Safety of patient handover in emergency care – results of a qualitative study

The paper presents the results of a qualitative study investigating safety of patient handover in the emergency care pathway. Semi-structured interviews were conducted with 39 practitioners from two NHS ambulance services and three hospitals in England. Thematic analysis identified two main themes: (1) there are tensions in the activity of handover, which practitioners deal with by making dynamic trade-offs based on their expertise and depending on the particular situation; (2) the management of patient and information flows across organisational boundaries is a key factor affecting the quality and safety of handover. The results suggest that there is a need for greater collaboration across organisational boundaries, and that organisational policies and procedures should provide flexibility to practitioners enabling them to make necessary local trade-offs based on their expertis

Factores de absentismo e quebra de rentabilidade do pessoal de enfermagem qualificado do Serviço Nacional de Saúde

Os problema do absentismo são discutidos dentro do contexto do Serviço de Saúde. São analisados factores (externos e pessoais) relacionados com o absentismo e a quebra de rendibilidade, incluindo estudos sobre a satisfação no emprego, com especial referência aos traços organizacionais do Serviço de Saúde. É discutida a relação entre o absentismo e a quebra de rendibilidade e sugere-se que uma teoria geral pode não ser conveniente. Antes se deve dar uma grande ênfase às necessidades do indivíduo e da organização como uma combinaçõo i. e., as necessidades do indivíduo quando ausente e a resposta da organização. ------ ABSTRACT ------ The problems of absenteeism are discussed in the context of the Health Service. Factors (external and personel) related to absence and wastage are considered including job satisfaction studies with special reference being made to organisational features of the Health Service. The relationship between absence and wastage is discussed and it is suggested that a general theory may not be suitable. Rather a great emphasis should be placed upon individual and organisational needs as a unique combination, i. e., individual needs when absent and the organization’s response

The role of dynamic trade-offs in creating safety - a qualitative study of handover across care boundaries in emergency care

The paper aims to demonstrate how the study of everyday clinical work can contribute novel insights into a common and stubborn patient safety problem – the vulnerabilities of handover across care boundaries in emergency care. Based on a dialectical interpretation of the empirical evidence gathered in five National Health Service organisations, the paper argues that performance variability is an essential component in the delivery of safe care, as practitioners translate tensions they encounter in their everyday work into safe practices through dynamic trade-offs based on their experience and the requirements of the specific situation. The findings may shed new light on the vulnerabilities of the handover process, and they might help explain why improvements to handover have remained largely elusive and what type of future recommendations may be appropriate for improving patient safety

Are we nearly there yet? A study of the English National Health Service as professional bureaucracies

PurposeThe purpose of this paper is to explore issues of medical engagement in the management and leadership of health services in the English National Health Service (NHS). The literature suggests that this is an important component of high performing health systems, although the NHS has traditionally struggled to engage doctors and has been characterised as a professional bureaucracy. This study explored the ways in which health care organisations structure and operate medical leadership processes to assess the degree to which professional bureaucracies still exist in the English NHS.Design/methodology/approachDrawing on the qualitative component of a research into medical leadership in nine case study sites, this paper reports on findings from over 150 interviews with doctors, general managers and nurses. In doing so, the authors focus specifically on the operation of medical leadership in nine different NHS hospitals.FindingsConcerted attention has been focussed on medical leadership and this has led to significant changes to organisational structures and the recruitment and training processes of doctors for leadership roles. There is a cadre of doctors that are substantially more engaged in the leadership of their organisations than previous research has found. Yet, this engagement has tended to only involve a small section of the overall medical workforce in practice, raising questions about the nature of medical engagement more broadly.Originality/valueThere are only a limited number of studies that have sought to explore issues of medical leadership on this scale in the English context. This represents the first significant study of this kind in over a decade.</jats:sec

Investigations of sulfur-silver interactions and mass transport on silver and gold surfaces

Adsorbates such as sulfur and oxygen can strongly affect metal transport on coinage metal surfaces. It has been proposed that the formation of metal-additive complexes aid in the enhancement of metal island coarsening. Our focus is solely on additive sulfur. We examined the interactions between sulfur and three different coinage metal surfaces at a very low temperature (5K) and low sulfur coverages to determine if M-S complexes formed under specific conditions. Our primary experimental technique is scanning tunneling microscopy (STM). The three surface studied were Ag(100), Ag(110), and Cu(110). On Ag(100) and Cu(110), only sulfur atoms were present at all experimental coverages. S atoms and linear independent AgS2 complexes were observed on the Ag(110) surface depending on the sulfur coverage. MS2 is a common motif observed in other coinage metal-sulfur complexes, and this is the first time that a MS2 complex has been directly observed isolated. Extensive DFT analysis supports the experimental observations. We have found that sulfur accelerates the coarsening of Au islands on Au(111) at room temperature (300K) under 0.31 ML S. The enhancement in the Au island decay rate was an order of magnitude, which is less of an enhancement compared to the Cu(111) and Ag(111) systems. A stabilization of the Au islands occurred at a higher sulfur coverage (0.56 ML), where the surface was covered by an 2D Au-S phase. In this dissertation, we describe work in which we have expanded the understanding of M-S complexes, and the role they play in mass transport. We believe this data will provide a better understanding of sulfur coinage metal interactions

Scientometric Analysis and Literature Research Growth of Lupus During 2010-2017

Abstract: The paper analyses the growth pattern of Lupus disease literature during 2010-2017. The data downloaded from web of science database, further interpreted and analyzed for the study purpose. Total number of publications has been identified as 38750 records. The distribution of publications based on the year of production, country wise productivity, document type of the publications, Major subject categories, Authors whose contribution is in the maximum level were studied. The study reveals a progressive increase on LUPUS research during 2010-2017. The year 2016 contributed highest number of publications. United States is the top contributor during 2010-2017. PETRI M is the leading author having 394 articles which is 1.017% of the total publications

Metallothioneins may not be enough - the role of phytochelatins in invertebrate metal detoxification

'Viewpoint' article