Editorial: Measuring quality of recovery

No Abstrac

Making Medical Homes Work: Moving From Concept to Practice

Explores practical considerations for implementing a medical home program of physician practices committed to coordinating and integrating care based on patient needs and priorities, such as how to qualify medical homes and how to match patients to them

Grassland in Ireland and the UK

Key points 1. Grassland is the dominant land use option in Ireland and the UK, and is characterised by a long growing season. 2. Dynamic, interactive systems of grassland management have been developed which combine high grass dry matter intakes with good sward quality. In the better grassland areas milk yields in excess of 7000 kg/cow are attainable with low levels of concentrate supplementation. 3. In the times to come, measures to protect the environment will constrain stocking rates, and fertiliser and manure use on intensive grassland enterprises. 4. A high proportion of beef and sheep farms participate in voluntary, EU-funded agrienvironmental schemes that promote less intensive production systems and high standards of environmental protection. 5. Access for the public to, and conservation by farmers of, the countryside have become increasingly important in the last 20 years. In the future, grasslands will have to meet a variety of demands and be truly multifunctional

Grassland in Ireland and the UK

Grassland is the dominant land use option in Ireland and the UK, and is characterised by a long growing season. Dynamic, interactive systems of grassland management have been developed which combine high grass dry matter intakes with good sward quality. In the better grassland areas milk yields in excess of 7000 kg/cow are attainable with low levels of concentrate supplementation. In the times to come, measures to protect the environment will constrain stocking rates, and fertiliser and manure use on intensive grassland enterprises. A high proportion of beef and sheep farms participate in voluntary, EU-funded agri- environmental schemes that promote less intensive production systems and high standards of environmental protection. Access for the public to, and conservation by farmers of, the countryside have become increasingly important in the last 20 years. In the future, grasslands will have to meet a variety of demands and be truly multifunctional

Clinical factors associated with the non-utilization of an anaesthesia incident reporting system

Background Incident reporting is a widely recommended method to measure undesirable events in anaesthesia. Under-utilization is a major weakness of voluntary incident reporting systems. Little is known about factors influencing reporting practices, particularly the clinical environment, anaesthesia team composition, severity of the incident, and perceived risk of litigation. The purpose of this study was to assess each of these, using an existing anaesthesia database. Methods We performed a retrospective cohort study and analysed 46 207 surgical patients. We used multivariate analysis to identify factors associated with the non-utilization of the reporting system. Results We found that in 7022 (15.1%) of the procedures performed, the incident reporting system was not used. Factors associated with the non-use of the system were regional anaesthesia/local anaesthesia, odds ratio (OR) 1.64 [95% confidence interval (CI) 1.03-2.62], emergency procedures OR 1.15 (95% CI: 1.05-1.27), and a consultant anaesthetist working without a trainee, OR 1.71 (95% CI: 1.03-2.82). In contrast, factors such as longer duration of surgery, OR 0.85 (95% CI: 0.76-0.94), the presence of a senior anaesthesia trainee, OR 0.86 (95% CI: 0.81-0.92), and the occurrence of severe complications with a high risk of litigation (i.e. death, nerve injuries) were less associated with a non-use of the reporting system, OR 0.65 (95% CI: 0.44-0.97). Team composition and time of day had no measurable impact on reporting practices. Conclusions Clinical factors play a significant role in the utilization of an anaesthesia incident reporting system and more particularly, severity of complications and higher liability risks which appear more as incentives than barriers to incident reportin

The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research