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Additional file 1. Sample Search Strategy (Ovid MEDLINE).

Increasingly, remote consultations are used within General Practice. This is a consequence of numerous factors including pandemic adaptations to appointment systems and the societal movement from personal to digital interaction. These have resulted in the development of the Total Triage Model of Appointment management. In addition to the pandemic, in recent years, there has been increasing pressure within general practice. With a decrease in general practitioners (GPs), population growth, increasing prevalence of chronic conditions, and appointment demand. Despite Government initiatives to recruit 6,000 more GPs in February 2020, the BMA has noted a real loss in full time equivalent hours of 1,808 GPs since September 2015. In the same period, the patient caseload has increased with practice’s having an average of 2,131 more patients. It has been noted that there has been a shift in GP workload with more need and demand for GPs to be completing administrative work, which often there is not scheduled time in their sessions for. Increased clinical and administrative workload has been identified as a key reason for leaving and / or intention to leave among GPs. Total Triage became critically important during the COVID-19 pandemic and in general practice, remote consultations increased from 14.7% in February 2020 to 48.1% in April 2020. Although this has now dropped to 28.5% as of September 2022. This major change within the traditional structure of general practice has been linked to workload shifts between staff, from GPs to practice nurses. Rapid changes such as this have stimulated differing opinions among key stakeholders. The NHS has stated that clinicians should offer Face to Face Appointments without prior Triage. However, research has found that patients value having the flexibility of remote consultations. The aim of this systematic review is to examine and configure the available literature about the implementation of Total Triage, the reported opportunities and challenges for patients and staff and further implications for patients and practices.

This research aimed to find out how newly graduated nurses, also known as novices, participate in clinical practice in their first year. Current literature adopts a fixed model of a competent identity, judging an individual nurse either competent or not without the consideration of the working context. We aimed to find out what really happens during their transition. The workplace is a shared space which all nurses have to navigate daily. This space consists a fabric of mental and physical factors such as people, their interactions and the perceived power positions among them. Just like how drivers do at any traffic intersection, nurses have to find their passage through this shared space with other healthcare workers. The passage each nurse negotiated is his/her Participation Space. There are various factors they need to take into consideration.We identified Prized Tasks, Relational Position and Contextual Dimensions.

Additional file 1. Figure of the initial programme theory.

Additional file 5. Final, refined realist analysis, with data extracts.

Additional file 2. Search conducted on MEDLINE.

Additional file 4. Table of studies coded to develop CMOCs.

BACKGROUND: This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice. DISCUSSION: This paper presents a social and ethical analysis of Quality of Care in the light of the moral notion of care and Bourdieu's conception of symbolic violence. We argue that Quality of Care bureaucracies show significant potential for symbolic violence or the domination of practice and health care professionals. This generates problematic, and unintended, consequences that can displace the goals of practice. SUMMARY: Quality of Care bureaucracies may have unintended consequences for the practice of health care. Consistent with feminist conceptions of care, Quality of Care 'audits' should be reconfigured so as to offer a more nuanced and responsive form of evaluation.

International audience; Marrow cells from patients with higher-risk myelodysplastic syndrome (MDS) exhibit constitutive nuclear factor (NF)-κB activation. The proteasome inhibitor, bortezomib, has limited efficacy as a single agent in acute myeloid leukaemia. Its activity on leukaemic cell lines is potentiated by chemotherapy. We treated 43 higher-risk MDS patients with bortezomib (1*5 mg/m(2) , days 1, 4, 8 and 11) and low dose cytarabine arabinoside (LDAC; 10 mg/m(2) , then 20 mg/m(2) from days 1-14), every 28 d for four cycles. Median follow-up was 29*7 months. Responses were seen in 12 of the 43 patients (28%), including complete response (CR, n = 1), marrow-CR (n = 3), partial response (PR, n = 5) and haematological improvement (HI, n = 3). Responses were seen in 12 (36%) of the 33 previously untreated patients (11% CR, 13% PR, 2*5% HI), compared to none in the 12 previously treated patients (P < 0*01). Responders had better overall survival (median 18*2 vs. 10 months). One CR and 3 marrow-CRs were seen in patients with complex karyotypes. Main toxicity was haematological, responsible for infection in six patients and bleeding in 3. Three patients with Grade 1-2 pre-treatment haematotoxicity developed Grade 3-4 toxicity. Neuropathy was seen in 12% of patients. The addition of bortezomib to LDAC in higher-risk MDS may improve results obtained with LDAC alone, especially in patients with unfavourable karyotypes.