Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator

Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care

Friends and Symptom Dimensions in Patients with Psychosis: A Pooled Analysis

PMCID: PMC3503760This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Spectrometric study of condensed phase species of thorium and palladium-based modifiers in a complex matrix for electrothermal atomic absorption spectrometry

The chemical and morphological transformations of condensed phase species of a thorium-based modifier were studied over the temperature range 200–2500 °C, without and with the presence of aluminium and silicon as matrix components, and in some instances, arsenic as an analyte element. A similar study was also conducted with palladium as the modifier, for comparison. Results were derived using scanning electron microscopy (SEM), energy dispersive (ED) X-ray spectrometry, Raman microanalysis and attenuated total reflectance (ATR) Fourier transform-infrared (FT-IR) spectrometry. Comparable results were found using pyrolytic and non-pyrolytic graphite platforms, with processes occurring at slightly higher temperatures on the pyrolytic graphite platform. With thorium as the modifier, metal oxides were the predominant species on the platform surface at relatively low temperatures (<1500 °C), whereas metal phases became prevalent at high temperatures, when thorium and aluminium tended to behave independently from one other. Some spatial variations in the composition of the salt residues on different regions of the platform were observed (from the region closest to the slot in the tube, to the region furthest from the slot). Nonetheless, thorium metal remained on the graphite platform to higher temperatures than did aluminium metal. In the presence of arsenic, the existence of mixtures of thorium and arsenic oxides, just before the appearance temperature of gas phase arsenic atoms, was confirmed by SEM studies, ED X-ray spectra and Raman microanalysis. This suggests that any modifying effect of thorium on arsenic occurs while the modifier is in the oxide phase rather than in the metal phase. The presence of silicon added as silica, did not influence significantly the thermochemical behaviour of mixtures of thorium and aluminium. However, coexistence of silicon and arsenic oxides at the appearance temperature of the atomic absorption signal of arsenic was obtained, confirming that silicon can act as an internal modifier for arsenic. In the presence of palladium, aluminium exhibited greater interaction with the modifier; consequently, aluminium metal was retained on the platform surface to higher temperatures than thorium, which could explain how interference effects of aluminium on e.g. arsenic are avoided or reduced. Similarly, there was evidence for interaction of palladium and arsenic in the reduced state. However, when aluminium and silicon were present, the transformation of the palladium oxide to the metallic state was affected, which could diminish the modifying benefits of palladium for arsenic in the presence of aluminium

The non-unique Universe

The purpose of this paper is to elucidate, by means of concepts and theorems drawn from mathematical logic, the conditions under which the existence of a multiverse is a logical necessity in mathematical physics, and the implications of Godel's incompleteness theorem for theories of everything. Three conclusions are obtained in the final section: (i) the theory of the structure of our universe might be an undecidable theory, and this constitutes a potential epistemological limit for mathematical physics, but because such a theory must be complete, there is no ontological barrier to the existence of a final theory of everything; (ii) in terms of mathematical logic, there are two different types of multiverse: classes of non-isomorphic but elementarily equivalent models, and classes of model which are both non-isomorphic and elementarily inequivalent; (iii) for a hypothetical theory of everything to have only one possible model, and to thereby negate the possible existence of a multiverse, that theory must be such that it admits only a finite model

Scoping exercise on fallers’ clinics : report to the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)

The National Service Framework for Older People has stated the need for fall-prevention programmes. An appraisal of fallers’ clinics launched by the National Institute for Health and Clinical Excellence (NICE) was suspended because of a lack of information regarding existing services and typology. This project aimed to determine the feasibility of conducting economic modelling to appraise fallers’ clinics. To achieve this a national survey of services and reviews of the evidence of effectiveness of various models of fallers’ clinics and screening tools were undertaken

The relaxation of OH (v = 1) and OD (v = 1) by H2O and D2O at temperatures from 251 to 390 K

We report rate coefficients for the relaxation of OH(v = 1) and OD(v = 1) by H2O and D2O as a function of temperature between 251 and 390 K. All four rate coefficients exhibit a negative dependence on temperature. In Arrhenius form, the rate coefficients for relaxation (in units of 10–12 cm3 molecule–1 s–1) can be expressed as: for OH(v = 1) + H2O between 263 and 390 K: k = (2.4 ± 0.9) exp((460 ± 115)/T); for OH(v = 1) + D2O between 256 and 371 K: k = (0.49 ± 0.16) exp((610 ± 90)/T); for OD(v = 1) + H2O between 251 and 371 K: k = (0.92 ± 0.16) exp((485 ± 48)/T); for OD(v = 1) + D2O between 253 and 366 K: k = (2.57 ± 0.09) exp((342 ± 10)/T). Rate coefficients at (297 ± 1 K) are also reported for the relaxation of OH(v = 2) by D2O and the relaxation of OD(v = 2) by H2O and D2O. The results are discussed in terms of a mechanism involving the formation of hydrogen-bonded complexes in which intramolecular vibrational energy redistribution can occur at rates competitive with re-dissociation to the initial collision partners in their original vibrational states. New ab initio calculations on the H2O–HO system have been performed which, inter alia, yield vibrational frequencies for all four complexes: H2O–HO, D2O–HO, H2O–DO and D2O–DO. These data are then employed, adapting a formalism due to Troe (J. Troe, J. Chem. Phys., 1977, 66, 4758), in order to estimate the rates of intramolecular energy transfer from the OH (OD) vibration to other modes in the complexes in order to explain the measured relaxation rates—assuming that relaxation proceeds via the hydrogen-bonded complexes

Data development for ASTM E24.06.02 round robin program on instability prediction

Basis data for use in an ASTM E24.06.02 task group round robin activity was developed. Compact specimens were made of 2024-T351, 7075-T651 aluminum alloys, and 304 stainless steel. All were 12.7 mm thick and planar dimension variables incorporated were for 1T, 2T and 4T sizes. Representative raw data for each material and specimen size are contained herein. R-curves plotted in terms of delta a physical and delta a effective are plotted for each material