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Introduction: This work describes a secondary analysis of a qualitative data set originally used to understand parent participants' preferences for the design and implementation of a screening programme for paediatric Type 1 diabetes (T1D). From this, their spontaneous preferences for peer support emerged, described here in the context of existing peer support programmes for the newly diagnosed alongside suggestions for their incorporation into screening programmes for T1D and a range of other conditions. Methods: Data were collected from semi‐structured interviews conducted with parents of children aged 3–13 years to explore their expectations, perceptions and preferences of a T1D paediatric screening programme. A secondary analysis of interviews from participants who spontaneously raised preferences for peer support was used to populate a novel framework informed by NHS England's key principles for the same, namely, Shared experiences and reciprocated support, Accessibility and inclusivity and Person‐centred and integrated peer support. Results: Parents in 29 of 33 interviews spontaneously described the potential value of peer support if receiving a result indicating a positive (presymptomatic T1D result) from a screening programme. Specifically, the value of 'Shared experiences and reciprocated support' in terms of emotional support and reassurance, and access to more directly interpretable and relevant information related to the condition; 'Accessibility and inclusivity' relating to access to a community of similar individuals, whether in person or online; 'Person‐centred and integrated peer‐support' and the need for support reflecting the changing need of the child and the integration of peer support with clinical care. Conclusions: The needs of peer support described by parents involved in T1D paediatric screening appear to be shared with those of families with children diagnosed with a range of life‐altering conditions. Although the needs of peer support for paediatric screening may differ across conditions, our findings are a valuable starting point for its design both in T1D and other examples of similar population screening programmes. Patient or Public Contribution: Patients and the public have been involved throughout the design of the ELSA study and have worked with us to inform the study process. They contributed to the design and content of patient‐facing materials, the content of our topic guides and the analysis and interpretation of our findings. [ABSTRACT FROM AUTHOR]

Background: Patient portals introduced in most of England’s general practices since 2015 have the potential to improve healthcare efficiency. There is a paucity of information on the use of patient portals within the NHS general practices and the potential impact on healthcare utilisation. Aim: To investigate the association between patient portal registration and care utilisation (measured by the number of general practice consultations) among general practice patients. Design & setting: A longitudinal analysis using electronic health record data from the Clinical Practice Research Datalink (CPRD). Method: We analysed patients registered for patient portals (n = 284 666), aggregating their consultations 1 year before and 1 year after registration. We ran a multilevel negative binomial regression model to examine patient portal registration’s association with face-to-face and remote consultations. Results: Patients who registered to the portal had a small decrease in the total number of face-to-face consultations after registering to the patient portal (incidence rate ratio = 0.93, 95% confidence interval [CI] = 0.93 to 0.94). Patients who registered to the portal had an increase in the total number of remote consultations after registering to the portal (incidence rate ratio = 1.16, 95% CI = 1.15 to 1.18). Conclusion: The study found minor changes in consultation numbers post-patient portal registration, notably with an increase in remote consultations. While causality between portal registration and consultation number remains unclear, the potential link between patient portal use and healthcare utilisation warrants further investigation, especially within the NHS, where portal impacts are not well-studied. Detailed portal utilisation data could clarify this relationship. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with multimorbidity have an increased likelihood of using unplanned secondary care including emergency department visits and emergency hospitalisations. Those with mental health comorbidities are affected to a greater extent. The Covid-19 pandemic has negatively impacted on psychosocial wellbeing and multimorbidity care, especially among vulnerable older individuals. Aim: To examine the risk of unplanned hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London, England, during- and post-Covid-19 lockdown. Methods: Retrospective cross-sectional data analysis with the Discover-NOW database for Northwest London was conducted. The overall sample consisted of 20,165 registered patients aged 65+ with depression. Two time periods were compared to observe the impact of the Covid-19 lockdown on emergency hospital admissions between 23rd March 2020 to 21st June 2021 (period 1) and equivalent-length post-lockdown period from 22nd June 2021 to 19th September 2022 (period 2). Multivariate logistic regression was conducted on having at least one emergency hospital admission in each period against sociodemographic and multimorbidity-related characteristics. Results: The odds of having an emergency hospitalisation were greater in men than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly increased with age, higher deprivation, and greater number of comorbidities in both periods across the majority of categories. There was an inconclusive pattern with ethnicity; with a statistically significant protective effect among Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients during post-lockdown period only. Conclusion: The likelihood of unplanned hospitalisation was higher in men than women, and significantly increased with age, higher deprivation, and comorbidities. Despite modest increases in magnitude of risk between lockdown and post-lockdown periods, there is evidence to support proactive case-review by multi-disciplinary teams to avoid unplanned admissions, particularly men with multimorbidity and comorbid depression, patients with higher number of comorbidities and greater deprivation. Further work is needed to determine admission reasons, multimorbidity patterns, and other clinical and lifestyle predictors. [ABSTRACT FROM AUTHOR]

Purpose: Allied Health Professionals (AHPs) are well placed to deliver physical activity advice but this is currently not routine clinical practice. Increasing evidence demonstrates physical activity can improve quality-of-life for people affected by cancer, enable behaviour change, improve survival and reduce longterm treatment effects. We aimed to understand AHPs' current knowledge and practice in advising about physical activity. Materials and methods: AHPs' self-reported knowledge, competency and training needs in managing physical effects of cancer, and the merits of physical activity data were collected via an online survey. The survey link was cascaded electronically to all NHS and NHS-affiliated AHPs working across several generic and non-cancer-specific healthcare interfaces across one city in England. Results: Eighty AHPs responded. Forty-one percent of AHPs had patients with current or past diagnoses of cancer. Overall, AHPs reported low confidence in giving physical activity advice, with physiotherapists the most confident. 60% of respondents identified training needs concerning the impact of cancer. Conclusions: Although the merits of physical activity for people affected by cancer is clearly evidenced, low levels of AHP confidence and competence in discussing this topic limit patients' awareness and access to services. Addressing this confidence and competence has potential to improve patient outcome. [ABSTRACT FROM AUTHOR]

An increasing number of people affected by cancer (PABC) are living longer lives as treatment continues to advance. There is growing evidence for physical activity (PA) supporting health in this population before, during and after cancer treatment, but PA advice is not part of usual care. This study investigates views of frontline oncology healthcare professionals (HCPs) in one NHS teaching hospital in England to understand the role of PA advice across cancer services. This was a qualitative study interviewing HCPs and using thematic analysis. Four main themes were identified: 1. Awareness of the roles of PA in cancer; 2. Patient-specific factors in rehabilitation; 3. Cancer-specific factors in rehabilitation; 4. Barriers and opportunities to integrating PA within usual care. HCPs' awareness of the role of PA in cancer rehabilitation was low overall and PA was found not to be embedded within rehabilitation. Contrastingly, there was awareness of PA's potential to impact disease and treatment-related outcomes positively. Ideas for PA integration included training for staff and giving PA advice within consultations. Low awareness of benefits of PA-based rehabilitation and lack of integration in usual care contrasted with HCPs' interest in this area's potential. Training HCPs to begin the conversation with patients affected by cancer in teachable moments may increase patient access. Integrating physical activity education and training for trainees and existing healthcare professionals workforce would help embed physical activity into routine clinical practice. Brief advice intervention training during every consultation, such as providing relevant individualised information and signposting, can be impactful. Physical activity within a broader cancer rehabilitation programme should be integrated as standard for every cancer patient. Individualised plans may include prehabilitation, restorative rehabilitation and palliative rehabilitation. Patient preferences and the patient experience should continue to shape service design. There is a need to ensure physical activity advice is consistent throughout healthcare settings and not fragmented between primary, secondary and tertiary care. [ABSTRACT FROM AUTHOR]

Unnecessarily delayed discharges from hospital of older people living with frailty can have negative consequences for their health and add significant costs to health services. We report on an ethnographic study at two English hospitals and their respective health and social care systems where we followed 37 patient journeys. The study aim was to understand why delays occur. Our findings indicate that working practices in the study hospitals may have inadvertently contributed to delays. While many pieces of patients' clinical and social information were collected, recorded and accessed in different ways by different professionals, to facilitate a discharge, these pieces needed to be re-found, integrated and re-constructed. A key component of this process was information related to patients' social, family and functional background. This was often missing, not accessed or perceived to be of low value compared to other more readily available clinical information. Patients' re-construction was thus often incomplete, or insufficient to reduce the clinical and prognostic uncertainty associated with frailty and to manage risks inherent in older people's discharge. Where this key component was present and integrated into decision-making in multi-disciplinary team working, uncertainty and risk were managed more constructively and sometimes avoided an escalation of care needs. [ABSTRACT FROM AUTHOR]

Recent events - on both a global scale and within individual countries - including the lockdowns associated with COVID-19 pandemic, inflation concerns, and political tensions, have increased pressure to reconfigure social services for ongoing sustainability. Healthcare services across the world are undergoing major system change (MSC). Given the complexity and different contextual drivers across healthcare systems, there is a need to use a variety of perspectives to improve our understanding of the processes for MSC. To expand the knowledge base and develop strategies for MSC requires analysing change projects from different perspectives to distil the elements that drove the success. We offer the Gateway Framework as a collaborative transformational system tool to assess and reorganise operations, services, and systems of healthcare organisations. This framework and guiding questions, accounts for past events whilst being proactive, future orientated, and derived from externally defined and a standardised requirements to promote safe, high-quality care. [ABSTRACT FROM AUTHOR]

Exercise support for people with cancer is a national priority. The purpose of this study was to identify the success factors necessary to create a model of exercise support for people affected by cancer in a large city in the north of England. Two groups of participants were recruited; people affected by cancer (n = 26) and professional stakeholders (n = 14) contributing to either focus groups or semi-structured interviews. Data were analysed using framework analysis. Results from this study suggest that the promotion of exercise is not a priority in routine cancer care. Patients identified a lack of support and difficulty attaining information as a barrier to becoming active, emphasising a gulf between the patients' needs and the health professionals' priorities. People affected by cancer and professionals agreed that exercise was beneficial to cancer patients both during and after treatment. For an exercise pathway to be successful, key factors were identified including accessibility; tailored support; social interaction; affordability; competence of exercise delivery staff. There was consensus on the importance of exercise and critical factors required to develop a sustainable, accessible and effective service. Evidence to inform the development of an exercise pathway for people affected by cancer is provided. Exercise should be an included component of a cancer treatment plan, discussed and initiated from diagnosis. Health professionals have a responsibility to provide clear, consistent evidence-based advice on exercise. Exercise professionals must be appropriately trained in cancer rehabilitation according to National Institute for Health and care Excellence (2014). Individual assessments of exercise needs, preferences and cancer limitations will result in a bespoke plan of recommendations and support. The option of group activities has the advantage of increased social interaction, peer support and shared experiences. Available exercise/physical activity services should be accessible and affordable but may involve a modest contribution. [ABSTRACT FROM AUTHOR]

Background: Amidst increased pressures on General Practice across England, the receptionist continues to fulfil key administrative and clinically related tasks. The need for more robust support for these key personnel to ensure they stay focussed and motivated is apparent, however, to be effective a more systematic understanding of the parameters of their work is required. Here we present a valuable insight into the tasks they fulfil, their relationship with colleagues and their organisation and their attitudes and behaviour at work collectively defined as their 'work design'. Methods: Our aim was to quantitatively assess the various characteristics of receptionists in primary care in England using the validated Work Design Questionnaire (WDQ) a 21 point validated questionnaire, divided into four categories: task, knowledge and social characteristics and work context with a series of sub-categories within each, disseminated online and as a postal questionnaire to 100 practices nationally. Results: Seventy participants completed the WDQ, 54 online and 16 using the postal questionnaire with the response rate for the latter being 3.1%. The WDQ suggested receptionists experience high levels of task variety, task significance and of information processing and knowledge demands, confirming the high cognitive load placed on receptionists by performing numerous yet significant tasks. Perhaps in relation to these substantial responsibilities a reliance on colleagues for support and feedback to help negotiate this workload was reported. Conclusion: The evidence of our survey suggests that the role of modern GP receptionists requires an array of skills to accommodate various administrative, communicative, problem solving, and decision-making duties. There are ways in which the role might be better supported for example devising ways to separate complex tasks to avoid the errors involved with high cognitive load, providing informal feedback, and perhaps most importantly developing training programmes. [ABSTRACT FROM AUTHOR]

Implementation of the Recovery Package is a priority in the recent NHS England cancer strategy, but information on local workforce readiness to implement the package was unavailable. Therefore, a survey of the lead cancer clinician and lead clinical nurse specialist for each cancer multidisciplinary team across Sheffield Teaching Hospitals NHS Foundation Trust was undertaken to measure understanding of the Recovery Package, good practice and gaps in service provision. This article reports on the results of the survey, which found that the Recovery Package's terminology -- particularly the word 'recovery', which implies the package is relevant only for those treated curatively -- has led to misunderstandings and that implementation has been variable across cancer teams. The article also discusses proposed solutions, which include improving medical staff awareness, reviewing nurse specialist workload and considering different ways of working. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for cardiovascular disease and prevalence varies by ethnic group. The diagnosis and management of blood pressure are informed by guidelines largely based on data from white populations. This study addressed whether accuracy of blood pressure measurement in terms of diagnosis of hypertension varies by ethnicity by comparing two measurement modalities (clinic blood pressure and home monitoring) with a reference standard of ambulatory BP monitoring in three ethnic groups.Methods: Cross-sectional population study (June 2010 - December 2012) with patients (40-75 years) of white British, South Asian and African Caribbean background with and without a previous diagnosis of hypertension recruited from 28 primary care practices. The study compared the test performance of clinic BP (using various protocols) and home-monitoring (1 week) with a reference standard of mean daytime ambulatory measurements using a threshold of 140/90 mmHg for clinic and 135/85 mmHg for out of office measurement.Results: A total of 551 participants had complete data of whom 246 were white British, 147 South Asian and 158 African Caribbean. No consistent difference in accuracy of methods of blood pressure measurement was observed between ethnic groups with or without a prior diagnosis of hypertension: for people without hypertension, clinic measurement using three different methodologies had high specificity (75-97%) but variable sensitivity (33-65%) whereas home monitoring had sensitivity of 68-88% and specificity of 64-80%. For people with hypertension, detection of a raised blood pressure using clinic measurements had sensitivities of 34-69% with specificity of 73-92% and home monitoring had sensitivity (81-88%) and specificity (55-65%).Conclusions: For people without hypertension, ABPM remains the choice for diagnosing hypertension compared to the other modes of BP measurement regardless of ethnicity. Differences in accuracy of home monitoring and clinic monitoring (higher sensitivity of the former; higher specificity of the latter) were also not affected by ethnicity. [ABSTRACT FROM AUTHOR]

Background: Self-monitoring of blood pressure is common but guidance on how it should be carried out varies and it is currently unclear how such guidance is viewed.Aim: To explore patients' and healthcare professionals' (HCPs) views and experiences of the use of different self-monitoring regimens to determine what is acceptable and feasible, and to inform future recommendations.Design and Setting: Thirteen focus groups and four HCP interviews were held, with a total of 66 participants (41 patients and 25 HCPs) from primary and secondary care with and without experience of self-monitoring.Method: Standard and shortened self-monitoring protocols were both considered. Focus groups and interviews were recorded, transcribed verbatim, and analysed using the constant comparative method.Results: Patients generally supported structured schedules but with sufficient flexibility to allow adaptation to individual routine. They preferred a shorter (3-day) schedule to longer (7-day) regimens. Although HCPs could describe benefits for patients of using a schedule, they were reluctant to recommend a specific schedule. Concerns surrounded the use of different schedules for diagnosis and subsequent monitoring. Appropriate education was seen as vital by all participants to enable a self-monitoring schedule to be followed at home.Conclusion: There is not a 'one size fits all approach' to developing the optimum protocol from the perspective of users and those implementing it. An approach whereby patients are asked to complete the minimum number of readings required for accurate blood pressure estimation in a flexible manner seems most likely to succeed. Informative advice and guidance should incorporate such flexibility for patients and professionals alike. [ABSTRACT FROM AUTHOR]

Background: Although there is considerable risk for patients from hospital-acquired thrombosis (HAT), current systems for reducing this risk appear inefficient and have focused predominantly on secondary care, leaving the role of primary care underexplored, despite the onset of HAT often occurring post-discharge.Aim: To gain an understanding of the perspectives of primary care clinicians on their contribution to the prevention of HAT. Their current role, perceptions of patient awareness, the barriers to better care, and suggestions for how these may be overcome were discussed.Design and Setting: Qualitative study using semi-structured interviews in Oxfordshire and South Birmingham, England.Method: Semi-structured telephone interviews with clinicians working at practices of a variety of size, socioeconomic status, and geographical location.Results: A number of factors that influenced the management of HAT emerged, including patient characteristics, a lack of clarity of responsibility, limited communication and poor coordination, and the constraints of limited practice resources. Suggestions for improving the current system include a broader role for primary care supported by appropriate training and the requisite funding.Conclusion: The role of primary care remains limited, despite being ideally positioned to either raise patient awareness before admission or support patient adherence to the thromboprophylaxis regimen prescribed in hospital. This situation may begin to be addressed by more robust lines of communication between secondary and primary care and by providing more consistent training for primary care staff. In turn, this relies on the allocation of appropriate funds to allow practices to meet the increased demand on their time and resources. [ABSTRACT FROM AUTHOR]

Background: Ambulatory and/or home monitoring are recommended in the UK and the US for the diagnosis of hypertension but little is known about their acceptability.Aim: To determine the acceptability of different methods of measuring blood pressure to people from different minority ethnic groups.Design and Setting: Cross-sectional study with focus groups in primary care in the West Midlands.Method: People of different ethnicities with and without hypertension were assessed for acceptability of clinic, home, and ambulatory blood pressure measurement using completion rate, questionnaire, and focus groups.Results: A total of 770 participants were included, who were white British (n = 300), South Asian (n = 241), and African Caribbean (n = 229). White British participants had significantly higher successful completion rates across all monitoring modalities compared with the other ethnic groups, especially for ambulatory monitoring: white British (n = 277, 92% [95% confidence interval [CI] = 89% to 95%]) versus South Asian (n = 171, 71% [95% CI = 65% to 76%], P<0.001) and African Caribbean (n = 188, 82% [95% CI = 77% to 87%], P<0.001), respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared with white British participants. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least acceptable without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input.Conclusion: Reduced acceptability and completion rates among minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring. Selection of method of blood pressure monitoring should take into account clinical need, patient preference, and potential cultural barriers to monitoring. [ABSTRACT FROM AUTHOR]

Background and Aims Questions about drinking 'yesterday' have been used to correct under-reporting of typical alcohol consumption in surveys. We use this method to explore patterns of over- and under-reporting of drinking quantity and frequency by population subgroups in four countries. Design Multivariate linear regression analyses comparing estimates of typical quantity and frequency of alcohol consumption with and without adjustments using the yesterday method. Setting and Participants Survey respondents in Australia ( n = 26 648), Canada ( n = 43 371), USA ( n = 7969) and England ( n = 8610). Measurements Estimates of typical drinking quantities and frequencies over the past year plus quantity of alcohol consumed the previous day. Findings Typical frequency was underestimated by less frequent drinkers in each country. For example, after adjustment for design effects and age, Australian males self-reporting drinking 'less than once a month' were estimated to have in fact drunk an average of 14.70 (± 0.59) days in the past year compared with the standard assumption of 6 days ( t = 50.5, P < 0.001). Drinking quantity 'yesterday' was not significantly different overall from self-reported typical quantities during the past year in Canada, the United States and England, but slightly lower in Australia (e.g. 2.66 versus 3.04 drinks, t = 20.4, P < 0.01 for women). Conclusions People who describe themselves as less frequent drinkers appear to under-report their drinking frequency substantially, but country and subgroup-specific corrections can be estimated. Detailed questions using the yesterday method can help correct under-reporting of quantity of drinking. [ABSTRACT FROM AUTHOR]

Background: National guidelines in the UK, United States of America, Canada, and Australia have recently stressed the importance of identifying and treating antenatal anxiety and depression. However, there is little research into the most effective and acceptable ways of helping women manage their symptoms of anxiety and stress during pregnancy. Research indicates the necessity to consider the unique needs and concerns of perinatal populations to ensure treatment engagement, highlighting the need to develop specialised treatments which could be integrated within routine antenatal healthcare services. This trial aims to develop a brief intervention for antenatal anxiety, with a focus on embedding the delivery of the treatment within routine antenatal care.Methods/design: This study is a two-phase feasibility trial. In phase 1 we will develop and pilot a brief intervention for antenatal anxiety, blended with group support, to be led by midwives. This intervention will draw on cognitive behavioural principles and wider learning from existing interventions that have been used to reduce anxiety in expectant mothers. The intervention will then be tested in a pilot randomised controlled trial in phase 2. The following outcomes will be assessed: (1) number of participants meeting eligibility criteria, (2) number of participants consenting to the study, (3) number of participants randomised, (4) number of sessions completed by those in the intervention arm, and (5) number of participants completing the post-intervention outcome measures. Secondary outcomes comprise: detailed feedback on acceptability, which will guide further development of the intervention; and outcome data on symptoms of maternal and paternal anxiety and depression, maternal quality of life, quality of couple relationship, mother-child bonding, infant temperament and infant sleep.Discussion: The study will provide important data to inform the design of a future full-scale randomised controlled trial of a brief intervention for anxiety during pregnancy. This will include information on its acceptability and feasibility regarding implementation within current antenatal services, which will inform whether ultimately this provision could be rolled out widely in healthcare settings.Trial Registration: Current Controlled Trials ISRCTN95282830 . Registered on 29 October 2014. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a common chronic inflammatory disease causing joint damage, disability, and reduced life expectancy. Highly effective drugs are now available for the treatment of RA. However, poor adherence to drug regimens remains a significant barrier to improving clinical outcomes in RA. Poor adherence has been shown to be linked to patients' beliefs about medicines with a potential impact on adherence. These beliefs are reported to be different between ethnic groups. The purpose of this study was to identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including an assessment of the influence of beliefs about medicines and satisfaction with information provided about DMARDs and compare determinants of adherence between RA patients of White British and South Asian.Methods: RA patients of either White British (n = 91) or South Asian (n = 89) origin were recruited from secondary care. Data were collected via questionnaires on patients': (1) self-reported adherence (Medication Adherence Report Scale-MARS); (2) beliefs about medicines (Beliefs about Medicines Questionnaire-BMQ); (3) illness perceptions (Illness Perceptions Questionnaire-IPQ) and (4) satisfaction with information about DMARDs (Satisfaction with Information about Medicines questionnaire-SIMS). In addition, clinical and demographic data were collected.Results: The results revealed that socio-demographic factors only explained a small amount of variance in adherence whereas illness representations and treatment beliefs were more substantial in explaining non-adherence to DMARDs. Patients' self-reported adherence was higher in White British than South Asian patients (median 28 (interquartile range 26-30) vs median 26 (interquartile range 23-30) respectively; P = 0.013, Mann-Whitney test). Patients who reported lower adherence were more dissatisfied with the information they had received about their DMARDs (P < 0.001, Spearman correlation, SIMS action and usage subscale; P < 0.001, Spearman correlation, SIMS potential problems subscale) and had more negative beliefs about their DMARDs and were related to ethnicity with South Asian patients having more negative views about medicines.Conclusions: Socio-demographic factors were found to explain a small amount of variance in adherence. Illness representations and treatment beliefs were more important in explaining non-adherence to DMARDs. Clinicians managing South Asian patients with RA need to be aware that low adherence may be linked to negative beliefs about medicines and illness representations of RA. [ABSTRACT FROM AUTHOR]

Background: Faecal incontinence is a common, distressing and debilitating condition which remains largely hidden, leading to social isolation and loss of confidence. Patients with faecal incontinence experience delays in accessing appropriate treatment services due to embarrassment and lack of enquiry from primary care health professionals. Despite the publication of three government documents related to continence services in the last decade, these services are still fragmented with asynchronous delivery and poor inter-professional integration. The aim of the study was to describe a novel integrated care pathway for the management of faecal incontinence and examine the experiences of patients with faecal incontinence in relation to this pathway.Methods: A focus group (eight participants) and narrative, qualitative individual interviews (five participants) were used to explore the views of patients with faecal incontinence, relating to access and quality of incontinence services and the new integrated care pathway. Emerging themes were identified from the transcribed focus group and interviews via the thematic analysis method.Results: The concept of an integrated care pathway is attractive for increasing accessibility, streamlining of the patient pathway and providing a dedicated service for the management of faecal incontinence. Patients' initial experiences of the pathway are positive.Discussion: A new ICP was developed and the initial patient evaluation of it was positive. Service users made various suggestions how the FI pathway could have been improved. The issues that patients were most concerned about were access to continence services, GP awareness of continence services and prompt, effective management of their condition. This service was set up within the pelvic floor dysfunction unit with BFNS and an integrated community continence team. The authors are aware that this is not a standard service setup across the country. The fact that it may be uncomfortable for patients to talk about their condition may have led to potential bias when discussing their beliefs or experiences. As with most qualitative studies, our aim was to identify a range of experiences rather than define our participant sample as being representative. Our participant sample was diverse in the key characteristics but a longitudinal study may reveal further important aspects of an ICP for FI.Conclusions: An integrated care pathway for faecal incontinence appears to have potential to address the long-standing service delivery issues that have blighted continence services historically. [ABSTRACT FROM AUTHOR]

Background Progressive ataxias are neurological disorders affecting balance, co-ordination of movement and speech. Objective A qualitative study was undertaken to discover patients' experiences of ataxia and its symptoms. Participants Thirty-eight people with ataxia recruited from patient support groups and two hospital outpatients departments. Design Cross-sectional qualitative study with thematic analysis. Results These accounts highlight the limits of medicine in the context of a rare, incurable and disabling disorder, and the embodied uncertainties brought by slowly progressive diseases that lie at the boundaries of mainstream medical knowledge. The existential crises faced by people with ataxia are seemingly magnified by sometimes idiopathic aetiologies and the limited number of inherited conditions identifiable by the available genetic tests. Interviewees were drawn into a medical system that was focused mainly on the diagnosis process, with widely varying results. However, when asked, most had rather valued the provision of disability aids and physical therapies. Only one informant reported overcoming the myriad uncertainties of progressive ataxia, and their account supported the notion of 'biographical repair' in chronic illness. Conclusions Clinical uncertainties in ataxia constrained people's attempts to deal with their condition. The construction of the proactive, informed, medical consumer who is assumed to be a partner in care is problematic in the context of a rare and difficult-to-diagnose disease for which there is usually no cure. Service providers should be mindful of the need to manage patient expectations in relation to diagnosis and cure. More focus might usefully be placed on the provision of physical therapies and disability aids. [ABSTRACT FROM AUTHOR]

Aims and objectives To report the findings gained from interviews with hospital nurses and care assistants, regarding the impact of hospital manual handling policies on their role in maintaining and promoting patients' mobility. Background Older hospitalised adults often experience deteriorations in mobility, which are often partially caused by protective or custodial care practice and environments that promote patient dependency. Hospital-induced mobility loss may be conceptualised as a problematic source of iatrogenic patient harm, worthy of attention from a patient safety standpoint. Preventative rehabilitation nursing interventions have the potential to prevent mobility loss. Design Grounded theory study. Methods Data were collected in three clinical settings: general rehabilitation, spinal injuries and stroke rehabilitation. Semi-structured interviews with 39 rehabilitation staff were completed. Results Perceptions of hospital manual handling policy were described via four subcategories: policy as stimulus to improved practice; policy as divorced from reality; policy as threat; and policy as hindrance to rehabilitation. Conclusions Hospital manual handling policy was perceived negatively by some nursing team members both as a threat and as a barrier to patients' rehabilitation. Risk aversion, divided teamwork practices and overuse of patient handling equipment were matters of concern. Relevance to clinical practice Perceptions of hospital manual handling policy should be openly discussed by nursing managers and direct care providers. It is important to recognise that beliefs about and perceptions of policy will often impact later on staff practices and behaviours. Unintended consequences arising from dominant interpretations of manual handling policy must be acknowledged and risks identified. It is important that practitioners balance risk assessment and prevention of falls with patients' needs for mobilisation. [ABSTRACT FROM AUTHOR]

The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda. [ABSTRACT FROM PUBLISHER]

The importance of home–school relationships between parents and practitioners in early childhood settings is widely accepted. This article discusses the effects of the level of involvement and the nature of practitioner–parent relationships in early years settings in England on the basis of a two part study that examined parents’ experience of home visits conducted before the children begin nursery. The first part of the study, a questionnaire survey of 52 teachers/practitioners from different nurseries in the south-east of England, established that 81 percent of these nurseries conduct a home visit before children began nursery. The second part of the study, based on one-to-one semi-structured interviews with eight early years practitioners and five parents, highlighted the tensions that seem to exist between them with regard to these visits. The main themes identified are: power, training and time. As a result of these findings, this article proposes that the nature of practitioner–parent relationships is determined by: 1) the training received by teachers and practitioners to work with parents; and 2) teachers’ and practitioners’ reflection on their practice. [ABSTRACT FROM PUBLISHER]

Background. Myocardial infarction (MI) is a leading cause of death in the UK. A good clinical outcome depends on rapid treatment following the onset of symptoms. A person’s knowledge of typical symptoms determines how quickly they present to the medical services.Objectives. To investigate knowledge of MI symptoms among the general population and the relationship between age, gender and socio-economic status with knowledge.Methods. Street survey of 302 participants in Birmingham, UK, using an interviewer-assisted questionnaire.Results. Of seven symptoms accepted in the medical literature as typical of an MI, central chest pain was the most frequently identified (75% of the sample), followed by arm pain or numbness (40%), shortness of breath (35%), fainting or dizziness (21%) and sweating (21%). Feeling or being sick and neck or jaw pain were mentioned by 8.1% and 5.9%, respectively, while an atypical or inapplicable symptom, collapse (9.9%) was mentioned more often than these. Over half the sample knew only two or fewer MI symptoms. The mean number of typical symptoms identified was 2.2 (SD = 1.28). Respondents from professional occupations and those with previous experience of MI, whether direct or indirect, showed better awareness.Conclusions. The study demonstrated a paucity of knowledge of MI symptoms among the general public. Such findings provide a baseline to guide public health campaigns targeting awareness of MI. [ABSTRACT FROM PUBLISHER]

Aims: Supervised exercise can benefit selected patients with heart failure, however the effectiveness of home-based exercise remains uncertain. We aimed to assess the effectiveness of a home-based exercise programme in addition to specialist heart failure nurse care. [ABSTRACT FROM PUBLISHER]

Objective: To compare the outcomes of home-based (using the Heart Manual) and centre-based cardiac rehabilitation programmes. Design: Randomised controlled trial and parallel economic evaluation. Setting: Predominantly inner-city, multi-ethnic population in the West Midlands, England. Patients: 525 patients referred to four hospitals for cardiac rehabilitation following myocardial infarction or coronary revascularisation. Interventions: A home-based cardiac rehabilitation programme compared with centre-based programmes. Main outcome measures: Smoking cessation, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), total cholesterol (TC) and high-density lipoprotein (HDL)-cholesterol, psychological status (HADS anxiety and depression) and exercise capacity (incremental shuttle walking test, ISWT) measured at 12 months. Health service resource use, quality of life utility and costs were quantified. Results: There were no significant differences in the main outcomes when the home-based was compared with the centre-based programme at 12 months. Adjusted mean difference (95% Cl) for SBP was 1.94 mm Hg (-1.1 to 5.0); DBP 0.42 mm Hg (-1.25 to 2.1); TC 0.1 mmol/l (-0.05 to 0.24); HADS anxiety -0.02 (-0.69 to 0.65); HADS depression -0.35 (-0.95 to 0.25); distance on ISVVT -21.5 m (-48.3 to 5.2). The relative risk of being a smoker in the home arm was 0.90. The cost per patient to the NHS was significantly higher in the home arm at £198, (95% Cl 189 to 208) compared to £157 (95% Cl 139 to 175) in the centre-based arm. However when the patients' cost of travel was included, these differences were no longer significant. Conclusions A home-based cardiac rehabilitation programme does not produce inferior outcomes when compared to traditional centre-based programmes as provided in the United Kingdom. [ABSTRACT FROM AUTHOR]

Several methods are investigated for the quantitative analysis of a range of Sn-W sheeted vein systems from southwest England and Spain. The methods are based on fractal concepts and include the measurement of vein thickness and spacing distributions, and the development of a multifractal interval-counting method, equivalent to box counting in two dimensions. The results indicate that sets of subparallel veins are generally distributed randomly or with only slight clustering, and develop from fracture systems in which the spacing of veins is homogeneous. The opening of the veins is much more heterogeneous, suggesting localization of subsequent deformation and flow. This is especially true in mineralized areas and, together with power-law distributions of vein thickness, can be used to characterize mineralized systems. New data presented in this paper suggest that fracture evolution may play a fundamental role in defining the location and style of Sn-W mineralization observed. Greisen-dominated and disseminated Sn-W systems develop where the initial fracture system dominates the fluid flow regime, whereas sheeted vein systems are best developed where stress-induced critical behavior of flow in fracture networks controls the permeability and fluid flow of the system. [ABSTRACT FROM AUTHOR]

Background: Exercise has been shown to be beneficial for selected patients with heart failure, but questions remain over its effectiveness, cost-effectiveness and uptake in a real world setting. This paper describes the design, rationale and recruitment for a randomised controlled trial that will explore the effectiveness and uptake of a predominantly home-based exercise rehabilitation programme, as well as its cost-effectiveness and patient acceptability. Methods/design: Randomised controlled trial comparing specialist heart failure nurse care plus a nurse-led predominantly home-based exercise intervention against specialist heart failure nurse care alone in a multiethnic city population, served by two NHS Trusts and one primary care setting, in the United Kingdom. 169 English speaking patients with stable heart failure, defined as systolic impairment (ejection fraction ⩽ 40%). with one or more hospital admissions with clinical heart failure or New York Heart Association (NYHA) II/III within previous 24-months were recruited. Main outcome measures at 1 year: Minnesota Living with Heart Failure Questionnaire, incremental shuttle walk test, death or admission with heart failure or myocardial infarction, health care utilisation and costs. Interviews with purposive samples of patients to gain qualitative information about acceptability and adherence to exercise, views about their treatment, self-management of their heart failure and reasons why some patients declined to participate. The records of 1639 patients managed by specialist heart failure services were screened, of which 997 (61%) were ineligible, due to ejection fraction>40%, current NYHA IV, no admission or NYHA II or more within the previous 2 years, or serious co-morbidities preventing physical activity. 642 patients were contacted: 289 (45%) declined to participate, 183 (39%) had an exclusion criterion and 169 (26%) agreed to randomisation. Discussion: Due to safety considerations for home-exercise less than half of patients treated by specialist heart failure services were eligible for the study. Many patients had co-morbidities preventing exercise and others had concerns about undertaking an exercise programme. [ABSTRACT FROM AUTHOR]

Background Telephone consultations are a part of everyday practice, there is surprisingly little research on the subject. Aim To describe the variation of consulting skills within a body of telephone consultations in primary care, highlighting the performance of one method of assessing the process of the consultation--the Roter Interaction Analysis System--with telephone consultations. Design of study Cross sectional study of 43 recordings of telephone consultations with GPs. Setting One rural county in the Midlands. Method Recordings were made of 8 GPs, purposively selected for maximum variance in one region of the UK. Forty-three consultations were coded using the Roter Interaction Analysis System. From the descriptive categories, six composite categories were compiled reflecting a number of domains of interaction in a consultation: rapport, data gathering, patient education and counselling, partnership building, doctor dominance and patient-centredness. Analysis of variance was undertaken to explain variations between consultations for the different domains. Comparison was made to findings from similar work for face-to-face consultations. Results These telephone consultations feature more biomedical information exchange than psychosocial or affective communication. Length of interaction accounts for much of the variation seen between consultations in the domains of rapport, data gathering, patient education and counselling and partnership. Male doctors are more patient centred in this study. There is the suggestion of more doctor dominance and a less patient-centred approach when comparisons are made with previous work on face-to-face consultations. Conclusions Although the telephone is increasingly being used 1o provide care, this study highlights the fact that telephone consultations cannot be taken as equivalent to those conducted face to face. More work needs to be done to delineate the features of telephone consultations. [ABSTRACT FROM AUTHOR]

Highlights struggles faced by women doctors in Victorian England portrayed in the Public Broadcasting Service Masterpiece Theatre series 'Bramwell.' Epitomization of Dr. Eleanor Bramwell for all problems experienced by young women in historic England; Factors responsible for more women joining medical profession; Traits that are typical to the new woman.

Context: Many medical students experience considerable anxiety when starting hospital experiences. Objectives: To investigate the role of gender in this transitional experience. Method: A questionnaire study was conducted in 1992 and 1995 to compare female and male anxieties about clinical situations they anticipated encountering. The 31-item questionnaire listed potential anxiety-provoking situations and requested the respondents' ratings of their reactions (from 1=not anxious to 4=very anxious). Results: Differences in rankings between males and females were consistent between 1992 and 1995. More detailed analysis of 1995 data showed females had significantly higher totals; for 16/31 situations the difference was statistically significantly higher. For 4/31 situations male score was statistically significantly higher. Males ranked clinical situations involving intimate contact with patients significantly higher. Females scored situations involving interactions with consultants significantly higher than other situations and higher than did males. Females compared to males ranked 6/31 situations over five places different. Conclusions: Customisation of clinical introductory courses should be introduced. Earlier community-based clinical experience may help reduce non-productive anxiety. [ABSTRACT FROM AUTHOR]

The article presents the author's insights on English literature and archives in Southampton, England. The author considers the literary works, theories and beliefs of several historians and authors in historical investigation including Mark Cousins, Penelope Lively, and Peter L. Allen. He mentions the role of post-modern theory or documentary evidence in literary texts similar to the records of Southampton which provide facts to traditional theatre history. He says that the use of dramatic records should reflect and shape individual's experiences, beliefs and nature of the records. Moreover, it explores the historical settings in Southampton where musicians Richard March, John Goddislond and William Goldfynch showed impressive performance.

In this article's study, the distinction between speaking an oral language and speaking written language is applied to different cultural groups in the United States and Africa. Speakers of an oral language rely more on context for the communication of their verbal messages. If the speaker of an oral language depends upon the surrounding context to communicate his message, then effective communication presupposes a common context and common point of view for both listener and speaker. Context-dependent forms of speech and thought are more primitive or basic than context-free ones.

Prehabilitation aims to optimise patients' physical and psychological status before treatment. The types of outcomes measured to assess the impact of prehabilitation interventions vary across clinical research and service evaluation, limiting the ability to compare between studies and services and to pool data. An international workshop involving academic and clinical experts in cancer prehabilitation was convened in May 2022 at Sheffield Hallam University's Advanced Wellbeing Research Centre, England. The workshop substantiated calls for a core outcome set to advance knowledge and understanding of best practice in cancer prehabilitation and to develop national and international databases to assess outcomes at a population level. [ABSTRACT FROM AUTHOR]

Background: Primary care is changing rapidly to meet the needs of an ageing and chronically ill population. New ways of working are called for yet the introduction of innovative service interventions is complicated by organisational challenges arising from its scale and diversity and the growing complexity of patients and their care. One such intervention is the multi-strand, single platform, Patient Safety Toolkit developed to help practices provide safer care in this dynamic and pressured environment where the likelihood of adverse incidents is increasing. Here we describe the attitudes of staff toward these tools and how their implementation was shaped by a number of contextual factors specific to each practice. Methods: The Patient Safety Toolkit comprised six tools; a system of rapid note review, an online staff survey, a patient safety questionnaire, prescribing safety indicators, a medicines reconciliation tool, and a safe systems checklist. We implemented these tools at practices across the Midlands, the North West, and the South Coast of England and conducted semi-structured interviews to determine staff perspectives on their effectiveness and applicability. Results: The Toolkit was used in 46 practices and a total of 39 follow-up interviews were conducted. Three key influences emerged on the implementation of the Toolkit these related to their ease of use and the novelty of the information they provide; whether their implementation required additional staff training or practice resource; and finally factors specific to the practice's local environment such as overlapping initiatives orchestrated by their CCG. Conclusions: The concept of a balanced toolkit to address a range of safety issues proved popular. A number of barriers and facilitators emerged in particular those tools that provided relevant information with a minimum impact on practice resource were favoured. Individual practice circumstances also played a role. Practices with IT aware staff were at an advantage and those previously utilising patient safety initiatives were less likely to adopt additional tools with overlapping outputs. By acknowledging these influences we can better interpret reaction to and adoption of individual elements of the toolkit and optimise future implementation. [ABSTRACT FROM AUTHOR]

The article discusses a study of the perception of general practitioners (GP) and patients on holding relationships in primary care in England. The study involved 11 GP and 14 patients in north west England. The shared narrative and pre-existing knowledge of a life story was described as valuable by the GP and patients. It emphasizes the necessity for the restatement of the doctor-patient relationship amid changes in the role of the GP.

The article examines a medical case of an 81-year-old presented with a history of cough, fever and pleuretic chest pain by researchers from Manchester, England. The patient had been diagnosed with B-cell chronic lymphocytic leukemia 4 years prior to her recent illness. Indications showed that the patient's multiple myeloma was characterized by extensive lytic lesions.

Reports on the views of consultants who shared teaching time with general practice teachers on a pilot study for third-year undergraduates at Birmingham University in England. Increasing interest in `community-based teaching'; Willingness of many consultants to recognize merit in the course; Remarks on student satisfaction.