domains Framework and COM-B

Objectives: Respiratory tract infections are frequently managed by nurse and pharmacist prescribers and these prescribers are responsible for 8% of all primary care antibiotic prescriptions. Few studies have explored antibiotic prescribing amongst these prescribers, and interventions to target their antibiotic prescribing behaviour do not exist. Research objectives were to (1) use the Theoretical Domains Framework to identify the factors that influence nurse and pharmacist prescriber management of respiratory tract infections, (2) identify the Behaviour Change Techniques that can be used as the basis for the development of a theoretically informed intervention to support appropriate prescribing behaviour. Design: Qualitative design comprising semi-structured interviews, using the Theoretical Domains Framework and Capability, Opportunity and Motivation for Behaviour (COM-B). Setting: Primary care Participants: Twenty one prescribers (4 pharmacists and 17 nurses) Results: A range of factors across twelve domains of the TDF were found to influence prescriber behavior, and forty BCTs were identified as supporting appropriate prescribing. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting, information about health consequences) were identified as supporting prescribers in managing these expectations. Conclusion:. With increasing numbers of nurse and pharmacist prescribers managing infections in primary care, these findings will inform theoretically grounded interventions to support appropriate prescribing behaviour by these groups

A Sterile 20 Family Kinase and Its Co-factor CCM-3 Regulate Contractile Ring Proteins on Germline Intercellular Bridges

Germ cells in most animals are connected by intercellular bridges, actin-based rings that form stable cytoplasmic connections between cells promoting communication and coordination [1]. Moreover, these connections are required for fertility [1, 2]. Intercellular bridges are proposed to arise from stabilization of the cytokinetic ring during incomplete cytokinesis [1]. Paradoxically, proteins that promote closure of cytokinetic rings are enriched on stably open intercellular bridges [1, 3, 4]. Given this inconsistency, the mechanism of intercellular bridge stabilization is unclear. Here, we used the C. elegans germline as a model for identifying molecular mechanisms regulating intercellular bridges. We report that bridges are actually highly dynamic, changing size at precise times during germ cell development. We focused on the regulation of bridge stability by anillins, key regulators of cytokinetic rings and cytoplasmic bridges [1, 4-7]. We identified GCK-1, a conserved serine/threonine kinase [8], as a putative novel anillin interactor. GCK-1 works together with CCM-3, a known binding partner [9], to promote intercellular bridge stability and limit localization of both canonical anillin and non-muscle myosin II (NMM-II) to intercellular bridges. Additionally, we found that a shorter anillin, known to stabilize bridges [4, 7], also regulates NMM-II levels at bridges. Consistent with these results, negative regulators of NMM-II stabilize intercellular bridges in the Drosophila egg chamber [10, 11]. Together with our findings, this suggests that tuning of myosin levels is a conserved mechanism for the stabilization of intercellular bridges that can occur by diverse molecular mechanisms

Clinicians' Understanding of Preferences and Values of People with Hematological Malignancies at the End of Life: Concurrent Surveys

Background: People with hematological malignancies can deteriorate rapidly to a terminal event and have variable levels of engagement when transitioning to palliative and end-of-life care. Objectives: To describe end-of-life care values and preferences of people with hematological malignancies and explore whether these align with hematology clinicians' perceptions. Design: Two matched anonymous quantitative cross-sectional surveys explored: (1) patients' values and preferences around manner and timing of discussions regarding life expectancy and prognosis, involvement in decision making, and concurrent integration of palliative care with active treatment; and (2) clinicians' perceptions of their patients' values and preferences in relation to prognostic information. Settings/Participants: Concurrent online national surveys of people with hematological malignancies known to the Leukemia Foundation of Australia, and clinicians in Australia with membership to the Hematology Society of Australia and New Zealand. Results: Five hundred nine (38% response rate) patients (median age 64 [min 20, max 89, interquartile range 56-70]) and 272 clinicians (21% response rate) responded to the survey. If their health was deteriorating, most patients wanted honest prognostic and life expectancy information (87%); welcomed involvement in decision making (94%); felt they would be comfortable talking to the treating team about the possibility of death (86%); and would be comfortable seeing someone from a specialist palliative care team (74%). Clinicians generally underestimated most of these responses. Conclusion: Although our findings indicate that most people believe they would be comfortable discussing prognosis, life expectancy, and wishes at the end of life, clinicians were largely unaware of their preferences. This highlights the need to embed values clarification in routine care for each patient and family.</p

Sexual assault and psychosis in two large general population samples:Is childhood and adolescence a developmental window of sensitivity?

Background: Research has shown a strong relationship between psychosis and sexual assault. Theories on developmental trauma as a causal factor for psychosis suggest that exposure to sexual trauma in childhood would have a stronger association with psychosis than sexual trauma in adulthood. We hypothesized that exposure to sexual trauma earlier in childhood and adolescence would be more strongly associated with hallucinations, delusional beliefs and psychotic disorder than sexual trauma that occurred later in life. Methods: Using the 2007 and 2014 Adult Psychiatric Morbidity Surveys (N = 14,949) we calculated the prevalence of sexual assault, hallucinations, delusional beliefs, and psychotic disorder. We used logistic regression to examine the relationship between age of exposure to sexual assault (first exposure 16. Our findings do not support the idea that childhood and adolescence are uniquely sensitive periods for the emergence of psychotic experiences or psychotic disorder in relation to sexual trauma

Hallucinations in the general population across the adult lifespan:Prevalence and psychopathologic significance

Background: Community studies have found a relatively high prevalence of hallucinations, which are associated with a range of (psychotic and non-psychotic) mental disorders, as well as with suicidal ideation and behaviour. The literature on hallucinations in the general population has largely focused on adolescents and young adults. Aims: We aimed to explore the prevalence and psychopathologic significance of hallucinations across the adult lifespan. Method: Using the 1993, 2000, 2007 and 2014 cross-sectional Adult Psychiatric Morbidity Survey series (N = 33 637), we calculated the prevalence of past-year hallucinations in the general population ages 16 to ≥90 years. We used logistic regression to examine the relationship between hallucinations and a range of mental disorders, suicidal ideation and suicide attempts. Results: The prevalence of past-year hallucinations varied across the adult lifespan, from a high of 7% in individuals aged 16-19 years, to a low of 3% in individuals aged ≥70 years. In all age groups, hallucinations were associated with increased risk for mental disorders, suicidal ideation and suicide attempts, but there was also evidence of significant age-related variation. In particular, hallucinations in older adults were less likely to be associated with a cooccurring mental disorder, suicidal ideation or suicide attempt compared with early adulthood and middle age. Conclusions Our findings highlight important life-course developmental features of hallucinations from early adulthood to old age