Raising positive expectations helps patients with minor ailments: A cross-sectional study

Background: Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study examines to what extent GPs display both strategies during consultations for minor ailments and investigates how each of these relate to the patients' perceived health, consultation frequency and medication adherence. Methods: 524 videotaped consultations between Dutch GPs and patients aged 18 years or older were selected. All patients presented a minor ailment, and none of them suffered from a diagnosed chronic illness. The observation protocol included the validated Active Listening Observation Scale (ALOS-global), as well as three domains of positive communication, i.e. providing reassurance, a clear explanation, and a favourable prognosis. Patients completed several questionnaires before, immediately after, and two weeks after the consultation. These included measures for state anxiety (STAI), functional health status (COOP/ WONCA charts) and medication adherence (MAQ). Consultation frequency was available from an ongoing patient registration. Data were analysed using multivariate regression analyses. Results: Reassurance was related to patients' better overall health. Providing a favourable prognosis was linked to patients feeling better, but only when accompanied by a clear explanation of the complaints. A clear explanation was also related to patients feeling better and less anxious, except when patients reported a low mood pre-visit. Active listening alone was positively associated with patients feeling worse. Among patients in a good mood state, active listening was associated with less adherence. Conclusion: To some extent, it seems helpful when GPs are at the same time clear and optimistic about the nature and course of minor ailments. Yet, it does not seem helpful always and in all cases, e.g. when patients feel low upon entering the consulting room. Although communication strategies might to some extent contribute to the management of minor ailments, the results of this observational study also indicate that it is important for a physician to pay attention to the mood of the patient who enters the consulting room. (aut. ref.

Angiotensin-Converting Enzyme (ACE) Gene Insertion/Deletion Polymorphism and ACE Inhibitor-Related Cough: A Meta-Analysis

Objective: An insertion/deletion (I/D) variant in the angiotensin-converting enzyme (ACE) gene was associated with ACE inhibitor (ACEI)-related cough in previous studies. However, the results were inconsistent. Our objective was to assess the relationship between the ACE I/D polymorphism and ACEI-related cough by meta-analysis and to summarize all studies that are related to ACE I/D polymorphism and ACEI-cough and make a summary conclusion to provide reference for the researchers who attempt to conduct such a study. Methods: Databases including PubMed, EMbase, Cochrane Library, and China National Knowledge Infrastructure, were searched for genetic association studies. Data were extracted by two independent authors and pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Metaregression and subgroup analyses were performed to identify the source of heterogeneity. Results: Eleven trials, including 906 cases (ACEI-related cough) and 1,175 controls, were reviewed in the present meta-analysis. The random effects pooled OR was 1.16 (95% CI: 0.78-1.74, p = 0.46) in the dominant model and 1.61 (95% CI: 1.18-2.20, p = 0.003) in the recessive model. Heterogeneity was found among and within studies. Metaregression indicated that the effect size was positively associated with age and negatively associated with follow-up duration of ACEI treatment. Subgroup analysis revealed a significant association between ACE I/D polymorphism and ACEI-related cough in studies with mean age >60 y, but not in studies with mean age 2 mo or in studies in Caucasians. No heterogeneity was detected in these two subgroups. Conclusions: Synthesis of the available evidence supports ACE I/D polymorphism as an age-dependent predictor for risk of ACEI-related cough

A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing

Purpose: Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator. Method: Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data. Results: Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced. Conclusion: The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses’ perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles

The contribution of timescales to the temperature response of climate models

Both the magnitude and timescale of climate change in response to anthropogenic forcing are important consideration in climate change decision making. Using a familiar, yet simple global energy balance model combined with a novel method for estimating the amount of gain in the global surface temperature response to radiative forcing associated with timescales in the range 10(0)-10(3) years we show that the introduction of large-scale circulation such as meridional overturning leads to the emergence of discrete gain-timescale relationships in the dynamics of this model. This same feature is found in the response of both an intermediate complexity and two atmosphere-ocean general circulation models run to equilibrium. As a result of this emergent property of climate models, it is possible to offer credible partitioning of the full equilibrium gain of these models, and hence their equilibrium climate sensitivity, between two discrete timescales; one decadal associated with near surface ocean heat equilibration; and one centennial associated with deep ocean heat equilibration. Timescales of approximately 20 and 700 years with a 60:40 partitioning of the equilibrium gain are found for the models analysed here. A re-analysis of the emulation results of 19 AOGCMs presented by Meinshausen et al. (Atmos Chem Phys Discuss 8:6153-6272, 2008) indicates timescales of 20 and 580 years with an approximate 50:50 partition of the equilibrium gain between the two. This suggests near equal importance of both short and long timescales in determining equilibrium climate sensitivity

Value-added measures for schools in England: looking inside the ‘black box’ of complex metrics

Value-added measures can be used to allocate funding to schools, to identify those institutions in need of special attention and to underpin government guidance on targets. In England, there has been a tendency to include in these measures an ever-greater number of contextualising variables and to develop ever-more complex models that encourage (or ‘impose’) in schools a single uniform method of analysing data, but whose intricacies are not fully understood by practitioners. The competing claims of robustness, usability and accessibility remain unresolved because it is unclear whether the purpose of the measurement is teacher accountability, pupil predictability or school improvement. This paper discusses the provenance and shortcomings of value-added measurement in England (and the Pupil Level Annual Schools Census that informs it) including the fact that although the metrics are essential for School Effectiveness Research, they fail to capture in its entirety the differential effectiveness of schools across the prior attainment range and across sub-groups of students and subjects