Global issues put a new perspective on working life.

PubMed

Subirana, Josep

2016-03-19

Having worked in general practice, Josep Subirana decided to broaden his experience in animal welfare and get involved in international development. Since then, he has worked across the world helping charities, universities and organisations with animal welfare issues. British Veterinary Association.

Transforming family practice in British Columbia

PubMed Central

Cavers, William J.R.; Tregillus, Valerie H.F.; Micco, Angela; Hollander, Marcus J.

2010-01-01

ABSTRACT OBJECTIVE To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC’s health authorities also attend as guests. METHOD This paper is based on the 2008–2009 annual report of the GPSC. It summarizes the history and main activities of the GPSC. REPORT The GPSC is currently supporting a number of key activities to transform primary care in BC. These activities include the Full Service Family Practice Incentive Program, which provides incentive payments to promote enhanced primary care; the Practice Support Program, which provides family physicians and their medical office assistants with various practical evidence-based strategies and tools for managing practice enhancement; the Family Physicians for BC Program to develop family practices in areas of identified need; the Shared Care Committee, which supports and enables the determination of appropriate scopes of practice among GPs, specialists, and other health care professionals; the Divisions of Family Practice, which are designed to facilitate interactions among family doctors and between doctors and their respective health authorities; and the Community Healthcare and Resource Directory, a Web-based resource to help health care providers find appropriate mental health resources. CONCLUSION Early results indicate that the GPSC’s initiatives are enhancing the delivery of primary care services in BC. PMID:21156899

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Separate But Equal? A Levels and GNVQs. Further Education Series.

ERIC Educational Resources Information Center

Edwards, Tony; Fitz-Gibbon, Carol Taylor; Hardman, Frank; Haywood, Roy; Meagher, Nick

This book contrasts British programs for vocationally and academically minded students and looks at differences and similarities in practice in General National Vocational Qualifications (GNVQs) and Advanced level (A level) courses. "Contrasts in Learning?" (Tony Edwards) provides background. "Educating Leaders and Training…

Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices.

PubMed

Ahmed, Faraz; Abel, Gary A; Lloyd, Cathy E; Burt, Jenni; Roland, Martin

2015-05-06

Ethnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored. We analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices. We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice. Availability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95%CI -4.2, -1.6), -1.9 (95%CI -2.6, -1.2) and -1.9 (95%CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95%CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+4.5, 95%CI -1.0,+10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95%CI -4.6, -2.0) and Pakistani (-2.7, 95%CI -3.6, -1.9) respondents when a concordant language was not offered. Substantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient's ethnicity.

Whither British general practice after the 2004 GMS contract? Stories and realities of change in four UK general practices.

PubMed

Huby, Guro; Guthrie, Bruce; Grant, Suzanne; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw

2008-01-01

The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact? The article is based on comparative in-depth case studies of four UK practices. There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision-making became concentrated in fewer hands. Formally or informally constituted "elite" multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant "story" each practice constructed about its unique ethos and style. The "stories" also failed to detect negative consequences to the practice flowing from its adaptation to the contract. The paper highlights how collective "sensemaking" in practices may fail to detect and address key organisational consequences from the nGMS.

The benefits of working abroad for British General Practice trainee doctors: the London deanery out of programme experience in South Africa.

PubMed

Reardon, Candice; George, Gavin; Enigbokan, Oluwatobi

2015-10-14

The value of international health experience for doctors from developed nations is well recognised. Provisions have been made for medical staff in the United Kingdom to embark on work experiences abroad during their careers in the National Health Service. The London Deanery and Africa Health Placements provide an Out of Programme Experience for British General Practice trainee doctors wanting to work for a year in rural hospitals in South Africa. A qualitative study was conducted among fifteen British General Practice trainees who participated in the programme. The research aim was to understand the perceived benefit and value of their experience and their opinions about the structure of the programme. The data was analysed using thematic analysis. Their experience provided an accelerated year of learning and development that contributed to their professional and personal development. In addition to their general development, their improved ability to work in resource limited settings, enhancement of soft skills, a greater appreciation for the National Health Service and a better understanding of working within foreign health care systems were important gains. The timing of the experience, the security of re-employment on their return, assistance with administrative requirements of destination countries and the opportunity to gain varied, hands-on experience were highly valued components of the Out of Programme Experience. The value and benefits derived from the doctors' experience in South Africa are discussed in relation to another evaluation of the Out of Programme Experience, as well as issues of transferability of skills and competencies and future impacts on career decisions. This study provides evidence to suggest programmes such as the OOPE have the potential to create substantial benefits for trainee doctors, both in terms of their medical skills and competencies and through the development of softer skills. This programme, through the supply of scarce skills, further benefits the host country and specifically the health facilities and communities served by these trainee doctors.

Significant event auditing.

PubMed

Pringle, M

2000-12-01

Significant event auditing has been described for 5 years and it is slowly gaining credibility as an effective method of quality assurance in British general practice. This paper describes what it is, what its background is, how it is done and whether it is effective. While it needs a positive team culture - and therefore may not suit every practice - where it is used it appears to be a useful adjunct to a clinical audit programme.

Microbial water quality communication: public and practitioner insights from British Columbia, Canada.

PubMed

Dunn, G; Henrich, N; Holmes, B; Harris, L; Prystajecky, N

2014-09-01

This work examines the communication interactions of water suppliers and health authorities with the general public regarding microbial source water quality for recreational and drinking water. We compare current approaches to risk communication observable in British Columbia (BC), Canada, with best practices derived from the communications literature, finding significant gaps between theory and practice. By considering public views and government practices together, we identify key disconnects, leading to the conclusion that at present, neither the public's needs nor public health officials' goals are being met. We find: (1) there is a general lack of awareness and poor understanding by the public of microbial threats to water and the associated health implications; (2) the public often does not know where to find water quality information; (3) public information needs are not identified or met; (4) information sharing by authorities is predominantly one-way and reactive (crisis-oriented); and (5) the effectiveness of communications is not evaluated. There is a need for both improved public understanding of water quality-related risks, and new approaches to ensure information related to water quality reaches audiences. Overall, greater attention should be given to planning and goal setting related to microbial water risk communication.

Observing Teaching. SEDA Paper 79.

ERIC Educational Resources Information Center

Brown, Sally, Ed.; And Others

This publication offers practical support to those in British higher education implementing the Observation of Teaching governmental directives. It provides discussion of key issues as well as a range of materials on how to carry out teaching observation including 23 checklists. The materials are grouped in four main areas: general issues, self…

Bilingualism and British Education: The Dimensions of Diversity.

ERIC Educational Resources Information Center

Centre for Information on Language Teaching, London (England).

This compilation of articles deals with practical questions of bilingualism that appear to be important to the development of education in Britain. The conference for which the papers were originally prepared concentrated on three general aspects: the existence of many thousands of bilingual children in Britain whose native languages are largely…

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

The Theory and Practice of Teaching English for Special Purposes.

ERIC Educational Resources Information Center

Cruickshank, Donald W.

English for special purposes (ESP) is the fastest growing facet of language teaching, led by the efforts of British and American linguists. The learner-centered orientation in English-as-a-second-language instruction and the expressed need of people around the world have stimulated development in the field. ESP courses are generally either…

Power in Practice: Trade Union Education in Sierra Leone

ERIC Educational Resources Information Center

Stirling, John

2013-01-01

This article presents an analysis of the development of a trade union education program in Sierra Leone in the geo-historical context of British colonialism. It places the argument in relation to the contradictory trends of trade unionism more generally and alongside their antagonistic cooperation with capitalism. It discusses the limits and…

Discipline Issues: Is There a Tempest Brewing in B.C. Schools?

ERIC Educational Resources Information Center

Fraser, Stephen R.

1987-01-01

Educational policy in British Columbia does not distinguish between special needs and regular class students in relation to discipline practices. Although Canadian courts have generally upheld the rights of school boards rather than the unspecified rights of special needs children, a recent court case suggests the possibility of change. (JW)

Unity is strength: staff college and the British officer corps.

PubMed

King, Anthony

2009-03-01

Utilizing Bourdieu's concept of the habitus, Keith Macdonald has recently examined the elite social origins of the British officer corps. His analysis is valid as far at it goes but it ignores the professional practices of British officers. This article examines Britain's Joint Services Command and Staff College to assess the unification of the three services around common forms of military practice. It argues that while the new staff college has been effective in disseminating new forms of professional expertise among British officers, various practices have been institutionalized which actively undermine the unity of the officer corps.

Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey.

PubMed

Edery, E G

2017-05-27

To investigate how first opinion small animal veterinary surgeons in the UK handled chemotherapeutic agents, a questionnaire was distributed at the 2014 British Small Animal Veterinary Association congress and by internet. Chemotherapy was regularly offered by 70.4 per cent of the respondents. Gold standards defined according to available guidelines for safe handling of antineoplastic drugs were poorly followed by general practitioners with only 2 per cent of respondents complying with all of them. Dedicated facilities for preparation and administration of cytotoxic drugs were variably available among participants. The level of training of staff indirectly involved in handling chemotherapy was appropriate in less than 50 per cent of practices. No association was found between demographic characteristics of the sampled population and the decision to perform chemotherapy. The results of this study raise concerns about the safety of the veterinary staff in first opinion practices involved in handling chemotherapy. British Veterinary Association.

Why British GPs use computers and hospital doctors do not.

PubMed Central

Benson, T.

2001-01-01

Almost all general medical practitioners (GPs) in the UK use computers, compared with less than one in ten of hospital doctors. This paper explains how this unexpected situation came about over a thirty-year period, identifying some of the successes and failures of British medical computing along the way. Twelve separate factors are considered. The major determinants have not been technical, but rather a strong tide of political backing for general practice and leadership from the profession at the highest level, which have combined to build an appropriate regulatory framework and financial incentives that have encouraged GPs to embrace computers. Hospital computing has some difficulties not met by GPs, but the main factor preventing progress has been the lack of any real incentive positive (carrot) or negative (stick), for hospital doctors to use computers. PMID:11825153

Why British GPs use computers and hospital doctors do not.

PubMed

Benson, T

2001-01-01

Almost all general medical practitioners (GPs) in the UK use computers, compared with less than one in ten of hospital doctors. This paper explains how this unexpected situation came about over a thirty-year period, identifying some of the successes and failures of British medical computing along the way. Twelve separate factors are considered. The major determinants have not been technical, but rather a strong tide of political backing for general practice and leadership from the profession at the highest level, which have combined to build an appropriate regulatory framework and financial incentives that have encouraged GPs to embrace computers. Hospital computing has some difficulties not met by GPs, but the main factor preventing progress has been the lack of any real incentive positive (carrot) or negative (stick), for hospital doctors to use computers.

Refugee experiences of general practice in countries of resettlement: a literature review.

PubMed

Cheng, I-Hao; Drillich, Ann; Schattner, Peter

2015-03-01

Refugees and asylum seekers often struggle to use general practice services in resettlement countries. To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. © British Journal of General Practice 2015.

Conditions for research in general practice. Can the Dutch and British experiences be applied to other countries, for example Spain?

PubMed

van der Zee, Jouke; Kroneman, Madelon; Bolíbar, Bonaventura

2003-06-01

The aim of this study is to identify conditions for research as part of professional development in general practice. Based on the work of Andrew Abbott, who studied the dynamics of professional development, five conditions were identified. These are: the creation of associations among professionals; control of work; the establishment of specialised education; the development of professional knowledge; and the creation of organised structures for professional work. Two countries with a well-established research tradition in general practice (the UK and the Netherlands) and one country where GP research development is still limited (Spain) were evaluated on the basis of these conditions. The conditions identified as favourable were as follows: the existence of a scientific association; a peer-reviewed journal; a defined population resulting in a population denominator for practices; a gatekeeping system; chairs and departments of general practice at universities; the integration of education centres and research centres; GPs working in group practices or health centres; a certain degree of independence from the Ministry of Health; and financial support for practicing GPs to conduct research activities. We showed that most conditions for the successful scientific progress of general practice in Spain are present. However there is still a gap between academia and general practice and a lack of research organisation and support.

“Markings” of a Class

PubMed Central

Mather, James M.; Anderson, Donald O.; Cox, Albert R.; Williams, Donald H.

1965-01-01

In 1954 the first class in medicine graduated from the University of British Columbia. This class of 57 men and three women left a statistical trail behind them which began before they entered medical school, and which now has extended 10 years into their professional postgraduate careers. This first class was made up largely of British Columbians of older age than subsequent classes. The overall achievement and aptitude of the class was high, as measured by premedical grades, intelligence tests and Medical College Admission Test scores. Interest tests at the time of admission indicated that the members of the class had major interest levels in the fields of science and social service or humanitarianism. The subsequent medical school performance of the class was exceptional. Of the class, 63.4% interned in teaching hospitals. By 1964 only 53.4% of the graduates were engaged in general practice. Most of the graduates are now practising in British Columbia. PMID:14278023

Near patient testing in general practice: attitudes of general practitioners and practice nurses, and quality assurance procedures carried out.

PubMed Central

Hilton, S; Rink, E; Fletcher, J; Sibbald, B; Freeling, P; Szczepura, A; Davies, C; Stilwell, J

1994-01-01

BACKGROUND. The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM. This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD. Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS. Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION. General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation. PMID:7748669

Undergraduate teaching in UK general practice: a geographical snapshot.

PubMed

Derbyshire, Helen; Rees, Eliot; Gay, Simon P; McKinley, Robert K

2014-06-01

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain. To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school. National survey of all medical schools in the UK. All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK's health departments. All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum-maximum) of 142 (17-385) practices per school. The median (minimum-maximum) distance between a school and a teaching practice was 28 km (0-1421 km), 41 (0:00-23:26) minutes' travel by car and 1 hour 12 (0:00-17:29) minutes' travel by public transport. All teaching practices were accessible by public transport in one school and 90-99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport. The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden. © British Journal of General Practice 2014.

The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review.

PubMed

Pettigrew, Luisa M; Kumpunen, Stephanie; Mays, Nicholas; Rosen, Rebecca; Posaner, Rachel

2018-03-01

Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. Systematic review. Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why. © British Journal of General Practice 2018.

The Current Use of Online Services in U.K. Academic Libraries.

ERIC Educational Resources Information Center

Foster, Allan; Akeroyd, John

This update of a survey taken by the authors in April 1978 on the use of online services in British academic libraries (Online Review; v3 n2 p195-204 1979) concentrates on the following areas: (1) general pattern of use; (2) current arguments for charging users for online services; (3) current academic library practice on charging; (4) specific…

Modelling and Close Observation: Ways of Teaching and Learning between Third-Generation Bangladeshi British Children and Their Grandparents in London

ERIC Educational Resources Information Center

Gregory, Eve; Ruby, Mahera; Kenner, Charmian

2010-01-01

Studies on child development in cross-cultural contexts generally contrast child-rearing practices in traditional or non-Western with those of Western societies. Thus, they show how non-Western communities tend to emphasise the importance of interdependence and collectivism between family and group members; Western communities focus rather on the…

Attitudes of newly qualified doctors towards a career in general practice: a qualitative focus group study.

PubMed

Merrett, Alexandra; Jones, Daniel; Sein, Kim; Green, Trish; Macleod, Una

2017-04-01

A key element of the NHS is universal access to a GP. Recently, UK general practice has been described as being in crisis, with training places unfilled and multiple practices reporting vacancies or facing closure. The recruitment of GPs continues to be a key focus for both the Royal College of General Practitioners (RCGP) and the government. To understand the attitudes of newly qualified doctors towards a career in general practice, to appreciate potential reasons for the crisis in GP recruitment, and to recommend ways to improve recruitment. A qualitative study comprising five focus groups with 74 Foundation Year 1 (FY1) doctors from one Yorkshire deanery. Audio recordings were transcribed verbatim and thematic analysis undertaken. Foundation Year 1 doctors' thoughts towards a career in general practice were summarised in four themes: quality of life, job satisfaction, uncertainty surrounding the future of general practice, and the lack of respect for GPs among both doctors and the public. Participants felt that general practice could provide a good work-life balance, fair pay, and job stability. Job satisfaction, with the ability to provide care from the cradle to the grave, and to work within a community, was viewed positively. Uncertainties around future training, skill levels, pay, and workload, together with a perceived stigma experienced in medical schools and hospitals, were viewed as a deterrent to a career in general practice. This study has gathered the opinions of doctors at a critical point in their careers, before they choose a future specialty. Findings highlight areas of concern and potential deterrents to a career in general practice, together with recommendations to address these issues. © British Journal of General Practice 2017.

Financial implications of the continuity of primary care.

PubMed

Hollander, Marcus J; Kadlec, Helena

2015-01-01

The objective of this study was to assess the financial implications of the continuity of care, for patients with high care needs, by examining the cost of government-funded health care services in British Columbia, Canada. Using British Columbia Ministry of Health administrative databases for fiscal year 2010-2011 and generalized linear models, we estimated cost ratios for 10 cost-related predictor variables, including patients' attachment to the practice. Patients were selected and divided into groups on the basis of their Resource Utilization Band (RUB) and placement in provincial registries for 8 chronic conditions (1,619,941 patients). The final dataset included all high- and very-high-care-needs patients in British Columbia (ie, RUB categories 4 and 5) in 1 or more of the 8 registries who met the screening criteria (222,779 patients). Of the 10 predictors, across 8 medical conditions and both RUBs, patients' attachment to the practice had the strongest relationship to costs (correlations = -0.168 to -0.322). Higher attachment was associated with lower costs. Extrapolation of the findings indicated that an increase of 5% in the overall attachment level, for the selected high-care-needs patients, could have resulted in an estimated cost avoidance of $142 million Canadian for fiscal year 2010-2011. Continuity of care, defined as a patient's attachment to his/her primary care practice, can reduce health care costs over time and across chronic conditions. Health care policy makers may wish to consider creating opportunities for primary care physicians to increase the attachment that their high-care-needs patients have to their practices.

General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland.

PubMed

McLean, Gary; Guthrie, Bruce; Mercer, Stewart W; Watt, Graham C M

2015-12-01

Universal access to health care, as provided in the NHS, does not ensure that patients' needs are met. To explore the relationships between multimorbidity, general practice funding, and workload by deprivation in a national healthcare system. Cross-sectional study using routine data from 956 general practices in Scotland. Estimated numbers of patients with multimorbidity, estimated numbers of consultations per 1000 patients, and payments to practices per patient are presented and analysed by deprivation decile at practice level. Levels of multimorbidity rose with practice deprivation. Practices in the most deprived decile had 38% more patients with multimorbidity compared with the least deprived (222.8 per 1000 patients versus 161.1; P<0.001) and over 120% more patients with combined mental-physical multimorbidity (113.0 per 1000 patients versus 51.5; P<0.001). Practices in the most deprived decile had 20% more consultations per annum compared with the least deprived (4616 versus 3846, P<0.001). There was no association between total practice funding and deprivation (Spearman ρ -0.09; P = 0.03). Although consultation rates increased with deprivation, the social gradients in multimorbidity were much steeper. There was no association between consultation rates and levels of funding. No evidence was found that general practice funding matches clinical need, as estimated by different definitions of multimorbidity. Consultation rates provide only a partial estimate of the work involved in addressing clinical needs and are poorly related to the prevalence of multimorbidity. In these circumstances, general practice is unlikely to mitigate health inequalities and may increase them. © British Journal of General Practice 2015.

Cultural and age differences in beliefs about depression: British Bangladeshis vs. British Whites

PubMed Central

McClelland, Alastair; Khanam, Shopnara; Furnham, Adrian

2013-01-01

This study examines beliefs about depression as a function of ethnic background (British Bangladeshis vs. British Whites) and age. A total of 364 participants completed a 65-item questionnaire, containing general questions regarding depression and anti-depressive behaviour; the causes of depression, and treatments for depression. The hypotheses were broadly supported; there were significant interactions between ethnicity and age, which generally revealed an increasingly negative attitude towards depression with increasing age amongst British Bangladeshis. Older British Bangladeshis believed depression was an illness that brought a sense of shame and loss of dignity to the individual and his or her family, and they also favoured a lay referral system for sufferers. They also had more superstitious beliefs about depression than both younger British Bangladeshis and British Whites. A pattern of increasing negativity with increasing age was not evident amongst the British Whites, but older individuals in both groups tended to believe that depression was not helped by psychological intervention. The attitudes towards depression in the young was similar (and generally positive) in both ethnic groups. These findings highlight the necessity to provide more culturally sensitive and accessible services for migrant communities – particularly amongst older individuals. PMID:25076835

The 'E' factor -- evolving endodontics.

PubMed

Hunter, M J

2013-03-01

Endodontics is a constantly developing field, with new instruments, preparation techniques and sealants competing with trusted and traditional approaches to tooth restoration. Thus general dental practitioners must question and understand the significance of these developments before adopting new practices. In view of this, the aim of this article, and the associated presentation at the 2013 British Dental Conference & Exhibition, is to provide an overview of endodontic methods and constantly evolving best practice. The presentation will review current preparation techniques, comparing rotary versus reciprocation, and question current trends in restoration of the endodontically treated tooth.

(Re-)reading medical trade catalogs: the uses of professional advertising in British medical practice, 1870-1914.

PubMed

Jones, Claire L

2012-01-01

This article explores how medical practitioners read, used, and experienced medical trade catalogs in late-nineteenth- and early-twentieth-century Britain. Reader responses to the catalog, a book-like publication promoting medical tools, appliances, and pharmaceuticals, have been chronically understudied, as have professional reading practices within medicine more generally. Yet, evidence suggests that clinicians frequently used the catalog and did so in three main ways: to order medical products, to acquire new information about these products, and to display their own product endorsements and product designs. The seemingly widespread nature of these practices demonstrates an individual and collective professional desire to improve medical practice and highlights the importance of studying professional reading practices in the cultural history of medicine.

GPs' views of health policy changes: a qualitative 'netnography' study of UK general practice online magazine commentary.

PubMed

Elvey, Rebecca; Voorhees, Jennifer; Bailey, Simon; Burns, Taylor; Hodgson, Damian

2018-06-01

Shifts in health policy since 2010 have brought major structural changes to the English NHS, with government stating intentions to increase GPs' autonomy and improve access to care. Meanwhile, GPs' levels of job satisfaction are low, while stress levels are high. PulseToday is a popular UK general practice online magazine that provides a key discussion forum on news relevant to general practice. To analyse readers' reactions to news stories about health policy changes published in an online general practice magazine. A qualitative 'netnography' was undertaken of readers' comments to PulseToday. METHOD: A sample of readers' comments on articles published in PulseToday was collated and subjected to thematic analysis. Around 300 comments on articles published between January 2012 and March 2016 were included in the analysis, using 'access to care' as a tracer theme. Concern about the demand and strain on general practice was perhaps to be expected. However, analysis revealed various dimensions to this concern: GPs' underlying feelings about their work and place in the NHS; constraints to GPs' control of their own working practices; a perceived loss of respect for the role of GP; and disappointment with representative bodies and GP leadership. This study shows a complex mix of resistance and resignation in general practice about the changing character of GPs' roles. This ambivalence deserves further attention because it could potentially shape responses to further change in primary care in ways that are as yet unknown. © British Journal of General Practice 2018.

PSYCHIATRIC OUT-PATIENT IN A GENERAL HOSPITAL OF ADDIS ABABA DIAGNOSTIC AND SOCIODEMOGRAPHIC CHARACTERISTICS

PubMed Central

Khandelwal, S.K.; Workneh, Fikre

1988-01-01

SUMMARY Delivery of mental care in developing countries has been awfully inadequate. General hospital psychiatric units can play a significant role in providing care to the mentally ill as well as in training aspects of the health professionals. The problems of mental illness are practically same all over as has been highlighted in the paper which discusses the functioning and diagnostic and demographic data of such a unit in Ethiopia. The paper also compares the diagnostic data with that of an Indian and a British study. PMID:21927303

National Service Frameworks and UK general practitioners: street-level bureaucrats at work?

PubMed

Checkland, Kath

2004-11-01

This paper argues that the past decade has seen significant changes in the nature of medical work in general practice in the UK. Increasing pressure to use normative clinical guidelines and the move towards explicit quantitative measures of performance together have the potential to alter the way in which health care is delivered to patients. Whilst it is possible to view these developments from the well-established sociological perspectives of deprofessionalisation and proletarianisation, this paper takes a view of general practice as work, and uses the ideas of Lipsky to analyse practice-level responses to some of these changes. In addition to evidence-based clinical guidelines, National Service Frameworks, introduced by the UK government in 1997, also specify detailed models of service provision that health care providers are expected to follow. As part of a larger study examining the impact of National Service Frameworks in general practice, the response of three practices to the first four NSFs were explored. The failure of NSFs to make a significant impact is compared to the practices' positive responses to purely clinical guidelines such as those developed by the British Hypertension Society. Lipsky's concept of public service workers as 'street-level bureaucrats' is discussed and used as a framework within which to view these findings.

Counsellors in primary care in Southampton: a questionnaire survey of their qualifications, working arrangements, and casemix.

PubMed Central

Clark, A; Hook, J; Stein, K

1997-01-01

BACKGROUND: There has been an upsurge of interest in counselling in primary care over the past five years. This has been stimulated by a growing demand for non-drug treatment of emotional disorders and by the extension of reimbursement for the costs of counsellors. Continued calls for careful evaluation have been largely unheeded in the face of heady growth. AIM: To establish the prevalence of counselling services in the 67 general practices in the Southampton and South West Hampshire Health District, and to describe in detail their qualifications, working arrangements, and casemix. METHOD: A questionnaire enquiring about counselling services was sent to all the general practices in the district. A second questionnaire was then posted to all the counsellors identified as working in these practices. RESULTS: Twenty-six (39%) practices employed one or more counsellors. Fundholding practices were four times more likely than non-fundholders to employ a counsellor. Most of the counselling work was short term (4-20 sessions). The most common presenting complaints were relationship problems, depression, anxiety, and bereavement. CONCLUSION: This descriptive study highlights the wide variation in the qualifications and training of counsellors. Until the issue of effectiveness is resolved through further research, the best safeguard of quality is to ensure that counsellors meet the appropriate training standards laid down by the British Association of Counsellors. Monitoring standards is a legitimate task for those commissioning health care who are increasingly responsible for reimbursement of a counsellor's salary. Counsellors who meet appropriate training criteria should be encouraged to pursue accreditation with the British Association of Counsellors. Those who do not meet these criteria should be encouraged to undergo additional training. PMID:9474822

British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update).

PubMed

McKenzie, Y A; Thompson, J; Gulia, P; Lomer, M C E

2016-10-01

Probiotics are often taken by individuals with irritable bowel syndrome (IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults. CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews (SRs) of randomised controlled trial (RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations. Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made. Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS. © 2016 The British Dietetic Association Ltd.

Motivation in medical education and patient communication. The EGPRN meeting in Zurich, Switzerland, October 2010.

PubMed

Rethans, Jan-Joost; Donner-Banzhoff, Norbert

2011-06-01

The European General Practice Research Network held an international research meeting on 'Motivation in medical education and patient communication' in Zürich, Switzerland, in October 2010. The two authors were keynote speakers, who introduced the theme from different angles and summarized and reflected on individual papers presented at the conference. The theme of the conference underlined the importance of communication in general practice and of motivation in medical education in particular. There were a variety of papers each addressing in its own way the topic of this meeting. We conclude that it is still uncommon to use psychological theories on motivation in research on motivation and patient communication in general practice/family medicine. Motivation and readiness to change are essential concepts in experimental health services research. Research designs increasingly follow the Framework for the Evaluation of Complex Interventions in Health Care as suggested by the British Medical Research Council. However, there are also difficulties related to classical experimental designs that have to be critically discussed.

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2017.

PubMed

Wieland, Mark L; Szostek, Jason H; Wingo, Majken T; Post, Jason A; Mauck, Karen F

2018-02-26

Clinicians are challenged to identify new practice-changing articles in the medical literature. To identify the practice-changing articles published in 2017 most relevant to outpatient general internal medicine, 5 internists reviewed the following sources: 1) titles and abstracts from internal medicine journals with the 7 highest impact factors, including New England Journal of Medicine, Lancet, Journal of the American Medical Association, British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine; 2) synopses and syntheses of individual studies, including collections in the American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine; 3) databases of synthesis, including Evidence Updates and the Cochrane Library. Inclusion criteria were perceived clinical relevance to outpatient general medicine, potential for practice change, and strength of evidence. This process yielded 140 articles. Clusters of important articles around one topic were considered as a single-candidate series. A modified Delphi method was utilized by the 5 authors to reach consensus on 7 topics to highlight and appraise from the 2017 literature. Copyright © 2018 Elsevier Inc. All rights reserved.

Updated posters to help manage medical emergencies in the dental practice.

PubMed

Jevon, P

2015-09-11

Medical emergencies can occur in the dental practice. Medical Emergencies in the Dental Practice and Emergency Drugs in the Dental Practice posters have been designed to help dental practitioners to respond effectively and safely to a medical emergency. These posters, endorsed by the British Dental Association, are included with this issue of the British Dental Journal. Further copies can be downloaded from: https://www.walsallhealthcare.nhs.uk/medical-education.aspx.

Scope of practice and supervision of orthodontic therapists in the United Kingdom: Part 2: a national cross-sectional survey of orthodontic therapists.

PubMed

Ahmed, Farooq; Dugdale, Charlotte; Malik, Ovais; Waring, David

2018-03-01

Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.

Parents Hearing Reading: Lessons for School Practice from the British and Australasian Research.

ERIC Educational Resources Information Center

Toomey, Derek

Concentrating on hearing reading rather than parents reading to children, this literature review examines research into parents' participation in their children's literacy development with the aim of providing information to assist school practice. The review focuses on attention to British studies involving systematic analysis of carefully…

Alternatives to the face-to-face consultation in general practice: focused ethnographic case study.

PubMed

Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris

2018-04-01

NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.

Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives.

PubMed

Park, Sophie E; Allfrey, Caroline; Jones, Melvyn M; Chana, Jasprit; Abbott, Ciara; Faircloth, Sofia; Higgins, Nicola; Abdullah, Laila

2017-04-01

Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education. This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information. Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically. Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs' involvement in teaching, and initiating student-patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback. This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters. © British Journal of General Practice 2017.

The Genesis of Public Relations in British Colonial Practice.

ERIC Educational Resources Information Center

Smyth, Rosaleen

2001-01-01

Demonstrates how the British Colonial Office employed public relations strategies as they administered the British colony of Northern Rhodesia before, during, and after World War II. Demonstrates how civil servants in London and colonial officials implemented public relations policies, strategies, and tactics on an ad hoc basis, covering political…

Practice patterns of lymph-node mapping and sentinel-node biopsy for breast cancer in British Columbia.

PubMed

Chua, Boon; Olivotto, Ivo A; Donald, James C; Hayashi, Allen H; Davis, Noelle; Rusnak, Conrad H

2003-08-01

Because there is no standardized technique for mapping of lymph nodes and no optimal technique for evaluating the sentinel node, we decided to evaluate practice patterns for sentinel-node biopsy (SNB) for breast cancer in British Columbia 5 years after its introduction in 1996. We carried out mail and telephone surveys of general surgeons performing at least 1 SNB (n = 28) or not performing SNB (n = 50), and carried out telephone surveys or on-site visits with pathologists (n = 7) and nuclear medicine physicians (n = 5) from institutions supporting SNB in the province. We collected data on training, perceived indications and techniques for the surgical, imaging and pathologic assessments of SNB to obtain data on practice patterns in 2001 and the degree of consistency among surgeons and institutions involved in performing SNB and reasons for not adopting the SNB technique. By 2001, SNB was incorporated into the practice of 19% of surgeons (28 of 150) performing breast cancer surgery in British Columbia. The survey response rate among SNB surgeons was 89% (25 of 28). Twelve (48%) of the 25 surgeons implemented SNB in the context of a validation study. Ten (40%) of the 25 had no data management support to monitor their results. Surgical training included intraoperative mentoring alone (48%), formal training courses alone (20%), both (24%) and self-teaching (8%). One-third of the surgeons had performed fewer than 10 procedures. Five surgeons had abandoned routine axillary dissection. There was considerable variation regarding the indications for SNB, definition of a sentinel node and surgical techniques. All nuclear medicine departments had a written lymphatic mapping protocol, but each used a different volume and activity of radiotracer. Immunohistochemical evaluation of the sentinel nodes was performed at just 3 pathology laboratories. The survey response rate from surgeons not practising SNB was 54% (27 of 50). Among 24 responders in active practice, 7 (29%) planned to perform SNB; 79% had not decided on the SNB indications. Lack of operating room time was a major limiting factor. There was considerable variation in the surgical, nuclear medicine and pathology techniques for SNB in the absence of a planned approach for its implementation in British Columbia. Developing consensus around written guidelines for the indications and techniques of SNB may reduce this variation.

Understandings of depression: an interview study of Yoruba, Bangladeshi and White British people.

PubMed

Lavender, Hilary; Khondoker, Abul Hussain; Jones, Roger

2006-12-01

Depression remains a major public health problem, but little is known about the views and understandings of depression held by many ethnic groups. Aim. To explore views and understandings of depression in three ethnic groups-Yoruba, Sylheti-speaking Bangladeshi and White British-living in South London. Qualitative, semi-structured interviews, using vignettes describing depressed individuals. General practice and the community in Southwark, South London, UK. Participants. 20 Yoruba, 20 Bangladeshi and 20 White British people, recruited from primary care. Interviews (in English for Yoruba and White British, in Sylheti for the Bangladeshi participants) were recorded and transcribed. Atlas ti software was used to organize the data. Views on the causes and cures for depression were diverse. A diagnosis of depression can have adverse social consequences in all groups. Magic had a role in both causation and cure in the Yoruba and to a lesser extent in the Bangladeshi groups. Religion was important for many people in all groups. Family factors were dominant in the Bangladeshi participants, whilst the White British often identified more 'psychological' causes of depression. Coping methods and health-seeking behaviours included religion, family, friends and neighbours, and becoming more active. Formal psychiatric interventions and taking antidepressants were not priorities. Cultural models of depression, including its causes and treatment, are diverse, and are different among cultural groups. This study raises questions about the value of Western approaches to mild and moderate depression in these groups of patients.

From precocious fame to mature obscurity: David Walker (1837-1917) MD, LRCSI, surgeon and naturalist to the Fox Arctic Expedition of 1857-59.

PubMed

Froggatt, Peter; Walker, Brian M

2012-11-01

The Belfast-born David Walker was the 19-year-old surgeon and naturalist on the epic Fox Arctic Expedition (1857-59) that established the fate of Sir John Franklin's unsuccessful (1845) search for the North-West Passage. On return the crew were fêted as heroes and decorated, and shared in a £5000 government bounty: Walker was also received by the Queen and (in Ireland) by the Lord Lieutenant, was honoured by the principal British and Irish natural history societies and his portrait was exhibited in the National Portrait Gallery, London. This paper describes his adventurous life, including the Fox Expedition, which from 1862 was spent abroad and included time in the Cariboo gold fields, service in the United States Army, practice in a notorious Californian frontier town and, in later life, the comparative quiet of general and occupational medical practice in Portland, Oregon. Once a household name, his death went unrecorded in the British and Irish medical and lay press.

Using alternatives to face-to-face consultations: a survey of prevalence and attitudes in general practice.

PubMed

Brant, Heather; Atherton, Helen; Ziebland, Sue; McKinstry, Brian; Campbell, John L; Salisbury, Chris

2016-07-01

The ubiquitous use of communication technologies has led to an expectation that a similar approach should extend to health care. Despite considerable rhetoric about the need for general practices to offer alternatives to face-to-face consultations, such as telephone, email, and internet video consultations, the extent to which such technologies are actually used at present is unclear. The aim of the survey was to identify the frequency and range of ways in which general practices are providing (or planning) alternatives to face-to-face consultations. A postal survey of practices around Bristol, Oxford, Lothian, the Highlands, and the Western Isles of Scotland. A postal questionnaire survey was sent to each of the GPs and practice managers of 421 practices between January and May 2015. A response was received from 319/421 practices (76%). Although the majority of the practices reported that they were conducting telephone consultations frequently (n = 211/318, 66%), fewer were implementing email consultations (n = 18/318, 6%), and most (n = 169/318, 53%) had no plans to introduce this. None were currently using internet video, and 86% (n = 273/318) had no plans to introduce internet video consultations. These findings were repeated in the reported use of alternatives to face-to-face consultations at an individual GP level. Optional free text responses were completed by 28% of responders, and offered an explanation for the (often perceived) barriers and incentives for implementation. Despite policy pressure to introduce consultations by email and internet video, there is a general reluctance among GPs to implement alternatives to face-to-face consultations. This identifies a substantial gap between rhetoric and reality in terms of the likelihood of certain alternatives (email, video) changing practice in the near future. © British Journal of General Practice 2016.

1776 - A Critical Time in the American Revolution

DTIC Science & Technology

2013-04-03

it identified it as a British officer’s weapon presented to General John Glover in recognition of his superior service upon the British surrender...battle. The contribution of forces with specialized abilities, such as John Glover and his regiment will be considered during this analysis. I...successful. The task fell upon General George Washington to develop the strategy that would eventually drive the British out of America . Washington

Memory Practices in History Education about the 1947 British India Partition: Opportunities and Challenges to Breaching Hegemonic Remembering

ERIC Educational Resources Information Center

Chhabra, Meenakshi

2015-01-01

This article is an epistemological reflection on memory practices in the construction, deconstruction, and reconstruction of collective memories of a historical event involving collective violence and conflict in formal and informal spaces of education. It focuses on the 1947 British India Partition of Punjab. The article engages with multiple…

The Aesthetics of Everyday Literacies: Home Writing Practices in a British Asian Household

ERIC Educational Resources Information Center

Pahl, Kate

2014-01-01

This article explores young people's home literacy practices drawing on an ethnographic study of writing in the home of a British Asian family living in northern England. The theoretical framework comes from the New Literacy Studies, and aesthetic and literary theory. It applies an ethnographic methodology together with an engaged approach to…

Pedagogy, Empowerment and Discipline: Comparative Perspectives of Novice Teachers in England and Turkey Reflecting on "the Other"

ERIC Educational Resources Information Center

Busher, Hugh; Lawson, Tony; Wilkins, Chris; Acun, Ismail

2011-01-01

This article discusses the views of Turkish and British novice teachers on pedagogy and pedagogical relationships with school students when confronted with the pedagogical practices of the "Other" in particular policy contexts. Experiences of those practices were gained by novice teachers during an exchange visit for British and Turkish…

Decolonizing the Archaeological Landscape: The Practice and Politics of Archaeology in British Columbia

ERIC Educational Resources Information Center

Nicholas, George P.

2006-01-01

In British Columbia, Canada, the practice of archaeology has been strongly influenced by issues of First Nations rights and the ways government and industry have chosen to address them. In turn, this situation has affected academic (i.e., research-based) and consulting (i.e., cultural resource management) archaeology, which have had to respond to…

Political Assumptions Underlying Pedagogies of National Education: The Case of Student Teachers Teaching 'British Values' in England

ERIC Educational Resources Information Center

Sant, Edda; Hanley, Chris

2018-01-01

Teacher education in England now requires that student teachers follow practices that do not undermine "fundamental British values" where these practices are assessed against a set of ethics and behaviour standards. This paper examines the political assumptions underlying pedagogical interpretations about the education of national…

Using Web-Based Technologies and Tools in Future Choreographers' Training: British Experience

ERIC Educational Resources Information Center

Bidyuk, Dmytro

2016-01-01

In the paper the problem of using effective web-based technologies and tools in teaching choreography in British higher education institutions has been discussed. Researches on the usage of web-based technologies and tools for practical dance courses in choreographers' professional training at British higher education institutions by such British…

The Making of a Moral British Bangladeshi

ERIC Educational Resources Information Center

Zeitlyn, Benjamin

2014-01-01

This article traces changing notions of a moral upbringing among British Bangladesh families in London. It reviews ideas of the making of a moral person ("manush corano") in Bangladesh and contrasts those with contemporary practices and ideas about the good child in London. It argues that in London, British Bangladeshis have embraced a…

Gambling problems among patients in primary care: a cross-sectional study of general practices.

PubMed

Cowlishaw, Sean; Gale, Lone; Gregory, Alison; McCambridge, Jim; Kessler, David

2017-04-01

Primary care is an important context for addressing health-related behaviours, and may provide a setting for identification of gambling problems. To indicate the extent of gambling problems among patients attending general practices, and explore settings or patient groups that experience heightened vulnerability. Cross-sectional study of patients attending 11 general practices in Bristol, South West England. Adult patients ( n = 1058) were recruited from waiting rooms of practices that were sampled on the basis of population characteristics. Patients completed anonymous questionnaires comprising measures of mental health problems (for example, depression) and addictive behaviours (for example, risky alcohol use). The Problem Gambling Severity Index (PGSI) measured gambling problems, along with a single-item measure of gambling problems among family members. Estimates of extent and variability according to practice and patient characteristics were produced. There were 0.9% of all patients exhibiting problem gambling (PGSI ≥5), and 4.3% reporting problems that were low to moderate in severity (PGSI 1-4). Around 7% of patients reported gambling problems among family members. Further analyses indicated that rates of any gambling problems (PGSI ≥1) were higher among males and young adults, and more tentatively, within a student healthcare setting. They were also elevated among patients exhibiting drug use, risky alcohol use, and depression. There is need for improved understanding of the burden of, and responses to, patients with gambling problems in general practices, and new strategies to increase identification to facilitate improved care and early intervention. © British Journal of General Practice 2017.

Cognitive development: no stages please--we're British.

PubMed

Goswami, U

2001-02-01

British cognitive developmental psychology is characterized by its interest in philosophical questions, its preference for linking basic research to applied issues in education and cognitive disorders, and its willingness to learn both methodologically and theoretically from work in animal psychology and in physiology more generally. It has also been influenced profoundly by Jean Piaget's cognitive stage theory although in general British work has focused on demonstrating early strengths, rather than early deficits, in infant and child cognition. Following an overview of British work that encompasses past and present interests, issues and challenges for the future are highlighted. While the perspectives of the founding members of the British Psychological Society (BPS), as outlined by Edgell (1947), are still apparent in British research in cognitive developmental psychology today, it is argued that future cognitive work must become even more interdisciplinary and that the symbiotic relationship between research in adult cognition and in cognitive development needs greater recognition.

Cognitive development: No stages please - we're British.

PubMed

Goswami, Usha

2001-02-01

British cognitive developmental psychology is characterized by its interest in philosophical questions, its preference for linking basic research to applied issues in education and cognitive disorders, and its willingness to learn both methodologically and theoretically from work in animal psychology and in physiology more generally. It has also been influenced profoundly by Jean Piaget's cognitive stage theory although in general British work has focused on demonstrating early strengths, rather than early deficits, in infant and child cognition. Following an overview of British work that encompasses past and present interests, issues and challenges for the future are highlighted. While the perspectives of the founding members of the British Psychological Society (BPS), as outlined by Edgell (1947), are still apparent in British research in cognitive developmental psychology today, it is argued that future cognitive work must become even more interdisciplinary and that the symbiotic relationship between research in adult cognition and in cognitive development needs greater recognition.

Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults' perceptions of this initiative.

PubMed

Jones, Leah Ffion; Ricketts, Ellie; Town, Katy; Rugman, Claire; Lecky, Donna; Folkard, Kate; Nardone, Anthony; Hartney, Thomas Nathan; McNulty, Cliodna

2017-07-01

Opportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013-2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines. To determine young adults' opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice. Qualitative interviews were conducted in a general practice setting in England between March and June 2013. Thirty interviews were conducted with nine male and 21 female patients aged 16-24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework. Participants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation. General practice staff should facilitate patients' preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way. © British Journal of General Practice 2017.

Public perceptions about climate change mitigation in British Columbia's forest sector

PubMed Central

Hagerman, Shannon; Kozak, Robert; Hoberg, George

2018-01-01

The role of forest management in mitigating climate change is a central concern for the Canadian province of British Columbia. The successful implementation of forest management activities to achieve climate change mitigation in British Columbia will be strongly influenced by public support or opposition. While we now have increasingly clear ideas of the management opportunities associated with forest mitigation and some insight into public support for climate change mitigation in the context of sustainable forest management, very little is known with respect to the levels and basis of public support for potential forest management strategies to mitigate climate change. This paper, by describing the results of a web-based survey, documents levels of public support for the implementation of eight forest carbon mitigation strategies in British Columbia’s forest sector, and examines and quantifies the influence of the factors that shape this support. Overall, respondents ascribed a high level of importance to forest carbon mitigation and supported all of the eight proposed strategies, indicating that the British Columbia public is inclined to consider alternative practices in managing forests and wood products to mitigate climate change. That said, we found differences in levels of support for the mitigation strategies. In general, we found greater levels of support for a rehabilitation strategy (e.g. reforestation of unproductive forest land), and to a lesser extent for conservation strategies (e.g. old growth conservation, reduced harvest) over enhanced forest management strategies (e.g. improved harvesting and silvicultural techniques). We also highlighted multiple variables within the British Columbia population that appear to play a role in predicting levels of support for conservation and/or enhanced forest management strategies, including environmental values, risk perception, trust in groups of actors, prioritized objectives of forest management and socio-demographic factors. PMID:29684041

Public perceptions about climate change mitigation in British Columbia's forest sector.

PubMed

Peterson St-Laurent, Guillaume; Hagerman, Shannon; Kozak, Robert; Hoberg, George

2018-01-01

The role of forest management in mitigating climate change is a central concern for the Canadian province of British Columbia. The successful implementation of forest management activities to achieve climate change mitigation in British Columbia will be strongly influenced by public support or opposition. While we now have increasingly clear ideas of the management opportunities associated with forest mitigation and some insight into public support for climate change mitigation in the context of sustainable forest management, very little is known with respect to the levels and basis of public support for potential forest management strategies to mitigate climate change. This paper, by describing the results of a web-based survey, documents levels of public support for the implementation of eight forest carbon mitigation strategies in British Columbia's forest sector, and examines and quantifies the influence of the factors that shape this support. Overall, respondents ascribed a high level of importance to forest carbon mitigation and supported all of the eight proposed strategies, indicating that the British Columbia public is inclined to consider alternative practices in managing forests and wood products to mitigate climate change. That said, we found differences in levels of support for the mitigation strategies. In general, we found greater levels of support for a rehabilitation strategy (e.g. reforestation of unproductive forest land), and to a lesser extent for conservation strategies (e.g. old growth conservation, reduced harvest) over enhanced forest management strategies (e.g. improved harvesting and silvicultural techniques). We also highlighted multiple variables within the British Columbia population that appear to play a role in predicting levels of support for conservation and/or enhanced forest management strategies, including environmental values, risk perception, trust in groups of actors, prioritized objectives of forest management and socio-demographic factors.

Medical humanities: some uses and problems.

PubMed

Downie, R

2016-12-01

The arts and humanities were allowed into the British medical curriculum in 1993 when the General Medical Council re-structured it in a paper entitled 'Tomorrow's Doctors'. Since then many medical schools have developed humanities modules and the broad term 'medical humanities' refers to these. They can contribute to medical education in at least three ways: as a supplement to what is already in the curriculum, especially for ethics and communication; as an outside critique of medical practice; and to personal and professional development. Nevertheless, there are practical problems concerning appropriate teachers and methods of assessment. Moreover, the dominant interest is now academic research rather than education.

Standardization of mapping practices in the British Geological Survey

NASA Astrophysics Data System (ADS)

Allen, Peter M.

1997-07-01

Because the British Geological Survey (BGS) has had, since its foundation in 1835, a mandate to produce geological maps for the whole of Great Britain, there is a long history of introducing standard practices in the way rocks and rock units have been named, classified and illustrated on maps. The reasons for the failure of some of these practices are examined and assessed in relation to the needs of computerized systems for holding and disseminating geological information.

Listeriosis in pregnancy: survey of British Columbia practitioners' knowledge of risk factors, counseling practices, and learning needs.

PubMed

Kirkham, Colleen; Berkowitz, Jonathan

2010-04-01

To determine the knowledge, counseling practices, and learning needs of practitioners in British Columbia regarding risk factors for listeriosis in pregnancy. A 1-page, mailed, self-administered, anonymous questionnaire. British Columbia. A total of 827 practitioners (614 family physicians, 93 midwives, and 120 family practice residents) were sent the questionnaire. Awareness of listeriosis, knowledge of the risk factors for listeriosis, practices for counseling pregnant women, practitioners' learning needs, and provider and practice characteristics. A total of 340 practitioners (41%) completed the questionnaire. While most (88%) physicians and midwives had heard of listeriosis, few (18%) were aware that infection was more common during pregnancy. One-third (33%) of practitioners counseled pregnant women about the risk factors for listeriosis. The main reasons for not providing such counseling were lack of knowledge and the perception that listeriosis was rare and not an important concern for pregnant women. Rates of counseling were highest among midwives (84%) and lowest among physicians practising outside the Lower Mainland of British Columbia (12%). Of those practitioners providing prenatal care, 47% counseled pregnant women about the risks of unpasteurized milk and 41% counseled women about the risks of consuming soft cheese; few counseled about the risks of consuming deli meat or raw hot dogs (25%), unwashed fruit and vegetables (12%), or refrigerated smoked seafood (6%). Most prenatal care providers in British Columbia are unaware of the risk factors for listeriosis or its propensity for pregnant women and do not counsel their pregnant patients about these risks.

Digital communication between clinician and patient and the impact on marginalised groups: a realist review in general practice.

PubMed

Huxley, Caroline J; Atherton, Helen; Watkins, Jocelyn Anstey; Griffiths, Frances

2015-12-01

Increasingly, the NHS is embracing the use of digital communication technology for communication between clinicians and patients. Policymakers deem digital clinical communication as presenting a solution to the capacity issues currently faced by general practice. There is some concern that these technologies may exacerbate existing inequalities in accessing health care. It is not known what impact they may have on groups who are already marginalised in their ability to access general practice. To assess the potential impact of the availability of digital clinician-patient communication on marginalised groups' access to general practice in the UK. Realist review in general practice. A four-step realist review process was used: to define the scope of the review; to search for and scrutinise evidence; to extract and synthesise evidence; and to develop a narrative, including hypotheses. Digital communication has the potential to overcome the following barriers for marginalised groups: practical access issues, previous negative experiences with healthcare service/staff, and stigmatising reactions from staff and other patients. It may reduce patient-related barriers by offering anonymity and offers advantages to patients who require an interpreter. It does not impact on inability to communicate with healthcare professionals or on a lack of candidacy. It is likely to work best in the context of a pre-existing clinician-patient relationship. Digital communication technology offers increased opportunities for marginalised groups to access health care. However, it cannot remove all barriers to care for these groups. It is likely that they will remain disadvantaged relative to other population groups after their introduction. © British Journal of General Practice 2015.

Patient views on primary care services for epilepsy and areas where additional professional knowledge would be welcome.

PubMed

Chappell, B; Smithson, W H

1998-12-01

In the past decade there has been increasing interest in the part that general practice can play in the care of people with epilepsy. Primary care services for epilepsy vary from practice to practice. Some studies have suggested that people with epilepsy prefer secondary care services and are not keen for their epilepsy to be managed in general practice, but much of the data were collected in secondary care. This study collected data from various sources about present provision of services, patient satisfaction with services, views about service development, areas where GP knowledge may be improved and whether the site of data collection influenced the results. A questionnaire was piloted, then distributed and collected through branches of the British Epilepsy Association, general practice and secondary care clinics. Data collected were both quantitative and qualitative. One hundred and seventy-eight questionnaires were collected from three sources. The responders were a severe seizure group. Structured care in general practice was uncommon with 54% being seen only when needed. Dose and type of antiepileptic medication was rarely altered in general practice. Information about their condition was given to 44% of the responders by their GP. Sixty-one percent would prefer their epilepsy care to be 'shared' between primary and secondary services. The majority of patients were satisfied with GP services, felt they could easily discuss their epilepsy, but 58% felt they 'rarely' or 'never' received enough information about their condition in general practice. Satisfaction with GP care varied, dependent on where the data were collected. Patients would value more information and more time to discuss the effects of their epilepsy. In conclusion general practice care for epilepsy is still reactive. Patients value more information and more time to discuss implications. The data collection point affects the results; any conclusions about the organisation of epilepsy care should draw data from community patient samples.

USAF Warrior Studies: Air Superiority in World War 2 and Korea,

DTIC Science & Technology

1983-01-01

was impractical and seldom, if ever. achievable. So the concept evolved in World War 11 into theater counter-air force operations. The practice was to...Crete had fallen, and the British had practically no airplanes at all in the Western Desert. From my observations. I think the British were really in...our relationships to the Arm\\. the XII Air Support Command, tf.or all practical purposes. was under If C’orps,. At the t ime. 11 Corps s% as commnanded

Paediatric primary care in Inner London

PubMed Central

Jackson, Jane

1980-01-01

A week's census was taken of children attending family doctors or hospital accident and emergency departments in an inner city area of London. Most attendances at general hospitals were for cases of trauma while the children's hospital was used mainly by the very young, coming from a wide catchment area. An over-emphasis on hospital-based primary care would not be appropriate in this area and would run counter to the whole philosophy of British medical practice. ImagesFigure 1.Figure 4. PMID:7452588

Images of otoscopy: rate and extent of non-compliance with good practice standards.

PubMed

Crundwell, G; Harmer, J; Maltby, M; Mills, T; Neumann, C; Walsh, L; Baguley, D

2015-01-01

The British Society of Audiology has produced clear guidelines as to how otoscopy should be undertaken; however, no nationally recognised guidelines exist for the wider clinical community. Images of otoscopy appear in many books, journals, magazines and websites. This study aimed to determine the rate of non-compliance with good practice in images of otoscopy, the seriousness of the breach, and whether this is more common in sites for professionals or the general public. Google Images was searched using the terms 'otoscopy' and 'ear examination'. A total of 200 images were identified and collated. The images were reviewed for compliance with good practice standards. Only 12.75 per cent of the images were graded as having no breach of good practice standards. Professional websites have a responsibility to show best practice. When choosing an image, the source of the image needs to be carefully considered.

Guidelines on the management of abnormal liver blood tests

PubMed Central

Cramb, Rob; Davison, Suzanne M; Dillon, John F; Foulerton, Mark; Godfrey, Edmund M; Hall, Richard; Harrower, Ulrike; Hudson, Mark; Langford, Andrew; Mackie, Anne; Mitchell-Thain, Robert; Sennett, Karen; Sheron, Nicholas C; Verne, Julia; Walmsley, Martine; Yeoman, Andrew

2018-01-01

These updated guidelines on the management of abnormal liver blood tests have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines, which this document supersedes, were written in 2000 and have undergone extensive revision by members of the Guidelines Development Group (GDG). The GDG comprises representatives from patient/carer groups (British Liver Trust, Liver4life, PBC Foundation and PSC Support), elected members of the BSG liver section (including representatives from Scotland and Wales), British Association for the Study of the Liver (BASL), Specialist Advisory Committee in Clinical Biochemistry/Royal College of Pathology and Association for Clinical Biochemistry, British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), Public Health England (implementation and screening), Royal College of General Practice, British Society of Gastrointestinal and Abdominal Radiologists (BSGAR) and Society of Acute Medicine. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. These guidelines deal specifically with the management of abnormal liver blood tests in children and adults in both primary and secondary care under the following subheadings: (1) What constitutes an abnormal liver blood test? (2) What constitutes a standard liver blood test panel? (3) When should liver blood tests be checked? (4) Does the extent and duration of abnormal liver blood tests determine subsequent investigation? (5) Response to abnormal liver blood tests. They are not designed to deal with the management of the underlying liver disease. PMID:29122851

The British Sign Language Variant of Stokoe Notation: Report on a Type-Design Project.

ERIC Educational Resources Information Center

Thoutenhoofd, Ernst

2003-01-01

Explores the outcome of a publicly-funded research project titled "Redesign of the British Sign Language (BSL) Notation System with a New Font for Use in ICT." The aim of the project was to redesign the British Sign Language variant of Stokoe notation for practical use in information technology systems and software, such as lexical…

The British Armed Forces Covenant - Protection for Tommy or a Civil Military Battleground

DTIC Science & Technology

2012-04-01

he would have been happy to hasten a General Election, which, in his mind, would have been for the good of both the country and the British Army...ire of the Labour government and probably expected to be fired for his actions. Matthew Paris of the [London] Times newspaper noted, “General Dannatt...winnable, as the historian Max Hasting stated in the Times “the British [ Labour ] Government has become increasingly cynical about its own war and

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2015.

PubMed

Szostek, Jason H; Wieland, Mark L; Post, Jason A; Sundsted, Karna K; Mauck, Karen F

2016-08-01

Identifying new practice-changing articles is challenging. To determine the 2015 practice-changing articles most relevant to outpatient general internal medicine, 3 internists independently reviewed the titles and abstracts of original articles, synopses of single studies and syntheses, and databases of syntheses. For original articles, internal medicine journals with the 7 highest impact factors were reviewed: New England Journal of Medicine, Lancet, Journal of the American Medical Association (JAMA), British Medical Journal, Public Library of Science Medicine, Annals of Internal Medicine, and JAMA Internal Medicine. For synopses of single studies and syntheses, collections in American College of Physicians Journal Club, Journal Watch, and Evidence-Based Medicine were reviewed. For databases of synthesis, Evidence Updates and the Cochrane Library were reviewed. More than 100 articles were identified. Criteria for inclusion were as follows: clinical relevance, potential for practice change, and strength of evidence. Clusters of important articles around one topic were considered as a single-candidate series. The 5 authors used a modified Delphi method to reach consensus on inclusion of 7 topics for in-depth appraisal. Copyright © 2016 Elsevier Inc. All rights reserved.

Incentive-Based Primary Care: Cost and Utilization Analysis.

PubMed

Hollander, Marcus J; Kadlec, Helena

2015-01-01

In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

PubMed

Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

2017-01-01

NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015. Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R 2 values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. © British Journal of General Practice 2017.

Vocational Training in the European Economic Community, with Particular Reference to its Likely Impact on British Training Policy and Practice.

ERIC Educational Resources Information Center

Perry, P. J. C., Comp.

This report documents the visits of a British delegation composed of representatives from three British vocational training organizations to the Commission of the European Economic Community (EEC) and to France, the Federal Republic of Germany, Italy, The Netherlands, and Belgium during June 6-14, 1972. The key areas investigated were: (1) the…

Impact of an interprofessional rural health care practice education experience on students and communities.

PubMed

Charles, Grant; Bainbridge, Lesley; Copeman-Stewart, Kathy; Kassam, Rosemin; Tiffin, Shelly

2008-01-01

The Interprofessional Rural Program of British Columbia (IRPBC) was established in 2003 as a pilot program aimed at supporting the recruitment of health and human service professionals to rural communities in British Columbia, Canada. The program was designed to expose students in the health and human service professions to rural communities and to assess whether this exposure increased the likelihood of their return to work in nonurban settings once they completed their studies. The initial qualitative evaluation of IRPBC was conducted via individual interviews in the first year and written questionnaires in the second year. In general, IRPBC was perceived by the participants to have had a significant impact on the students and communities. The students who participated in it benefited not only from the chance to engage in rural practice but also from the opportunity to interact within an interprofessional context; and the communities participating in the program profited from enhanced health care and the possibility of attracting new practitioners from these students. Exposure to new ways of providing service and the impact that the introduction of teams of passionate students can have on both practitioners and small communities have greatly enriched the broader communities.

Cardiovascular disease mortality in British merchant shipping and among British seafarers ashore in Britain.

PubMed

Roberts, Stephen E; Jaremin, Bogdan

2010-01-01

The objective was to investigate trends in work-related mortality from cardiovascular disease (CVD) among seafarers employed in British merchant shipping from 1919 to 2005, to compare CVD mortality among British seafarers at work in British shipping - and ashore in Britain - with that in the general British population, and to investigate work-related CVD mortality in British shipping during recent years according to factors such as rank, nationality, location, and type of ship. A longitudinal study based on examination of death inquiry files and death registers, official death returns, and information from occupational mortality decennial supplements. The main outcome measures were population-based mortality rates and standardised mortality ratios. There was an increase in work-related CVD mortality throughout much of the period from 1919 to 1962, but a subsequent reduction to 2005. Work-related mortality from CVD and ischaemic heart disease (IHD) was lower among seafarers employed in British shipping than in the corresponding general population (SMRs = 0.35 to 0.46), but mortality from CVD among British seafarers ashore in Britain was often increased. An elevated risk of work-related CVD mortality was also identified among the crews of North Sea offshore ships. This study shows a healthy worker effect against CVD mortality among seafarers at work in British shipping, but increased risks among British seafarers ashore in Britain, which would include seafarers discharged through CVD morbidity and other illnesses. The high risks of CVD mortality among seafarers in North Sea supply ships may reflect particular work-related hazards in this sector.

Ethnic differences in consultation rates in urban general practice.

PubMed Central

Gillam, S. J.; Jarman, B.; White, P.; Law, R.

1989-01-01

OBJECTIVE--To determine the patterns of consultations with the general practitioner among different ethnic groups and the outcome of these consultations. DESIGN--Retrospective analysis of data from one urban group general practice collected during 1979-81 as part of a research project in seven practices. SETTING--Group general practice in the London borough of Brent with a list size of 10,877 patients in July 1980. SUBJECTS--Patients registered with the practice during the 23 months to April 1981 who accounted for 67,197 consultations. MAIN OUTCOME MEASURES--Ethnic state, sex and social class distribution, and diagnosis of patients consulting and frequency of consultations analysed as standardised consultation ratios and standardised patient consultation ratios. RESULTS--Compared with other ethnic groups male Asians (that is, including those born in Britain and those originating from the Indian subcontinent and east Africa) had a substantially increased standardised patient consultation ratio. Consultation rates for mental disorders--in particular, anxiety and depression--were reduced in all groups of immigrant descent. West Indians consulted more frequently for hypertension and asthma, and their children less frequently with otitis media. Asians consulted more frequently with upper respiratory tract infections and non-specific symptoms. Native British patients were more likely to leave the surgery with a follow up appointment, prescription, or certificate. CONCLUSION--Notwithstanding the limitations of this study, ethnic differences in consultation rates were apparent. These differences require further investigation if the needs of minority ethnic groups are not to be overlooked. PMID:2508951

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children.

PubMed

Drinkwater, Jessica; Stanley, Nicky; Szilassy, Eszter; Larkins, Cath; Hester, Marianne; Feder, Gene

2017-06-01

Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. To explore how and why general practice clinicians document DVA in families with children. A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access. © British Journal of General Practice 2017.

General practice--reflection on five years of multidisciplinary training at Medical Centre Gütersloh.

PubMed

van den Heuvel, H G J

2011-12-01

Medical Centre Gütersloh is a primary care setting which provides the full range of general practice care for British Forces Germany Health Service (BFG HS). The aim of this article is to evaluate the multidisciplinary training organised by the author there, to exchange information and to provide suggestions for improvement and development. Description of the training scheme and analysis of routinely collected management data. The training scheme is based on adult education principles with a focus on interactive learning. Over the period November 2005-July 2010 a total of 1201 members of staff from various disciplines participated in 86 documented training sessions. The majority of the attending staff considered the training to be relevant, interesting and well presented. A substantial proportion indicated that they would change their practice as a result of the training. These views remained stable over time. The majority of facilitators consisted of medical centre employees. This article provides an overview onfive years of multidisciplinary training in a general practice setting. Overall feedback from staff suggests that the training has been highly valued over those years. However, it is recognised that this evaluation has its limitations and suggestions are made regarding how these types of training schemes can be improved and developed further.

The Significance of the Bulgarian Senior Military Leadership in World War I: A Comparative Study of the Bulgarian Army Operations at Dobro Pole and Doiran in 1918

DTIC Science & Technology

2012-06-08

the 9th Infantry (Pleven) Division under the command of General Ivan Vazov not only defeated the combined British, French , and Greek offensive at...of General Ivan Vazov not only defeated the combined British, French , and Greek offensive at Doiran, but also created the conditions for what might...Pleven) Division in particular, not only defeated the joint British, French , and Greek offensive at Doiran, but also created the 2 conditions

A General Tank Test of a Model of the Hull of the British Singapore IIC Flying Boat

NASA Technical Reports Server (NTRS)

Dawson, John R; Truscott, Starr

1936-01-01

A general test was made in the N.A.C.A. tank of a 1/12-size model of the hull of the British Singapore IIC flying boat loaned by the Director of Research, British Air Ministry. The results are given in charts and are compared with the results of tests of a model of an American flying-boat hull, the Sikorsky S-40. The Singapore hull has a greater hump resistance but a much lower high-speed resistance than the S-40.

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed

Wonderling, D; McDermott, C; Buxton, M; Kinmonth, A L; Pyke, S; Thompson, S; Wood, D

1996-05-18

To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. 13 general practices across Britain. 4185 men aged 40-59 and their 2827 partners. Nurse led programme using a family centered approach, with follow up according to degree of risk. Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

PubMed Central

Wonderling, D.; McDermott, C.; Buxton, M.; Kinmonth, A. L.; Pyke, S.; Thompson, S.; Wood, D.

1996-01-01

OBJECTIVE--To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. DESIGN--Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. SETTING--13 general practices across Britain. SUBJECTS--4185 men aged 40-59 and their 2827 partners. INTERVENTION--Nurse led programme using a family centered approach, with follow up according to degree of risk. MAIN OUTCOME MEASURES--Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. RESULTS--Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). CONCLUSIONS--The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women. PMID:8634617

Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate.

PubMed

Dixon, William H R; Kinnison, Tierney; May, Stephen A

2017-11-01

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patient information materials in general practices and promotion of health literacy: an observational study of their effectiveness.

PubMed

Protheroe, Joanne; Estacio, Emee Vida; Saidy-Khan, Sirandou

2015-03-01

Government policy in the UK emphasises providing patients with good health information to encourage participation in their health care. Patient information leaflets (PILs) form part of this policy and have been shown to affect patient health outcomes; however, many are poorly written. To describe the PILs in general practice surgeries in Stoke-on-Trent in terms of readability and variety of content. An observational study of randomly selected GP practices (n = 17) across Stoke-on-Trent. PILs were assessed for readability (Flesch Reading Ease and Flesch-Kincaid Grade Level) and compared with national skills level data and with the recommended level for medical information. The PILs were also categorised for content using the Rudd (2007) health material classification framework. A total of 345 PILs were collected and assessed. Only 24.3% meet recommended reading-level criteria. Compared with national skills levels, over 75% of the PILs collected were too complex for at least 15% of the English population. Of the PILs, 47.8% were classified as 'systems navigation' (information regarding services); 22.9% were disease prevention (screening and immunisations); 14.2% personal and public safety; and less than 10% were for managing illness or health promotion. Current PILs in general practices do not all promote health literacy. Information only accessible to a proportion of higher skilled patients may increase inequalities in health. Less than 10% of PILs promote managing illness or healthy lifestyles. Processes must be put in place to improve the readability and variety of content of PILs in GP practices. © British Journal of General Practice 2015.

Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice.

PubMed

Margham, Tom; Symes, Natalie; Hull, Sally A

2018-04-01

Identifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations. This study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety. Mixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice. The project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians. Trigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs' work is generally reactive and GPs welcomed an approach that identified patients who were 'under the radar' of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time. Electronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks. © British Journal of General Practice 2018.

Practice and payment preferences of newly practising family physicians in British Columbia

PubMed Central

Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

2012-01-01

Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

The Barriers to Achieving the Wider Goals of General Education and Their Implications for the British Educational Research Association.

ERIC Educational Resources Information Center

Raven, John

1990-01-01

Advocates revamping the British educational system from technical-rational content model to student-centered process programs designed to promote critical thinking, individual initiative, and communication skills. Discusses obstacles to this educational reform, emphasizing research orientation. Urges the British Educational Research Association to…

Proceedings of the European ISTVS Conference (6th) , OVK Symposium (4th), On ’Off Road Vehicles in Theory and Practice’ , Held at Vienna, Austria on 28-30 September 1994 in Vienna, Austria. Volume 1.

DTIC Science & Technology

1994-09-30

The Commander-in-Chief of the British troops, General Sir Peter de la Billiere, reported that each vehicle of the Tenth Transport Regiment covered 400...Simulation des Reifenprofileinflusses fuir die Gelaindebeweglichkeit von Fahrzeugen C. W. FERVERS IKK-University of German Armed Forces Hamburg, Germany...of the Process) 731 Experimentelle und theoretische Analyse kohaisiven Erdreichs beim Verschiebevorgang (Optimierung des Vorganges) A. JARZEBOWSKI, J

Spheres of Interest: Imperialism, Culture, and Practice in British Solar Eclipse Expeditions, 1860-1914

NASA Astrophysics Data System (ADS)

Pang, Alex Soojung-Kim

Scientific expeditions have played an important role in the development of Western Science, but have received far less attention than theory-making or experiment. This is a cultural and social history of British solar eclipse expeditions and observing practices. An introductory chapter outlines the historiography of scientific practice, imperialism and science, and scientific expeditions, and explains the importance of solar eclipses to nineteenth-century science. The chapters follow expeditions from their planning, through their execution, and into the publication of results. Chapter 2 is an institutional and social history of British and American eclipse planning. British expeditions were organized by national societies, while American expeditions were planned by individual observatories and colleges. Chapters 3 and 4 move into the field. They show how the evolution of tourist culture, the expansion of imperial spheres of political control, the transfer of Western technological systems to colonial territories shaped the experience of going on an expedition, and even made accurate astrophysical observation possible. They also examine the roles women played on eclipse expeditions. Chapters 5 and 6 examine spectroscopic and visual observation. They study the effects of intellectual shifts, the introduction of photography, and the scaling up of instruments on observing practices. Chapter 6 shows how visual and photographic observations of the solar corona were made. Chapter 7 follows those pictures out of the field, and examines how they were copied and shared with other astronomers.

Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study.

PubMed

Cope, Anwen L; Chestnutt, Ivor G; Wood, Fiona; Francis, Nick A

2016-05-01

The frequency of consulting for dental problems in general medical practice, and antibiotic prescribing associated with these consultations, is poorly described. To describe consultation rates and antibiotic use for dental problems in UK general medical practice, and explore factors associated with antibiotic prescribing for dental conditions. A retrospective cohort study using Clinical Practice Research Datalink, a database of general practice patient records in the UK. All dental consultations between 2004 and 2013 were identified. The main outcome was the prescription of an antibiotic during a dental consultation. Multilevel logistic regression was conducted to examine factors associated with antibiotic prescription. In all, 288 169 dental consultations were included in the cohort. The average rate of dental consultations was 6.06 consultations per 1000 patient-years. Rates of dental consultation decreased from 6.84 consultations per 1000 patient-years in 2008, to 4.23 consultations per 1000 patient-years in 2013. Consultation rates were higher among females than males and highest in patients aged 20-29 years. An antibiotic was prescribed in 57.1% of consultations. Significant predictors (P<0.001) of antibiotic prescribing included: patient middle age, male sex, and previous consultations for tooth-related problems. Antibiotics were more likely to be prescribed during consultations in December (odds ratio [OR] 1.18, 95% confidence interval [CI] = 1.13 to 1.24, P<0.001, reference month: June) and on a Monday (OR 1.10, 95% CI = 1.07 to 1.13, P<0.001) or a Friday (OR 1.15, 95% CI = 1.12 to 1.18, P<0.001, reference day: Wednesday). Consultation rates for dental problems in UK general practice are relatively low but more than half result in the prescription of an antibiotic. This raises concerns about patient morbidity and contributions to antimicrobial resistance. © British Journal of General Practice 2016.

Incentive-Based Primary Care: Cost and Utilization Analysis

PubMed Central

Hollander, Marcus J; Kadlec, Helena

2015-01-01

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. Design: The study used Ministry of Health administrative data for Fiscal Year 2010–2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Main Outcome Measures: Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). Results: After controlling for patients’ age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Conclusion: Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization. PMID:26263389

Oxford Guide to British and American Culture for Learners of English.

ERIC Educational Resources Information Center

Crowther, Jonathan, Ed.; Kavanagh, Kathryn, Ed.

The guide to American and British culture, for upper secondary- and university-level students, is intended for use by learners of English as a second language. It is designed to explain specific aspects of British and American life and traditions not generally included in English language dictionaries. The guide has a dictionary format, with terms…

Changing Clinical Practice: Evaluation of Implementing Recommendations for Opportunistic Salpingectomy in British Columbia and Ontario.

PubMed

Lander, Bryn; Wilcox, Elizabeth; McAlpine, Jessica N; Finlayson, Sarah J; Huntsman, David G; Miller, Dianne; Hanley, Gillian E

2018-05-11

The aim of the study was to explore the factors that contributed to the adoption of opportunistic salpingectomies (removal of fallopian at the time of hysterectomy or in lieu of tubal ligation) by gynecologic surgeons in British Columbia (where a knowledge translation initiative took place) and in Ontario (a comparator where no knowledge translation initiative took place). We aimed to understand why the knowledge translation initiative undertaken by OVCARE in British Columbia resulted in such a dramatic uptake in opportunistic salpingectomy. We undertook a qualitative evaluation of clinicians' decisions about whether or not they should adopt the practice of opportunistic salpingectomy based on interviews with gynecologic surgeons in British Columbia and Ontario (n = 28). The analysis draws from the Consolidated Framework for Implementation Research. Regional cohesion combined with practice change information exposure and thought leader support were important in explaining differences in adoption levels between participants. The British Columbian knowledge translation campaign was successful because provincial thought leaders exposed gynecologic surgeons to recommendations through multiple sources within a highly socially cohesive environment wherein clinicians felt pressure to adopt the recommendations. In both provinces, high adopters often believed that the workload and surgical risk associated with the adoption was low and the potential benefit-because of limited ovarian cancer detection and treatment options-was high. This research points to the important role that local professional networks can play in encouraging clinicians to change their practice by creating a cohesive regional environment where clinicians are repeatedly exposed to important information and supported in their practice change by local thought leaders.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

British Logistics Challenges in the American Revolution: How Logistics was a Critical Vulnerability in the British Effort to Ensure Victor

DTIC Science & Technology

2012-05-01

as the French entered the war, the British had to divide resources and supplies elsewhere. The British General Cornwallis decided to chase the...military equipment, such as ammunition, cannons, and life support, such as food and water, then how could they expect to sustain operations...problems of supplying the army from Great Britain were great, and the most serious challenge was that of providing food over such a tremendous

Test-retest reliability and practice effects of the Wechsler Memory Scale-III.

PubMed

Lo, Ada H Y; Humphreys, Michael; Byrne, Gerard J; Pachana, Nancy A

2012-09-01

Although serial administration of cognitive tests is increasingly common, there is a paucity of research on test-retest reliabilities and practice effects, both of which are important for evaluating changes in functioning. Reliability is generally conceptualized as involving short-lasting changes in performance. However, when repeated testing occurs over a period of years, there will be some longer lasting effects. The implications of these longer lasting effects and practice effects on reliability were examined in the context of repeated administrations of the Wechsler Memory Scale-III in 339 community-dwelling women aged 40-79 years over 2 to 7 years. The results showed that Logical Memory and Verbal Paired Associates subtests were consistently the most reliable subtests across the age cohorts. The magnitude of practice effects varied as a function of subtests and age. The largest practice effects were found in the youngest age cohort, especially on the Faces, Logical Memory, and Verbal Paired Associates subtests. ©2012 The British Psychological Society.

Instructor Training on British Railways

ERIC Educational Resources Information Center

Gibson, J. D.

1970-01-01

The value of instructor training was recognized by British Railways as early as 1950 with the setting up of a training center at Darlington. This article shows the results of this continuous training experience in the benefits to be obtained from re-appraisal techniques and practical work. (Author/EB)

British Students' Perceptions of Ethical Issues in International Marketing: An Empirical Investigation.

ERIC Educational Resources Information Center

Amin, Sammy G.

1996-01-01

A survey investigated 122 British business students' perceptions of ethics in international marketing practices, particularly as they are affected by demographic characteristics. In response to 12 specific scenarios, students indicated relatively liberal attitudes. Implications for global marketing specialists and for business education are…

Email communication at the medical primary-secondary care interface: a qualitative exploration.

PubMed

Sampson, Rod; Barbour, Rosaline; Wilson, Philip

2016-07-01

There is little published research into the influence of email communication between primary and secondary care clinicians on patient care. To explore the use of email communication between clinicians across the primary- secondary care interface, and how this may relate to patient care. A qualitative study involving primary and secondary care services in the NHS Highland Health Board area, Scotland. Ten GPs and 12 hospital consultants were purposively sampled to reflect diversity. Eligible clinicians were invited to take part in a semi-structured interview. Data were analysed using a thematic analysis approach. Key themes that emerged for clinicians included general perceptions of email; using email in practice (managing workload, impact on patient journeys, and 'quick answers'); system issues (variability and governance); relational aspects; and email skills. Email communication between primary and secondary care clinicians generally has a positive impact on patient access to specialist expertise. Governance issues around the use of clinical email need to be defined. There may currently be a two-tier health service for those patients (and their GPs) requiring 'quick answers'. © British Journal of General Practice 2016.

Providing end-of-life care in general practice: findings of a national GP questionnaire survey.

PubMed

Mitchell, Sarah; Loew, Joelle; Millington-Sanders, Catherine; Dale, Jeremy

2016-09-01

With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC). To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. Responses were analysed using descriptive statistics and an inductive thematic analysis. Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care - which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors - with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management - including effective symptom-control and access to specialist palliative care services; and expertise and training - the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care. © British Journal of General Practice 2016.

British Romantic Generalism in the Age of Specialism, 1870–1990

PubMed Central

Casper, Stephen T.; Welsh, Rick

2016-01-01

This essay explores the impact of ‘generalism’ and ‘general practice’ on the specialisation of British medicine using the case of neurology in Britain to reveal characteristics of British ‘generalist medical culture’ from 1870 to 1990. It argues that ‘generalism’ represented a particular epistemological position in Victorian medicine, one that then created a natural bridge between science and medicine over which almost all physicians and scientists were comfortable walking. The legacies of that Victorian ‘generalist preference’ exerted an enduring impact on the specialisation process as physicians experienced it in the twentieth century and as this case of neurology reveals so clearly. Neurologists and general physicians would still be arguing about the relative merits of a general medical education into the 1980s. By then, however, the emergence of government bodies promoting specialist labour conditions would have rendered the process seemingly inexorable. PMID:26858515

Simplified sleep restriction for insomnia in general practice: a randomised controlled trial.

PubMed

Falloon, Karen; Elley, C Raina; Fernando, Antonio; Lee, Arier C; Arroll, Bruce

2015-08-01

Insomnia is common in primary care. Cognitive behavioural therapy for insomnia (CBT-I) is effective but requires more time than is available in the general practice consultation. Sleep restriction is one behavioural component of CBT-I. To assess whether simplified sleep restriction (SSR) can be effective in improving sleep in primary insomnia. Randomised controlled trial of patients in urban general practice settings in Auckland, New Zealand. Adults with persistent primary insomnia and no mental health or significant comorbidity were eligible. Intervention patients received SSR instructions and sleep hygiene advice. Control patients received sleep hygiene advice alone. Primary outcomes included change in sleep quality at 6 months measured by the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and sleep efficiency (SE%). The proportion of participants reaching a predefined 'insomnia remission' treatment response was calculated. Ninety-seven patients were randomised and 94 (97%) completed the study. At 6-month follow-up, SSR participants had improved PSQI scores (6.2 versus 8.4, P<0.001), ISI scores (8.6 versus 11.1, P = 0.001), actigraphy-assessed SE% (difference 2.2%, P = 0.006), and reduced fatigue (difference -2.3 units, P = 0.04), compared with controls. SSR produced higher rates of treatment response (67% [28 out of 42] versus 41% [20 out of 49]); number needed to treat = 4 (95% CI = 2.0 to 19.0). Controlling for age, sex, and severity of insomnia, the adjusted odds ratio for insomnia remission was 2.7 (95% CI = 1.1 to 6.5). There were no significant differences in other outcomes or adverse effects. SSR is an effective brief intervention in adults with primary insomnia and no comorbidities, suitable for use in general practice. © British Journal of General Practice 2015.

Functions and responsibilities of organizations dealing with surrogate motherhood in the UK.

PubMed

van Den Akker, Olga B. A.

1998-01-01

The separation of maternity from social motherhood and progress in reproductive technology raise many social, psychological, medical and legal issues (van den Akker, 1994). The most recent British Medical Association report (BMA, 1996) acknowledged the practice of surrogacy and issued new guidelines for good practice and support for those involved. Surrogate motherhood services have increased around the country over the last decade, even before the formal British Medical Association acknowledgement of their necessity and existence (BMA, 1996). The present survey investigated the incidence, accessibility, and functions of such organizations, specifically, the legal, medical and psychological problems encountered and how they were dealt with, to discover what advice and support is given. Ten centres were interviewed. The incidence of surrogacy conducted through these organizations is widespread, but the processes involved and therefore the implications of the types of surrogacy dealt with are very different. The two major surrogacy agencies deal primarily with partial surrogacy, whereas the clinics are concerned almost exclusively with full (IVF) surrogacy. Information about the procedures involved appears to rely on experience; screening is generally carried out 'in house', and psychological factors are dealt with by counsellors on request by the couples. In general, although the roles of the organizations are disparate and clearly defined, no holistic or long-term care is provided by any of the organizations involved with surrogacy in the UK. The reasons for this are clear cut and stem from the nature of the organizations, and the behaviour of the clients. The data indicate that the current procedures used by the organizations are adequate but could be improved and standardized.

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

PubMed

Ford, Elizabeth; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-08-01

Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients. © British Journal of General Practice 2017.

Alcohol and ischaemic heart disease in middle aged British men.

PubMed Central

Shaper, A G; Phillips, A N; Pocock, S J; Walker, M

1987-01-01

The relation between alcohol intake and ischaemic heart disease was examined in a large scale prospective study of middle aged men drawn from general practices in 24 British towns. After an average follow up of 6.2 years 335 of the 7729 men had experienced a myocardial infarction (fatal or non-fatal) or sudden cardiac death. No significant relation was found between reported alcohol intake and the incidence of such events. Though the group of light daily drinkers had the lowest incidence of ischaemic heart disease events, it also contained the lowest proportion of current smokers, had the lowest mean blood pressure, had the lowest mean body mass index, and contained the lowest proportion of manual workers. These characteristics are more likely to account for the apparent protective effect of alcohol against ischaemic heart disease than a direct effect of alcohol. Compared with the effects of established risk factors alcohol seems to be quite unimportant in the development of ischaemic heart disease. PMID:3105714

Altschul's legacy in mediating British and American psychiatric nursing discourses: common sense and the 'absence' of the accountable practitioner.

PubMed

Tilley, S

1999-08-01

This paper contributes to an archaeology of knowledge in the field of psychiatric and mental health nursing. It focuses on a principal concern of contributors to literature on British psychiatric nursing: the problem of defining psychiatric nursing. Early British writers describing psychiatric nursing accomplished the 'presence' of psychiatric nursing as a discursive object, by discursively constructing the 'absence' of the psychiatric nurse doing, and being accountable for, 'appropriate' work. Altschul's (1972) Patient-nurse Interaction was the key text in this tradition, mediating British and American discourses, setting the methodological and substantive agenda for an important body of subsequent British psychiatric nursing research. The paper examines a number of topics in the American and British discourses mediated by Altschul: the privileging of nurses' presence and language in communication with patients; lay versus professional knowledge, and interaction as gossip; 'common sense' as a topic; common sense as different from 'identifiable perspective'; the problem of accountability and the hierarchy of credibility; accountability, the 'absent' nurse, and issues of method. Altschul's later work keeps in tension two potentially conflicting claims--on the one hand, that the practice of psychiatric nursing depends on the 'kind of person' the nurse is, and on the other, that specialist discourses have priority in determining the basis for practice. Altschul played a crucial role in establishing the role of research in British psychiatric nursing discipline: locating the accountable individual practitioner, and devising remedies for 'absence'. In doing so, she anticipated current discourses on nurses' accountability, particularly their inability to demonstrate 'evidence' of their 'effectiveness'.

Developing patient reference groups within general practice: a mixed-methods study.

PubMed

Smiddy, Jane; Reay, Joanne; Peckham, Stephen; Williams, Lorraine; Wilson, Patricia

2015-03-01

Clinical commissioning groups (CCGs) are required to demonstrate meaningful patient and public engagement and involvement (PPEI). Recent health service reforms have included financial incentives for general practices to develop patient reference groups (PRGs). To explore the impact of the patient participation direct enhanced service (DES) on development of PRGs, the influence of PRGs on decision making within general practice, and their interface with CCGs. A mixed-methods approach within three case study sites in England. Three case study sites were tracked for 18 months as part of an evaluation of PPEI in commissioning. A sub-study focused on PRGs utilising documentary and web-based analysis; results were mapped against findings of the main study. Evidence highlighted variations in the establishment of PRGs, with the number of active PRGs via practice websites ranging from 27% to 93%. Such groups were given a number of descriptions such as patient reference groups, patient participation groups, and patient forums. Data analysis highlighted that the mode of operation varied between virtual and tangible groups and whether they were GP- or patient-led, such analysis enabled the construction of a typology of PRGs. Evidence reviewed suggested that groups functioned within parameters of the DES with activities limited to practice level. Data analysis highlighted a lack of strategic vision in relation to such groups, particularly their role within an overall patient and PPEI framework). Findings identified diversity in the operationalisation of PRGs. Their development does not appear linked to a strategic vision or overall PPEI framework. Although local pragmatic issues are important to patients, GPs must ensure that PRGs develop strategic direction if health reforms are to be addressed. © British Journal of General Practice 2015.

Barriers and facilitators to integration of physician associates into the general practice workforce: a grounded theory approach.

PubMed

Jackson, Ben; Marshall, Michelle; Schofield, Susie

2017-11-01

Physician associates (PAs) are described as one solution to workforce capacity in primary care in the UK. Despite new investment in the role, how effective this will be in addressing unmet primary care needs is unclear. To investigate the barriers and facilitators to the integration of PAs into the general practice workforce. A modified grounded theory study in a region unfamiliar with the PA role. No a priori themes were assumed. Themes generated from stakeholder interviews informed a literature review and theoretical framework, and were then tested in focus groups with GPs, advanced nurse practitioners (ANPs), and patients. Recorded data were transcribed verbatim, and organised using NVivo version 10.2.2, with iterative analysis of emergent themes. A reflexive diary and independent verification of coding and analysis were included. There were 51 participants (30 GPs, 11 ANPs, and 10 patients) in eight focus groups. GPs, ANPs, and patients recognised that support for general practice was needed to improve access. GPs expressed concerns regarding PAs around managing medical complexity and supervision burden, non-prescriber status, and medicolegal implications in routine practice. Patients were less concerned about specific competencies as long as there was effective supervision, and were accepting of a PA role. ANPs highlighted their own negative experiences entering advanced clinical practice, and the need for support to counteract stereotypical and prejudicial attitudes CONCLUSION: This study highlights the complex factors that may impede the introduction of PAs into UK primary care. A conceptual model is proposed to help regulators and educationalists support this integration, which has relevance to other proposed new roles in primary care. © British Journal of General Practice 2017.

Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report.

PubMed

Turner, Gill; Clegg, Andrew

2014-11-01

Older people are majority users of health and social care services in the UK and internationally. Many older people who access these services have frailty, which is a state of vulnerability to adverse outcomes. The existing health care response to frailty is mainly secondary care-based and reactive to the acute health crises of falls, delirium and immobility. A more proactive, integrated, person-centred and community-based response to frailty is required. The British Geriatrics Society Fit for Frailty guideline is consensus best practice guidance for the management of frailty in community and outpatient settings. The BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailty. A gait speed <0.8m/s; a timed-up-and-go test >10s; and a score of ≥3 on the PRISMA 7 questionnaire can indicate frailty. The common clinical presentations of frailty (falls, delirium, sudden immobility) can also be used to indicate the possible presence of frailty. The BGS recommends an holistic medical review based on the principles of comprehensive geriatric assessment (CGA) for all older people identified with frailty. This will: diagnose medical illnesses to optimise treatment; apply evidence-based medication review checklists (e.g. STOPP/START criteria); include discussion with older people and carers to define the impact of illness; work with the older person to create an individualised care and support plan. The BGS does not recommend population screening for frailty using currently available instruments. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Listeriosis in pregnancy

PubMed Central

Kirkham, Colleen; Berkowitz, Jonathan

2010-01-01

ABSTRACT OBJECTIVE To determine the knowledge, counseling practices, and learning needs of practitioners in British Columbia regarding risk factors for listeriosis in pregnancy. DESIGN A 1-page, mailed, self-administered, anonymous questionnaire. SETTING British Columbia. PARTICIPANTS A total of 827 practitioners (614 family physicians, 93 midwives, and 120 family practice residents) were sent the questionnaire. MAIN OUTCOME MEASURES Awareness of listeriosis, knowledge of the risk factors for listeriosis, practices for counseling pregnant women, practitioners’ learning needs, and provider and practice characteristics. RESULTS A total of 340 practitioners (41%) completed the questionnaire. While most (88%) physicians and midwives had heard of listeriosis, few (18%) were aware that infection was more common during pregnancy. One-third (33%) of practitioners counseled pregnant women about the risk factors for listeriosis. The main reasons for not providing such counseling were lack of knowledge and the perception that listeriosis was rare and not an important concern for pregnant women. Rates of counseling were highest among midwives (84%) and lowest among physicians practising outside the Lower Mainland of British Columbia (12%). Of those practitioners providing prenatal care, 47% counseled pregnant women about the risks of unpasteurized milk and 41% counseled women about the risks of consuming soft cheese; few counseled about the risks of consuming deli meat or raw hot dogs (25%), unwashed fruit and vegetables (12%), or refrigerated smoked seafood (6%). CONCLUSION Most prenatal care providers in British Columbia are unaware of the risk factors for listeriosis or its propensity for pregnant women and do not counsel their pregnant patients about these risks. PMID:20393078

From "La Plume de Ma Tante" to "Parlez-Vous Francais?" The Making of French Language Policy in British Columbia, 1945-1982

ERIC Educational Resources Information Center

Raptis, Helen; Fleming, Thomas

2004-01-01

During the first half of the twentieth century in British Columbia, French language was considered a school subject to be taught as any other using formal classical approaches. Generally, no specific provincial or local policies existed to guide how French was taught and learned. By 1981, however, British Columbia had developed explicit language…

Managing patients with acute liver failure: developing a tool for practitioners.

PubMed

O'Neal, Helen; Olds, Jane; Webster, Nicola

2006-01-01

Patients with acute liver failure (ALF) are treated on the general intensive care unit (ICU) within this regional centre for hepatology and liver transplantation. This group of patients are at high risk of developing cerebral oedema, but because of the associated coagulopathy, intracranial pressure is not measured invasively. The safe management of these patients is vital to their outcome, and yet, there is no national or local guidance on the best practice for this group of patients. An absence of guidelines, or evidence base specific to caring for hepatology patients, was highlighted as we reviewed local clinical practices and those at other liver specialty centres, the British Liver Trust and published literature. We identified a need to develop evidence-based guidance for staff caring for patients with ALF within ICUs. A systematic approach enabled us to identify best practice to support the development of a structured evidence-based approach to care.

Comparison of Thermal Safety Practice Guidelines for Diagnostic Ultrasound Exposures.

PubMed

Harris, Gerald R; Church, Charles C; Dalecki, Diane; Ziskin, Marvin C; Bagley, Jennifer E

2016-02-01

This article examines the historical evolution of various practice guidelines designed to minimize the possibility of thermal injury during a diagnostic ultrasound examination, including those published by the American Institute of Ultrasound in Medicine, British Medical Ultrasound Society and Health Canada. The guidelines for prenatal/neonatal examinations are in general agreement, but significant differences were found for postnatal exposures. We propose sets of thermal index versus exposure time for these examination categories below which there is reasonable assurance that an examination can be conducted without risk of producing an adverse thermal effect under any scanning conditions. If it is necessary to exceed these guidelines, the occurrence of an adverse thermal event is still unlikely in most situations because of mitigating factors such as transducer movement and perfusion, but the general principle of "as low as reasonably achievable" should be followed. Some limitations of the biological effects studies underpinning the guidelines also are discussed briefly. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Effects of patient safety culture interventions on incident reporting in general practice: a cluster randomised trial.

PubMed

Verbakel, Natasha J; Langelaan, Maaike; Verheij, Theo J M; Wagner, Cordula; Zwart, Dorien L M

2015-05-01

A constructive safety culture is essential for the successful implementation of patient safety improvements. To assess the effect of two patient safety culture interventions on incident reporting as a proxy of safety culture. A three-arm cluster randomised trial was conducted in a mixed method study, studying the effect of administering a patient safety culture questionnaire (intervention I), the questionnaire complemented with a practice-based workshop (intervention II) and no intervention (control) in 30 general practices in the Netherlands. The primary outcome, the number of reported incidents, was measured with a questionnaire at baseline and a year after. Analysis was performed using a negative binomial model. Secondary outcomes were quality and safety indicators and safety culture. Mixed effects linear regression was used to analyse the culture questionnaires. The number of incidents increased in both intervention groups, to 82 and 224 in intervention I and II respectively. Adjusted for baseline number of incidents, practice size and accreditation status, the study showed that practices that additionally participated in the workshop reported 42 (95% confidence interval [CI] = 9.81 to 177.50) times more incidents compared to the control group. Practices that only completed the questionnaire reported 5 (95% CI = 1.17 to 25.49) times more incidents. There were no statistically significant differences in staff perception of patient safety culture at follow-up between the three study groups. Educating staff and facilitating discussion about patient safety culture in their own practice leads to increased reporting of incidents. It is beneficial to invest in a team-wise effort to improve patient safety. © British Journal of General Practice 2015.

Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada.

PubMed

Roots, Robin K; Brown, Helen; Bainbridge, Lesley; Li, Linda C

2014-01-01

Providing rehabilitation services to address the health needs of rural residents requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists (OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this study was designed to explore rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC). A purposive sample of OTs and PTs in rural communities (population <15 000) in northern BC was recruited for this qualitative study. Potential participants received an invitation mailed to workplaces and were selected to ensure a variety of work experiences, roles and practice settings. In semi-structured interviews, participants were asked to describe the skills and knowledge they perceived as unique to rural practice and strategies they used to overcome challenges. Guided by interpretive description, transcripts were analysed inductively using broad-level coding, and findings were collapsed into interpretive categories. Interpretations and implications for education, practice and policy were reviewed with participants to ensure relevance to rural practice. From interviews with 6 OTs and 13 PTs, serving a total of 15 rural communities, rehabilitation practice and participants' definition of health were understood to be substantially shaped by rurality or the contextual features of geography, determinants of health and access to services. Participants considered general practice 'a specialty' requiring advanced skills in assessment. They described 'stretching their role' and 'participating in, and partnerships with, community' as ways to overcome resource shortages. Reflective practice, networking and collaboration were deemed essential to maintaining competence. Rural clinical placements, mentoring and improving access to continuing professional development were regarded as central to the recruitment and retention required to sustain optimal levels of service to residents. The research findings illustrate the unique influence that the rural context has on the practice of OTs and PTs in BC. They underscore the importance of facilitating learning about rural health within professional training programs and of providing accessible professional development resources to address health human resource shortages and meet the rehabilitation needs of rural residents.

Receptionists' role in new approaches to consultations in primary care: a focused ethnographic study.

PubMed

Brant, Heather Dawn; Atherton, Helen; Bikker, Annemieke; Porqueddu, Tania; Salisbury, Chris; McKinstry, Brian; Campbell, John; Gibson, Andy; Ziebland, Sue

2018-06-04

The receptionist is pivotal to the smooth running of general practice in the UK, communicating with patients and booking appointments. The authors aimed to explore the role of the receptionist in the implementation of new approaches to consultations in primary care. The authors conducted a team-based focused ethnography. Three researchers observed eight general practices across England and Scotland between June 2015 and May 2016. Interviews were conducted with 39 patients and 45 staff in the practices, all of which had adopted one or more methods (telephone, email, e-consultation, or internet video) for providing an alternative to face-to-face consultation. Receptionists have a key role in facilitating patient awareness regarding new approaches to consultations in primary care, while at the same time ensuring that patients receive a consultation appropriate to their needs. In this study, receptionists' involvement in implementation and planning for the introduction of alternative approaches to face-to-face consultations was minimal, despite the expectation that they would be involved in delivery. A shared understanding within practices of the potential difficulties and extra work that might ensue for reception staff was lacking. This might contribute to the low uptake by patients of potentially important innovations in service delivery. Involvement of the wider practice team in planning and piloting changes, supporting team members through service reconfiguration, and providing an opportunity to discuss and contribute to modifications of any new system would ensure that reception staff are suitably prepared to support the introduction of a new approach to consultations. © British Journal of General Practice 2018.

Views of newly-qualified GPs about their training and preparedness: lessons for extended generalist training.

PubMed

Sabey, Abigail; Hardy, Holly

2015-04-01

General practice is becoming increasingly complex due to an ageing population with multiple morbidities and the shift of services from secondary to primary care, yet GP training remains largely the same. Extended training is now recommended, initially proposed as a fourth GP specialty trainee year, but more recently as a broad-based 4-year specialty training programme. To explore the views of newly-qualified GPs about their training and preparedness for specific aspects of the GP's role. Qualitative study with newly-qualified GPs who qualified with Severn Deanery between 2007 and 2010. Semi-structured interviews with 18 GPs between November 2011 and April 2012. Gaining experience in a variety of primary care environments widens insight into patient populations as well as helping GPs develop adaptability and confidence, although this is not routinely part of GP training. However, alongside variety, having continuity with patients in practice remains important. Opportunities to be involved in the management of a practice or to take on substantial leadership roles also vary widely and this may limit preparedness and development of generalist skills. Extended training could help prepare GPs for the current challenges of general practice. It could ensure all trainees are exposed to a greater variety of primary care settings including those outside GP practice, as well as experience of business, finance, and leadership roles. Collectively, these changes have the potential to produce GPs with both generalist and enhanced skills, who are better prepared to work collaboratively across the organisational boundaries between primary, secondary, and community care. © British Journal of General Practice 2015.

Barriers for integrating personalized medicine into clinical practice: a qualitative analysis.

PubMed

Najafzadeh, Mehdi; Davis, Jennifer C; Joshi, Pamela; Marra, Carlo

2013-04-01

Personalized medicine-tailoring interventions based on individual's genetic information-will likely change routine clinical practice in the future. Yet, how practitioners plan to apply genetic information to inform medical decision making remains unclear. We aimed to investigate physician's perception about the future role of personalized medicine, and to identify the factors that influence their decision in using genetic testing in their practice. We conducted three semi-structured focus groups in three health regions (Fraser, Vancouver coastal, and Interior) in British Columbia, Canada. In the focus groups, participants discussed four topics on personalized medicine: (i) physicians' general understanding, (ii) advantages and disadvantages, (iii) potential impact and role in future clinical practice, and (iv) perceived barriers to integrating personalized medicine into clinical practice. Approximately 36% (n = 9) of physicians self-reported that they were not familiar with the concept of personalized medicine. After introducing the concept, the majority of physicians (68%, n = 19 of 28) were interested in incorporating personalized medicine in their practice, provided they have access to the necessary knowledge and tools. Participants mostly believed that genetic developments will directly affect their practice in the future. The key concerns highlighted were physician's access to clinical guidelines and training opportunities for the use of genetic testing and data interpretation. Despite the challenges that personalized medicine can create, in general, physicians in the focus groups expressed strong interest in using genetic information in their practice if they have access to the necessary knowledge and tools. Copyright © 2013 Wiley Periodicals, Inc.

From "Public Health" to "Safeguarding Children": British Health Visiting in Policy, Practice and Research

ERIC Educational Resources Information Center

Peckover, Sue

2013-01-01

This study examines the location of British health visiting in contemporary policy discourses concerned with public health and safeguarding children. It argues that professional identity and orientation can be understood through health visiting's long history of public health work with children and families, which has included an engagement with…

Nursery practices in western Canada

Treesearch

Eric van Steenis

2002-01-01

Forest seedling production in British Columbia began with bareroot production in the 1930s and has evolved to be 95'/0+ containerized entering the new millennium. Until the late 1970s most production was limited to government facilities. Currently private industry produces 85% of seedlings planted in British Columbia. Production levels are at approximately 300+...

Children, Schools and Hallowe'en

ERIC Educational Resources Information Center

Plater, Mark

2013-01-01

This article explores the attitudes and experiences of key stage one and two children concerning the British autumn festival of Hallowe'en, and then compares the results with data on the attitudes and practices of British primary schools and their teachers towards the festival, showing that there is a discordance between the two. After outlining…

Curriculum and Psychology--Reflections on the Issues Raised at the 1983 British Psychological Society Education Section Conference.

ERIC Educational Resources Information Center

Barratt, Gill

1984-01-01

Issues concerning psychology and education that were raised at the 1983 British Psychology Society Education Section Conference are discussed. With respect to teacher training courses, a major issue is whether only practical experience and reflection on the experience can make theoretical learning relevant and usable. (RM)

Migrant Workers and the Changing Psychological Contract

ERIC Educational Resources Information Center

Morgan, Arthur; Finniear, Jocelyn

2009-01-01

Purpose: The influx of migrant workers in the UK has widespread interest. This group's experience of the British work place has evoked considerable debate ranging from the potential to be exploited through unscrupulous practices to allegations about taking away jobs from British workers. The purpose of this paper is to extend knowledge about the…

The British Airways Employee Assistance Programme: a community response to a company's problems.

PubMed

Smith, K G; McKee, A D

1992-02-01

Employee Assistance Programmes have developed since the early 1940s, particularly in North America, and are now part of many UK companies benefits packages for their staff (particularly in North America). This article details the development, philosophy, structure and practice of the British Airways Employee Assistance Programme.

Cancer fear and fatalism among ethnic minority women in the United Kingdom.

PubMed

Vrinten, Charlotte; Wardle, Jane; Marlow, Laura Av

2016-03-01

Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism. A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure. Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21-0.45, all P<0.05) or feel particularly afraid (ORs 0.11-0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97-3.03, all P<0.05). Lower acculturation (ORs 4.30-17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined. In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection.

Cancer fear and fatalism among ethnic minority women in the United Kingdom

PubMed Central

Vrinten, Charlotte; Wardle, Jane; Marlow, Laura AV

2016-01-01

Background: Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism. Methods: A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure. Results: Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21–0.45, all P<0.05) or feel particularly afraid (ORs 0.11–0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97–3.03, all P<0.05). Lower acculturation (ORs 4.30–17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined. Conclusions: In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection. PMID:26867159

Data security and patient confidentiality: the manager's role.

PubMed

Fisher, F; Madge, B

1996-10-01

The maintenance of patient confidentiality is of utmost importance in the doctor patient relationship. With the advent of networks such as the National Health Service Wide Area Network in the UK, the potential to transmit identifiable clinical data will become greater. Links between general practitioners (GPs) and hospitals will allow the rapid transmission of data which if intercepted could be potentially embarrassing to the patient concerned. In 1994 the British Medical Association launched a draft bill on privacy and confidentiality and in association with this bill it is pushing for encryption of all clinical data across electronic networks. The manager's role within an acute hospital, community units and general practice, is to ensure that all employees are aware of the principles of data protection, security of hospital computer systems and that no obvious breaches of security can occur at publicly accessible terminals. Managers must be kept up to date with the latest developments in computer security such as digital signatures and be prepared to instigate these developments where practically possible. Managers must also take responsibility for the monitoring of access to terminals and be prepared to deal severely with staff who breach the code of confidentiality. Each manager must be kept informed of employees status with regard to their 'need to know' clearance level and also to promote confidentiality of patient details throughout the hospital. All of the management team must be prepared to train new staff in the principles of data security as they join the organisation and recognise their accountability if the programme fails. Data security and patient confidentiality is a broad responsibility in any healthcare organisation, with the Chief Executive accountable. In family practice, the partners are responsible and accountable. The British Medical Association believes as a matter of policy, that allowing access to personal health data without the patients consent, except in a legally allowable situation, should be a statutory offence.

Cost-effectiveness of population-level expansion of highly active antiretroviral treatment for HIV in British Columbia, Canada: a modelling study.

PubMed

Nosyk, Bohdan; Min, Jeong E; Lima, Viviane D; Hogg, Robert S; Montaner, Julio S G

2015-09-01

Widespread HIV screening and access to highly active antiretroviral treatment (ART) were cost effective in mathematical models, but population-level implementation has led to questions about cost, value, and feasibility. In 1996, British Columbia, Canada, introduced universal coverage of drug and other health-care costs for people with HIV/AIDS and and began extensive scale-up in access to ART. We aimed to assess the cost-effectiveness of ART scale-up in British Columbia compared with hypothetical scenarios of constrained treatment access. Using comprehensive linked population-level data, we populated a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1997 to 2010. We estimated HIV incidence, prevalence, mortality, costs (in 2010 CAN$), and quality-adjusted life-years (QALYs) for the study period, which was 1997-2010. We calculated incremental cost-effectiveness ratios from societal and third-party-payer perspectives to compare actual practice (true numbers of individuals accessing ART) to scenarios of constrained expansion (75% and 50% probability of accessing ART). We also investigated structural and parameter uncertainty. Actual practice resulted in 263 averted incident cases compared with 75% of observed access and 676 averted cases compared with 50% of observed access to ART. From a third-party-payer perspective, actual practice resulted in incremental cost-effectiveness ratios of $23 679 per QALY versus 75% access and $24 250 per QALY versus 50% access. From a societal perspective, actual practice was cost saving within the study period. When the model was extended to 2035, current observed access resulted in cumulative savings of $25·1 million compared with the 75% access scenario and $65·5 million compared with the 50% access scenario. ART scale-up in British Columbia has decreased HIV-related morbidity, mortality, and transmission. Resulting incremental cost-effectiveness ratios for actual practice, derived within a limited timeframe, were within established cost-effectiveness thresholds and were cost saving from a societal perspective. BC Ministry of Health, National Institute of Drug Abuse at the US National Institutes of Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

Management of medical confidentiality in English professional football clubs: some ethical problems and issues

PubMed Central

Waddington, I; Roderick, M; Bundred, P

2002-01-01

Objective: To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Methods: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. Results: There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Conclusions: Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines. PMID:11916894

Management of medical confidentiality in English professional football clubs: some ethical problems and issues.

PubMed

Waddington, I; Roderick, M

2002-04-01

To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.

GPs' perceptions of workload in England: a qualitative interview study.

PubMed

Croxson, Caroline Hd; Ashdown, Helen F; Hobbs, Fd Richard

2017-02-01

GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. To gather an in-depth understanding of GPs' perceptions and attitudes towards workload. All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Semi-structured, qualitative interviews were conducted. Data were analysed thematically. In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. © British Journal of General Practice 2017.

A generalized linear factor model approach to the hierarchical framework for responses and response times.

PubMed

Molenaar, Dylan; Tuerlinckx, Francis; van der Maas, Han L J

2015-05-01

We show how the hierarchical model for responses and response times as developed by van der Linden (2007), Fox, Klein Entink, and van der Linden (2007), Klein Entink, Fox, and van der Linden (2009), and Glas and van der Linden (2010) can be simplified to a generalized linear factor model with only the mild restriction that there is no hierarchical model at the item side. This result is valuable as it enables all well-developed modelling tools and extensions that come with these methods. We show that the restriction we impose on the hierarchical model does not influence parameter recovery under realistic circumstances. In addition, we present two illustrative real data analyses to demonstrate the practical benefits of our approach. © 2014 The British Psychological Society.

The British Sign Language Versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-Item Scale, and the Work and Social Adjustment Scale

ERIC Educational Resources Information Center

Rogers, Katherine D.; Young, Alys; Lovell, Karina; Campbell, Malcolm; Scott, Paul R.; Kendal, Sarah

2013-01-01

The present study is aimed to translate 3 widely used clinical assessment measures into British Sign Language (BSL), to pilot the BSL versions, and to establish their validity and reliability. These were the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Work and Social Adjustment Scale (WSAS).…

The British National Formulary: Checking, medicines and clinicians.

PubMed

Dickson, Jane

2015-01-01

The British National Formulary underpins the way medical practice is made safe in the UK. Its move from book to digital product has been identified as welcome but with problematic aspects. This chapter describes and investigates the current use of the formulary in order to examine how a rapid, well-targeted project is designed and executed.

Uncomfortable Departments: British Historians of Science and the Importance of Disciplinary Communities

ERIC Educational Resources Information Center

Fyfe, Aileen

2015-01-01

This paper explores issues around disciplinary belonging and academic identity. Historians of science learn to think and practise like historians in terms of research practice, but this paper shows that British historians of science do not think of themselves as belonging to the disciplinary community of historians. They may be confident that they…

What Has "Harry Potter" Done for Me? Children's Reflections on Their "'Potter' Experience"

ERIC Educational Resources Information Center

Dempster, Steve; Oliver, Alice; Sunderland, Jane; Thistlethwaite, Joanne

2016-01-01

This article reports findings from a small-scale focus-group study funded by the British Academy. Drawing on Herbert Marsh and Richard Shavelson's notion of "Academic Self-Concept" and David Barton and Mary Hamilton's view of literacy as context-specific social practices, the authors examine what young British "Harry Potter"…

Judging Risk: Key Determinants in British Domestic Violence Cases

ERIC Educational Resources Information Center

Robinson, Amanda L.; Howarth, Emma

2012-01-01

Data from the largest study to date of the working practices of British victim support workers (known as Independent Domestic Violence Advisors or IDVAs) are used to provide insight into how "risk judgments" are made in cases of domestic violence. Using data from more than 2,000 victims, this study found a convergence between actuarial…

The Cultural Context of Child-Rearing: A Study of Indigenous and British Punjabis.

ERIC Educational Resources Information Center

Dosanjh, J. S.; Ghuman, Paul A. S.

1996-01-01

Used qualitative data to compare child-rearing practices of second-generation Punjabi mothers living in England and those of Punjabis in India using a qualitative analysis. Found that compared to Indian Punjabis, British Punjabis had smaller families, less preference for sons, were less likely to massage and bathe infants traditionally or to…

Illness beliefs and the sociocultural context of diabetes self-management in British South Asians: a mixed methods study.

PubMed

Patel, Neesha R; Chew-Graham, Carolyn; Bundy, Christine; Kennedy, Anne; Blickem, Christian; Reeves, David

2015-05-10

British South Asians have a higher incidence of diabetes and poorer health outcomes compared to the general UK population. Beliefs about diabetes are known to play an important role in self-management, yet little is known about the sociocultural context in shaping beliefs. This study aimed to explore the influence of sociocultural context on illness beliefs and diabetes self-management in British South Asians. A mixed methods approach was used. 67 participants recruited using random and purposive sampling, completed a questionnaire measuring illness beliefs, fatalism, health outcomes and demographics; 37 participants completed a social network survey interview and semi-structured interviews. Results were analysed using SPSS and thematic analysis. Quantitative data found certain social network characteristics (emotional and illness work) were related to perceived concern, emotional distress and health outcomes (p < 0.05). After multivariate analysis, emotional work remained a significant predictor of perceived concern and emotional distress related to diabetes (p < 0.05). Analysis of the qualitative data suggest that fatalistic attitudes and beliefs influences self-management practices and alternative food 'therapies' are used which are often recommended by social networks. Diabetes-related illness beliefs and self-management appear to be shaped by the sociocultural context. Better understanding of the contextual determinants of behaviour could facilitate the development of culturally appropriate interventions to modify beliefs and support self-management in this population.

My career - from a youth training scheme to practice manager.

PubMed

Rickard, Renay

2017-04-01

Renay Rickard is practice manager of Kernow Veterinary Group in Cornwall. Her entry to the veterinary profession was as a veterinary nurse, but her role evolved into a management one as the practice grew into a group. She is president of the Veterinary Practice Management Association. British Veterinary Association.

The ‘Dangerous’ Women of Animal Welfare: How British Veterinary Medicine Went to the Dogs

PubMed Central

Gardiner, Andrew

2014-01-01

This paper examines the turn toward the small companion animal that occurred in British veterinary medicine in the twentieth century. The change in species emphasis is usually attributed to post-war socioeconomic factors, however this explanation ignores the extensive small animal treatment that was occurring outwith the veterinary profession in the interwar period. The success of this unqualified practice caused the veterinary profession to rethink attitudes to small animals (dogs initially, later cats) upon the decline of horse practice. This paper argues that a shift toward seeing the small animal as a legitimate veterinary patient was necessary before the specialty could become mainstream in the post-war years, and that this occurred between the wars as a result of the activities of British animal welfare charities, especially the People's Dispensary for Sick Animals of the Poor. PMID:25067889

Mapping the field of medical sociology: a comparative analysis of journals.

PubMed

Seale, Clive

2008-07-01

A comparative keyword analysis of the content of nine leading journals is used to suggest potential new directions for medical sociology. The major British and American journals in sociology and medical sociology tend to publish authors based in their own countries, contrasting with the internationalism of other social science disciplines relevant to health, although Sociology of Health and Illness is an exception to this. Medical sociology journals on both sides of the Atlantic focus on individual experience more than general sociology journals, which focus more on social systems levels of analysis. While journal contents reveal British medical sociology to be relatively atheoretical when compared with British general sociology journals, American medical sociology appears relatively apolitical on the same comparison with American general journals. American journals of sociology publish more quantitative studies than their British equivalents, more studies concerning race and other social divisions in American society, and less work drawing on social constructionist perspectives or that is engaged with social theory. Analysis of health and health care at societal and global levels and a deeper engagement with the political and public issues that concern non-sociologists represents a possible future for a medical sociology that is internationally relevant and outward looking.

Chiropody/Podiatry: Interprovincial Differences in Profession Formation.

PubMed

Adams, Tracey L

2017-01-01

The regulation of foot health care professionals varies across provinces in Canada. In Ontario, the regulated health profession is chiropody. Chiropodists are foot specialists with a limited scope of practice. In contrast, British Columbia and five other provinces regulate podiatrists, who are highly trained foot physicians with an extensive scope of practice. This article explores the history of chiropody/podiatry in Ontario and British Columbia from the early 1900s through the 1980s in order to understand how professional development in this field took such divergent paths within Canada. In so doing, it not only sheds light on a health practice that has received little scholarly attention, but it also highlights the centrality of inter-professional conflict and state actors' agendas to professional regulatory outcomes.

Adding Human Rights to the Shopping List: British Women's Abolitionist Boycotts as Radical Learning and Practice

ERIC Educational Resources Information Center

Jubas, Kaela

2008-01-01

Working from a feminist/critical cultural studies perspective, which perceives culture and society as imbued with political tensions, I pose two central questions in this article. First, how can community-based, consumer activism be understood as a strategy adopted by marginalised groups to assert rights claims? I focus on British women's…

British Gujarati Indian immigrants' and British Caucasians' beliefs about health and illness.

PubMed

Jobanputra, Rena; Furnham, Adrian

2005-12-01

This study examined cultural differences in beliefs about health and illness to explore differences in younger and older British Caucasians' and British Gujarati Indian immigrants' beliefs about health and illness. This study required a matched group consisting of first- and second-generation Gujarati Indian immigrants and native British Caucasians to complete a questionnaire assessing their beliefs concerning health and illness. Factor analysis of the health beliefs questionnaire identified six clear factors accounting for 36.04% of the variance. Subsequent ANCOVAs conducted on the factor scores, partialling out the demographic differences between the participants, revealed that Gujarati Indian immigrants agreed with items reflecting supernatural explanations of ill health more than indigenous British Caucasian participants. Older Indian immigrants also rated chance-related factors as more important than older Caucasian immigrants. There were no significant differences between the Gujarati Indian immigrants and British Caucasians in terms of attributions made to psychological factors and self-responsibility, social factors and life circumstances, medical treatment and physical vulnerability and the external environment. Findings are discussed in relation to the model proposed by Helman (2001) and the impact of migration on health beliefs systems; practical implications of the findings are also highlighted.

Recent developments in blast furnace process control within British Steel

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warren, P.W.

1995-12-01

British Steel generally operates seven blast furnaces on four integrated works. All furnaces have been equipped with comprehensive instrumentation and data logging computers over the past eight years. The four Scunthorpe furnaces practice coal injection up to 170 kg/tHM (340 lb/THM), the remainder injecting oil at up to 100 kg/tHM (200 lb/THM). Distribution control is effected by Paul Wurth Bell-Less Tops on six of the seven furnaces, and Movable Throat Armour with bells on the remaining one. All have at least one sub burden probe. The blast furnace operator has a vast quantity of data and signals to consider andmore » evaluate when attempting to achieve the objective of providing a consistent supply of hot metal. Techniques have been, and are being, developed to assist the operator to interpret large numbers of signals. A simple operator guidance system has been developed to provide advice, based on current operating procedures and interpreted data. Further development will involve the use of a sophisticated Expert System software shell.« less

A feasibility study for a clinical decision support system prompting HIV testing.

PubMed

Chadwick, D R; Hall, C; Rae, C; Rayment, Ml; Branch, M; Littlewood, J; Sullivan, A

2017-07-01

Levels of undiagnosed HIV infection and late presentation remain high globally despite attempts to increase testing. The objective of this study was to evaluate a risk-based prototype application to prompt HIV testing when patients undergo routine blood tests. Two computer physician order entry (CPOE) systems were modified using the application to prompt health care workers (HCWs) to add an HIV test when other tests selected suggested that the patient was at higher risk of HIV infection. The application was applied for a 3-month period in two areas, in a large London hospital and in general practices in Teesside/North Yorkshire. At the end of the evaluation period, HCWs were interviewed to assess the usability and acceptability of the prompt. Numbers of HIV tests ordered in the general practice areas were also compared before and after the prompt's introduction. The system was found to be both useable and generally acceptable to hospital doctors, general practitioners and nurse practitioners, with little evidence of prompt/alert fatigue. The issue of the prompt appearing late in the patient consultation did lead to some difficulties, particularly around discussion of the test and consent. In the general practices, around 1 in 10 prompts were accepted and there was a 6% increase in testing rates over the 3-month study period (P = 0.169). Using a CPOE-based clinical decision support application to prompt HIV testing appears both feasible and acceptable to HCWs. Refining the application to provide more accurate risk stratification is likely to make it more effective. © 2016 British HIV Association.

Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care.

PubMed

Levene, Louis S; Baker, Richard; Walker, Nicola; Williams, Christopher; Wilson, Andrew; Bankart, John

2018-06-01

Increased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes. To investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors. An observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012-2017 inclusive. Patient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken. Relationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year. The decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics. © British Journal of General Practice 2018.

Managing barriers to empathy in the clinical encounter: a qualitative interview study with GPs.

PubMed

Derksen, Frans Awm; Olde Hartman, Tim C; Bensing, Jozien M; Lagro-Janssen, Antoine Lm

2016-12-01

Current daily general practice has become increasingly technical and somatically oriented (where attention to patients' feelings is decreased) due to an increase in protocol-based guidelines. Priorities in GP-patient communication have shifted from a focus on listening and empathy to task-oriented communication. To explore what barriers GPs experience when applying empathy in daily practice, and how these barriers are managed. Thirty Dutch GPs with sufficient heterogeneity in sex, age, type of practice, and rural or urban setting were interviewed. The consolidated criteria for reporting qualitative research (COREQ) were applied. The verbatim transcripts were then analysed. According to participating GPs, the current emphasis on protocol-driven care can be a significant barrier to genuineness in communication. Other potential barriers mentioned were time pressures and constraints, and dealing with patients displaying 'unruly behaviour' or those with personality disorders. GPs indicated that it can be difficult to balance emotional involvement and professional distance. Longer consulting times, smaller practice populations, and efficient practice organisation were described as practical solutions. In order to focus on a patient-as-person approach, GPs strongly suggested that deviating from guidelines should be possible when necessary as an element of good-quality care. Joining intercollegiate counselling groups was also discussed. In addition to practical solutions for barriers to behaving empathically, GPs indicated that they needed more freedom to balance working with protocols and guidelines, as well as a patient-as-person and patient-as-partner approach. This balance is necessary to remain connected with patients and to deliver care that is truly personal. © British Journal of General Practice 2016.

Work-related homicides among seafarers and fishermen.

PubMed

Roberts, Stephen E

2004-01-01

To analyse work related homicides among various defined populations of seafarers and fishermen during the period 1976-2002, to compare homicide rates with other occupations and general populations, and to discuss implications for maritime health and safety. A longitudinal study of work related homicides, based on official mortality files, with an aggregated population of almost two million seafarer-and fishermen-years at risk. Of 46 work related homicides, 44 occurred among seafarers, and two among fishermen. Homicide rates were 1.5 per 100,000 worker-years among seafarers in British merchant shipping (1976-2002), 2.9 per 100,000 among British seafarers employed in non British shipping (1986-95), 3.7 in Singapore shipping (1984-95) and in Hong Kong shipping (1981-95), and 0.4 among fishermen in British fishing (1976-2002). The homicide rate in British shipping increased from 2.7 per 100,000 seafarer-years in 1961-65 to 4.4 per 100,000 in 1971-75, but has declined to 0.0 in 1996-2002. Although work related homicides were generally quite rare occurrences, among British seafarers and fishermen, they were largely caused by attacks from assailants, other than colleagues, that occurred ashore. The decline in the homicide rate in British shipping since the 1970s has coincided with the reduction in deep-sea ships trading to high risk countries for homicide. Among Asian seafarers, most homicides resulted from disputes among colleagues that mainly occurred on board ships. Prevention should include alertness to potential risks when spending off-duty time ashore in locations with high homicide rates, and conflict resolution for disputes among seafarers.

Classroom Disruption in English Comprehensive Schools.

ERIC Educational Resources Information Center

Dierenfield, Richard B.

A comparative study was made of disruptive behavior in British comprehensive schools and American high schools. A survey was conducted in 41 British schools to obtain the opinions of teachers and administrators on severe discipline problems, causes of disruptive behavior, and possible solutions. There was general agreement that classroom…

Nutrition research in the military.

PubMed

Hill, Neil E; Fallowfield, J L; Delves, S K; Wilson, D R

2014-06-01

Military research performed in an operational environment involves mission-specific considerations. The Institute of Naval Medicine was tasked in 2008 by the Surgeon General to investigate the nutritional status of deployed British military personnel, and how this might affect body composition, physical fitness and operational capability. This paper briefly describes the logistic and technical issues specific to military research that were encountered by the study team, how these issues were overcome and how this research has influenced military practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.

PubMed

Blom, Jeanet; den Elzen, Wendy; van Houwelingen, Anne H; Heijmans, Margot; Stijnen, Theo; Van den Hout, Wilbert; Gussekloo, Jacobijn

2016-01-01

older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

Implications of a Non-Unified Command System and the Need for a Unified Command System in Zambia

DTIC Science & Technology

2015-06-12

vein, it is indicated that the concept of Chief of General Staff would have been advantageous in the development of the Defence Forces had it been well...process. For example, British failures during the Crimean War caused the British to look towards the German General Staff system in effect during the...economic and social development . Nevertheless, any meaningful economic and social development needs to be well protected and anchored upon an effective

Implementing practice management strategies to improve patient care: the EPIC project.

PubMed

Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

2012-01-01

Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

Consistent and Persistent: A Necessary Response to Children Involved in Prostitution.

ERIC Educational Resources Information Center

LeBlanc, L. Suzanne

This document presents a systematic, comparative review of three reports: (1) "Community Consultation on Prostitution in British Columbia: Overview of Results" (released in March 1996 by the Ministry of the Attorney General in British Columbia); (2) "Children Involved in Prostitution" (from Alberta in January 1997); and (3)…

Continuing Education Activities of the University of British Columbia, 1977/1978.

ERIC Educational Resources Information Center

British Columbia Univ., Vancouver.

The 1977-78 annual report on continuing education activities of the University of British Columbia is presented. The provision of continuing education by the university is decentralized. Several administrative units are responsible for credit and noncredit, general and professional continuing education, and professional development. The following…

Sources of information and health beliefs related to SARS and avian influenza among Chinese communities in the United Kingdom and The Netherlands, compared to the general population in these countries.

PubMed

Voeten, Helene A C M; de Zwart, Onno; Veldhuijzen, Irene K; Yuen, Cicely; Jiang, Xinyi; Elam, Gillian; Abraham, Thomas; Brug, Johannes

2009-01-01

Ethnic minorities in Europe such as the Chinese may need a special strategy with regard to risk communication about emerging infectious diseases. To engage them in precautionary actions, it is important to know their information sources, knowledge, and health beliefs. This study's purpose is to study the use of information sources, knowledge, and health beliefs related to SARS and avian flu of Chinese people in the UK and The Netherlands, and to make comparisons with the general population in these countries. Results of a self-administered questionnaire among 300 British/Dutch Chinese were compared to data obtained from a computer-assisted phone survey among the general population (n = 800). British/Dutch Chinese got most information about emerging diseases from family and friends, followed by Chinese media and British/Dutch TV. They had less confidence than general groups in their doctor, government agencies, and consumer/patient interest groups. Their knowledge of SARS was high. They had a lower perceived threat than general populations with regard to SARS and avian flu due to a lower perceived severity. They had higher self-efficacy beliefs regarding SARS and avian flu. In case of new outbreaks of SARS/avian flu in China, local authorities in the UK and The Netherlands can best reach Chinese people through informal networks and British/Dutch TV, while trying to improve confidence in information from the government. In communications, the severity of the disease rather than the susceptibility appears to need most attention.

Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens.

PubMed

Tarlier, Denise S; Browne, Annette J

2011-06-01

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.

Historical thinking in clinical medicine: lessons from R.G. Collingwood's philosophy of history.

PubMed

Chin-Yee, Benjamin H; Upshur, Ross E G

2015-06-01

The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889-1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re-centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient-centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice. © 2015 John Wiley & Sons, Ltd.

Educational Borrowing as Negotiation: Re-Examining the Influence of the American Black Industrial Education Model on British Colonial Education in Africa

ERIC Educational Resources Information Center

Yamada, Shoko

2008-01-01

This study explores the extent to which American educational ideas made an impact on policy-making and practice of education in British African colonies between the two World Wars. The analysis re-examines the apparent "borrowing" of American black industrial education models for application in Africa. It is argued that, while the view…

SunSmart? Skin Cancer Knowledge and Preventive Behaviour in a British Population Representative Sample

ERIC Educational Resources Information Center

Miles, A.; Waller, J.; Hiom, S.; Swanston, D.

2005-01-01

The incidence of skin cancer has risen rapidly in the UK over the last 20 years, prompting public health organizations to try and raise awareness of the dangers of sun exposure and the need to practice sun-safe behaviour. This study aimed to assess baseline levels of sun-safe knowledge and behaviour in a British population-representative sample,…

Surveying the Extent of, and Attitudes Towards, the Use of Prayer as a Spiritual Intervention among British Mainstream Counsellors

ERIC Educational Resources Information Center

Gubi, Peter M.

2004-01-01

A questionnaire was sent to 578 BACP Accredited Counsellors and 122 CMCS Approved Counsellors to survey the use, and attitudes to the use, of prayer as a spiritual intervention in British mainstream counselling. The data reveal that prayer influences the practice of a significant number of mainstream counsellors at a philosophical, a covert and an…

Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England.

PubMed

Davies-Kershaw, Hilary; Petersen, Irene; Nazareth, Irwin; Stevenson, Fiona

2018-04-01

Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. A semi-structured qualitative interview study of GPs working in general practices across England. Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. © British Journal of General Practice 2018.

Wind energy on the horizon in British Columbia. A review and evaluation of the British Columbia wind energy planning framework

NASA Astrophysics Data System (ADS)

Day, Jason

This study examines the wind energy planning frameworks from ten North American jurisdictions, drawing important lessons that British Columbia could use to build on its current model which has been criticized for its limited scope and restriction of local government powers. This study contributes to similar studies conducted by Kimrey (2006), Longston (2006), and Eriksen (2009). This study concludes that inclusion of wind resource zones delineated through strategic environmental assessment, programme assessment, and conducting research-oriented studies could improve the current British Columbia planning framework. The framework should also strengthen its bat impact assessment practices and incorporate habitat compensation. This research also builds upon Rosenberg's (2008) wind energy planning framework typologies. I conclude that the typology utilized in Texas should be employed in British Columbia in order to facilitate utilizing wind power. The only adaptation needed is the establishment of a cross-jurisdictional review committee for project assessment to address concerns about local involvement and site-specific environmental and social concerns.

An exploratory study of image and performance enhancement drug use in a male British South Asian community.

PubMed

Van Hout, Marie Claire; Kean, Joseph

2015-09-01

Consumerism of image and performance enhancement drugs (IPEDs) is a world-wide public health concern. Given anecdotal reporting of increased normalisation of IPED use and uptake of British South Asian male IPED users at UK needle and syringe exchange services, the study aimed to explore use of IPEDs among this under-researched ethnic group. 20 in depth interviews were conducted with a purposive sample of British South Asian males attending harm reduction outreach in the North East of England. The interviews explored motives for use of IPEDs, sourcing routes, information seeking, injecting behaviours and cultural and community sensitivities around IPED use among this group. The data was collected and analysed using the Interpretative Phenomenological Analysis approach (IPA). Motives for use centred on the achievement of enhanced definition and density of muscle, and improved recovery from training and injuries. All participants reported initial stimulation of interest and triggers to seek information on IPEDs due to social media, community and peer messages. Diverse forms of IPED use were described, with rational and moderated use common among older participants. In contrast younger participants adopted more excessive use in seeking short cuts to attaining muscle size. Sourcing of androgenic-anabolic steroids (AAS) and growth hormones from originating countries (Pakistan, India) was reported, along with diversification of entrepreneurial activity into IPED dealing networks. Sellers were generally reported to provide effective and reliable products and mentoring to inexperienced users. Group injecting practices were common. IPED use was observed by some as health promotion medium within religious contexts. Crime deterrence and drug abstinence occurred for some while involved in AAS cycles. The study is intended to contribute to health policy and practice debate around the targeting of dedicated education, outreach and harm reduction for ethnic groups engaged in IPED use. Copyright © 2015 Elsevier B.V. All rights reserved.

The Modern Major General: Patterns in the Careers of the British Army Major Generals on Active Duty at the Time of the Sarajevo Assassinations

DTIC Science & Technology

1980-05-11

Contemptibles." But the slender strength of the "Old Contemptibles" was not equal to the tasks demanded by the War. In the end, the War was won by Kitchener’s new...8 The dangers made evident by the Boer War demanded a broader mission than Secretary of War Edward Stanhope had envisaged in 1891. The British public...a reconstruction of the War Office, they demanded the formation of a general staff. The monthly reviews were filled with sim-1 lar pleas. In 1902 L. S

Comparison of anaesthesia 'Day 1 skills' expectations between veterinary anaesthetists and general practitioners.

PubMed

Duncan, J C; Ross, M; Rhind, S; Clutton, E; Shaw, D J

2015-02-28

Day One Skills (DOS) were introduced by the Royal College of Veterinary Surgeons (RCVS) in 2006 as a guideline for minimum skills required by a veterinary graduate. However, the RCVS anaesthesia DOS are broad and do not specify differences in skills required for different species. The aims of this study were: (1) to determine which anaesthesia skills were considered essential for day one practice by UK-based veterinary practitioners (GPs) and anaesthetists; and (2) to explore current opinions on veterinary undergraduate anaesthesia training. Questionnaires for veterinary GPs (QGPs) and veterinary anaesthetists (QVAs) were developed which asked general information on expectations of anaesthesia skills as well as specific expectations for the common veterinary species. Fifty-five UK-based members of the Association of Veterinary Anaesthetists responded, with a random sample of veterinary practices stratified by UK county generating 234 responses and a convenience sample targeted at more specialist veterinary specialities in the UK generating 161 responses. There was close overall agreement between the two groups of GPs and anaesthetists on essential anaesthesia DOS. However, expectations varied with species-greatest in cats and dogs, lowest in exotics. Many respondents commented that new veterinary graduates lack practical skills and should not be expected to be omnicompetent across all species. In conclusion, anaesthesia undergraduate training should prioritise essential practical DOS. British Veterinary Association.

The Mental Health of British Adults with Intellectual Impairments Living in General Households

ERIC Educational Resources Information Center

Hatton, Chris; Emerson, Eric; Robertson, Janet; Baines, Susannah

2017-01-01

Background: People with intellectual disability or borderline intellectual functioning may have poorer mental health than their peers. The present authors sought to (i) estimate the risk of poorer mental health among British adults with and without intellectual impairments and (ii) estimate the extent to which any between-group differences in…

The Control of Sexuality in the Early British Boy Scouts Movement

ERIC Educational Resources Information Center

Pryke, Sam

2005-01-01

This article looks at the way in which the early (1907-1922) British Boy Scouts movement attempted to control sexuality through archival examination of the organization's preoccupation with preventing masturbation or, as it was generally referred to, "self abuse". Having briefly outlined the origination and nature of the Scouts, it considers why…

General William Slim and the Power of Emotional and Cultural Intelligence in Multinational and Multicultural Operations

DTIC Science & Technology

2015-06-12

including Sikhs, Punjabis , Rajputs, Gurkhas, and Jats to name only a few. Due to its multi-ethnic nature, British officers were required to adapt to the...including Jats, Dogras, Sikhs, Pathans, Rajputs and Punjabi Mussalmen, although a large number of mixed regiments did exist. The British regimental...

The pattern of prescribing of glucose modulating agents for type 2 diabetes in general practices in England 2016/17.

PubMed

Heald, Adrian H; Livingston, Mark; Bien, Zuzanna; Moreno, Gabriela Y C; Laing, Ian; Stedman, Mike

2018-03-14

In the financial year 2016/17 there were 52.0 million items prescribed for diabetes at a total net ingredient cost of £983.7 million - up from 28.9 million prescription items and £572.4 million in 2006/07. Anti-diabetes drugs (British National Formulary section 6.1.2) make up 45.1 per cent of the total £983.7 million net ingredient cost of drugs used in diabetes and account for 72.0 per cent of prescription items for all diabetes prescribing. We examined the way that agents licensed to treat type 2 diabetes were used across GP practices in England in the year 2016/2017. Analysis was at a GP practice level not at the level of patient data. Annual prescribing costs / patient / medication type for monotherapy varied considerable from £11/year for gliclazide and glimepiride to £885/year for Liraglutide. The use of SGLT-2i agents grew strongly at 70% per annum to around 100,000 DDD with prescriptions seen in 95% of GP practices. Liraglutide expenditure (11% of total) was high for a relatively small number of patients (1.3% of Defined Daily Doses), with still significant spend on exenatide. Liraglutide use significantly exceeded that of other glucagon-like peptide-1 (GLP-1) agonists. Our work demonstrates the significant cost of medication to modulate tissue glucose levels in type 2 diabetes and the dominance of some non-generic preparations in terms of number of prescriptions and overall spend. There are some older sulphonylureas in use, which should not generally be prescribed. Regular audit of patient treatment at a general practice level will ensure appropriate targeted use of licensed medications and of their cost effectiveness. © 2018 John Wiley & Sons Ltd.

Proving instruments credible in the early nineteenth century: The British Magnetic Survey and site-specific experimentation

PubMed Central

Goodman, Matthew

2016-01-01

For several decades now, many histories of science have sought to emphasize the important role of instruments and other material objects in the operation of science. Many, too, have been attentive to ideas of space and place and the different geographies which are visible in the historical practice of science. This paper draws on both traditions in its interpretation of a heretofore neglected aspect of Britain's nineteenth-century geomagnetic story: that of the British Magnetic Survey, 1833–38. Far from being a footnote to the more expansive geomagnetic projects then taking place in mainland Europe or to the later British worldwide magnetic scheme, this paper argues that the British Magnetic Survey represents an important instance in which magnetic instruments, their users and their makers, were tested, developed and ultimately proved credible.

Lost to the NHS: a mixed methods study of why GPs leave practice early in England.

PubMed

Doran, Natasha; Fox, Fiona; Rodham, Karen; Taylor, Gordon; Harris, Michael

2016-02-01

The loss of GPs in the early stages of their careers is contributing to the GP workforce crisis. Recruitment in the UK remains below the numbers needed to support the demand for GP care. To explore the reasons why GPs leave general practice early. A mixed methods study using online survey data triangulated with qualitative interviews. Participants were GPs aged <50 years who had left the English Medical Performers List in the last 5 years (2009-2014). A total of 143 early GP leavers participated in an online survey, of which 21 took part in recorded telephone interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis techniques. Reasons for leaving were cumulative and multifactorial. Organisational changes to the NHS have led to an increase in administrative tasks and overall workload that is perceived by GP participants to have fundamentally changed the doctor-patient relationship. Lack of time with patients has compromised the ability to practise more patient-centred care, and, with it, GPs' sense of professional autonomy and values, resulting in diminished job satisfaction. In this context, the additional pressures of increased patient demand and the negative media portrayal left many feeling unsupported and vulnerable to burnout and ill health, and, ultimately, to the decision to leave general practice. To improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced. © British Journal of General Practice 2016.

Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care.

PubMed

Dale, Jeremy; Russell, Rachel; Harkness, Frances; Wilkie, Veronica; Aiello, Matthew

2017-09-01

It has been argued that UK general practice specialist training should be extended to better prepare GPs for the challenges facing 21st-century health care. Evidence is needed to inform how this should occur. To investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice; and its impact on subsequent career development. Semi-structured interviews conducted longitudinally over 2 years augmented by observational data in the West Midlands, England. Participants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants' clinical and academic activities were observed. Data were analysed using a framework approach. Seven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed it was making general practice a more attractive career option for newly qualified doctors. The 1-year fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces with the skills to support service improvement and integration. It appears to be well suited to preparing GPs for portfolio roles, but its wider applicability and impact on NHS service delivery needs further investigation. © British Journal of General Practice 2017.

Increasing awareness of gynaecological cancer symptoms: a GP perspective.

PubMed

Evans, Ruth E C; Morris, Melanie; Sekhon, Mandeep; Buszewicz, Marta; Walter, Fiona M; Waller, Jo; Simon, Alice E

2014-06-01

In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs' views about this type of activity, however, is crucial prior to implementation. To describe GPs' attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. An online survey with a convenience sample recruited from 1860 UK general practices. An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs' lists. Participants could offer additional free text comments which were coded using content analysis. A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. GPs were generally positive about an intervention to improve patients' awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals. © British Journal of General Practice 2014.

A qualitative study in parental perceptions and understanding of SIDS-reduction guidance in a UK bi-cultural urban community.

PubMed

Crane, Denise; Ball, Helen L

2016-01-30

Differences in both Sudden Infant Death Syndrome (SIDS) rates and infant care practices between white British and South Asians in UK are well known, but research has not yet examined how these two groups understand and implement SIDS-reduction guidance. This study aimed to discover how white British and Pakistani mothers in Bradford recall, understand and interpret SIDS-reduction guidance, and to explore whether and how they implement this guidance in caring for their infants. In-depth narrative interviews with 46 mothers (25 white British origin and 21 Pakistani origin) of 8-12 week old infants recruited from the pool of participants enrolled in the 'Born in Bradford' (BiB) cohort study. All mothers were aware of UK SIDS-reduction guidance from leaflets presented to them during antenatal or postnatal interactions with health care providers. Pakistani mothers tended to dismiss the guidance in toto as being irrelevant to their cultural practices; white British mothers dismissed, adapted and adopted aspects of the guidance to suit their preferred parenting decisions and personal circumstances. Many mothers misunderstood or misinterpreted the guidance given and explained their infant care behaviour according to their social and cultural circumstances. Current SIDS reduction information in the UK does not meet the needs of immigrant families, and is easily misinterpreted or misunderstood by mothers from all sections of the community. Tailored information acknowledging cultural differences in infant care practices is vital, as is greater discussion with all mothers about the reasons for SIDS reduction guidance.

The Power of One? Conditions Which Challenge Managerial Professional Development Practices

ERIC Educational Resources Information Center

Hardy, Ian

2014-01-01

This paper draws upon Bourdieu's concepts of habitus, capital and field to better understand and appreciate the conditions which encouraged the productive professional development (PD) practices of one very capable teacher working in a secondary school in the British Midlands. Rather than celebrating this teacher's practices and perspective as…

On the Influence of Grouping Practices on Classroom Teaching

ERIC Educational Resources Information Center

Aydin, Emin; Tugal, Ilker

2005-01-01

The article starts with a historical overview, discusses the arguments for and against ability grouping. It surveys the literature on different practices of grouping that exist in the American and British literature. The study mainly focuses on instructional grouping practices based on ability and on cooperation. It discusses arguments for and…

A cross-cultural comparison of British and Pakistani medical students' understanding of schizophrenia.

PubMed

Furnham, Adrian; Raja, Nazia; Khan, Umar Ali

2008-06-30

This study aimed to compare British, British Pakistani and Native Pakistani (from Pakistan) medical students' beliefs about the manifestation, causes and cures of schizophrenia, prior to any psychiatric training. A total of 305 participants completed a questionnaire on general beliefs about people with schizophrenia, causal explanations concerning the aetiology of schizophrenia and the role of hospitals and society in treating people with schizophrenia. It was predicted that compared with the British and British Pakistanis, the Pakistanis would have more negative beliefs and attitudes, considering people with schizophrenia to be more dangerous and unpredictable; they were also expected to use more superstitious beliefs to explain the cause of schizophrenia and its symptoms; as well as believe more in seeking help from God and faith healers. There was strong evidence to suggest that Pakistanis possessed more negative beliefs and attitudes about people with schizophrenia, but there was no evidence to indicate that Pakistanis believed more in superstitious causal explanations. Pakistanis were more likely to consider seeking help from faith healers, but not God, compared with British Pakistanis and the British. Results confirm previous European-Asian difference in the understanding of the cause, manifestation and cure of schizophrenia. The impact of traditional and Western cultural influences on British Pakistanis is considered.

Needlestick and other potential blood and body fluid exposures among health care workers in British Columbia, Canada.

PubMed

Alamgir, Hasanat; Cvitkovich, Yuri; Astrakianakis, George; Yu, Shicheng; Yassi, Annalee

2008-02-01

Health care workers have high risk of exposure to human blood and body fluids (BBF) from patients in acute care and residents in nursing homes or personal homes. This analysis examined the epidemiology for BBF exposure across health care settings (acute care, nursing homes, and community care). Detailed analysis of BBF exposure among the health care workforce in 3 British Columbian health regions was conducted by Poisson regression modeling, with generalized estimating equations to determine the relative risk associated with various occupations. Acute care had the majority of needlestick, sharps, and splash events with the BBF exposure rate in acute care 2 to 3 times higher compared with nursing home and community care settings. Registered nurses had the highest frequency of needlestick, sharps, and splash events. Laboratory assistants had the highest exposure rates from needlestick injuries and splashes, whereas licensed practical nurses had the highest exposure rate from sharps. Most needlestick injuries (51.3%) occurred at the patient's bedside. Sharps incidents occurred primarily in operating rooms (26.9%) and at the patient's bedside (20.9%). Splashes occurred most frequently at the patient's bedside (46.1%) and predominantly affected the eyes or face/mouth. The majority of needlestick/sharps injuries occurred during use for registered nurses, during disposal for licensed practical nurses, and after disposal for care aides. The high risk of BBF exposure for some occupations indicates there is room for improvement to reduce BBF exposure by targeting high-risk groups for prevention strategies.

Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.

PubMed

Swann, Ruth; McPhail, Sean; Witt, Jana; Shand, Brian; Abel, Gary A; Hiom, Sara; Rashbass, Jem; Lyratzopoulos, Georgios; Rubin, Greg

2018-01-01

Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. Clinical audit of cancer diagnosis in general practices in England. Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15-86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0-27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer. © British Journal of General Practice 2018.

Carboxyhaemoglobin levels and their determinants in older British men.

PubMed

Whincup, Peter; Papacosta, Olia; Lennon, Lucy; Haines, Andrew

2006-07-18

Although there has been concern about the levels of carbon monoxide exposure, particularly among older people, little is known about COHb levels and their determinants in the general population. We examined these issues in a study of older British men. Cross-sectional study of 4252 men aged 60-79 years selected from one socially representative general practice in each of 24 British towns and who attended for examination between 1998 and 2000. Blood samples were measured for COHb and information on social, household and individual factors assessed by questionnaire. Analyses were based on 3603 men measured in or close to (< 10 miles) their place of residence. The COHb distribution was positively skewed. Geometric mean COHb level was 0.46% and the median 0.50%; 9.2% of men had a COHb level of 2.5% or more and 0.1% of subjects had a level of 7.5% or more. Factors which were independently related to mean COHb level included season (highest in autumn and winter), region (highest in Northern England), gas cooking (slight increase) and central heating (slight decrease) and active smoking, the strongest determinant. Mean COHb levels were more than ten times greater in men smoking more than 20 cigarettes a day (3.29%) compared with non-smokers (0.32%); almost all subjects with COHb levels of 2.5% and above were smokers (93%). Pipe and cigar smoking was associated with more modest increases in COHb level. Passive cigarette smoking exposure had no independent association with COHb after adjustment for other factors. Active smoking accounted for 41% of variance in COHb level and all factors together for 47%. An appreciable proportion of men have COHb levels of 2.5% or more at which symptomatic effects may occur, though very high levels are uncommon. The results confirm that smoking (particularly cigarette smoking) is the dominant influence on COHb levels.

Gender and Cultural Differences in Internet Use: A Study of China and the UK

ERIC Educational Resources Information Center

Li, Nai; Kirkup, Gill

2007-01-01

This study investigates differences in use of, and attitudes toward the Internet and computers generally for Chinese and British students, and gender differences in this cross-cultural context. Two hundred and twenty Chinese and 245 British students' responses to a self-report survey questionnaire are discussed. Significant differences were found…

Images of Older People in UK Magazine Advertising: Toward a Typology

ERIC Educational Resources Information Center

Williams, Angie; Wadleigh, Paul Mark; Ylanne, Virpi

2010-01-01

The use of images of older people in the British advertising media has been under-researched to date. Further, previous research in any country has tended to examine such images from an "a priori" framework of general impressions and stereotypes of older people. This study addresses these issues with British consumers' (n = 106)…

Barriers to medication adherence for the secondary prevention of stroke: a qualitative interview study in primary care.

PubMed

Jamison, James; Graffy, Jonathan; Mullis, Ricky; Mant, Jonathan; Sutton, Stephen

2016-08-01

Medications are highly effective at reducing risk of recurrent stroke, but success is influenced by adherence to treatment. Among survivors of stroke and transient ischaemic attack (TIA), adherence to medication is known to be suboptimal. To identify and report barriers to medication adherence for the secondary prevention of stroke/TIA. A qualitative interview study was conducted within general practice surgeries in the East of England, UK. Patients were approached by letter and invited to take part in a qualitative research study. Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence. Key themes were identified using a grounded theory approach. Verbatim quotes describing the themes are presented here. In total, 28 survivors of stroke, including 14 accompanying caregivers and five GPs, were interviewed. Two key themes were identified. Patient level barriers included ability to self-care, the importance people attach to a stroke event, and knowledge of stroke and medication. Medication level barriers included beliefs about medication and beliefs about how pills work, medication routines, changing medications, and regimen complexity and burden of treatment. Patients who have had a stroke are faced with multiple barriers to taking secondary prevention medications in UK general practice. This research suggests that a collaborative approach between caregivers, survivors, and healthcare professionals is needed to address these barriers and facilitate medication-taking behaviour. © British Journal of General Practice 2016.

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic

PubMed Central

2013-01-01

Background Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. Methods The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. Results A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Conclusion Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia. PMID:23927011

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic.

PubMed

Hennius, Bjorn J

2013-08-08

Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia.

Benchmarking and Its Relevance to the Library and Information Sector. Interim Findings of "Best Practice Benchmarking in the Library and Information Sector," a British Library Research and Development Department Project.

ERIC Educational Resources Information Center

Kinnell, Margaret; Garrod, Penny

This British Library Research and Development Department study assesses current activities and attitudes toward quality management in library and information services (LIS) in the academic sector as well as the commercial/industrial sector. Definitions and types of benchmarking are described, and the relevance of benchmarking to LIS is evaluated.…

Prescribing benzodiazepines for noninstitutionalized elderly.

PubMed Central

Thomson, M.; Smith, W. A.

1995-01-01

OBJECTIVE: To describe benzodiazepine prescribing for elderly people living in the community in British Columbia, and to compare such prescribing with an indicator of current guidelines. DESIGN: Descriptive analysis of pharmacy billing data. SETTING: Province of British Columbia. PARTICIPANTS: All elderly persons (age 65 and older) dispensed benzodiazepines by community pharmacies in British Columbia during 1990. MAIN OUTCOME MEASURE: Potentially inappropriate prescriptions were defined by a maximum 2-month limit of 20 diazepam equivalents daily, as determined by the BC Drug Usage Review Program in consultation with experts in the field. Physicians' rates of potentially inappropriate prescribing were determined per 100 benzodiazepine prescriptions written. RESULTS: Almost 24% of elderly people in British Columbia were prescribed benzodiazepines at least once during 1990. Of these, 17.1% were given potentially inappropriate prescriptions. Physicians who prescribed benzodiazepines most frequently had the highest rates of potentially inappropriate prescriptions. CONCLUSION: Prescribing practice does not correspond with our indicator of current guidelines. PMID:7756916

Social space, social class and Bourdieu: health inequalities in British Columbia, Canada.

PubMed

Veenstra, Gerry

2007-03-01

This article adopts Pierre Bourdieu's cultural-structuralist approach to conceptualizing and identifying social classes in social space and seeks to identify health effects of class in one Canadian province. Utilizing data from an original questionnaire survey of randomly selected adults from 25 communities in British Columbia, social (class) groupings defined by cultural tastes and dispositions, lifestyle practices, social background, educational capital, economic capital, social capital and occupational categories are presented in visual mappings of social space constructed by use of exploratory multiple correspondence analysis techniques. Indicators of physical and mental health are then situated within this social space, enabling speculations pertaining to health effects of social class in British Columbia.

Independent extended and supplementary nurse prescribing practice in the UK: a national questionnaire survey.

PubMed

Courtenay, Molly; Carey, Nicola; Burke, Joanna

2007-09-01

Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing. To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing. National questionnaire survey. United Kingdom. A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire. A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development. Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

Learning, Changing and Managing in Mental Health.

ERIC Educational Resources Information Center

Henderson, Jeanette

2001-01-01

Examined factors affecting the application of learning to practice in British mental health services, considering the role of administrators and emphasizing distance education. Data from administrators and health professionals indicated that workers who studied mental health often felt disempowered and isolated when introducing new practice ideas…

Bedside resuscitation of newborns with an intact umbilical cord: Experiences of midwives from British Columbia.

PubMed

Fulton, Colleen; Stoll, Kathrin; Thordarson, Dana

2016-03-01

level 1 evidence supports the practice of delayed cord clamping, and many doctors and midwives consider it routine care when delivering vigorous, term neonates. However, scarce research exists regarding the risks or benefits of delayed cord clamping for infants needing resuscitation with positive pressure ventilation. Nonetheless, some midwives in British Columbia already practice intact cord resuscitation (ICR) at planned home births and in the hospital in order to facilitate delayed cord clamping for infants who need resuscitation. we distributed an online survey to all registered midwives in British Columbia through the Midwives Association of BC between October 22nd and November 13th, 2014. This survey examined how midwives balance a commitment to delayed cord clamping with the need for resuscitation in home and hospital settings. a total of 82 midwives responded to the survey (response rate=35%). Many have practiced ICR (56, 69%). However, the majority (42, 78%) of respondents had only performed this type of resuscitation at planned home births and not in the hospital setting. In both settings, midwives found the ergonomics of resuscitation with an intact cord challenging, but cited a smoother physiologic transition for neonates as their primary reasons for this practice, despite the obstacles. Midwives reported a greater ability to use their delivery equipment to provide stable thermoregulation at the bedside at planned home births during a resuscitation compared with the set up of hospital delivery rooms. although the majority of participants practice ICR at planned home births, very few use this practice in the hospital setting. In the home, ergonomics is the primary obstacle for easily practicing ICR; hospital culture, protocols and lack of training are additional barriers to this practice in the hospital setting. Ergonomics and lack of appropriate set up in the delivery room were also primary obstacles. Midwives expressed a desire to find ways to incorporate ICR into the hospital setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

ADULT EDUCATION AND THE ADOPTION OF INNOVATIONS BY ORCHARDISTS IN THE OKANAGAN VALLEY OF BRITISH COLUMBIA.

ERIC Educational Resources Information Center

MILLERD, FRANK W.; VERNER, COOLIE

THIS STUDY ANALYZED THE GENERAL BEHAVIOR OF ORCHARDISTS IN THE OKANAGAN VALLEY, BRITISH COLUMBIA, AND THE FACTORS RELATED TO ADOPTION OF INNOVATIONS IN THIS SETTING. FIVE PERCENT SAMPLES WERE DRAWN FROM 19 DISTRICTS CONSISTING OF 2,721 ORCHARDS, AND DATA WERE GATHERED BY RESIDENT AGRICULTURISTS. THE DATA WERE ANALYZED BY STAGE IN THE ADOPTION…

A practical Bayesian stepped wedge design for community-based cluster-randomized clinical trials: The British Columbia Telehealth Trial.

PubMed

Cunanan, Kristen M; Carlin, Bradley P; Peterson, Kevin A

2016-12-01

Many clinical trial designs are impractical for community-based clinical intervention trials. Stepped wedge trial designs provide practical advantages, but few descriptions exist of their clinical implementational features, statistical design efficiencies, and limitations. Enhance efficiency of stepped wedge trial designs by evaluating the impact of design characteristics on statistical power for the British Columbia Telehealth Trial. The British Columbia Telehealth Trial is a community-based, cluster-randomized, controlled clinical trial in rural and urban British Columbia. To determine the effect of an Internet-based telehealth intervention on healthcare utilization, 1000 subjects with an existing diagnosis of congestive heart failure or type 2 diabetes will be enrolled from 50 clinical practices. Hospital utilization is measured using a composite of disease-specific hospital admissions and emergency visits. The intervention comprises online telehealth data collection and counseling provided to support a disease-specific action plan developed by the primary care provider. The planned intervention is sequentially introduced across all participating practices. We adopt a fully Bayesian, Markov chain Monte Carlo-driven statistical approach, wherein we use simulation to determine the effect of cluster size, sample size, and crossover interval choice on type I error and power to evaluate differences in hospital utilization. For our Bayesian stepped wedge trial design, simulations suggest moderate decreases in power when crossover intervals from control to intervention are reduced from every 3 to 2 weeks, and dramatic decreases in power as the numbers of clusters decrease. Power and type I error performance were not notably affected by the addition of nonzero cluster effects or a temporal trend in hospitalization intensity. Stepped wedge trial designs that intervene in small clusters across longer periods can provide enhanced power to evaluate comparative effectiveness, while offering practical implementation advantages in geographic stratification, temporal change, use of existing data, and resource distribution. Current population estimates were used; however, models may not reflect actual event rates during the trial. In addition, temporal or spatial heterogeneity can bias treatment effect estimates. © The Author(s) 2016.

Personal Transferable Skills in Higher Education: The Problems of Implementing Good Practice.

ERIC Educational Resources Information Center

Drummond, Ian; Nixon, Iain; Wiltshire, John

1998-01-01

Promotion of effective development of personal transferable skills has had limited success in British higher education. Difficulties inherent in implementing established good practice include institutional inertia, issues of academic freedom, resources, high levels of commitment to a particular discipline, and modularization. (SK)

Use of text messaging in general practice: a mixed methods investigation on GPs' and patients' views.

PubMed

Leahy, Dorothy; Lyons, Aoife; Dahm, Matthias; Quinlan, Diarmuid; Bradley, Colin

2017-11-01

Text messaging has become more prevalent in general practice as a tool with which to communicate with patients. The main objectives were to assess the extent, growth, and perceived risks and benefits of text messaging by GPs to communicate with patients, and assess patients' attitudes towards receiving text messages from their GP. A mixed methods study, using surveys, a review, and a focus group, was conducted in both urban and rural practices in the south-west of Ireland. A telephone survey of 389 GPs was conducted to ascertain the prevalence of text messaging. Subsequently, the following were also carried out: additional telephone surveys with 25 GPs who use text messaging and 26 GPs who do not, a written satisfaction survey given to 78 patients, a review of the electronic information systems of five practices, and a focus group with six GPs to ascertain attitudes towards text messaging. In total, 38% ( n = 148) of the surveyed GPs used text messaging to communicate with patients and 62% ( n = 241) did not. Time management was identified as the key advantage of text messaging among GPs who used it (80%; n = 20) and those who did not (50%; n = 13). Confidentiality was reported as the principal concern among both groups, at 32% ( n = 8) and 69% ( n = 18) respectively. Most patients (99%; n = 77) were happy to receive text messages from their GP. The GP focus group identified similar issues and benefits in terms of confidentiality and time management. Data were extracted from the IT systems of five consenting practices and the number of text messages sent during the period from January 2013 to March 2016 was generated. This increased by 40% per annum. Collaborative efforts are required from relevant policymakers to address data protection and text messaging issues so that GPs can be provided with clear guidelines to protect patient confidentiality. © British Journal of General Practice 2017.

National citation patterns of NEJM, The Lancet, JAMA and The BMJ in the lay press: a quantitative content analysis

PubMed Central

Rius, Roser

2017-01-01

Objectives To analyse the total number of newspaper articles citing the four leading general medical journals and to describe national citation patterns. Design Quantitative content analysis. Setting/sample Full text of 22 general newspapers in 14 countries over the period 2008–2015, collected from LexisNexis. The 14 countries have been categorised into four regions: the USA, the UK, Western World (European countries other than the UK, and Australia, New Zealand and Canada) and Rest of the World (other countries). Main outcome measure Press citations of four medical journals (two American: NEJM and JAMA; and two British: The Lancet and The BMJ) in 22 newspapers. Results British and American newspapers cited some of the four analysed medical journals about three times a week in 2008–2015 (weekly mean 3.2 and 2.7 citations, respectively); the newspapers from other Western countries did so about once a week (weekly mean 1.1), and those from the Rest of the World cited them about once a month (monthly mean 1.1). The New York Times cited above all other newspapers (weekly mean 4.7). The analysis showed the existence of three national citation patterns in the daily press: American newspapers cited mostly American journals (70.0% of citations), British newspapers cited mostly British journals (86.5%) and the rest of the analysed press cited more British journals than American ones. The Lancet was the most cited journal in the press of almost all Western countries outside the USA and the UK. Multivariate correspondence analysis confirmed the national patterns and showed that over 85% of the citation data variability is retained in just one single new variable: the national dimension. Conclusion British and American newspapers are the ones that cite the four analysed medical journals more often, showing a domestic preference for their respective national journals; non-British and non-American newspapers show a common international citation pattern. PMID:29133334

Inequalities in immunisation and breast feeding in an ethnically diverse urban area: cross-sectional study in Manchester, UK.

PubMed

Baker, Deborah; Garrow, Adam; Shiels, Christopher

2011-04-01

To examine inequalities in immunisation and breast feeding by ethnic group and their relation to relative deprivation. Cross-sectional study. Manchester, UK. 20 203 children born in Manchester (2002-2007), who had been coded as of white, mixed, Indian, Pakistani, Bangladeshi and black or black British ethnicity in the Child Health System database. Breast feeding at 2 weeks post partum; uptake of triple vaccine (diphtheria, pertussis and tetanus) at 16 weeks post partum; uptake of the measles, mumps and rubella vaccine (MMR) by the age of 2. Black or black British infants had the highest rates of breast feeding at 2 weeks post partum (89%), and South Asian infants had the highest triple and MMR vaccination rates (Indian, 95%, 96%; Pakistani 95%, 95%; Bangladeshi 96%, 95%) after area level of deprivation, parity, parenthood status and age had been controlled for. White infants were least likely to be breast fed at 2 weeks post partum (36%), and to be vaccinated with triple (92%) and MMR vaccines (88%). Within the white ethnic group, lower percentages of immunisation and breast feeding were significantly associated with living in a deprived area and with increasing parity. This was not found within black or black British and Pakistani ethnic groups. Practices that are protective of child health were consistently less likely to be adopted by white mothers living in deprived areas. Methods of health education and service delivery that are designed for the general population are unlikely to be successful in this context, and evidence of effective interventions needs to be established.

Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey.

PubMed

Burt, Jenni; Lloyd, Cathy; Campbell, John; Roland, Martin; Abel, Gary

2016-01-01

Doctor-patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor-patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. To determine how reported GP-patient communication varies between patients from different ethnic groups, stratified by age and gender. Analysis of data from the English GP Patient Survey from 2012-2013 and 2013-2014, including 1,599,801 responders. A composite score was created for doctor-patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP-patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor-patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as 'Any other white'. The identification of groups with particularly marked differences in experience of GP-patient communication--older, female, Asian patients and younger 'Any other white' patients--underlines the need for a renewed focus on quality of care for these groups. © British Journal of General Practice 2016.

The legacy of Michael Balint.

PubMed

Johnson, Alan H; Brock, Clive D; Zacarias, Ashleigh

2014-01-01

Michael Balint's lead article, "Repeat Prescription Patients: Are They An Identifiable Group?" inaugurated the first issue of Psychiatry in Medicine, Vol. 1, No. 1, 1970. A few years later, this Journal would be renamed International Journal of Psychiatry in Medicine (IJPM). Who is this author of over 165 papers, 10 books, practicing psychoanalyst from 1926 to 1970, director of the Budapest Psychoanalytic Institute from 1935 to 1939, consultant at the Tavistock Clinic from 1948 to 1961, President of the British Psycho-Analytical Society from 1968 to 1970, literary executor of Sandor Ferenczi, a foremost theorist of object relations, and international educator and statesman for general practitioners? We would like to review for you some of the formative experiences in Michael's life that wedded psychoanalysis and general practice, and how they contributed to his major educational commitment over 40 years to furthering the understanding and integration of psychosocial factors in the practice of primary healthcare as experienced by doctors all over the world. We would also like to highlight some of his major insights and see to what extent they are incorporated in contemporary medical education and practice. We believe that some of his major insights have been neglected and others have been further amplified and extended. Our intention is to speak not only to medical students who desire to pursue medicine related directly to patient care but as well to seasoned practitioners who continue on a daily basis to care for individual patients and their families.

Usual medical treatments or levonorgestrel-IUS for women with heavy menstrual bleeding: long-term randomised pragmatic trial in primary care.

PubMed

Kai, Joe; Middleton, Lee; Daniels, Jane; Pattison, Helen; Tryposkiadis, Konstantinos; Gupta, Janesh

2016-12-01

Heavy menstrual bleeding (HMB) is a common, chronic problem affecting women and health services. However, long-term evidence on treatment in primary care is lacking. To assess the effectiveness of commencing the levonorgestrel-releasing intrauterine system (LNG-IUS) or usual medical treatments for women presenting with HMB in general practice. A pragmatic, multicentre, parallel, open-label, long term, randomised controlled trial in 63 primary care practices across the English Midlands. In total, 571 women aged 25-50 years, with HMB were randomised to LNG-IUS or usual medical treatment (tranexamic/mefenamic acid, combined oestrogen-progestogen, or progesterone alone). The primary outcome was the patient reported Menorrhagia Multi-Attribute Scale (MMAS, measuring effect of HMB on practical difficulties, social life, psychological and physical health, and work and family life; scores from 0 to 100). Secondary outcomes included surgical intervention (endometrial ablation/hysterectomy), general quality of life, sexual activity, and safety. At 5 years post-randomisation, 424 (74%) women provided data. While the difference between LNG-IUS and usual treatment groups was not significant (3.9 points; 95% confidence interval = -0.6 to 8.3; P = 0.09), MMAS scores improved significantly in both groups from baseline (mean increase, 44.9 and 43.4 points, respectively; P<0.001 for both comparisons). Rates of surgical intervention were low in both groups (surgery-free survival was 80% and 77%; hazard ratio 0.90; 95% CI = 0.62 to 1.31; P = 0.6). There was no difference in generic quality of life, sexual activity scores, or serious adverse events. Large improvements in symptom relief across both groups show treatment for HMB can be successfully initiated with long-term benefit and with only modest need for surgery. © British Journal of General Practice 2016.

Performing Academic Practice: Using the Master Class to Build Postgraduate Discursive Competences

ERIC Educational Resources Information Center

Baerenholdt, Jorgen Ole; Gregson, Nicky; Everts, Jonathan; Granas, Brynhild; Healey, Ruth L.

2010-01-01

How can we find ways of training PhD students in academic practices, while reflexively analysing how academic practices are performed? The paper's answer to this question is based on evaluations from a British-Nordic master class. The paper discusses how master classes can be used to train the discursive skills required for academic discussion,…

Addressing the crisis of GP recruitment and retention: a systematic review.

PubMed

Marchand, Catherine; Peckham, Stephen

2017-04-01

The numbers of GPs and training places in general practice are declining, and retaining GPs in their practices is an increasing problem. To identify evidence on different approaches to retention and recruitment of GPs, such as intrinsic versus extrinsic motivational determinants. Synthesis of qualitative and quantitative research using seven electronic databases from 1990 onwards (Medline, Embase, Cochrane Library, Health Management Information Consortium [HMIC], Cumulative Index to Nursing and Allied Health Literature (Cinahl), PsycINFO, and the Turning Research Into Practice [TRIP] database). A qualitative approach to reviewing the literature on recruitment and retention of GPs was used. The studies included were English-language studies from Organisation for Economic Cooperation and Development countries. The titles and abstracts of 138 articles were reviewed and analysed by the research team. Some of the most important determinants to increase recruitment in primary care were early exposure to primary care practice, the fit between skills and attributes, and a significant experience in a primary care setting. Factors that seemed to influence retention were subspecialisation and portfolio careers, and job satisfaction. The most important determinants of recruitment and retention were intrinsic and idiosyncratic factors, such as recognition, rather than extrinsic factors, such as income. Although the published evidence relating to GP recruitment and retention is limited, and most focused on attracting GPs to rural areas, the authors found that there are clear overlaps between strategies to increase recruitment and retention. Indeed, the most influential factors are idiosyncratic and intrinsic to the individuals. © British Journal of General Practice 2017.

Harnessing the Power of Difference: Colonialism and British Chronic Disease Research, 1940–1975

PubMed Central

Moore, Martin D.

2016-01-01

Abstract Recent studies of post-war chronic disease epidemiology have generally focused on the histories of research in the USA and UK. Using the archival records of a major British funding body, the Colonial Medical Research Committee and its successor the Tropical Medical Research Board, this article demonstrates the advantages of bringing a post-colonial analytic to this historiography. It highlights how the administrative and medical interests in population difference at the centre of the new epidemiology came to map onto political apparatus initially created to know, reform and govern colonial subjects. Although detached from imperial aims, British medical scientists nonetheless attached value to colonial populations on the basis of British benefit and turned various sites into laboratories to extract it. This relationship did not die with the end of imperial rule. British scientists continued to pursue chronic disease epidemiology in former colonies well into the post-war period, informing debates about Britain's own public health concerns. PMID:28751816

Harnessing the Power of Difference: Colonialism and British Chronic Disease Research, 1940-1975.

PubMed

Moore, Martin D

2016-05-01

Recent studies of post-war chronic disease epidemiology have generally focused on the histories of research in the USA and UK. Using the archival records of a major British funding body, the Colonial Medical Research Committee and its successor the Tropical Medical Research Board, this article demonstrates the advantages of bringing a post-colonial analytic to this historiography. It highlights how the administrative and medical interests in population difference at the centre of the new epidemiology came to map onto political apparatus initially created to know, reform and govern colonial subjects. Although detached from imperial aims, British medical scientists nonetheless attached value to colonial populations on the basis of British benefit and turned various sites into laboratories to extract it. This relationship did not die with the end of imperial rule. British scientists continued to pursue chronic disease epidemiology in former colonies well into the post-war period, informing debates about Britain's own public health concerns.

Think Locally, Act Globally? The Transnationalization of Canadian Resource-Use Conflicts.

ERIC Educational Resources Information Center

Barker, Mary L.; Soyez, Dietrich

1994-01-01

Describes the reversal of the strategy to "think globally, act locally," whereby environmentalists and indigenous peoples of Canada, protesting environmentally unsound practices, have taken their protests to the countries most related to those practices. Issues discussed include logging in British Columbia, the James Bay hydroelectric…

Level Descriptions and Teacher Assessment in England: Towards a Community of Assessment Practice.

ERIC Educational Resources Information Center

Hall, Kathy; Harding, Austin

2002-01-01

Interviews with 48 British elementary teachers and assessment coordinators about level descriptions to evaluate students (summary statements of performance on the National Curriculum) found that communities of assessment practice have developed within schools but not more widely. Factors inhibiting growth include lesser status of teacher…

Work-Life Balance: Beyond the Rhetoric. IES Report.

ERIC Educational Resources Information Center

Kodz, J.; Harper, H.; Dench, S.

The current status of British policy and practice related to work-life balance was examined through case studies of six organizations identified as having well-developed work-life balance and flexible working practices. Interviews were conducted with human resource (HR) managers at all six organizations, and interviews and focus group discussions…

The European Engineer: A British Civil Engineering Viewpoint.

ERIC Educational Resources Information Center

Fleming, George

1988-01-01

Confronts the problems of defining the European Engineer in terms of educational and practical training. Analyzes the supply and demand requirements of engineering management and practice. Compares these analyses with conditions in the United States. Gives details of the educational process in a number of European countries. (CW)

Towards Distributed Leadership as Standards-Based Practice in British Columbia

ERIC Educational Resources Information Center

Cherkowski, Sabre; Brown, Willow

2013-01-01

This narrative study of four BC principals was an initial investigation of distributed leadership using their provincial leadership standards as an organizing framework. The researchers invited participants to describe their understanding and practice of distributed leadership in terms of the Standards. Findings revealed three themes, or sets of…

Getting the Best Out of Your Competencies.

ERIC Educational Resources Information Center

Strebler, Marie; And Others

A study explored practical issues in the use of competencies in performance review and in assessment and measurement of competencies by eight leading British employers at different stages in their use of competencies. The practices of 5 organizations using competencies for performance review of their managers were evaluated through feedback from…

Language Teachers Making Sense of Exploratory Practice

ERIC Educational Resources Information Center

Hanks, Judith

2015-01-01

This article critically examines the implementation of Exploratory Practice in an English for academic purposes (EAP) context in a British university. The innovation involved challenges as well as opportunities for uniting learning, teaching and research. Particular emphasis is given to two teachers, who are the focus of this article: the story of…

Trends in oropharyngeal and oral cavity cancer incidence of human papillomavirus (HPV)-related and HPV-unrelated sites in a multicultural population: the British Columbia experience.

PubMed

Auluck, Ajit; Hislop, Greg; Bajdik, Chris; Poh, Catherine; Zhang, Lewei; Rosin, Miriam

2010-06-01

There is a growing recognition of the involvement of human papilloma virus infection in the etiology of head and neck cancers at some sites, mainly the base of the tongue, tonsils, and other oropharynx (hereafter termed oropharyngeal cancer). Other oral sites (hereafter termed oral cavity cancer [OCC]) show a stronger association with tobacco and alcohol. Little is known about the ethnic variation in incidence for these cancers. This study determined incidence rates of OCC and oropharyngeal cancer among South Asian, Chinese, and the general population in British Columbia, Canada. Patients with OCC and oropharyngeal cancer diagnosed from 1980 to 2006 were identified through the British Columbia cancer registry, and surname lists were used to establish ethnicity. Age-adjusted incidence rates were determined for these cancers by sex, topographical site, and ethnicity, and temporal trends were examined. Age-adjusted incidence rates have been decreasing for OCC and increasing for oropharyngeal cancer in the general population for both sexes, with men having higher incidence rates than women. Ethnic differences were found, with the highest age-adjusted incidence rates for OCC for men in South Asians and for women in Chinese, and with the highest age-adjusted incidence rates for oropharyngeal cancer for men in Chinese and for women in the general population. Differences were also found for OCC topographical sites by sex and ethnicity. The incidence of oropharyngeal cancer has now surpassed OCC in the British Columbia male population. Ethnic minorities are at higher risk than the general population for both OCC and oropharyngeal cancer for men, and for OCC for women. (c) 2010 American Cancer Society.

Survivors in a Male Preserve: A Study of British Women Academics' Experiences and Perceptions of Discrimination in a UK University.

ERIC Educational Resources Information Center

Bagilhole, Barbara

1993-01-01

A study of 43 British women university faculty suggested that, in general, women faculty are small minorities, feel isolated and excluded, feel their authority challenged by male students, and pressure themselves to perform better than men. Women faculty tend to have fewer support systems, role models or mentors, and have difficulty with work…

Managing Discourse in Intercultural Business Email Interactions: A Case Study of a British and Italian Business Transaction

ERIC Educational Resources Information Center

Incelli, Ersilia

2013-01-01

This paper investigates native speaker (NS) and non-native speaker (NNS) interaction in the workplace in computer-mediated communication (CMC). Based on empirical data from a 10-month email exchange between a medium-sized British company and a small-sized Italian company, the general aim of this study is to explore the nature of the intercultural…

Virtual reality: A new track in psychological research.

PubMed

de la Rosa, Stephan; Breidt, Martin

2018-05-10

One major challenge of social interaction research is to achieve high experimental control over social interactions to allow for rigorous scientific reasoning. Virtual reality (VR) promises this level of control. Pan and Hamilton guide us with a detailed review on existing and future possibilities and challenges of using VR for social interaction research. Here, we extend the discussion to methodological and practical implications when using VR. © 2018 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

British media attacks on homeopathy: are they justified?

PubMed

Vithoulkas, George

2008-04-01

Homeopathy is being attacked by the British media. These attacks draw support from irresponsible and unjustified claims by certain teachers of homeopathy. Such claims include the use of 'dream' and 'imaginative' methods for provings. For prescribing some such teachers attempt to replace the laborious process of matching symptom picture and remedy with spurious theories based on 'signatures', sensations and other methods. Other irresponsible claims have also been made. These "new ideas" risk destroying the principles, theory, and practice of homeopathy.

British sociology and public intellectuals: consumer society and imperial decline.

PubMed

Turner, Bryan S

2006-06-01

The following is the lecture given for the BJS 2005 Public Sociology Debate given at the London School of Economics and Political Science on ll October 2005. This lecture on the character of British sociology provides a pretext for a more general inquiry into public intellectual life in postwar Britain. The argument put forward falls into several distinctive sections. First, British social science has depended heavily on the migration of intellectuals, especially Jewish intellectuals who were refugees from fascism. Second, intellectual innovation requires massive, disruptive, violent change. Third, British sociology did nevertheless give rise to a distinctive tradition of social criticism in which one can argue there were (typically home-grown) public intellectuals. The main theme of their social criticism was to consider the constraining and divisive impact of social class, race and gender on the enjoyment of expanding social citizenship. Fourth, postwar British sociology came to be dominated by the analysis of an affluent consumer society. Finally, the main failure of British sociology in this postwar period was the absence of any sustained, macro-sociological analysis of the historical decline of Britain as a world power in the twentieth century.

Randomised controlled trial of a brief intervention targeting predominantly non-verbal communication in general practice consultations.

PubMed

Little, Paul; White, Peter; Kelly, Joanne; Everitt, Hazel; Mercer, Stewart

2015-06-01

The impact of changing non-verbal consultation behaviours is unknown. To assess brief physician training on improving predominantly non-verbal communication. Cluster randomised parallel group trial among adults aged ≥16 years attending general practices close to the study coordinating centres in Southampton. Sixteen GPs were randomised to no training, or training consisting of a brief presentation of behaviours identified from a prior study (acronym KEPe Warm: demonstrating Knowledge of the patient; Encouraging [back-channelling by saying 'hmm', for example]; Physically engaging [touch, gestures, slight lean]; Warm-up: cool/professional initially, warming up, avoiding distancing or non-verbal cut-offs at the end of the consultation); and encouragement to reflect on videos of their consultation. Outcomes were the Medical Interview Satisfaction Scale (MISS) mean item score (1-7) and patients' perceptions of other domains of communication. Intervention participants scored higher MISS overall (0.23, 95% confidence interval [CI] = 0.06 to 0.41), with the largest changes in the distress-relief and perceived relationship subscales. Significant improvement occurred in perceived communication/partnership (0.29, 95% CI = 0.09 to 0.49) and health promotion (0.26, 95% CI = 0.05 to 0.46). Non-significant improvements occurred in perceptions of a personal relationship, a positive approach, and understanding the effects of the illness on life. Brief training of GPs in predominantly non-verbal communication in the consultation and reflection on consultation videotapes improves patients' perceptions of satisfaction, distress, a partnership approach, and health promotion. © British Journal of General Practice 2015.

The British and curriculum development in West Africa: A historical discourse

NASA Astrophysics Data System (ADS)

Ofori-Attah, Kwabena Dei

2006-09-01

THE BRITISH AND CURRICULUM DEVELOPMENT IN WEST AFRICA: A HISTORICAL STUDY - Only recently have African nations begun to make their way towards establishing genuinely autonomous education systems incorporating elements of indigenous culture. The present study examines the historical development of curriculum in British West Africa in its links with the educational activities of the early Christian missionaries and the imposition of British colonial rule. For over 300 years, the curriculum content was essentially European in nature. African interests and cultural practices were largely excluded, as "bookwork" was favored over "handwork". The colonial curriculum also helped introduce a new social order to West Africa, leading to the rise of new local elites reading, writing, and speaking foreign European languages. This study explores how the idea of a "civilized" person, promoted through the colonial school curriculum, developed new local elites with different sets of values and expectations that often made them strangers in their own societies. It also describes the connection between this curriculum and the repeated failure of education-reform efforts.

Images of welfare in law and society: the British welfare state in comparative perspective.

PubMed

Wincott, Daniel

2011-01-01

Designed by Beveridge and built by Attlee's post-war Labour government, the welfare state was created during the 1940s. Britain has been seen – in domestic debates and internationally – as a world first: the place where both the idea and the practice of the welfare state were invented. I draw together comparative welfare state analysis with law and society scholarship (previously largely developed in isolation from one another) – as well as using British political cartoons as a source – to develop a revisionist historical critique of this conventional wisdom. First, the British welfare state has always been comparatively parsimonious. Second, the idea of the welfare state seems to have its origins outside the United Kingdom and this terminology was adopted relatively late and with some ambivalence in public debate and scholarly analysis. Third, a large body of socio-legal scholarship shows that robust ‘welfare rights’ were never embedded in the British ‘welfare state’.

Dispensers, obeah and quackery: medical rivalries in post-slavery British Guiana.

PubMed

De Barros, Juanita

2007-08-01

This paper examines the ambiguous place of medical assistants-dispensers-in a post-slavery British Caribbean colony, British Guiana, from the end of slavery in the 1830s to the early twentieth century. Although the latter were crucial to the functioning of the colonial medical system, local physicians resented them, complaining about the economic threat they posed and at times condemning them as quacks. These attacks were part of a wider discussion about the composition of the medical profession and the role of medical auxiliaries in colonial society, and to an extent, they echoed debates conducted in other jurisdictions in this period. But in the British Caribbean, this discussion was significantly different. There, long-standing views about obeah-an Afro-Creole medico-religious practice-as a particularly dangerous and uncivilised type of quackery was part of the discursive context. That those participating in this debate included African-descended physicians whose arrival in the medical profession was recent and contested demonstrates the vexed and complex nature of professionalisation in a post-slavery society.

What impact do questionnaire length and monetary incentives have on mailed health psychology survey response?

PubMed

Robb, Kathryn A; Gatting, Lauren; Wardle, Jane

2017-11-01

Response rates to health-related surveys are declining. This study tested two strategies to improve the response rate to a health psychology survey mailed through English general practices: (1) sending a shortened questionnaire and (2) offering a monetary incentive to return a completed questionnaire. Randomized controlled trial. Adults (n = 4,241) aged 45-59 years, from four General Practices in South-East England, were mailed a survey on attitudes towards bowel cancer screening. Using a 2 × 4 factorial design, participants were randomized to receive a 'short' (four A4 pages) or a 'long' (seven A4 pages) questionnaire, and one of four monetary incentives to return a completed questionnaire - (1) no monetary incentive, (2) £2.50 shop voucher, (3) £5.00 shop voucher, and (4) inclusion in a £250 shop voucher prize draw. Age, gender, and area-level deprivation were obtained from the General Practices. The overall response rate was 41% (n = 1,589). Response to the 'short' questionnaire (42%) was not significantly different from the 'long' questionnaire (40%). The £2.50 incentive (43%) significantly improved response rates in univariate analyses, and remained significant after controlling for age, gender, area-level deprivation, and questionnaire length. The £5.00 (42%) and £250 prize draw (41%) incentives had no significant impact on response rates compared to no incentive (38%). A small monetary incentive (£2.50) may slightly increase response to a mailed health psychology survey. The length of the questionnaire (four pages vs. seven pages) did not influence response. Although frequently used, entry into a prize draw did not increase response. Achieving representative samples remains a challenge for health psychology. Statement of contribution What is already known on this subject Response rates to mailed questionnaires continue to decline, threatening the representativeness of data. Prize draw incentives are frequently used but there is little evidence to support their efficacy. Research on interactions between incentives, questionnaire length, and demographics is lacking. What does this study add Contrary to previous findings, questionnaire length did not influence response rate. A £2.50 incentive increased response, while incentives of £5.00 and a £250 prize draw did not. Achieving representative samples to questionnaires remains a challenge for health psychology. © 2017 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Report and Recommendations of the British Columbia Teacher's Federation's (BCTF) Task Force on First Nations Education to the Annual General Meeting (January 1999). (Revised Annotated Version).

ERIC Educational Resources Information Center

British Columbia Teachers' Federation, Vancouver.

In 1998, the British Columbia Teachers' Federation (BCTF) appointed an eight-member task force to investigate the effectiveness of the education system for First Nations students. The task force report and recommendations are intended to serve several groups of Aboriginal students: First Nations students, with or without status under Canada's…

The Income Generation Handbook: A Practical Guide for Educational Institutions.

ERIC Educational Resources Information Center

Warner, David; Leonard, Charles

This book sets out the British policy context and theoretical framework for income generation by institutions of higher education and provides practical guidance in this area. Income generation is defined as all income generated over and above the core funding provided by an institution's primary funding body. Chapter 1 offers an overview of…

Multicultural Integration in British and Dutch Societies: Education and Citizenship

ERIC Educational Resources Information Center

Bagley, Christopher Adam; Al-Refai, Nader

2017-01-01

Purpose: The purpose of this paper is to review and synthesize published studies and practice in the "integration" of ethnic and religious minorities in Britain and The Netherlands, 1965-2015, drawing out implications for current policy and practice. Design/methodology/approach: This paper is an evaluative review and report of results of…

Religious Diversity and Inclusion: Policy and Accommodation Practices in British Columbia's Secular School System

ERIC Educational Resources Information Center

Jacquet, Marianne; D'Amico, Laura

2016-01-01

The religious diversity of students and staff within a secular school system may sometimes create tensions. To better understand the possible issues generated by and practical accommodations made with respect to these tensions, interviews were conducted at the district level with key administrators in metropolitan school districts in British…

The Rise of Applied Geography.

ERIC Educational Resources Information Center

Philpponneau, Michel

1981-01-01

Presents an historical overview of the use of the science of geography for practical purposes. Topics discussed include British schools of geography during the 19th century, contributions of many of the founders of applied geography, forms in which geographical work can be used for practical purposes, and the status of applied geography in various…

Performance Management in Education: Improving Practice. British Educational Management Series.

ERIC Educational Resources Information Center

Reeves, Jenny; Forde, Christine; O'Brien, Jim; Smith, Pauline; Tomlinson, Harry

This book explores managing the performance of education staff in England and Wales and in Scotland. It compares the different policies of performance management as practiced in England and Wales and in Scotland. (The Scottish system of education is independent of that of England and Wales.) Chapter 1 provides an introduction to performance…

Children, Child Abuse and Child Protection: Placing Children Centrally.

ERIC Educational Resources Information Center

1999

This book provides an overview of the political, moral, and social context within which British child welfare practitioners and managers attempt to work with children, families, and others. The book reviews the development of improved policy and practices in child protection. Placing children at the center of policy, practice, and discourse, it…

Hijama therapy (wet cupping) - its potential use to complement British healthcare in practice, understanding, evidence and regulation.

PubMed

Sajid, Mohammed Imran

2016-05-01

Wet cupping was used in the nineteenth century for treatment of patients in the United Kingdom (UK) by a few experienced practitioners. Revival Hijama use by practitioners in the UK in recent years has been observed as well as interest from the public, with developments of specific certified training programmes, established businesses providing tailored Hijama therapy Clinical Waste disposal services, provisions of insurance cover, involvement of medical professionals and membership with the General Regulatory Council for Complementary Therapies (GRCCT). However, there has also been noted that there is not much in the way of guidance or regulation. Therefore, we would like to initiate some communication and understanding of Hijama (wet cupping) to benefit medical professionals, discussing recent research undertaken as a basis for potentially more in the future (evidence-based practice), in the likely event that a patient might request to be referred for this therapy during a consultation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Internationalization of general surgical journals: origin and content of articles published in North America and Great Britain from 1983 to 1998.

PubMed

Tompkins, R K; Ko, C Y; Donovan, A J

2001-12-01

The origin and characteristics of articles published in the 6 highest rated (Institute for Scientific Information classification) English-language general surgical journals have changed significantly during the past 15 years. All articles published in 1983, 1988, 1993, and 1998 in 5 US surgical journals and 1 British surgical journal were reviewed and characterized. Absolute numbers and proportions of national and international articles published in each journal. Articles reviewed included 4868 in US journals and 1380 in the British journal. The total number of US journal articles decreased by 15.1%. The total number of British journal articles increased by 58.9%. The percentage of national articles decreased from 87.5% to 68.8% in US journals (P<.001) and constituted the minority of freely submitted articles in 1998 in 3 of 5 US journals. The percentage of national articles also decreased from 74.8% to 47.1% in the British journal (P<.001). Articles by European and Asian authors showed the most striking increases in all journals. The percentage of basic research articles declined in US journals from 23.3% to 17.9% (P =.001) owing to a 14.9% decline in national basic research articles. The percentage of clinical randomized studies increased from 2.2% to 4.1% (P<.008), but the increase was attributable to international articles. Government funding alone decreased from 13.6% to 11.2%, and government plus another source of funding decreased from 19.2% to 16.7% for national articles in US journals. Internationalization of the highly rated British and the 5 highest rated US general surgical journals has occurred. The decrease in the number of national articles in the US journals has been accompanied by significant decreases in government funding and basic research articles and a static output of clinical randomized studies from North America.

Electricity and Empire in 1920s Palestine under British Rule.

PubMed

Shamir, Ronen

2016-12-01

This article examines some techno-political aspects of the early years of electrification in British-ruled 1920s Palestine. It emphasizes the importance of local technical, topographical and hydrological forms of knowledge for understanding the dynamics of electrification. Situating the analysis in a general colonial context of electrification, the study shows that British colonial rulers lagged behind both German firms and local entrepreneurs in understanding the specific conditions pertaining to electrification in Palestine. Subsequently, the study shows that the British had limited control of the actual electrification process and its declared/professed developmental purposes, thereby complicating assumptions about electrification as a tool of the Empire/tool of empire. Finding some similarities between the cases of electrifying Palestine and India, the article's findings may shed further light on the importance of micro-politics of knowledge for understanding the trajectory of electrification in the colonies.

Dietitians' views of overweight and obese people and reported management practices.

PubMed

Harvey, E L; Summerbell, C D; Kirk, S F L; Hill, A J

2002-10-01

To examine dietitians' views of overweight and obese people, to explore the role of level of severity on these perceptions (overweight vs. obesity), and to explore the relationship between dietitians' views and their reported weight management practices. An independent measures survey, questioning dietitians about either overweight or obese people. One-hundred and eighty-seven members of the British Dietetic Association. A questionnaire exploring beliefs about the causes, attitudes, perceptions of responsibility and reported weight management practices. Physical inactivity was identified as an important causative factor for both overweight and obesity. Mood, eating too much of the wrong foods, repeated dieting and interpersonal factors were also seen as relatively important for both groups. Attitudes were mixed, but were generally neutral to positive. The most negative attitudes were described in terms of perceived reduced self-esteem, sexual attractiveness and health. Dietitians rated obese people more negatively than overweight people. They viewed both overweight and obese people as being responsible for their excess weight. They also reported very similar management practices for overweight and obese people. Beliefs about the causes of overweight explained more of the variance in practice than dietitians' attitudes towards or perceived responsibility of overweight and obese people. However, these associations were not consistent and strong, and other factors not investigated here are likely to have a greater influence on weight management practices.

Systematic review of recent dementia practice guidelines.

PubMed

Ngo, Jennifer; Holroyd-Leduc, Jayna M

2015-01-01

dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Myasthenia gravis: Association of British Neurologists' management guidelines.

PubMed

Sussman, Jon; Farrugia, Maria E; Maddison, Paul; Hill, Marguerite; Leite, M Isabel; Hilton-Jones, David

2015-06-01

Myasthenia gravis is an autoimmune disease of the neuromuscular junction for which many therapies were developed before the era of evidence based medicine. The basic principles of treatment are well known, however, patients continue to receive suboptimal treatment as a result of which a myasthenia gravis guidelines group was established under the aegis of The Association of British Neurologists. These guidelines attempt to steer a path between evidence-based practice where available, and established best practice where evidence is unavailable. Where there is insufficient evidence or a choice of options, the guidelines invite the clinician to seek the opinion of a myasthenia expert. The guidelines support clinicians not just in using the right treatments in the right order, but in optimising the use of well-known therapeutic agents. Clinical practice can be audited against these guidelines. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Trends in teachers' recommendations for changing elementary and junior-high school science programs

NASA Astrophysics Data System (ADS)

Stronck, David R.

Since 1978 many studies have called for changes in the practices of science teaching. These changes in instruction will occur only when the teachers decide to change their practices. This study uses surveys to consider the question of what were the trends in the teachers' recommendations for changes in elementary and junior-high school science programs between the years of 1978 and 1982. Large samples of teachers in British Columbia, Canada, responded anonymously to questionnaires in these years: 3040 teachers in 1978 and 1631 in 1982, with return rates ranging from 77.5% to 85%. These teachers described themselves as shifting their classroom practices toward ones that emphasize passive learning and memorization. The British Columbia Science Assessments recommend more inservice programs to stop this trend. There were very few differences in the teachers' recommendations for changes in the schools. The elementary-school teachers had major changes in their rankings of only two activities: they increased their ranking of activity-centered learning and reduced their ranking of outdoor education.

Effect of financial incentives on ethnic disparities in smoking cessation interventions in primary care: cross-sectional study.

PubMed

Hamilton, F L; Laverty, A A; Vamos, E P; Majeed, A; Millett, C

2013-03-01

Smoking cessation interventions are underprovided in primary care. Financial incentives may help address this. However, few studies in the UK have examined their impact on disparities in the delivery of smoking cessation interventions. Cross-sectional study using 2007 data from 29 general practices in Wandsworth, London, UK. We used logistic regression to examine associations between disease group [cardiovascular disease (CVD), respiratory disease, depression or none of these diseases], ethnicity and smoking outcomes following the introduction of the Quality and Outcomes Framework in 2004. Significantly, more CVD patients had smoking status ascertained compared with those with respiratory disease (89 versus 72%), but both groups received similar levels of cessation advice (93 and 89%). Patients with depression or none of the diseases were less likely to have smoking status ascertained (60% for both groups) or to receive advice (80 and 75%). Smoking prevalence was high, especially for patients with depression (44%). White British patients had higher rates of smoking than most ethnic groups, but black Caribbean men with depression had the highest smoking prevalence (62%). Smoking rates remain high, particularly for white British and black Caribbean patients. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking cessation outcomes in primary care.

Prevalence of masturbation and associated factors in a British national probability survey.

PubMed

Gerressu, Makeda; Mercer, Catherine H; Graham, Cynthia A; Wellings, Kaye; Johnson, Anne M

2008-04-01

A stratified probability sample survey of the British general population, aged 16 to 44 years, was conducted from 1999 to 2001 (N = 11,161) using face-to-face interviewing and computer-assisted self-interviewing. We used these data to estimate the population prevalence of masturbation, and to identify sociodemographic, sexual behavioral, and attitudinal factors associated with reporting this behavior. Seventy-three percent of men and 36.8% of women reported masturbating in the 4 weeks prior to interview (95% confidence interval 71.5%-74.4% and 35.4%-38.2%, respectively). A number of sociodemographic and behavioral factors were associated with reporting masturbation. Among both men and women, reporting masturbation increased with higher levels of education and social class and was more common among those reporting sexual function problems. For women, masturbation was more likely among those who reported more frequent vaginal sex in the last four weeks, a greater repertoire of sexual activity (such as reporting oral and anal sex), and more sexual partners in the last year. In contrast, the prevalence of masturbation was lower among men reporting more frequent vaginal sex. Both men and women reporting same-sex partner(s) were significantly more likely to report masturbation. Masturbation is a common sexual practice with significant variations in reporting between men and women.

Name analysis to classify populations by ethnicity in public health: validation of Onomap in Scotland.

PubMed

Lakha, F; Gorman, D R; Mateos, P

2011-10-01

Health inequalities between ethnic minorities and the general population are persistent. Addressing them is hampered by the inability to classify individuals' ethnicity accurately. This is addressed by a new name-based ethnicity classification methodology called 'Onomap'. This paper evaluates the diagnostic accuracy of Onomap in identifying population groups by ethnicity, and discusses applications to public health practice. Onomap was applied to three independent reference datasets (birth registration, pupil census and register of Polish health professionals) collected in Britain and Poland at individual level (n = 260,748). Results were compared with the reference database ethnicity 'gold standard'. Outcome measures included sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Ninety-five percent confidence intervals and Chi-squared tests were used. Onomap identified the majority of those in the British participant group with high sensitivity and PPV (>95%), and low misclassification (<5%), although specificity and NPV were lowest in this group (56-87%). Outcome measures for all other non-British groupings were high for specificity and NPV (>98%), but variable for sensitivity and PPV (17-89%). Differences in misclassification by gender were statistically significant. Using maiden name rather than married name in women improved classification outcomes for those born in the British Isles (0.53%, 95% confidence interval 0.26-0.8%; P < 0.001) but not for South Asian or Polish groups. Onomap offers an effective methodology for identifying population groups in both health-related and educational datasets, categorizing populations into a variety of ethnic groups. This evaluation suggests that it can successfully assist health researchers, planners and policy makers in identifying and addressing health inequalities. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study.

PubMed

Grant, Sabrina; Greenfield, Sheila M; Nouwen, Arie; McManus, Richard J

2015-11-01

Self-monitoring blood pressure (SMBP) is becoming an increasingly prevalent practice in UK primary care, yet there remains little conceptual understanding of why patients with hypertension engage in self-monitoring. To identify psychological factors or processes prompting the decision to self-monitor blood pressure. A qualitative study of patients previously participating in a survey study about SMBP from four general practices in the West Midlands. Taped and transcribed in-depth interviews with 16 patients (6 currently monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic analysis was undertaken. Three main themes emerged: 'self' and 'living with hypertension' described the emotional element of living with an asymptomatic condition; 'self-monitoring behaviour and medication' described overall views about self-monitoring, current practice, reasons for monitoring, and the impact on medication adherence; and 'the GP-patient transaction' described the power relations affecting decisions to self-monitor. Self-monitoring was performed by some as a protective tool against the fears of a silent but serious condition, whereas others self-monitor simply out of curiosity. People who self-monitored tended not to discuss this with their nurse or GP, partly due to perceiving minimal or no interest from their clinician about home monitoring, and partly due to fear of being prescribed additional medication. The decision to self-monitor appeared often to be an individual choice with no schedule or systems to integrate it with other medical care. Better recognition by clinicians that patients are self-monitoring, perhaps utilising the results in shared decision-making, might help integrate it into daily practice. © British Journal of General Practice 2015.

Personnel Attrition Rates in Historical Land Combat Operations: A Catalog of Attrition and Casualty Data Bases on Diskettes Usable with Personal Computers

DTIC Science & Technology

1993-09-01

la Universidad de Malaga, et al., 1991, pp 4985-5017. (2) Pearson, Frederic S., and Robert A. Baumann, "International Military Intervention in Sub...unobtainable in practice. Instead, we must use the data as we find it, warts and all. This is not a new observation. Beebe. Gilbert W., and De Bakey...original or US copies of the British "Nord de Guerre Zone," based on the Lambert Conformal Conical Projection, which the British call the Lambert Conical

National citation patterns of NEJM, The Lancet, JAMA and The BMJ in the lay press: a quantitative content analysis.

PubMed

Casino, Gonzalo; Rius, Roser; Cobo, Erik

2017-11-12

To analyse the total number of newspaper articles citing the four leading general medical journals and to describe national citation patterns. Quantitative content analysis. Full text of 22 general newspapers in 14 countries over the period 2008-2015, collected from LexisNexis. The 14 countries have been categorised into four regions: the USA, the UK, Western World (European countries other than the UK, and Australia, New Zealand and Canada) and Rest of the World (other countries). Press citations of four medical journals (two American: NEJM and JAMA ; and two British: The Lancet and The BMJ ) in 22 newspapers. British and American newspapers cited some of the four analysed medical journals about three times a week in 2008-2015 (weekly mean 3.2 and 2.7 citations, respectively); the newspapers from other Western countries did so about once a week (weekly mean 1.1), and those from the Rest of the World cited them about once a month (monthly mean 1.1). The New York Times cited above all other newspapers (weekly mean 4.7). The analysis showed the existence of three national citation patterns in the daily press: American newspapers cited mostly American journals (70.0% of citations), British newspapers cited mostly British journals (86.5%) and the rest of the analysed press cited more British journals than American ones. The Lancet was the most cited journal in the press of almost all Western countries outside the USA and the UK. Multivariate correspondence analysis confirmed the national patterns and showed that over 85% of the citation data variability is retained in just one single new variable: the national dimension. British and American newspapers are the ones that cite the four analysed medical journals more often, showing a domestic preference for their respective national journals; non-British and non-American newspapers show a common international citation pattern. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Driven by a passion for people and their pets (and dancing).

PubMed

Bailey, Paula

2016-04-30

Paula Bailey thought she might enter academia after gaining clinical experience. However, a period of travelling and locum work confirmed her enjoyment of practice life. British Veterinary Association.

Mental health awareness.

PubMed

2017-07-22

Independent, family-owned veterinary group White Cross Vets has been focusing on wellbeing. One of its clinic directors, Rob Reid, joined a group from the practice for some training in mental health awareness. British Veterinary Association.

"I'm Managing My Diabetes between Two Worlds": Beliefs and Experiences of Diabetes Management in British South Asians on Holiday in the East--A Qualitative Study.

PubMed

Patel, Neesha R; Kennedy, Anne; Blickem, Christian; Reeves, David; Chew-Graham, Carolyn

2016-01-01

Diabetes is disproportionately high among British South Asians compared to the general UK population. Whilst the migrant British South Asians group has received most attention on research related to diabetes management, little consideration has been given to impact of travel back to the East. This study aimed to explore the role of social networks and beliefs about diabetes in British South Asians, to better understand their management behaviours whilst holidaying in the East. Semistructured interviews were conducted in Greater Manchester. Forty-four participants were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Migrant British South Asians expressed a strong preference to be in a hot climate; they felt they had a healthier lifestyle in the East and often altered or abandoned their diabetes medication. Information acquisition on diabetes and availability of social networks in the East was valued. Social networks in the East are a valued source of information and support for diabetes. The lack of adherence to medication whilst abroad suggests that some migrant British South Asians have a poor understanding of diabetes. Future research needs to explore whether patients are seeking professional advice on diabetes management prior to their extended holiday.

Gender and gender role differences in self- and other-estimates of multiple intelligences.

PubMed

Szymanowicz, Agata; Furnham, Adrian

2013-01-01

This study examined participant gender and gender role differences in estimates of multiple intelligences for self, partner, and various hypothetical, stereotypical, and counter-stereotypical target persons. A general population sample of 261 British participants completed one of four questionnaires that required them to estimate their own and others' multiple intelligences and personality traits. Males estimated their general IQ slightly, but mathematic IQ significantly higher than females, who rated their social and emotional intelligence higher than males. Masculine individuals awarded themselves somewhat higher verbal and practical IQ scores than did female participants. Both participant gender and gender role differences in IQ estimates were found, with gender effects stronger in cognitive and gender role than in "personal" ability estimates. There was a significant effect of gender role on hypothetical persons' intelligence evaluations, with masculine targets receiving significantly higher intelligence estimates compared to feminine targets. More intelligent hypothetical figures were judged as more masculine and less feminine than less intelligent ones.

Gender and Gender Role Differences in Self- and Other-Estimates of Multiple Intelligences

PubMed Central

Szymanowicz, Agata

2013-01-01

This study examined participant gender and gender role differences in estimates of multiple intelligences for self, partner, and various hypothetical, stereotypical, and counter-stereotypical target persons. A general population sample of 261 British participants completed one of four questionnaires that required them to estimate their own and others’ multiple intelligences and personality traits. Males estimated their general IQ slightly, but mathematic IQ significantly higher than females, who rated their social and emotional intelligence higher than males. Masculine individuals awarded themselves somewhat higher verbal and practical IQ scores than did female participants. Both participant gender and gender role differences in IQ estimates were found, with gender effects stronger in cognitive and gender role than in “personal” ability estimates. There was a significant effect of gender role on hypothetical persons’ intelligence evaluations, with masculine targets receiving significantly higher intelligence estimates compared to feminine targets. More intelligent hypothetical figures were judged as more masculine and less feminine than less intelligent ones. PMID:23951949

Singing in Primary Schools: Case Studies of Good Practice in Whole Class Vocal Tuition

ERIC Educational Resources Information Center

Lamont, Alexandra; Daubney, Alison; Spruce, Gary

2012-01-01

Within the context of British initiatives in music education such as the Wider Opportunities programme in England and the recommendations of the Music Manifesto emphasising the importance of singing in primary schools, the current paper explores examples of good practice in whole-class vocal tuition. The research included seven different primary…

Theory and (In) Practice: The Problem of Integration in Art and Design Education

ERIC Educational Resources Information Center

Rintoul, Jenny Ruth

2014-01-01

This paper examines the relationship between art "theory" and art "practice" in British art education at post-compulsory level, with a focus on the ways in which theory is framed and delivered and what this means for its integration. Drawing upon constructions of knowledge and approaches to integration as a technique and…

Passion for poultry.

PubMed

Garton, William

2016-02-20

William Garton's interest in poultry began when he was a boy. Despite trying many aspects of veterinary medicine as a student, it was poultry-specific work that he enjoyed most. As a poultry intern with the Minster Veterinary Practice he wrote a monthly blog for Vet Record Careers, and he is now associate poultry director for the practice's north-west branches. British Veterinary Association.

Pathways to Fitness for Practice: National Vocational Qualifications as a Foundation of Competence in Nurse Education.

ERIC Educational Resources Information Center

Grundy, Lynne

2001-01-01

The movement in British nursing education from nursing schools to higher education has been criticized for deficiencies in skills-based training. Adding a competency-based approach using National Vocational Qualifications is a way to ensure that nurses have practical competence as well as knowledge and understanding. (Contains 24 references.) (SK)

Research and Its Relationship to Nurse Education: Focus and Capacity.

ERIC Educational Resources Information Center

Newell, Robert

2002-01-01

Examination of two British mental health journals and a government document on the future of nursing found a lack of focus on clinical research and little reference to the role of research and development in practice. The increasing importance of evidence-based practice demands a strategy for developing nurses' capacity to understand, undertake,…

Genres and Registers of Student Report Writing: An SFL Perspective on Texts and Practices

ERIC Educational Resources Information Center

Gardner, Sheena

2012-01-01

Academic literacies research has tended to focus on writers in context, while systemic functional linguistic research has tended to focus on texts in context. While literacy practices and written texts may be usefully analysed independently, this paper describes how an investigation of genres of academic writing in the BAWE (British Academic…

From "Learning Disability to Intellectual Disability"--Perceptions of the Increasing Use of the Term "Intellectual Disability" in Learning Disability Policy, Research and Practice

ERIC Educational Resources Information Center

Cluley, Victoria

2018-01-01

Background: The term "intellectual disability" is increasingly used to refer to people with learning disabilities in British learning disability policy, practice and research. This change is undoubtedly a reflection of the changing international context. The inclusion of the term "intellectual disability" has been particularly…

Assessment of Forest Insect Conditions at Opax Mountain Silviculture Trail

Treesearch

Dan Miller; Lorraine Maclauchlan

1998-01-01

Forest management in British Columbia requires that all resource values are considered along with a variety of appropriate management practices. For the past l00 years, partial-cutting practices were the method of choice whenharvesting in Interior Douglas-fir (IDF) zone ecosystems. Along with a highly effective fire suppression program and minimal stand tending, these...

Peer Review of Teaching: Sharing Best Practices

ERIC Educational Resources Information Center

Golparian, Shaya; Chan, Judy; Cassidy, Alice

2015-01-01

In this paper, we share examples of best peer review of teaching practices, drawing on our involvement in the design and implementation of the Peer Review of Teaching program at the Centre for Teaching, Learning and Technology. We review the history of the Peer Review of Teaching Initiative at the University of British Columbia and explain key…

De Facto Language Education Policy through Teachers' Attitudes and Practices: A Critical Ethnographic Study in Three Jamaican Schools

ERIC Educational Resources Information Center

Nero, Shondel J.

2014-01-01

Using Jamaica, a former British colony where Jamaican Creole (JC) is the mass vernacular but Standard Jamaican English is the official language, as an illustrative case, this critical ethnographic study in three Jamaican schools examines the theoretical and practical challenges of language education policy (LEP) development and implementation in…

A method of assigning socio-economic status classification to British Armed Forces personnel.

PubMed

Yoong, S Y; Miles, D; McKinney, P A; Smith, I J; Spencer, N J

1999-10-01

The objective of this paper was to develop and evaluate a socio-economic status classification method for British Armed Forces personnel. Two study groups comprising of civilian and Armed Forces families were identified from livebirths delivered between 1 January-30 June 1996 within the Northallerton Health district which includes Catterick Garrison and RAF Leeming. The participants were the parents of babies delivered at a District General Hospital, comprising of 436 civilian and 162 Armed Forces families. A new classification method was successfully used to assign Registrar General's social classification to Armed Forces personnel. Comparison of the two study groups showed a significant difference in social class distribution (p = 0.0001). This study has devised a new method for classifying occupations within the Armed Forces to categories of social class thus permitting comparison with Registrar General's classification.

Disentangling the Purposes of Staff Appraisal.

ERIC Educational Resources Information Center

Wilson, D.

1993-01-01

Critiques Annual Staff Reports, personnel evaluations in the British Civil Service. Considers the implications of management by objectives and staff evaluation practices in the National Health Service and universities for Civil Service evaluations. (SK)

RITUALS OF INFANT DEATH: DEFINING LIFE AND ISLAMIC PERSONHOOD

PubMed Central

SHAW, ALISON

2014-01-01

This article is about the recognition of personhood when death occurs in early life. Drawing from anthropological perspectives on personhood at the beginnings and ends of life, it examines the implications of competing religious and customary definitions of personhood for a small sample of young British Pakistani Muslim women who experienced miscarriage and stillbirth. It suggests that these women's concerns about the lack of recognition given to the personhood of their fetus or baby constitute a challenge to customary practices surrounding burial as a Muslim. The article suggests that these women's concerns cannot be adequately glossed as a clash of Islamic belief versus Western medicine. Rather, they represent a renegotiation of Islamic opinion and customary practices within the broader context of changes in the medical and social norms surrounding pregnancy loss and infant death in multi-ethnic British society. PMID:23906387

Attitudes towards domestic violence in Lebanon: a qualitative study of primary care practitioners.

PubMed

Usta, Jinan; Feder, Gene; Antoun, Jumana

2014-06-01

Domestic violence (DV) is highly prevalent in the developing and developed world. Healthcare systems internationally are still not adequately addressing the needs of patients experiencing violence. To explore physicians' attitudes about responding to DV, their perception of the physician's role, and the factors that influence their response. Qualitative study using individual interviews among primary care practitioners working in Lebanon. Primary care clinicians practising for >5 years and with >100 patient consultations a week were interviewed. Physicians were asked about their practice when encountering women disclosing abuse, their opinion about the engagement of the health services with DV, their potential role, and the anticipated reaction of patients and society to this extended role. Physicians felt that they were well positioned to play a pivotal role in addressing DV; yet they had concerns related to personal safety, worry about losing patients, and opposing the norms of a largely conservative society. Several physicians justified DV or blamed the survivor rather than the perpetrator for triggering the violent behaviour. Moreover, religion was perceived as sanctioning DV. Perceived cultural norms and religious beliefs seem to be major barriers to physicians responding to DV in Lebanon, and possibly in the Arab world more generally. Financial concerns also need to be addressed to encourage physicians to address DV. © British Journal of General Practice 2014.

HIV testing in dermatology - a national audit.

PubMed

Esson, Gavin A; Holme, S A

2018-05-01

Forty percent of individuals have late-stage HIV at the time of diagnosis, resulting in increased morbidity. Identifying key diseases which may indicate HIV infection can prompt clinicians to trigger testing, which may result in more timely diagnosis. The British HIV Association has published guidelines on such indicator diseases in dermatology. We audited the practice of HIV testing in UK dermatologists and General Practitioners (GPs) and compared results with the national guidelines. This audit showed that HIV testing in key indicator diseases remains below the standard set out by the national guidelines, and that GPs with special interest in dermatology have a lower likelihood for testing, and lower confidence when compared to consultants, registrars and associate specialists. Large proportions of respondents believed further training in HIV testing would be beneficial.

Summer Internships: 12 Years' Experience with Undergraduate Medical Students in Summer Employment in Various Areas of Preventive Medicine

PubMed Central

Mackenzie, C. J. G.; Elliot, G. R. F.

1965-01-01

Twelve years' experience in providing summer employment for students in official health agencies in British Columbia is reviewed and a two-week orientation course given prior to employment in 1964 is described. In the program, which provides experience in teaching, research and community service, a total of 43 students have been employed. Students seeking this type of employment and accepted for it tend to have high academic standing. They prefer employment in or near Vancouver irrespective of their original home location. Two main employers have been available: specialized agencies in metropolitan Vancouver, or “rural” health units. Students serving in health units showed a strong tendency to enter general practice after graduation. Urban experience tended to lead to specialization. PMID:14278027

Off-label prescribing to children: attitudes and experience of general practitioners

PubMed Central

Ekins-Daukes, Suzie; Helms, Peter J; Taylor, Michael W; McLay, James S

2005-01-01

Aim To identify experience with and attitudes towards paediatric off-label prescribing in primary care. Method A prospective questionnaire survey was sent to a sample of Scottish primary care practices (346 doctors in 80 general practices located throughout Scotland). Results Two hundred and two (58%) completed questionnaires were returned. Over 70% of GPs admitted to being familiar with the concept, and 40% to knowingly prescribing off-label. The most important sources of paediatric prescribing information were the British National Formulary (81%), personal experience (71%) and previous prescription notes (45%). The most common reason given by GPs for off-label prescribing was prescribing for a younger age than recommended, although prescribing data confirm that age is the least important and dose the most important reason for such prescribing. When asked to comment upon different causes for off-label prescribing, 80% of respondents expressed appropriate awareness of and concern for the described scenarios. Over 97% of GPs ranked development of paediatric formulations and clearer dosage information more highly than clinical trials as a means to reducing off-label prescribing. Conclusions Despite high levels of off-label prescribing in primary care in the UK, the majority of GPs claimed to be familiar with the concept, although less than half were aware of this common practice. A clear disparity between perceived and actual reasons for off-label prescribing was noted, possibly due to a reliance on personal experience, colleague experience or previous patient prescription notes as a guide to prescribing. PMID:16042667

Having diabetes and having to fast: a qualitative study of British Muslims with diabetes.

PubMed

Patel, Neesha R; Kennedy, Anne; Blickem, Christian; Rogers, Anne; Reeves, David; Chew-Graham, Carolyn

2015-10-01

There are approximately 2.7 million Muslims in the UK, constituting 4.8% of the population. It is estimated that 325,000 UK Muslims have diabetes. Whilst dietary practices of Muslims with diabetes have been explored, little work has described the beliefs and decisions to fast during Ramadan, whereby Muslims with diabetes refrain from eating, drinking and taking medication between sunrise and sunset. To explore beliefs and experiences of fasting during Ramadan of Muslim respondents with diabetes and their perceptions of the role played by their general practitioner (GP) and/or practice nurse (PN) in supporting them. Qualitative study. General practices and community groups located in Greater Manchester. 23 South Asian Muslims. Semi-structured interviews were conducted as part of the Collaboration of Applied Health Research and Care (CLAHRC) programme, Greater Manchester. Respondents were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Thirteen respondents reported they fasted and altered diabetes medication and diet during Ramadan. The decision to fast was influenced by pressures from the family and the collective social aspect of fasting, and respondents made limited contact with primary care during fasting. Tensions exist between the respondent's personal desire to fast or not fast and their family's opinion on the matter, with a strong reluctance to disclose fasting to GP and/or PN. Future research needs to explore whether GPs or PNs feel competent enough to support patients who wish to fast. © 2014 John Wiley & Sons Ltd.

GPs' perceptions of resilience training: a qualitative study.

PubMed

Cheshire, Anna; Hughes, John; Lewith, George; Panagioti, Maria; Peters, David; Simon, Chantal; Ridge, Damien

2017-10-01

GPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care. To explore GPs' perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes. This was a qualitative study of the perspectives of GPs currently practising in England. GPs were recruited through convenience sampling, and data were collected from two focus groups ( n = 15) and one-to-one telephone interviews ( n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis. Participants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues. A multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience. © British Journal of General Practice 2017.

Performance characteristics of visualising the cervix in symptomatic young females: a review of primary care records in females with and without cervical cancer.

PubMed

Lim, Anita Wey Wey; Hamilton, Willie; Hollingworth, Antony; Stapley, Sally; Sasieni, Peter

2016-03-01

The current strategy for timely detection of cervical cancer in young females centres on visualising the cervix when females present with gynaecological symptoms, but is based on expert opinion without an evidence base. To assess visualising the cervix in primary care in young females with gynaecological symptoms. A review of primary care records for females in England aged 20-29 years with cervical cancer (nationwide interview-based study) and in the general population (Clinical Practice Research Datalink database). From primary care records the proportion of females was identified with gynaecological symptoms who had documented cervical examination in the year before diagnosis (cancers) and in 1-year age bands (general population). Of these, the proportion was identified that was then referred for suspected malignancy. Only 39% of young females with cervical cancer had documented examination at symptomatic presentation. Visualisation resulted in referral for suspected malignancy for 18% of those examined (95% confidence interval = 5% to 40%). Very few (<1.7%) symptomatic females in the general population had documented cervical examination. None were referred for suspected malignancy at the time. The sensitivity of cervical examination to detect cancer is very low, highlighting the need for better triage tools for primary care. Until such tools are identified GPs should continue to consider cervical cancer when symptoms persist and the cervix is not obviously abnormal on clinical examination. Further research on additional triage tools such as cervical cytology used as a diagnostic aid is needed urgently. © British Journal of General Practice 2016.

Life and death in a civitas capital: metabolic disease and trauma in the children from late Roman Dorchester, Dorset.

PubMed

Lewis, Mary E

2010-07-01

The impact that "Romanization" and the development of urban centers had on the health of the Romano-British population is little understood. A re-examination of the skeletal remains of 364 nonadults from the civitas capital at Roman Dorchester (Durnovaria) in Dorset was carried out to measure the health of the children living in this small urban area. The cemetery population was divided into two groups; the first buried their dead organized within an east-west alignment with possible Christian-style graves, and the second with more varied "pagan" graves, aligned north-south. A higher prevalence of malnutrition and trauma was evident in the children from Dorchester than in any other published Romano-British group, with levels similar to those seen in postmedieval industrial communities. Cribra orbitalia was present in 38.5% of the children, with rickets and/or scurvy at 11.2%. Twelve children displayed fractures of the ribs, with 50% of cases associated with rickets and/or scurvy, suggesting that rib fractures should be considered during the diagnosis of these conditions. The high prevalence of anemia, rickets, and scurvy in the Poundbury children, and especially the infants, indicates that this community may have adopted child-rearing practices that involved fasting the newborn, a poor quality weaning diet, and swaddling, leading to general malnutrition and inadequate exposure to sunlight. The Pagan group showed no evidence of scurvy or rib fractures, indicating difference in religious and child-rearing practices but that both burial groups were equally susceptible to rickets and anemia suggests a shared poor standard of living in this urban environment. (c) 2009 Wiley-Liss, Inc.

Evidence-based management of systemic sclerosis: Navigating recommendations and guidelines.

PubMed

Pellar, Russell Edward; Pope, Janet Elizabeth

2017-06-01

Systemic sclerosis (SSc) is a rare heterogeneous connective tissue disease. Recommendations addressing the major issues in the management of SSc including screening and treatment of organ complications are needed. The updated European League Against Rheumatism/European Scleroderma Trial and Research (EULAR/EUSTAR) and the British Society of Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines were compared and contrasted. The updated EULAR/EUSTAR guidelines focus specifically on the management of SSc features and include data on newer therapeutic modalities and mention a research agenda. These recommendations are pharmacologic, with few guidelines regarding investigations and non-pharmacologic management. Recommendations from BSR/BHPR are similar to the organ manifestations mentioned in the EULAR/EUSTAR recommendations, and expand on several domains of treatment, including general measures, non-pharmacologic treatment, cardiac involvement, calcinosis, and musculoskeletal features. The guidelines usually agree with one another. Limitations include the lack of guidance for combination or second-line therapy, algorithmic suggestions, the absence of evidence-based recommendations regarding the treatment of specific complications (i.e., gastric antral ectasia and erectile dysfunction). Consensus for when to treat interstitial lung disease in SSc is lacking. There are differences between Europe and North American experts due to access and indications for certain therapies. Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc and future updates of these recommendations. Care gaps in SSc have been demonstrated so the EULAR/EUSTAR and BSR/BHP guidelines can promote best practices. Certain complications warrant active investigation to further improve outcomes in SSc. Copyright © 2017 Elsevier Inc. All rights reserved.

Still a difficult business? Negotiating alcohol-related problems in general practice consultations.

PubMed

Rapley, Tim; May, Carl; Frances Kaner, Eileen

2006-11-01

This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.

Cannabis, tobacco smoking, and lung function: a cross-sectional observational study in a general practice population.

PubMed

Macleod, John; Robertson, Roy; Copeland, Lorraine; McKenzie, James; Elton, Rob; Reid, Peter

2015-02-01

Health concerns around cannabis use have focused on the potential relationship with psychosis but the effect of cannabis smoking on respiratory health has received less attention. To investigate the association between tobacco-only smoking compared with tobacco plus cannabis smoking and adverse outcomes in respiratory health and lung function. The design was cross-sectional with two groups recruited: cigarette smokers with tobacco pack-years; cannabis smokers with cannabis joint-years. Recruitment occurred in a general practice in Scotland with 12 500 patients. Exposures measured were tobacco smoking (pack-years) and cannabis smoking (joint-years). Cannabis type (resin, herbal, or both) was recorded by self-report. Respiratory symptoms were recorded using NHANES and MRC questionnaires. Lung function was measured by spirometry (FEV1/FVC ratio). Participants consisted of 500 individuals (242 males). Mean age of tobacco-only smokers was 45 years; median tobacco exposure was 25 pack-years. Mean age of cannabis and tobacco smokers was 37 years; median tobacco exposure was 19 pack-years, rising to 22.5 when tobacco smoked with cannabis. Although tobacco and cannabis use were associated with increased reporting of respiratory symptoms, this was higher among those who also smoked cannabis. Both tobacco and cannabis users had evidence of impaired lung function but, in fully adjusted analyses, each additional joint-year of cannabis use was associated with a 0.3% (95% confidence interval = 0.0 to 0.5) increase in prevalence of chronic obstructive pulmonary disease. In adults who predominantly smoked resin cannabis mixed with tobacco, additional adverse effects were observed on respiratory health relating to cannabis use. © British Journal of General Practice 2015.

Structural abnormalities and persistent complaints after an ankle sprain are not associated: an observational case control study in primary care.

PubMed

van Ochten, John M; Mos, Marinka C E; van Putte-Katier, Nienke; Oei, Edwin H G; Bindels, Patrick J E; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke

2014-09-01

Persistent complaints are very common after a lateral ankle sprain. To investigate possible associations between structural abnormalities on radiography and MRI, and persistent complaints after a lateral ankle sprain. Observational case control study on primary care patients in general practice. Patients were selected who had visited their GP with an ankle sprain 6-12 months before the study; all received a standardised questionnaire, underwent a physical examination, and radiography and MRI of the ankle. Patients with and without persistent complaints were compared regarding structural abnormalities found on radiography and MRI; analyses were adjusted for age, sex, and body mass index. Of the 206 included patients, 98 had persistent complaints and 108 did not. No significant differences were found in structural abnormalities between patients with and without persistent complaints. In both groups, however, many structural abnormalities were found on radiography in the talocrural joint (47.2% osteophytes and 45.1% osteoarthritis) and the talonavicular joint (36.5% sclerosis). On MRI, a high prevalence was found of bone oedema (33.8%) and osteophytes (39.5) in the talocrural joint; osteophytes (54.4%), sclerosis (47.2%), and osteoarthritis (55.4%, Kellgren and Lawrence grade >1) in the talonavicular joint, as well as ligament damage (16.4%) in the anterior talofibular ligament. The prevalence of structural abnormalities is high on radiography and MRI in patients presenting in general practice with a previous ankle sprain. There is no difference in structural abnormalities, however, between patients with and without persistent complaints. Using imaging only will not lead to diagnosis of the explicit reason for the persistent complaint. © British Journal of General Practice 2014.

Media work adds a new dimension to my clinical practice.

PubMed

Wedderburn, Pete

2017-06-24

Pete Wedderburn describes his media career as 'accidental and unexpected', but having dipped his toe in the water, he found he enjoyed it. Here, he explains how it started. British Veterinary Association.

Undergraduates' perceptions of the value of practical inhalation sedation experience in a UK dental school.

PubMed

Walley, S; Albadri, S

2015-10-01

This was to establish the level and reported value of paediatric IHS experience from the perspective of final year undergraduates and to evaluate whether those students with more experience expressed feeling better-prepared for future practice and more likely to undertake further postgraduate education in IHS. All final year students were invited to complete an anonymous questionnaire designed to elicit undergraduate perceptions of IHS using visual analogue scales and free-text questions. A response rate of 77 % was achieved. Results revealed that only 21 % of participants reported acting as operator sedationist in ten or more IHS cases. Thus, the majority of undergraduates' did not meet the recommended quantity of practical IHS experiences, as outlined by the British Dental Sedation Teachers Group. In general, students felt on the value of IHS in the management of anxious children and expressed a desire to undertake further postgraduate education in conscious sedation. However, those students with more experience of practical IHS expressed feeling better able to describe the IHS experience with patients and parents, and were more satisfied with the quality of teaching. Furthermore free-text comments revealed that, regardless of experience, students wished to gain more experience of the practical administration of IHS. There is a need to increase the provision of IHS training within an undergraduate curriculum, in addition to improving the accessibility of postgraduate sedation courses.

Nursing Practice Should Be Informed by the Best Available Evidence, but Should All First-Level Nurses Be Competent at Research Appraisal and Utilization?

ERIC Educational Resources Information Center

White, Robert; Taylor, Shirley

2002-01-01

The British model of nurses as finders, appraisers, and users of research in practice is unattainable, given the technical complexity of research and the skills and time required. Clinical governance mechanisms and accountability demands further undermine the approach. An alternative is development of nursing research specialists and…

Faculty Perceptions of Challenges and Enablers of Effective Teaching in a Large Research-Intensive University: Preliminary Findings

ERIC Educational Resources Information Center

Briseño-Garzón, Adriana; Han, Andrea; Birol, Gülnur; Bates, Simon; Whitehead, Lorne

2016-01-01

In October 2014, the University of British Columbia Vancouver campus (UBCV) ran a campus-wide survey to establish baseline information on teaching practices and attitudes among faculty, to measure the impact of existing teaching and learning initiatives and to identify the conditions leading to change in practices and attitudes around teaching.…

How the World's Best Schools Stay on Top: Study's Key Findings Pinpoint Practices That Align with Learning Forward

ERIC Educational Resources Information Center

Killion, Joellen

2016-01-01

Key findings from a new study highlight how Learning Forward's long-standing position on professional learning correlates with practices in high-performing systems in Singapore, Shanghai, Hong Kong, and British Columbia. The purpose of this article is to share key findings from the study so that educators might apply them to strengthening…

Identifying the need for curriculum change. When a rural training program needs reform.

PubMed

Whiteside, C; Pope, A; Mathias, R

1997-08-01

To identify what changes should be made in the University of British Columbia's rural family practice training program curriculum to help graduates be better prepared to practice. Two cross-sectional surveys via mailed questionnaires: one designed to measure physicians' self-reported preparedness for practice and the other to measure the importance of various rural family medicine components. Rural training program graduates and preceptors representing rural communities in British Columbia. Thirty-nine graduates of the rural training program between 1982 and 1991 and 14 community-based rural training program preceptors representing eight communities throughout the province participated in this study. Percentage of graduates of the rural program who reported themselves to be underprepared on each family practice item and preceptors' mean scores for the attributed importance to rural practice of each item on this questionnaire. A list of curriculum areas most in need of reform was created. This list included trauma, counseling skills, radiology, vacuum extraction, fracture care, exercising community leadership, cost-effective use of diagnostic tests, using community health resources, obtaining hospital privileges, ophthalmology, dermatology, otolaryngology, personal and professional growth, relationships with other physicians, and personnel issues. Using both the level of graduates' self-reported underpreparedness and the attributed importance of elements of rural practice, as indicated by the preceptor survey, we developed a list of the areas of the rural training program curriculum most in need of reform.

Is the Culture of the British Army Conducive to the Successful Execution of Mission Command

DTIC Science & Technology

2016-06-10

NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) U.S. Army Command and General Staff College ATTN: ATZL-SWD-GD...The British Role from the Early 1980s to the end of the Gulf War” (PhD thesis, King’s College London , University of London , 1994); Dr Christopher...thesis, King’s College London , University of London , 1994. LETC/DLW. Integrated Action, Doctrine Note 15/01. January 2015. Macgregor, Douglas A

It’s Just Not Cricket - The Anglo-Afghan Wars and Their Relevance to Current Operations

DTIC Science & Technology

2010-03-30

Khan wished to seize the initiative and on 28 May began an artillery bombardment on the city of Thai , which stood on the British-Afghan border... Thai was under siege for six days and although the resident garrison repelled the Afghans, the situation was perilous for those that survived the...onslaught. Consequently, the British ordered a relief-in-place. Having dealt with Afghan resistance en route, Brigadier General Dyer arrived at Thai on 1

“I'm Managing My Diabetes between Two Worlds”: Beliefs and Experiences of Diabetes Management in British South Asians on Holiday in the East—A Qualitative Study

PubMed Central

Patel, Neesha R.; Kennedy, Anne; Blickem, Christian; Reeves, David; Chew-Graham, Carolyn

2016-01-01

Background. Diabetes is disproportionately high among British South Asians compared to the general UK population. Whilst the migrant British South Asians group has received most attention on research related to diabetes management, little consideration has been given to impact of travel back to the East. This study aimed to explore the role of social networks and beliefs about diabetes in British South Asians, to better understand their management behaviours whilst holidaying in the East. Methods. Semistructured interviews were conducted in Greater Manchester. Forty-four participants were recruited using random and purposive sampling techniques. Interviews were analysed thematically using a constant comparison approach. Results. Migrant British South Asians expressed a strong preference to be in a hot climate; they felt they had a healthier lifestyle in the East and often altered or abandoned their diabetes medication. Information acquisition on diabetes and availability of social networks in the East was valued. Conclusion. Social networks in the East are a valued source of information and support for diabetes. The lack of adherence to medication whilst abroad suggests that some migrant British South Asians have a poor understanding of diabetes. Future research needs to explore whether patients are seeking professional advice on diabetes management prior to their extended holiday. PMID:26697499

Sincere but naive: methodological queries concerning the British Columbia polygamy reference trial.

PubMed

Ashley, Sean Matthew

2014-11-01

Academics frequently serve as expert witnesses in legal cases, yet their role as transmitters of social scientific knowledge remains under-examined. The present study analyzes the deployment of social science within British Columbia's polygamy reference trial where research is used to support the assertion that polygamy is inherently harmful to society. Within the trial record and the written decision, the protection of monogamy as an institution is performed in part through the marginalization of qualitative methodology and the concurrent privileging of quantitative studies that purportedly demonstrate widespread social harms associated with the practice of polygyny.

Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities

PubMed Central

Roe, Jenny; Aspinall, Peter A.; Ward Thompson, Catharine

2016-01-01

Very little is known about how differences in use and perceptions of urban green space impact on the general health of black and minority ethnic (BME) groups. BME groups in the UK suffer from poorer health and a wide range of environmental inequalities that include poorer access to urban green space and poorer quality of green space provision. This study used a household questionnaire (n = 523) to explore the relationship between general health and a range of individual, social and physical environmental predictors in deprived white British and BME groups living in ethnically diverse cities in England. Results from Chi-Squared Automatic Interaction Detection (CHAID) segmentation analyses identified three distinct general health segments in our sample ranging from “very good” health (people of Indian origin), to ”good” health (white British), and ”poor” health (people of African-Caribbean, Bangladeshi, Pakistani origin and other BME groups), labelled ”Mixed BME” in the analyses. Correlated Component Regression analyses explored predictors of general health for each group. Common predictors of general health across all groups were age, disability, and levels of physical activity. However, social and environmental predictors of general health-including use and perceptions of urban green space-varied among the three groups. For white British people, social characteristics of place (i.e., place belonging, levels of neighbourhood trust, loneliness) ranked most highly as predictors of general health, whilst the quality of, access to and the use of urban green space was a significant predictor of general health for the poorest health group only, i.e., in ”Mixed BME”. Results are discussed from the perspective of differences in use and perceptions of urban green space amongst ethnic groups. We conclude that health and recreation policy in the UK needs to give greater attention to the provision of local green space amongst poor BME communities since this can play an important role in helping address the health inequalities experienced by these groups. PMID:27399736

Understanding Relationships between Health, Ethnicity, Place and the Role of Urban Green Space in Deprived Urban Communities.

PubMed

Roe, Jenny; Aspinall, Peter A; Ward Thompson, Catharine

2016-07-05

Very little is known about how differences in use and perceptions of urban green space impact on the general health of black and minority ethnic (BME) groups. BME groups in the UK suffer from poorer health and a wide range of environmental inequalities that include poorer access to urban green space and poorer quality of green space provision. This study used a household questionnaire (n = 523) to explore the relationship between general health and a range of individual, social and physical environmental predictors in deprived white British and BME groups living in ethnically diverse cities in England. Results from Chi-Squared Automatic Interaction Detection (CHAID) segmentation analyses identified three distinct general health segments in our sample ranging from "very good" health (people of Indian origin), to "good" health (white British), and "poor" health (people of African-Caribbean, Bangladeshi, Pakistani origin and other BME groups), labelled "Mixed BME" in the analyses. Correlated Component Regression analyses explored predictors of general health for each group. Common predictors of general health across all groups were age, disability, and levels of physical activity. However, social and environmental predictors of general health-including use and perceptions of urban green space-varied among the three groups. For white British people, social characteristics of place (i.e., place belonging, levels of neighbourhood trust, loneliness) ranked most highly as predictors of general health, whilst the quality of, access to and the use of urban green space was a significant predictor of general health for the poorest health group only, i.e., in "Mixed BME". Results are discussed from the perspective of differences in use and perceptions of urban green space amongst ethnic groups. We conclude that health and recreation policy in the UK needs to give greater attention to the provision of local green space amongst poor BME communities since this can play an important role in helping address the health inequalities experienced by these groups.

Rituals of infant death: defining life and Islamic personhood.

PubMed

Shaw, Alison

2014-02-01

This article is about the recognition of personhood when death occurs in early life. Drawing from anthropological perspectives on personhood at the beginnings and ends of life, it examines the implications of competing religious and customary definitions of personhood for a small sample of young British Pakistani Muslim women who experienced miscarriage and stillbirth. It suggests that these women's concerns about the lack of recognition given to the personhood of their fetus or baby constitute a challenge to customary practices surrounding burial as a Muslim. The article suggests that these women's concerns cannot be adequately glossed as a clash of Islamic belief versus Western medicine. Rather, they represent a renegotiation of Islamic opinion and customary practices within the broader context of changes in the medical and social norms surrounding pregnancy loss and infant death in multi-ethnic British society. © 2013 The Author. Bioethics published by John Wiley & Sons Ltd.

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

GPs' knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England.

PubMed

Chatterjee, Robin; Chapman, Tim; Brannan, Mike Gt; Varney, Justin

2017-10-01

Physical activity (PA) brief advice in health care is effective at getting individuals active. It has been suggested that one in four people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients. To assess the knowledge, use, and confidence in national PA and Chief Medical Officer (CMO) health guidelines and tools among GPs in England. Online questionnaire-based survey of self-selecting GPs in England that took place over a 10-day period in March 2016. The questionnaire consisted of six multiple-choice questions and was available on the Doctors.net.uk (DNUK) homepage. Quotas were used to ensure good regional representation. The final analysis included 1013 responses. Only 20% of responders were broadly or very familiar with the national PA guidelines. In all, 70% of GPs were aware of the General Practice Physical Activity Questionnaire (GPPAQ), but 26% were not familiar with any PA assessment tools, and 55% reported that they had not undertaken any training with respect to encouraging PA. The majority of GPs in England (80%) are unfamiliar with the national PA guidelines. Awareness of the recommended tool for assessment, GPPAQ, is higher than use by GPs. This may be because it is used by other clinical staff, for example, as part of the NHS Health Check programme. Although brief advice in isolation by GPs on PA will only be a part of the behaviour change journey, it is an important prompt, especially if repeated as part of routine practice. This study highlights the need for significant improvement in knowledge, skills, and confidence to maximise the potential for PA advice in GP consultations. © British Journal of General Practice 2017.

Informing the market: the strengths and weaknesses of information in the British National Health Service.

PubMed

McKee, M; Chenet, L

1997-06-01

Many countries are experimenting with planned (or quasi-) markets to discover if they can efficiently deliver health care in keeping with societal objectives. This paper examines the information requirements of this approach. Information is necessary in order to compare the performance of providers, to support billing, and to monitor access to care. It should be accurate, unambiguous, and resistant to manipulation. We draw on a project to find out how information on hospitalisation could be used in contracting in the British National Health Service. We conclude that the existing British system fails to provide robust measures of how many patients are treated, for what conditions, and with what treatments. We identify some promising remedies, others that are more difficult, and some which may be impossible to implement in any planned market, given the uncertainty of clinical practice.

Dystocia in nine British breeds of cattle and its relationship to the dimensions of the dam and calf.

PubMed

Schwabe, A E; Hall, S J

The degree of assistance provided at 1353 calvings from 954 heifers and cows of nine breeds of British cattle (Ayrshire, British White, Dexter, Friesian/Holstein type, Gloucester, Kerry, Longhorn, Shetland and White Park) was recorded and analysed in terms of the dimensions of the dam and the calf. The sires had been chosen in accordance with normal farming practice. A heavy calf did not lead to dystocia. Assistance at calving was most frequently provided in the Ayrshire herd, which was used for veterinary teaching. There were very few difficult calvings in the seven rare breeds, but this was as likely to have been due to management policy as to the breed characteristics. A large tuber coxae measurement was associated with ease of calving, particularly in the Dexter. The breeds showed a wide range of pelvic dimensions and therefore provide a source of genetic variation.

Practice patterns of family physicians with 2-year residency v. 1-year internship training: do both roads lead to Rome?

PubMed Central

Sheps, S B; Schechter, M T; Grantham, P; Finlayson, N; Sizto, R

1989-01-01

Are there differences in patterns of practice between actively practising physicians who have been certified after a 2-year family practice residency and matched physicians without certification who have completed the standard 1-year internship? With the use of billing files prepared by the British Columbia Medical Association a group of 65 family practice certificants in active practice in British Columbia was compared with a control group of 130 internship trainees matched by year and school of graduation, category of billing (i.e., solo or group) and region. A wide range of practice features was assessed for the fiscal years 1984-85, 1985-86 and 1986-87. No differences were detected between the groups in 1986-87 for the following practice variables: number of patients (1888 and 1842 respectively), number of personal services billed for (7265 and 7173), number of personal services per patient (3.9), amount of funding for personal services ($140,192 and $140,100) and amount per patient for personal services ($77 and $79). Age-adjusted costs for male and female patients were similar in the two groups. Of six services thought to be influenced by type of training, only maternity care generated a significantly higher number of billings in the study group (341 v. 249). These results suggest that there is no demonstrable effect of training on patterns of practice. However, the question of the effect of training on quality of care and whether the 2-year residency may have a longer effect on practice patterns should be the focus of future research. PMID:2702528

Sociodemographic profile of an Olympic team.

PubMed

Lawrence, D W

2017-07-01

To document the distribution of sociodemographic markers (race and relative access to wealth) in athletes participating at the summer and Winter Olympic Games (OGs). Cross-sectional descriptive epidemiological study. Sociodemographic data were collected from publically available resources for all athletes representing four countries (Canada, United States of America, Great Britain and Australia) at the 2014 Sochi Winter OGs and 2016 Rio Summer OGs. The prevalence of white and privately educated athletes were identified for each sport, country, and team with consideration and comparison to the general population. Access indices (i.e. the combined race socio-economic access index [CAI]) were developed to describe the relative distribution of white and privately educated athletes representing each sport, country and team compared to the respective general population. A total of 568 winter and 1643 summer athletes were included in this study. Privately educated athletes constituted 30.3% and 32.7% of winter and summer athletes, respectively; while 94.9% of winter and 81.7% of summer athletes were white. The CAIs of the Canadian, American, British and Australian winter Olympic teams were 0.52, 0.42, 0.61 and 0.45, respectively. The CAIs, for the Canadian, American, British and Australian summer Olympic teams were 0.89, 1.13, 0.82 and 0.83, respectively. Summer and winter sports with the greatest and least racial and socio-economic biases were identified. Racial and socio-economic biases were identified in both summer and winter Olympic sports; predominantly favouring white and privately educated Olympic athletes. These findings prompt further inquiry into barriers for sport-specific participation and advancement, in addition to the practice of providing substantial public resources in support for Olympic sports and athletes. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The doctor and the rebels--the diary of Charles Molteno Murray, recorded during the 1914 Boer rebellion.

PubMed

Murray, R

2000-12-01

Just 12 years after the conclusion of the Anglo-Boer war, South Africa was led by ex-Boer Generals Botha and Smuts into what was to become the Great War, on the side of the British. This was utterly unacceptable to thousands of Boers who had engaged in a bitter struggle, against overwhelming odds, to prevent their country from becoming part of the mighty British Empire. Led by Generals de Wet, Beyers, and de la Rey, Lieutenant-Colonel Maritz and Major Kemp, they took up arms in a doomed rebellion, without proper weapons, equipment or organisation--by the time they were defeated the casualty figures for both sides exceeded those that would later result from the German South West campaign. Charles Molteno Murray, 37 years old, was a GP in Kenilworth, Cape Town, at the time. His father was an Irish immigrant doctor, his mother the daughter of the first Prime Minister of the Cape, Sir John Charles Molteno. In spite of having a busy and successful practice, with a surgical appointment at Victoria Hospital, Charles Murray volunteered for duty and soon found himself in the Orange Free State and northern Cape, caring for the wounded and dying of both sides in the rebellion. He kept a meticulous record of his experiences, written on loose-leaf pages sent as letters to his wife, which were later bound into leather-backed diaries. These diaries were passed on to his grandson, Dr Robert Murray, who had them transcribed into modern format. They contain details of daily life in the midst of military action, and also insights into important and little-publicised events of the Boer Rebellion of 1914.

How to write a Critically Appraised Topic: evidence to underpin routine clinical practice.

PubMed

Callander, J; Anstey, A V; Ingram, J R; Limpens, J; Flohr, C; Spuls, P I

2017-10-01

Critically appraised topics (CATs) are essential tools for busy clinicians who wish to ensure that their daily clinical practice is underpinned by evidence-based medicine. CATs are short summaries of the most up-to-date, high-quality available evidence that is found using thorough structured methods. They can be used to answer specific, patient-orientated questions that arise recurrently in real-life practice. This article provides readers with a detailed guide to performing their own CATs. It is split into four main sections reflecting the four main steps involved in performing a CAT: formulation of a focused question, a search for the most relevant and highest-quality evidence, critical appraisal of the evidence and application of the results back to the patient scenario. As well as helping to improve patient care on an individual basis by answering specific clinical questions that arise, CATs can help spread and share knowledge with colleagues on an international level through publication in the evidence-based dermatology section of the British Journal of Dermatology. © 2017 British Association of Dermatologists.

A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

PubMed

Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

2015-04-08

Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of Surgery and General Practice are well placed to invest in such infrastructure to provide long-term, high-quality service and training in the community. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Guided and unguided internet-based vestibular rehabilitation versus usual care for dizzy adults of 50 years and older: a protocol for a three-armed randomised trial

PubMed Central

van der Wouden, Johannes C; Bosmans, Judith E; Smalbrugge, Martin; van Diest, Willianne; Essery, Rosie; Yardley, Lucy; van der Horst, Henriëtte E; Maarsingh, Otto R

2017-01-01

Introduction Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective. Online interventions are low cost and easily accessible, but prone to attrition and non-adherence. A combination of online and face-to-face therapy, known as blended care, may balance these advantages and disadvantages. Methods and analysis A single-blind, three-arm, randomised controlled trial among patients aged 50 years and over presenting with dizziness of vestibular origin in general practice will be performed. In this study, we will compare the clinical and cost-effectiveness of stand-alone internet-based VR and internet-based VR with physiotherapeutic support (‘blended care’) with usual care during 6 months of follow-up. We will use a translated Dutch version of a British online VR intervention. Randomisation will be stratified by dizziness severity. The primary outcome measure is the Vertigo Symptoms Scale—Short Form. Intention-to-treat analysis will be performed, adjusting for confounders. The economic evaluation will be conducted from a societal perspective. We will perform an additional analysis on the data to identify predictors of successful treatment in the same population to develop a clinical decision rule for general practitioners. Ethics and dissemination The ethical committee of the VU University Medical Center approved ethics and dissemination of the study protocol. The insights and results of this study will be widely disseminated through international peer-reviewed journals and conference presentations. Trial registration number Pre-results, NTR5712. PMID:28110290

Prevalence of treatment-resistant hypertension after considering pseudo-resistance and morbidity: a cross-sectional study in Irish primary care.

PubMed

Hayes, Peter; Casey, Monica; Glynn, Liam G; Molloy, Gerard J; Durand, Hannah; O'Brien, Eoin; Dolan, Eamon; Newell, John; Murphy, Andrew W

2018-06-01

To confirm treatment-resistant hypertension (TRH), ambulatory blood pressure measurement (ABPM) must exclude white-coat hypertension (WCH), three or more medications should be prescribed at the optimal doses tolerated, and non-adherence and lifestyle should be examined. Most previous studies have not adequately considered pseudo-resistance and merely provide an apparent TRH (aTRH) prevalence figure. To conduct a cross-sectional study of the prevalence of aTRH in general practice, and then consider pseudo-resistance and morbidity. With support, 16 practices ran an anatomical therapeutic chemical (ATC) drug search, identifying patients on any possible hypertensive medications, and then a search of individual patients' electronic records took place. ABPM was used to rule out WCH. The World Health Organization-defined daily dosing guidelines determined adequate dosing. Adherence was defined as whether patients requested nine or more repeat monthly prescriptions within the past year. Sixteen practices participated ( n = 50 172), and 646 patients had aTRH. Dosing was adequate in 19% of patients, 84% were adherent to medications, as defined by prescription refill, and 43% had ever had an ABPM. Using a BP cut-off of 140/90 mmHg, the prevalence of aTRH was 9% (95% confidence interval [CI] = 9.0 to 10.0). Consideration of pseudo-resistance further reduced prevalence rates to 3% (95% CI = 3.0 to 4.0). Reviewing individual patient records results in a lower estimate of prevalence of TRH than has been previously reported. Further consideration for individual patients of pseudo-resistance additionally lowers these estimates, and may be all that is required for management in the vast majority of cases. © British Journal of General Practice 2018.

Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia.

PubMed

Hardefeldt, L Y; Browning, G F; Thursky, K; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Bailey, K E

2018-01-01

Antimicrobials are widely used in Australian veterinary practices, but no investigation into the classes of antimicrobials used, or the appropriateness of use in horses, has been conducted. The aim of the study was to describe antimicrobial use for surgical prophylaxis in equine practice in Australia. Cross-sectional questionnaire survey. An online questionnaire was used to document antimicrobial usage patterns. Information solicited in the questionnaire included demographic details of the respondents, the frequency with which antimicrobials were used for specific surgical conditions (including the dose, timing and duration of therapy) and practice antimicrobial use policies and sources of information about antimicrobials and their uses. A total of 337 members of the Australian veterinary profession completed the survey. Generally, the choice of antimicrobial was appropriate for the specified equine surgical condition, but the dose and duration of therapy varied greatly. While there was poor optimal compliance with British Equine Veterinary Association guidelines in all scenarios (range 1-15%), except removal of a nonulcerated dermal mass (42%), suboptimal compliance (compliant antimicrobial drug selection but inappropriate timing, dose or duration of therapy) was moderate for all scenarios (range 48-68%), except for an uninfected contaminated wound over the thorax, where both optimal and suboptimal compliance was very poor (1%). Veterinarians practicing at a university hospital had higher odds of compliance than general practice veterinarians (Odds ratio 3.2, 95% CI, 1.1-8.9, P = 0.03). Many survey responses were collected at conferences which may introduce selection bias, as veterinarians attending conferences may be more likely to have been exposed to contemporary antimicrobial prescribing recommendations. Antimicrobial use guidelines need to be developed and promoted to improve the responsible use of antimicrobials in equine practice in Australia. An emphasis should be placed on antimicrobial therapy for wounds and appropriate dosing for procaine penicillin. © 2017 EVJ Ltd.

Education and Training: Springboard or Hurdle?

ERIC Educational Resources Information Center

Walsh, M.

1987-01-01

A survey of 19 British companies documented their use of education and training programs. Questions covered such areas as (1) expenditure rates, (2) strategy and policies, (3) appraisal and budgeting, and (4) accounting practice. Problems and potential changes were solicited. (CH)

Working To Learn: A Holistic Approach to Young People's Education and Training.

ERIC Educational Resources Information Center

Senker, Peter; Rainbird, Helen; Evans, Karen; Hodkinson, Phil; Keep, Ewart; Maguire, Malcolm; Raffe, David; Unwin, Lorna

2000-01-01

Highlights deficiencies in current British policies on work-based learning for 16-19 year-olds. Discusses problems arising from employers' voluntary participation. Outlines a holistic approach based on the community of practice model. (SK)

The Investment Decision: Theory and Practice.

ERIC Educational Resources Information Center

Walton, Martin

1978-01-01

Investigates investment behavior of 42 British business firms to determine the degree to which firms are influenced by standard economic theory. Findings indicated that orthodox economic theories of investment and appraisal techniques have little influence on investment behavior. (Author/DB)

Greeks, British Greek Cypriots and Londoners: a comparison of morbidity.

PubMed

Mavreas, V G; Bebbington, P E

1988-05-01

This paper reports the results of a comparison of the rates of psychiatric disorder from three general population surveys in which the PSE-ID-CATEGO system was used for case-definition. These surveys were of an English sample in Camberwell, London, and of two Greek samples, the first in Athens, the second of Greek Cypriot immigrants living in Camberwell. The results show that the rates of psychiatric disorders in both Greek samples were somewhat higher than those of the Camberwell population, the differences being accounted for by higher rates of anxiety disorders, especially in women. Comparisons in terms of syndrome profiles showed that Greeks reported more symptoms of generalized anxiety than their English counterparts who, in their turn, reported higher rates of obsessive symptoms, and symptoms of social anxiety. The higher rates in the Greek samples were possibly due to an increased frequency of non-specific neurotic symptoms like worrying and tension. The results of other European community surveys with the PSE suggest that there might be a genuine and general North-South difference in the expression of psychological distress. Cultural differences in terms of personality traits and culturally sanctioned child rearing practices might account for the findings.

Cognitive Ability, Learning Approaches and Personality Correlates of General Knowledge

ERIC Educational Resources Information Center

Furnham, Adrian; Swami, Viren; Arteche, Adriane; Chamorro-Premuzic, Tomas

2008-01-01

The relationship between general knowledge (GK) and cognitive ability (IQ and abstract reasoning), learning approaches, and personality ("big five" traits and typical intellectual engagement) was investigated in a sample of 101 British undergraduates. As predicted, GK was positively correlated with cognitive ability (more so with IQ than…

Vague Language in Conference Abstracts

ERIC Educational Resources Information Center

Cutting, Joan

2012-01-01

This study examined abstracts for a British Association for Applied Linguistics conference and a Sociolinguistics Symposium, to define the genre of conference abstracts in terms of vague language, specifically universal general nouns (e.g. people) and research general nouns (e.g. results), and to discover if the language used reflected the level…

Comparing Content in Selected GCE A Levels and Advanced GNVQs.

ERIC Educational Resources Information Center

Holding, Gordon; And Others

1996-01-01

In an action research project, four British further education colleges compared mandatory units of three Advanced General National Vocational Qualifications (GNVQs)--business, art and design, and health and social care--with related General Certificate of Education Advanced Level (GCE A-level) syllabuses. Activities included a detailed comparison…

The NATO Special Operations Forces Transformation Initiative: Opportunities and Challenges

DTIC Science & Technology

2009-03-01

reality in the starkest possible terms when British Lieutenant General Sir Michael Jackson refused to comply with the orders of the then-SACEUR...http://www.strategicstudiesinstitute.army.mil/pdffiles/PUB889.pdf (accessed 15 November 2008). 58 General Sir Michael Jackson , “My Clash With NATO

The politics of gender and medicine in colonial India: the Countess of Dufferin's Fund, 1885-1888.

PubMed

Lal, M

1994-01-01

This article examines the relationship of gender issues and the practice of medicine in the context of colonialism as revealed through an analysis of the Dufferin Fund in India. Early private efforts to deliver Western health care in India were confined to combatting disease among the military and to the work of a few missionaries. The Dufferin Fund was created by Queen Victoria to provide health services to Indian women by training women physicians and personnel, establishing medical facilities, and providing female nurses and midwives. Fund-raising subscriptions were largely supported by wealthy Indians. British perceptions about Indian society and the nature of colonial rule were reflected by the Fund which responded to the misguided notion that Indian women would only accept the services of female physicians. In contrast with British officialdom, however, the Fund accepted the existence of purdah although the multifaceted nature of this social institution was ignored or misunderstood. These positions buttressed arguments to promote the medical training of English women (who would be shipped out of the way to India). The positions also assigned blame for the poor condition of Indian women to Indian men who were, nonetheless, expected to support the work of the Fund. British opposition to traditional forms of medicine were evident by the Fund's vociferous criticisms of Indian midwives. The Fund was criticized in turn for relying on trained Western women instead of training native women. When Lord Dufferin's stint as Viceroy was over, praise was lavished upon the departing Lady Dufferin as a proxy used by the Indian press for expressing a desire for a more humanitarian style of colonial rule. From the colonial point of view, Lady Dufferin set an example for the good works of the future vicereines. However, any accomplishments of the Fund were adopted by the imperial government as its own, and insufficient funding and inactivity led to a loss in the Fund's ability to function. In fact, the existence of the Fund impeded later efforts which may have been more in line with the real needs of India's women. The importance of the Fund to the British lay in its representation of the alleged superiority of British gender relations and health practices, its involvement of the Indian elite in British-type philanthropy, and its role in fostering the medical training of English women.

A population-based study of antenatal corticosteroid prophylaxis for preterm birth.

PubMed

Kazem, Mikameh; Hutcheon, Jennifer A; Joseph, K S

2012-09-01

National and international clinical practice guidelines, based on the meta-analysis of randomized trials, recommend antenatal corticosteroid (ACS) prophylaxis for threatened preterm delivery. We carried out a study to determine the extent to which current clinical practice in British Columbia adheres to these guidelines with a focus on preterm deliveries at 33 to 34 weeks of gestation. Data were obtained from the British Columbia Perinatal Database Registry, a comprehensive provincial registry containing detailed information on all births in the province. All preterm live births between 2000 and 2009 were included in the study. The rate of ACS administration was assessed in different gestational age groups. Determinants of ACS administration (such as maternal characteristics and obstetric factors) were also studied. The frequency of ACS prophylaxis was estimated using rates and exact 95% confidence intervals, and associations were assessed using odds ratios and 95% confidence intervals. Among 35 862 preterm births in British Columbia, the rate of ACS administration was 56.0% in the 26- to 32-week group (95% CI 54.7% to 57.4%) and 19.4% in the 33- to 34-week group (95% CI 18.5% to 20.4%). Rates were reasonably consistent between 2000 and 2009 and by region of residence in British Columbia. Women with hypertension (OR 1.51; 95% CI 1.32 to 1.72), gestational diabetes (OR 1.21; 95% CI 1.05 t01.40), and iatrogenic deliveries (OR 1.34; 95% CI 1.22 to 1.47) were significantly more likely to receive ACS. Despite explicit clinical guidelines, ACS usage in preterm deliveries at 33 to 34 weeks of gestation appears to be suboptimal.

The science, policy and practice of nature-based solutions: An interdisciplinary perspective.

PubMed

Nesshöver, Carsten; Assmuth, Timo; Irvine, Katherine N; Rusch, Graciela M; Waylen, Kerry A; Delbaere, Ben; Haase, Dagmar; Jones-Walters, Lawrence; Keune, Hans; Kovacs, Eszter; Krauze, Kinga; Külvik, Mart; Rey, Freddy; van Dijk, Jiska; Vistad, Odd Inge; Wilkinson, Mark E; Wittmer, Heidi

2017-02-01

In this paper, we reflect on the implications for science, policy and practice of the recently introduced concept of Nature-Based Solutions (NBS), with a focus on the European context. First, we analyse NBS in relation to similar concepts, and reflect on its relationship to sustainability as an overarching framework. From this, we derive a set of questions to be addressed and propose a general framework for how these might be addressed in NBS projects by funders, researchers, policy-makers and practitioners. We conclude that: To realise their full potential, NBS must be developed by including the experience of all relevant stakeholders such that 'solutions' contribute to achieving all dimensions of sustainability. As NBS are developed, we must also moderate the expectations placed on them since the precedent provided by other initiatives whose aim was to manage nature sustainably demonstrates that we should not expect NBS to be cheap and easy, at least not in the short-term. Copyright © 2016 British Geological Survey, NERC. Published by Elsevier B.V. All rights reserved.

Ageism and the abuse of older people in health and social care.

PubMed

Ward, D

Ageing is a natural process and yet ageism, ageist practice and abuse of older people occur among not only the general public but also in health and social care settings. Recent media reports have highlighted delays in meeting the needs of older people, physical and psychological abuse and that decisions are being made about whether or not to resuscitate an older patient without consultation with the patient and his/her family (e.g. British Journal of Nursing, 2000). This article looks at ageism and the abuse of older people and discusses what can be done to achieve quality care for older people while dealing with obstacles such as poor collaboration between agencies, a lack of support for carers and the belief that the needs of older people are less important than those of the young.

Employers, the government, and industrial fatigue in Britain, 1890-1918.

PubMed Central

McIvor, A J

1987-01-01

The evolution of the concept of industrial fatigue and the responses of employers and the government in Britain to research initiatives in this field of industrial medicine up to the end of the first world war is explored. The discussion dovetails in with the broader debate about the characteristics and dissemination of scientific labour management in Britain. The first section focuses on attitudes towards human energy expenditure and overwork in the nineteenth century. Following this is a discussion of the shorter hours movement of the 1890s, the important experiment at the Manchester engineering firm of Mather and Platt, and the reaction of British employers and the government to this. Finally, a brief analysis is made of the progress in research into workers' health, fatigue, and efficiency during the 1914-8 war, particularly concentrating on the role of the Health and Munition Workers Committee in pioneering the scientific study of industrial medicine. This led directly to the establishment of the Industrial Fatigue Research Board in 1918. Though there are significant caveats, it is argued that before the first world war a wide gap existed between research findings, best practice, and the common workshop experience and that in general British management (with some notable exceptions) grossly neglected the human element in production, ignored human physiological and psychological limitations, and hence both created and exacerbated serious problems of mental and physical fatigue and overstrain. PMID:3318915

The presentation of depression in the British Army.

PubMed

Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin G; Ashford, Robert

2014-01-01

The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK.

PubMed

Unnithan, Maya; Dubuc, Sylvie

2018-06-01

Reports in the British media over the last 4 years have highlighted the schisms and contestations that have accompanied the reports of gender selective abortions amongst British Asian families. The position that sex-selection may be within the terms of the 1967 Abortion Act has particularly sparked controversy amongst abortion campaigners and politicians but equally among medical practitioners and the British Pregnancy Advisory Service who have hitherto tended to stay clear of such debates. In what ways has the controversy around gender-based abortion led to new framings of the entitlement to service provision and new ways of thinking about evidence in the context of reproductive rights? We reflect on these issues drawing on critiques of what constitutes best evidence, contested notions of reproductive rights and reproductive governance, comparative work in India and China as well as our involvement with different groups of campaigners including British South Asian NGOs. The aim of the paper is to situate the medical and legal provision of abortion services in Britain within current discursive practices around gender equality, ethnicity, reproductive autonomy, probable and plausible evidence, and policies of health reform.

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

PubMed

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

[Healthcare aspects of domestic abuse].

PubMed

Kórász, Krisztián

2015-03-08

The paper reviews the forms of domestic abuse, its causes, prevalence and possible consequences. British and Hungarian Law, guidelines and the roles and responsibilities of healthcare professionals in relation to dealing with domestic abuse in their practice is also addressed within the paper.

SALMON 2100 PROJECT: LIKELY SCENARIOS FOR WILD SALMON

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

Salmon 2100: Some recovery strategies that just might work

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and southern British Columbia. The Project does not ...

British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism

PubMed Central

Howard, Luke S; Barden, Steven; Condliffe, Robin; Connolly, Vincent; Davies, Chris; Donaldson, James; Everett, Bernard; Free, Catherine; Horner, Daniel; Hunter, Laura; Kaler, Jasvinder; Nelson-Piercy, Catherine; O’Dowd, Emma; Patel, Raj; Preston, Wendy; Sheares, Karen; Tait, Campbell

2018-01-01

The following is a summary of the recommendations and good practice points for the BTS Guideline for the initial outpatient management of pulmonary embolism. Please refer to the full guideline for full information about each section.

Assuring Quality in Collaborative Provision.

ERIC Educational Resources Information Center

Bocock, Jean; Edwards, Judith

1998-01-01

This bulletin is intended to help British further education colleges clarify their rationale for entering into collaborative programs, assess prospective partners, define and implement good practice at all stages of provision, and establish rigorous quality assurance procedures. Following an introduction, Further Education Funding Council…

Practically perfect: learning by doing at AVS congress.

PubMed

2017-02-18

It has been some time since Cambridge vet school last hosted the annual AVS congress, which meant that this year's congress committee faced a steep learning curve. However, as Gill Harris reports, it rose to the occasion. British Veterinary Association.

Ability Grouping Practices in the Primary School: A Survey.

ERIC Educational Resources Information Center

Hallam, Susan; Ireson, Judith; Lister, Veronica; Chaudhury, Indrani Andon; Davies, Jane

2003-01-01

Surveys how British primary schools group their students for different school subjects, such as according to class ability or mixed ability grouping. Finds that most schools used the class ability groupings, either in mixed or ability groupings. Includes references. (CMK)

Cross-cultural differences in oral impacts on daily performance between Greek and British older adults.

PubMed

Tsakos, G; Marcenes, W; Sheiham, A

2001-12-01

To examine whether there are significant cross-cultural differences in oral health-related quality of life and perceived treatment need between older people of similar clinical oral status living in Greece and Britain. Cross-sectional surveys of adults living independently aged 65 years or older. In Britain, data from the national diet and nutrition survey were used, while the Greek sample was drawn from two municipalities in Athens. Participants 753 in Britain and 681 in Greece. Oral health-related quality of life, assessed through the modified Oral Impacts on Daily Performance (OIDP) indicator, and perceived need for dental treatment. Thirty-nine per cent of Greek and 12.3% of British dentate and 47.6% of Greek and 16.3% of British edentulous participants had experienced oral impacts affecting their daily life in the last six months. The most prevalent impact was difficulty eating. Apart from that, 56.3% of Greek and 37.1% of British dentate and 33.5% of Greek and 25.3% of British edentulous participants perceived dental treatment need. After controlling for sociodemographic variables, perceived general health and clinical oral status, Greek dentate and edentulous participants were significantly more likely to experience oral impacts than their British counterparts, while in relation to perceived treatment need significant cross-cultural differences existed only between dentate respondents. The results indicated an independent cultural influence in the perception of oral impacts in older people.

Immunization delivery in British Columbia

PubMed Central

Omura, John; Buxton, Jane; Kaczorowski, Janusz; Catterson, Jason; Li, Jane; Derban, Andrea; Hasselback, Paul; Machin, Shelagh; Linekin, Michelle; Morgana, Tamsin; O’Briain, Barra; Scheifele, David; Dawar, Meena

2014-01-01

Abstract Objective To explore the experiences of family physicians and pediatricians delivering immunizations, including perceived barriers and supports. Design Qualitative study using focus groups. Setting Ten cities throughout British Columbia. Participants A total of 46 family physicians or general practitioners, 10 pediatricians, and 2 residents. Methods A semistructured dialogue guide was used by a trained facilitator to explore participants’ experiences and views related to immunization delivery in British Columbia. Verbatim transcriptions were independently coded by 2 researchers. Key themes were analyzed and identified in an iterative manner using interpretive description. Main findings Physicians highly valued vaccine delivery. Factors facilitating physician-delivered immunizations included strong beliefs in the value of vaccines and having adequate information. Identified barriers included the large time commitment and insufficient communication about program changes, new vaccines, and the adult immunization program in general. Some physicians reported good relationships with local public health, while others reported the opposite experience, and this varied by geographic location. Conclusion These findings suggest that physicians are supportive of delivering vaccines. However, there are opportunities to improve the sustainability of physician-delivered immunizations. While compensation schemes remain under the purview of the provincial governments, local public health authorities can address the information needs of physicians. PMID:24627403

Translational neuropharmacology and the appropriate and effective use of animal models.

PubMed

Green, A R; Gabrielsson, J; Fone, K C F

2011-10-01

This issue of the British Journal of Pharmacology is dedicated to reviews of the major animal models used in neuropharmacology to examine drugs for both neurological and psychiatric conditions. Almost all major conditions are reviewed. In general, regulatory authorities require evidence for the efficacy of novel compounds in appropriate animal models. However, the failure of many compounds in clinical trials following clear demonstration of efficacy in animal models has called into question both the value of the models and the discovery process in general. These matters are expertly reviewed in this issue and proposals for better models outlined. In this editorial, we further suggest that more attention be made to incorporate pharmacokinetic knowledge into the studies (quantitative pharmacology). We also suggest that more attention be made to ensure that full methodological details are published and recommend that journals should be more amenable to publishing negative data. Finally, we propose that new approaches must be used in drug discovery so that preclinical studies become more reflective of the clinical situation, and studies using animal models mimic the anticipated design of studies to be performed in humans, as closely as possible. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

Conducting research in clinical psychology practice: Barriers, facilitators, and recommendations.

PubMed

Smith, Kirsten V; Thew, Graham R

2017-09-01

The combination of clinical psychologists' therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice. We reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations. We considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles. We suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings. Clinical implications Emerging evidence suggests that clinical settings that foster research are associated with better patient outcomes. Suggestions to increase the feasibility of research projects in clinical settings are detailed. Limitations The present recommendations are drawn from the authors' practical experience and may need adaptation to individual practitioners' settings. This study does not attempt to assess the efficacy of the strategies suggested. © 2017 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Promoting a culture of innovation: BJSP and the emergence of new paradigms in social psychology.

PubMed

Reicher, Stephen

2011-09-01

In this paper, I start by describing the role played by British Journal of Social Psychology (BJSP) in nurturing two important new paradigms in social psychology - the social identity approach and discourse psychology. I then consider the forces in contemporary academia, in general, and psychology, in particular, that militate against innovation. I conclude by suggesting some ways in which individual social psychologists and our journals, particularly BJSP, can contribute to the development of an innovative and intellectually dynamic discipline. ©2011 The British Psychological Society.

Comparison of access to services in rural emergency departments in Quebec and British Columbia.

PubMed

Fleet, Richard; Audette, Louis-David; Marcoux, Jérémie; Villa, Julie; Archambault, Patrick; Poitras, Julien

2014-11-01

Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services. British Columbia has more rural EDs (n  =  34) than Quebec (n  =  26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

Characterization of Environmental Sources of the Human and Animal Pathogen Cryptococcus gattii in British Columbia, Canada, and the Pacific Northwest of the United States▿

PubMed Central

Kidd, Sarah E.; Chow, Yat; Mak, Sunny; Bach, Paxton J.; Chen, Huiming; Hingston, Adrian O.; Kronstad, James W.; Bartlett, Karen H.

2007-01-01

Cryptococcus gattii has recently emerged as a primary pathogen of humans and wild and domesticated animals in British Columbia, particularly on Vancouver Island. C. gattii infections are typically infections of the pulmonary and/or the central nervous system, and the incidence of infection in British Columbia is currently the highest reported globally. Prior to this emergence, the environmental distribution of and the extent of colonization by C. gattii in British Columbia were unknown. We characterized the environmental sources and potential determinants of colonization in British Columbia. C. gattii was isolated from tree surfaces, soil, air, freshwater, and seawater, and no seasonal prevalence was observed. The C. gattii concentrations in air samples were significantly higher during the warm, dry summer months, although potentially infectious propagules (<3.3 μm in diameter) were present throughout the year. Positive samples were obtained from many different areas of British Columbia, and some locations were colonization “hot spots.” C. gattii was generally isolated from acidic soil, and geographic differences in soil pH may influence the extent of colonization. C. gattii soil colonization also was associated with low moisture and low organic carbon contents. Most of the C. gattii isolates recovered belonged to the VGIIa genetic subtype; however, sympatric colonization by the VGIIb strain was observed at most locations. At one sampling site, VGIIa, VGIIb, VGI, and the Cryptococcus neoformans serotype AD hybrid all were coisolated. Our findings indicate extensive colonization by C. gattii within British Columbia and highlight an expansion of the ecological niche of this pathogen. PMID:17194837

Fatal accidents and injuries among merchant seafarers worldwide.

PubMed

Roberts, S E; Nielsen, D; Kotłowski, A; Jaremin, B

2014-06-01

The British merchant fleet has expanded in recent years but it is not known whether this expansion has led to proportionate changes in mortality. To investigate mortality from accidents and injuries in British merchant shipping, to determine whether this has increased in recent years, to compare fatal accident rates across British industries and to review fatal accident rates in merchant shipping worldwide over the last 70 years. Examinations of marine accident investigation files, death registers and death inquiry files, national mortality statistics, worldwide surveys and review methodology. The main outcome measure was the fatal accident rate per 100 000 worker-years. Of 66 deaths in British shipping from 2003 to 2012, 49 were caused by accidents, which largely affected deck ratings. The fatal accident rate in British shipping increased by 4.7% per annum from 2003, although this was not significant (95% confidence interval: -5.1 to 15.6%). During 2003-12, the fatal accident rate in shipping (14.5 per 100 000) was 21 times that in the general British workforce, 4.7 times that in the construction industry and 13 times that in manufacturing. Of 20 merchant fleets worldwide with population-based fatal accident rates, most have shown large reductions over time. The expansion of the British merchant fleet in recent years does not appear to have had a major impact on fatal accidents. Further preventive measures should target fatalities during mooring and towing operations. Internationally, most shipping fleets have over time experienced large decreases in fatal accident rates. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Diffusing Innovations in Nursing Education: From PDAs to OERs.

PubMed

Doyle, Glynda; Budz, Bernice

2016-01-01

The Canadian educational and healthcare practice landscapes are ever-evolving technologically. In response to these changes, the British Columbia Institute of Technology (BCIT) has integrated various educational technologies using Rogers Diffusion of Innovation model as a guiding framework for this integration with considerable success. This poster describes BCIT's journey with diffusing innovations, discusses examples of these technological integrations in accordance with Roger's model, and outlines several implications for educational practice.

"I Understood the Words but I Didn't Know What They Meant": Japanese Online MBA Students' Experiences of British Assessment Practices

ERIC Educational Resources Information Center

Fenton-O'Creevy, Mark; van Mourik, Carien

2016-01-01

We report on a case study of high Japanese student failure rates in an online MBA programme. Drawing on interviews, and reviews of exam and assignment scripts we frame the problems faced by these students in terms of a "language as social practice" approach and highlight the students' failure to understand the specific language games…

Flow Control and Design Assessment for Drainage System at McMurdo Station, Antarctica

DTIC Science & Technology

2014-11-24

Council BMP Best Management Practice CASQUA California Storm Water Quality Task Force CRREL Cold Regions Research and Engineering Laboratory DS...ponds The California Storm Water Quality Task Force (CASQUA 1993) defines a sediment basin as “a pond created by excavation or constructing an em...British Standards Institution. California Storm Water Quality Task Force (CASQUA). 1993. ESC41: Check Dams. In Stormwater Best Management Practices

Identity processes, threat, and interpersonal relations: accounts from British Muslim gay men.

PubMed

Jaspal, Rusi; Cinnirella, Marco

2012-01-01

This study explores identity processes, identity threat, and interpersonal relations with other gay men in a qualitative interview study with a sample of young British Muslim gay men of Pakistani background. Transcripts were subjected to qualitative thematic analysis. Data were analyzed through the interpretive lens of Identity Process Theory. Three superordinate themes are reported: (a) self-continuity and the transition from straight to gay space; (b) interpersonal relations with other gay men and self- and other categorization; and (c) interpersonal contact or identification with White gay men as an identity enhancer. Theoretical and practical implications of the results are discussed.

Choice of contracts in the British National Health Service: an empirical study.

PubMed

Chalkley, Martin; McVicar, Duncan

2008-09-01

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.

What makes British general practitioners take part in a quality improvement scheme?

PubMed

Spooner, A; Chapple, A; Roland, M

2001-07-01

To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

Secondary science teachers' attitudes toward and beliefs about science reading and science textbooks

NASA Astrophysics Data System (ADS)

Yore, Larry D.

Science textbooks are dominant influences behind most secondary science instruction but little is known about teachers' approach to science reading. The purpose of this naturalistic study was to develop and validate a Science and Reading Questionnaire to assess secondary science teachers' attitudes toward science reading and their beliefs or informed opinions about science reading. A survey of 428 British Columbia secondary science teachers was conducted and 215 science teachers responded. Results on a 12-item Likert attitude scale indicated that teachers place high value on reading as an important strategy to promote learning in science and that they generally accept responsibility for teaching content reading skills to science students. Results on a 13-item Likert belief scale indicated that science teachers generally reject the text-driven model of reading, but they usually do not have well-formulated alternative models to guide their teaching practices. Teachers have intuitive beliefs about science reading that partially agree with many research findings, but their beliefs are fragmented and particularly sketchy in regard to the cognitive and metacognitive skills required by readers to learn from science texts. The findings for attitude, belief, and total scales were substantiated by further questions in the Science and Reading Questionnaire regarding classroom practice and by individual interviews and classroom observations of a 15-teacher subsample of the questionnaire respondents.

Ward nurses' experiences of the discharge process between intensive care unit and general ward.

PubMed

Kauppi, Wivica; Proos, Matilda; Olausson, Sepideh

2018-05-01

Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit. The aim of this study was to explore general ward nurses' experiences of caring for patients being discharged from an ICU. Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen. The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses' powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses' caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization's care guidelines did not always favour the patients. The structure of the organization and its leadership appear to have a significant impact on the nurses' ability to offer patients the care they need. This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period. © 2018 British Association of Critical Care Nurses.

An exploration of student midwives' language to describe non-formal learning in professional practice.

PubMed

Finnerty, Gina; Pope, Rosemary

2005-05-01

The essence of non-formal learning in midwifery practice has not been previously explored. This paper provides an in-depth analysis of the language of a sample of student midwives' descriptions of their practice learning in a range of clinical settings. The students submitted audio-diaries as part of a national study (Pope, R., Graham. L., Finnerty. G., Magnusson, C. 2003. An investigation of the preparation and assessment for midwifery practice within a range of settings. Project Report. University of Surrey). Participants detailed their learning activities and support obtained whilst working with their named mentors for approximately 10 days or shifts. The rich audio-diary data have been analysed using Discourse Analysis. A typology of non-formal learning (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136) has been used to provide a framework for the analysis. Non-formal learning is defined as any learning which does not take place within a formally organised learning programme (Eraut, M. 2000. Non-formal learning and implicit knowledge in professional work. British Journal of Educational Psychology 70, 113-136). Findings indicate that fear and ambiguity hindered students' learning. Recommendations include the protection of time by mentors within the clinical curriculum to guide and supervise students in both formal and non-formal elements of midwifery practice. This paper will explore the implications of the findings for practice-based education.

Shiatsu in Britain and Japan: Personhood, holism and embodied aesthetics.

PubMed

Adams, Glyn

2002-01-01

In this paper, globalisation processes are examined through the prism of shiatsu, an originally Japanese, touch-based therapy, now practised in Europe, Japan, North America, and many other places. Examining this emergent plane of therapeutic practice provides an opportunity to reflect on categories of personhood, notably that of the individual, and its place within processes of globalisation. The article is divided into two parts. In the first part the holisms inherent to East Asian medical practice and underlying notions of personhood in Japan and Britain are critically examined. The seemingly reductionistic practice of 'bodily holism' in Japan is shown to reflect socio-centred notions of the person. The concept of holism animating shiatsu in a British school in London, far from being Japanese, 'ancient', or 'timeless', is shown to reflect individualism characteristic of the New Age movement. In the second part of the paper, using an auto-phenomenological approach, a description of practitioner (my own) and client's lived experience of shiatsu is given in case study form. This illustrates how 'holism' is felt within the context of a shiatsu treatment. The aesthetic form of the shiatsu touch described is shown to be implicitly individualising. This has, it is argued, profound implications for understanding the embodied dimensions of practitioner-patient encounters, the potential efficacy of treatment, and more generally the practice of globalised East Asian 'holistic' therapies in Britain and other settings.

Perceiving the target's state or state provoked by the target? An analysis of the descriptive and evaluative knowledge in person perception.

PubMed

Mignon, Astrid; Mollaret, Patrick

2012-12-01

In line with the theory of traits as generalized affordances, the present article argues that target's states (TSs) and states provoked by a target (other's states (OSs) towards target) are two components of the meaning of traits referring, respectively, to a descriptive and to an evaluative knowledge of people. A preliminary study confirmed that TS and OS were equally representative of a trait. Two studies were designed to study the effects of practising the use of traits as either TS or OS categories (an induction procedure) on a subsequent person perception task, requiring participants to rate photographed targets on a series of traits. Results show that both the differentiation between targets and evaluative consistency of ratings were enhanced under the OS condition compared to TS and control (with no practice of traits) conditions. Importantly, Study 2 tends to show that the effects of the induction procedure are not limited to the practised traits but also generalize to unpractised traits. Implications of these findings for social perception research are discussed. ©2011 The British Psychological Society.

Cognitive correlates of performance in advanced mathematics.

PubMed

Wei, Wei; Yuan, Hongbo; Chen, Chuansheng; Zhou, Xinlin

2012-03-01

Much research has been devoted to understanding cognitive correlates of elementary mathematics performance, but little such research has been done for advanced mathematics (e.g., modern algebra, statistics, and mathematical logic). To promote mathematical knowledge among college students, it is necessary to understand what factors (including cognitive factors) are important for acquiring advanced mathematics. We recruited 80 undergraduates from four universities in Beijing. The current study investigated the associations between students' performance on a test of advanced mathematics and a battery of 17 cognitive tasks on basic numerical processing, complex numerical processing, spatial abilities, language abilities, and general cognitive processing. The results showed that spatial abilities were significantly correlated with performance in advanced mathematics after controlling for other factors. In addition, certain language abilities (i.e., comprehension of words and sentences) also made unique contributions. In contrast, basic numerical processing and computation were generally not correlated with performance in advanced mathematics. Results suggest that spatial abilities and language comprehension, but not basic numerical processing, may play an important role in advanced mathematics. These results are discussed in terms of their theoretical significance and practical implications. ©2011 The British Psychological Society.

Assessment of man's thermal comfort in practice

PubMed Central

Fanger, P. O.

1973-01-01

Fanger, P. O. (1973).British Journal of Industrial Medicine,30, 313-324. Assessment of man's thermal comfort in practice. A review is given of existing knowledge regarding the conditions for thermal comfort. Both physiological and environmental comfort conditions are discussed. Comfort criteria are shown diagrammatically, and their application is illustrated by numerous practical examples. Furthermore, the effect on the comfort conditions of age, adaptation, sex, seasonal and circadian rhythm, and unilateral heating or cooling of the body is discussed. The term `climate monotony' is considered. A method is recommended for the evaluation of the quality of thermal environments in practice. Images PMID:4584998

'Looking as little like patients as persons well could': hypnotism, medicine and the problem of the suggestible subject in late nineteenth-century Britain.

PubMed

Chettiar, Teri

2012-07-01

During the late nineteenth century, many British physicians rigorously experimented with hypnosis as a therapeutic practice. Despite mounting evidence attesting to its wide-ranging therapeutic uses publicised in the 1880s and 1890s, medical hypnosis remained highly controversial. After a decade and a half of extensive medical discussion and debate surrounding the adoption of hypnosis by mainstream medical professionals--including a thorough inquiry organised by the British Medical Association--it was decisively excluded from serious medical consideration by 1900. This essay examines the complex question of why hypnosis was excluded from professional medical practice by the end of the nineteenth century. Objections to its medical adoption rarely took issue with its supposed effectiveness in producing genuine therapeutic and anaesthetic results. Instead, critics' objections were centred upon a host of social and moral concerns regarding the patient's state of suggestibility and weakened 'will-power' while under the physician's hypnotic 'spell'. The problematic question of precisely how far hypnotic 'rapport' and suggestibility might depart from the Victorian liberal ideal of rational individual autonomy lay at the heart of these concerns. As this essay demonstrates, the hypnotism debate was characterised by a tension between physicians' attempts to balance their commitment to restore patients to health and pervasive middle-class concerns about the rapid and ongoing changes transforming British society at the turn of the century.

Collaborative Inquiry and the Professional Development of Science Teachers.

ERIC Educational Resources Information Center

Erickson, Gaalen L.

1991-01-01

Argues that the nature and meaning of collaborative relationships depend upon their particular, practical context. Describes an ongoing collaborative research project, the Students' Intuitions and Science Instruction Group (University of British Columbia), detailing its research agenda, postulates pertaining to teacher development, collaborative…

Who is responsible for developing experienced vets?

PubMed

2016-04-30

Reports from practice suggest an apparent shortage of experienced vets. A debate at this year's BSAVA congress explored what was meant by 'experienced vet' and who should be responsible for helping new graduates gain the necessary experience. Kathryn Clark reports. British Veterinary Association.

Particle Physics: From School to University.

ERIC Educational Resources Information Center

Barlow, Roger

1992-01-01

Discusses the teaching of particle physics as part of the A-level physics course in British secondary schools. Utilizes the quark model of hadrons and the conceptual kinematics of particle collisions, as examples, to demonstrate practical instructional possibilities in relation to student expectations. (JJK)

British-Pakistani women's perspectives of diabetes self-management: the role of identity.

PubMed

Majeed-Ariss, Rabiya; Jackson, Cath; Knapp, Peter; Cheater, Francine M

2015-09-01

To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management. Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention. An explorative qualitative study. Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically. Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social support enabled women to accept changes within themselves and Supporting family is a barrier to self-management demonstrated how family roles were an aspect of women's identities that was resilient to change. The over-arching theme Role re-alignment enables successful self-management encapsulated how self-management was a continuous process where achievements needed to be sustained. Inter-generational differences were also noted: first generation women talked about challenges associated with ageing and co-morbidities; second generation women talked about familial and work roles competing with self-management. The complex nature of British-Pakistani women's self-identification requires consideration when planning and delivering healthcare. Culturally competent practice should recognise how generational status influences self-identity and diabetes self-management in ethnically diverse women. Health professionals should remain mindful of effective self-management occurring alongside, and being influenced by, other aspects of life. © 2015 John Wiley & Sons Ltd.

Japan - UK Conference: Trends in Physics and Chemistry Education in Secondary Schools

NASA Astrophysics Data System (ADS)

1998-11-01

This conference, held in Tokyo between 3-5 April 1998, was the most recent product of a now longstanding involvement between British and Japanese physics teachers which has grown out of a personal friendship between Brenda Jennison (Cambridge University and Vice Chair of the Education Group) and Tae Ryu (Sophia University). For a number of years British teachers have hosted Japanese counterparts at the annual ASE meetings and in visits to schools following the conference. For this conference a team of four physicists, Brenda Jennison, lan Lawrence (King's School Worcester), Philip Britton (Leeds Grammar School) and Phil Scott (University of Leeds) travelled to Japan to contribute to a conference and visit schools and University Departments. Feelings on reading a conference report can too often resemble the experience of being shown a friend's holiday snaps. They are clearly very interesting but equally clearly your friend is enjoying it more than you are, because the snaps are rekindling memories and thoughts. This set of reflections is an attempt to report on just four of those memories and thoughts rather than describe the pictures. Why organize an international conference? The conference was an event that almost took more months of tireless organization than it lasted in hours. It was conceived and brought to fruition amongst a welter of e-mail communications between Brenda Jennison, Tae Ryu and Maurice Jenkins of the British Council, who sponsored the event. Given this immense organizational task, just why did we bother? What can be gained by holding such an international event? The significant benefit of discussing issues between two cultures is clarifying which are the issues that are intrinsically due to the nature of physics teaching rather than the extrinsic effects of educational systems and customs. Unsurprisingly pupil motivation, pupil numbers, relevance, `up-to-date-ness' and the role of mathematics emerged as concerns in both cultures. Also there are always benefits from gaining a wider view. Whether this is a need to see a classroom other than your own, a school other than your own or a country other than your own, the result is the same: setting challenges and discussions in context and helping to provide a sense of perspective. What we had to give to the conference During the conference the British contingent reviewed the present state of science education in Britain, particularly giving information on the Institute of Physics 16-19 Initiative and National Curriculum consultation, concentrating rather more on the principles than the detail, which by nature was not immediately relevant to the audience. To this was added a research perspective on Children's Learning in Science, focusing on the importance of discussion and conversation in reaching understanding. The central day was dominated by workshops attempting to argue why we undertake some experimental work in physics education. Four possible purposes of practical work were identified and then demonstrated by a hands-on practical circus. An investigative practical, necessarily open-ended and probably empirically messy, possibly not yielding clean results. A clearly illustrative practical intended to readily allow observation and discussion of a phenomenon with the ability to alter appropriate parameters and stimulating discussion. Practical work intended to produce clear, reproducible, reliable results if good care is taken: the `can-do' aspect of physics giving pride in obtaining a result. The demonstration intended to stimulate teacher-led class discussion. The abiding memory of this practical circus was of its role as the ultimate international ice-breaker. Previously formal conference discussion became animated and language difficulties became less important as teachers engaged in the truly international business of playing with and becoming fascinated with practical apparatus. What we gained from the conference On the Saturday evening we were treated to demonstrations by groups of physics and chemistry teachers of apparatus that they had made. This hugely enjoyable session has resulted in a great number of good ideas appearing ready for use in a certain British physics lab. Poaching ideas in teaching can be an international activity as well! One impression that this session left us with is that, making a gross generalization, the Japanese are physics teachers, the British physics teachers. How delightful if we in Britain could more often gather in this fashion to delight in exploring physics for ourselves. A substantial benefit of the conference was the challenge of presenting the substantive arguments behind the philosophy of curriculum change to teachers from a different culture, with thoughts being tempered in the furnace of translation. When each word requires lengthy translation, they become precious. An attempt to explain what was meant by the phrase `positive formative reinforcement' that had been carelessly written on one overhead transparency on the purpose of assessment has left permanent mental scars (and perhaps rightly so!). And what of the future? The conference, and perhaps more especially the surrounding visits, resulted in the start of new friendships and the renewal of old acquaintances. Other visits and conferences will doubtless be arranged. The two groups of physics teachers have much to share and discuss with each other. In the short term it is hoped that fruitful e-mail communication and cooperation can be continued both between participants and among a wider circle of physics teachers from both countries. Philip Britton and Ian Lawrence Head of Physics, Leeds Grammar School, and Secretary, IoP Education Group King's School Worcester, and Chairman, IoP Education Group

Physician self-disclosure in primary care: a mixed methods study of GPs' attitudes, skills, and behaviour.

PubMed

Allen, Emily-Charlotte Frances; Arroll, Bruce

2015-09-01

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure. To explore what GPs' attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources. Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts. Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis. Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP's intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful. Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship. © British Journal of General Practice 2015.

Experiences of a commercial weight-loss programme after primary care referral: a qualitative study.

PubMed

Allen, Jodie T; Cohn, Simon R; Ahern, Amy L

2015-04-01

Referral to a commercial weight-loss programme is a cost-effective intervention that is already used within the NHS. Qualitative research suggests this community-based, non-medical intervention accords with participants' view of weight management as a lifestyle issue. To examine the ways in which participants' attitudes and beliefs about accessing a commercial weight management programme via their doctor relate to their weight-loss experience, and to understand how these contextual factors influence motivation and adherence to the intervention. A qualitative study embedded in a randomised controlled trial evaluating primary care referral to a commercial weight-loss programme in adults who are overweight or obese in England. The study took place from June-September 2013. Twenty-nine participants (body mass index [BMI] ≥28 kg/m(2); age ≥18 years), who took part in the WRAP (Weight Loss Referrals for Adults in Primary Care) trial, were recruited at their 3-month assessment appointment to participate in a semi-structured interview about their experience of the intervention and weight management more generally. Interviews were audiorecorded, transcribed verbatim, and analysed inductively using a narrative approach. Although participants view the lifestyle-based, non-medical commercial programme as an appropriate intervention for weight management, the referral from the GP and subsequent clinical assessments frame their experience of the intervention as medically pertinent with clear health benefits. Referral by the GP and follow-up assessment appointments were integral to participant experiences of the intervention, and could be adapted for use in general practice potentially to augment treatment effects. © British Journal of General Practice 2015.

Prediction of true test scores from observed item scores and ancillary data.

PubMed

Haberman, Shelby J; Yao, Lili; Sinharay, Sandip

2015-05-01

In many educational tests which involve constructed responses, a traditional test score is obtained by adding together item scores obtained through holistic scoring by trained human raters. For example, this practice was used until 2008 in the case of GRE(®) General Analytical Writing and until 2009 in the case of TOEFL(®) iBT Writing. With use of natural language processing, it is possible to obtain additional information concerning item responses from computer programs such as e-rater(®). In addition, available information relevant to examinee performance may include scores on related tests. We suggest application of standard results from classical test theory to the available data to obtain best linear predictors of true traditional test scores. In performing such analysis, we require estimation of variances and covariances of measurement errors, a task which can be quite difficult in the case of tests with limited numbers of items and with multiple measurements per item. As a consequence, a new estimation method is suggested based on samples of examinees who have taken an assessment more than once. Such samples are typically not random samples of the general population of examinees, so that we apply statistical adjustment methods to obtain the needed estimated variances and covariances of measurement errors. To examine practical implications of the suggested methods of analysis, applications are made to GRE General Analytical Writing and TOEFL iBT Writing. Results obtained indicate that substantial improvements are possible both in terms of reliability of scoring and in terms of assessment reliability. © 2015 The British Psychological Society.

British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).

PubMed

McKenzie, Y A; Bowyer, R K; Leach, H; Gulia, P; Horobin, J; O'Sullivan, N A; Pettitt, C; Reeves, L B; Seamark, L; Williams, M; Thompson, J; Lomer, M C E

2016-10-01

The first British Dietetic Association (BDA) guidelines for the dietary management of irritable bowel syndrome (IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines. Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA. Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice. These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults. © 2016 The British Dietetic Association Ltd.

Illness perception, help-seeking attitudes, and knowledge related to obsessive-compulsive disorder across different ethnic groups: a community survey.

PubMed

Fernández de la Cruz, Lorena; Kolvenbach, Sarah; Vidal-Ribas, Pablo; Jassi, Amita; Llorens, Marta; Patel, Natasha; Weinman, John; Hatch, Stephani L; Bhugra, Dinesh; Mataix-Cols, David

2016-03-01

Despite similar prevalence rates across ethnicities, ethnic minorities with obsessive-compulsive disorder (OCD) are under-represented in research and clinical settings. The reasons for this disproportion have been sparsely studied. We explored potential differences in illness perception, help-seeking attitudes, illness knowledge, and causal attributions that could help explain the lower uptake of treatment for OCD amongst ethnic minorities. Two-hundred and ninety-three parents (139 White British, 61 Black African, 46 Black Caribbean, and 47 Indian) were recruited from the general population in South-East London, UK. Using a text vignette methodology, participants completed a survey including questions on illness perception, help-seeking attitudes, OCD knowledge, and causal attributions. The groups did not differ in socio-demographic characteristics and family history of OCD. White British parents perceived that the OCD difficulties would have more negative impact on their children and that treatment would be more helpful, compared to the ethnic minorities; the largest differences were observed between White British and Indian parents. Ethnic minorities were more prone to say that would seek help from their religious communities. Black African parents were more in favor of not seeking help for the described difficulties and, in general, perceived more treatment barriers. White British parents seemed to be better informed about OCD than ethnic minority parents. The results offer some plausible explanations for the large inequalities in access to services amongst ethnic minorities with OCD. Clinicians and policy-makers need to be aware of these socio-cultural factors when designing strategies to encourage help-seeking behaviors in these populations.

The rolling evolution of biomedical science as an essential tool in modern clinical practice.

PubMed

Blann, Andrew

2016-01-01

The British Journal of Biomedical Science is committed to publishing high-quality original research that represents a clear advance in the practice of biomedical science, and reviews that summarise recent advances in the field of biomedical science. The overall aim of the Journal is to provide a platform for the dissemination of new and innovative information on the diagnosis and management of disease that is valuable to the practicing laboratory scientist. The Editorial that follows describes the Journal and provides a perspective of its aims and objectives.

Promoting safer blood transfusion practice in hospital.

PubMed

Parris, E; Grant-Casey, J

Results from a national comparative audit of bedside transfusion practice show that patients in the UK are at risk of misidentification and poor monitoring when undergoing a blood transfusion. A commonly identified reason for poor compliance with guidelines from the British Committee for Standards in Haematology (BCSH et al 1999) is a lack of awareness of good transfusion practice (National Blood Service (NBS) 2005). This article discusses the implications of the audit findings for the administration of blood at the bedside and examines initiatives to support hospital staff in their efforts to improve blood transfusion safety.

Burden of poor oral health in older age: findings from a population-based study of older British men.

PubMed

Ramsay, S E; Whincup, P H; Watt, R G; Tsakos, G; Papacosta, A O; Lennon, L T; Wannamethee, S G

2015-12-29

Evidence of the extent of poor oral health in the older UK adult population is limited. We describe the prevalence of oral health conditions, using objective clinical and subjective measures, in a population-based study of older men. Cross-sectional study. A representative sample of men aged 71-92 years in 2010-2012 from the British Regional Heart Study, initially recruited in 1978-1980 from general practices across Britain. Physical examination among 1660 men included the number of teeth, and periodontal disease in index teeth in each sextant (loss of attachment, periodontal pocket, gingival bleeding). Postal questionnaires (completed by 2147 men including all participants who were clinically examined) included self-rated oral health, oral impacts on daily life and current perception of dry mouth experience. Among 1660 men clinically examined, 338 (20%) were edentulous and a further 728 (43%) had <21 teeth. For periodontal disease, 233 (19%) had loss of attachment (>5.5 mm) affecting 1-20% of sites while 303 (24%) had >20% sites affected. The prevalence of gingival bleeding was 16%. Among 2147 men who returned postal questionnaires, 35% reported fair/poor oral health; 11% reported difficulty eating due to oral health problems. 31% reported 1-2 symptoms of dry mouth and 20% reported 3-5 symptoms of dry mouth. The prevalence of edentulism, loss of attachment, or fair/poor self-rated oral health was greater in those from manual social class. These findings highlight the high burden of poor oral health in older British men. This was reflected in both the objective clinical and subjective measures of oral health conditions. The determinants of these oral health problems in older populations merit further research to reduce the burden and consequences of poor oral health in older people. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cigarette smoking in British men and selection for coronary artery bypass surgery.

PubMed Central

Morris, R. W.; McCallum, A. K.; Walker, M.; Whincup, P. H.; Ebrahim, S.; Shaper, A. G.

1996-01-01

OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery. PMID:8697156

[250 years of English psychiatry].

PubMed

Freeman, H

1996-08-01

The history of British psychiatry is considered from five main viewpoints: clinical practice, the institutional basis, the legislative basis, lay perspectives of-mental disorder, and European influences. Its philosophical basis can be traced back to the work of the seventeenth-century philosophers. Thomas Hobbes and John Locke. In Scotland, both 'philosophy of mind' and new clinical methods flourished during its Enlightenment; the concept of 'neurosis' was developed by William Cullen. Around 1800, James Prichard's concept of 'moral insanity' became the foundation of modern work on personality disorder and psychopathy. The psychotic illness of King George III, beginning in 1788, led to greater public sympathy for the mentally ill. Attitudes since then have varied, with 'antipsychiatry' becoming very influential in the 1960s. By the mid-eighteenth century, specialised institutions for the mentally ill existed in a number of cities, there were also units attached to charitable general hospitals, but none of these continued after about 1830. The neglect of patients in private madhouses, prisons, and poorhouses led to increasing concern by Parliament, which resulted in the development of public asylums throughout the country. Severe legal restrictions on their activities were modified in 1930 and completely reformed in 1959. From the mid-nineteenth century, French and German influences became increasingly strong, but British universities played no active part in psychiatry until the 1950s. Psycho-analysis did not develop strongly in Britain, where the main contribution was through translation and biography, but some leading analysts came as refugees in the 1930s-as did other psychiatrists from central Europe. Another important influence was that of Adolf Meyer at the Institute of Psychiatry, London, particularly through Sir Aubrey Lewis; physical treatment methods also came to Britain from Europe. In the second half of this century, the most important British developments have been in social psychiatry therapeutic communities, day hospitals, comprehensive district services, psychogeriatrics, etc. Academic psychiatry has also become strong since the 1960s.

Impact on practice of a British Association for Sexual Health and HIV Sexually Transmitted Infections Foundation (STIF) course: an audit of the first four years in Ireland.

PubMed

Calamai, A; Howard, R; Kelly, R; Lambert, J

2013-02-01

In order to investigate the overall impact of the British Association for Sexual Health and HIV (BASHH) Sexually Transmitted Infections Foundation (STIF) course taught in Ireland since 2007, attendees were sent two questionnaires to investigate the overall impact of the course, its effect on clinical practice and the need for further education. Response rate was 19.4%. The majority found the course beneficial and that it did cover their practice needs (96.4%), with 83.6% saying that their confidence and technique in sexual history taking had improved. There was a 3.7% increase in the provision of HIV testing from precourse levels, although only 80% did so routinely; a 12.7% increase in syphilis testing; a 5.4% increase in testing for Chlamydia and a 12.7% increase for gonorrhoea. Some confusion seems to persist in relation to sexually transmitted infection (STI) risk factors. The second questionnaire tested STI knowledge. Most respondents scored well (average 81% correct answers); however, respondents who attended four years previously scored, on average, 7% worse than the others, suggesting the need for a periodic update in the area of STI education.

Improving patient safety in Libya: insights from a British health system perspective.

PubMed

Elmontsri, Mustafa; Almashrafi, Ahmed; Dubois, Elizabeth; Banarsee, Ricky; Majeed, Azeem

2018-04-16

Purpose Patient safety programmes aim to make healthcare safe for both patients and health professionals. The purpose of this paper is to explore the UK's patient safety improvement programmes over the past 15 years and explore what lessons can be learnt to improve Libyan healthcare patient safety. Design/methodology/approach Publications focusing on UK patient safety were searched in academic databases and content analysed. Findings Several initiatives have been undertaken over the past 15 years to improve British healthcare patient safety. Many stakeholders are involved, including regulatory and professional bodies, educational providers and non-governmental organisations. Lessons can be learnt from the British journey. Practical implications Developing a national patient safety strategy for Libya, which reflects context and needs is paramount. Above all, Libyan patient safety programmes should reference internationally approved guidelines, evidence, policy and learning from Britain's unique experience. Originality/value This review examines patient safety improvement strategies adopted in Britain to help developing country managers to progress local strategies based on lessons learnt from Britain's unique experience.

PNW WILD SALMON IN 2100: AN ALTERNATIVE FUTURES PERSPECTIVE ON SALMON RECOVERY

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and southern British Columbia. The Project does not...

THE WEST COAST IN 2100: AN ALTERNATIVE FUTURES PERSPECTIVE ON SALMON RECOVERY

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

WILD SALMON IN 2100: AN ALTERNATIVE FUTURES PERSPECTIVE ON SALMON RECOVERY - MAY 2006

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and southern British Columbia. The Project does not...

THe Pacific Northwest in 2010: An alternative futures perspective on salmon recovery

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

A Study Tour of India.

ERIC Educational Resources Information Center

French, Shirley

1992-01-01

Describes 1991 site visits by British educational administrators of early childhood educational institutions in Delhi and Bombay, India. Discusses philosophies and practices witnessed at a national center providing preschool education and meals, a mobile day-care center for children of migrant workers, a preschool teacher training institute, and…

THE PACIFIC NORTHWEST IN 2100: AN ALTERNATIVE FUTURES PERSPECTIVE ON SALMON RECOVERY

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and southern British Columbia. The Project does not ...

Living Citizenship: Transcending the Cultural Divide

ERIC Educational Resources Information Center

Coombs, Steven; Potts, Mark

2013-01-01

Living citizenship emerging from reflection on an international educational partnership makes a unique contribution to the field and importantly fulfils the British Educational Research Association aim of improving educational practice for the public benefit. This paper explores the conceptual framework of 'living citizenship' as a means for…

Languages in Schools: From Complacency to Conviction.

ERIC Educational Resources Information Center

Phillips, David, Ed.

This collection of essays gives an overview of recent trends and developments in second language instruction, particularly in the context of British education. Contents include: "From Complacency to Conviction: Thirty Years of Language Teaching Theory, Practice, and Policy" (David Phillips); "Lessons from the Graded Objectives…

Determinants of Rural Physicians' Life and Job Satisfaction

ERIC Educational Resources Information Center

Lavanchy, Marcel; Connelly, Ian; Grzybowski, Stefan; Michalos, Alex C.; Berkowitz, Jonathan; Thommasen, Harvey V.

2004-01-01

Objective: To identify and quantify factors that contribute to rural physicians' satisfaction with their jobs and life as a whole. Design: Cross-sectional, mailed survey. Study population: Family physicians practicing in rural communities eligible for British Columbia's Northern and Isolation Allowance. Main measures: Demographics, Domain…

Parallel careers: a parasitologist and a vet.

PubMed

Wright, Ian

2017-09-02

Ian Wright heads the European Scientific Counsel Companion Animal Parasites (ESCCAP) UK and Ireland, which involves some international travel. He and his wife are also practice owners and they have two children. He admits that work-life balance can be a challenge. British Veterinary Association.

Make customer service a priority.

PubMed

2017-09-02

BVA has partnered with Moneypenny, one of the UK's leading outsourced communications providers, to provide members with an effective way to respond to client calls. Moneypenny talked to Pauline Sloan, receptionist at Village Vets in East Lothian, about her practice's experience of using their service. British Veterinary Association.

Programmed Learning in Integrated Industrial Training.

ERIC Educational Resources Information Center

Shirley-Smith, Katalin

Beginning with the system of industrial training boards and other background considerations, this British work gives detailed, practical guidance on applying programed instruction (PI) principles in various job functions and industries. Potential advantages of PI in industrial training are summarized, along with uses of audiovisual aids and…

Records of Pupil Achievement: Some Philosophical Issues.

ERIC Educational Resources Information Center

Bridges, David

1992-01-01

Discusses a British national initiative to introduce records of pupil achievement (RPAs) and student profiles into schools, focusing on practical issues (values, meaning, truth, and validity); what RPAs are; positive reporting; authenticity of assessment; agreeing upon statements; holistic student profiles; and the relationship between assessment…

Integrated and isolated impact of high-performance work practices on employee health and well-being: A comparative study.

PubMed

Ogbonnaya, Chidiebere; Daniels, Kevin; Connolly, Sara; van Veldhoven, Marc

2017-01-01

We investigate the positive relationships between high-performance work practices (HPWP) and employee health and well-being and examine the conflicting assumption that high work intensification arising from HPWP might offset these positive relationships. We present new insights on whether the combined use (or integrated effects) of HPWP has greater explanatory power on employee health, well-being, and work intensification compared to their isolated or independent effects. We use data from the 2004 British Workplace Employment Relations Survey (22,451 employees nested within 1,733 workplaces) and the 2010 British National Health Service Staff survey (164,916 employees nested within 386 workplaces). The results show that HPWP have positive combined effects in both contexts, and work intensification has a mediating role in some of the linkages investigated. The results also indicate that the combined use of HPWP may be sensitive to particular organizational settings, and may operate in some sectors but not in others. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Targeting the American market for medicines, ca. 1950s-1970s: ICI and Rhône-Poulenc compared.

PubMed

Quirke, Viviane

2014-01-01

The forces that have shaped American medicine include a wide set of interrelated changes, among them the changing research, development, and marketing practices of the pharmaceutical industry. This article compares the research and development (R&D) and marketing strategies of the British group Imperial Chemical Industries (ICI, whose Pharmaceutical Division was spun off and merged with the Swedish company Astra to form AstraZeneca) and its French counterpart Rhône-Poulenc (now part of Sanofi-Aventis) in dealing with the American medical market. It examines how, in the process, the relationship between R&D and marketing was altered, and the firms themselves were transformed. The article also questions the extent to which their approaches to this market, one of the most significant markets for drugs in general, and for anticancer drugs in particular, became standardized in the period of "scientific marketing."

The management of acute myocardial infarction: guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians.

PubMed

De Bono, D P; Hopkins, A

1994-01-01

Successful management of acute myocardial infarction depends in the first instance on the patient recognising the symptoms and seeking help as quickly as possible. Once in hospital, fast track admission procedures and protocols for pain relief, early thrombolysis and appropriate ancillary measures (eg aspirin, i.v. betablockers) should be promptly instituted. Specialist advice and, if necessary, transfer to specialist unit should be considered if additional complications arise. Follow-up management after discharge from hospital requires cooperation between primary and secondary care to prolong survival by reducing risk factors, using aspirin, betablockers and angiotensin converting enzyme inhibitors and instituting a suitable rehabilitation programme. Audit measures are included in the report to help general practitioners and hospital doctors review their practice and assess it against the standards set.

Targeting the American Market for Medicines, ca. 1950s–1970s:

PubMed Central

Quirke, Viviane

2014-01-01

summary The forces that have shaped American medicine include a wide set of interrelated changes, among them the changing research, development, and marketing practices of the pharmaceutical industry. This article compares the research and development (R&D) and marketing strategies of the British group Imperial Chemical Industries (ICI, whose Pharmaceutical Division was spun off and merged with the Swedish company Astra to form AstraZeneca) and its French counterpart Rhône-Poulenc (now part of Sanofi-Aventis) in dealing with the American medical market. It examines how, in the process, the relationship between R&D and marketing was altered, and the firms themselves were transformed. The article also questions the extent to which their approaches to this market, one of the most significant markets for drugs in general, and for anticancer drugs in particular, became standardized in the period of “scientific marketing.” PMID:25557515

Clinical autonomy, individual and collective: the problem of changing doctors' behaviour.

PubMed

Armstrong, David

2002-11-01

Evidence-based medicine enables the profession to resist at least some of the challenges to its traditional autonomy: if informed doctors provide what is scientifically proven to be the best care there is less justification for external constraints. Yet, this defensive strategy depends on enforcing a new discipline within the profession such that individual practitioners accept mechanisms of external 'decision support' in their clinical practice. A study of the ways in which general practitioners in British Primary Care change their clinical behaviour shows that an emphasis on a 'patient centred' approach establishes an alternative individualised autonomy that seems inimical to the logic of evidence-based medicine. A tension therefore emerges between the maintenance of the autonomy of the profession as a collectivity through the promotion of a therapeutic rationality and the maintenance of the autonomy of the individual practitioner through the rhetoric of patient-centredness.

Sir William Knighton Bt MD GCH LRCP (1776-1836): courtier and confidante--testimony to physicianly virtues?

PubMed

Hoffbrand, Barry I

2010-02-01

Sir William Knighton went from general practitioner in Devon to close friend and adviser of King George IV. He contributed remarkably to the stability of the Crown, bringing this dysfunctional King's finances under control and enabling the work of government requiring Royal decision-making to proceed much more effectively than it might otherwise have done. Inevitably he was involved in the making and breaking of ministries but appears to have done so with some reluctance. His detractors appear to have been motivated mainly by envy, fear of loss of patronage and social prejudice. His Royal career echoes physicianly virtues of fidelity to trust, empathy and honesty. He made every effort to keep a low public profile in order to minimize envy and intrusion into his private life. His success in this regard may account for the fact that he is practically unknown today despite a unique career in British medicine.

How Providing Mentoring Relates to Career Success and Organizational Commitment: A Study in the General Managerial Population

ERIC Educational Resources Information Center

Bozionelos, Nikos; Bozionelos, Giorgos; Kostopoulos, Konstantinos; Polychroniou, Panagiotis

2011-01-01

Purpose: This study aims to investigate the relationship of mentoring provided with career success and organizational commitment in the general managerial population. Design/methodology/approach: Participants were 194 native British who were employed in a variety of jobs, professions and industries in the United Kingdom. Findings: Mentoring…

Cancer incidence among HIV-positive women in British Columbia, Canada: Heightened risk of virus-related malignancies.

PubMed

Salters, K A; Cescon, A; Zhang, W; Ogilvie, G; Murray, M C M; Coldman, A; Hamm, J; Chiu, C G; Montaner, J S G; Wiseman, S M; Money, D; Pick, N; Hogg, R S

2016-03-01

We used population-based data to identify incident cancer cases and correlates of cancer among women living with HIV/AIDS in British Columbia (BC), Canada between 1994 and 2008. Data were obtained from a retrospective population-based cohort created from linkage of two province-wide databases: (1) the database of the BC Cancer Agency, a province-wide population-based cancer registry, and (2) a database managed by the BC Centre for Excellence in HIV/AIDS, which contains data on all persons treated with antiretroviral therapy in BC. This analysis included women (≥ 19 years old) living with HIV in BC, Canada. Incident cancer diagnoses that occurred after highly active antiretroviral therapy (HAART) initiation were included. We obtained a general population comparison of cancer incidence among women from the BC Cancer Agency. Bivariate analysis (Pearson χ(2) , Fisher's exact or Wilcoxon rank-sum test) compared women with and without incident cancer across relevant clinical and sociodemographic variables. Standardized incidence ratios (SIRs) were calculated for selected cancers compared with the general population sample. We identified 2211 women with 12 529 person-years (PY) of follow-up who were at risk of developing cancer after HAART initiation. A total of 77 incident cancers (615/100 000 PY) were identified between 1994 and 2008. HIV-positive women with cancer, in comparison to the general population sample, were more likely to be diagnosed with invasive cervical cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma and Kaposi's sarcoma and less likely to be diagnosed with cancers of the digestive system. This study observed elevated rates of cancer among HIV-positive women compared to a general population sample. HIV-positive women may have an increased risk for cancers of viral-related pathogenesis. © 2015 British HIV Association.

The Hypersensitivity of Horses to Culicoides Bites in British Columbia

PubMed Central

Anderson, Gail S.; Belton, Peter; Kleider, Nicholas

1988-01-01

Culicoides hypersensitivity is a chronic, recurrent, seasonal dermatitis of horses that has a worldwide distribution, but has only recently been reported in Canada. It is characterized by intense pruritus resulting in lesions associated with self-induced trauma. A survey of veterinarians and horse-owners in British Columbia showed no differences in susceptibility due to the sex, color, breed, or height of the horses. The prevalence of the disease in the 209 horses surveyed was 26%. Horses sharing the same pasture could be unaffected. The disease was reported primarily from southwestern British Columbia; it occurred between April and October and usually affected the ventral midline, mane, and tail. Horses were generally less than nine years old when the clinical signs first appeared ([unk]=5.9 yr). Culicoides hypersensitivity was common in the lineage of several affected horses, possibly indicating a genetic susceptibility. Most cases were severe enough to require veterinary attention and some horses were euthanized. PMID:17423117

Diet and fecal steroid profile in a South Asian population with a low colon-cancer rate.

PubMed

McKeigue, P M; Adelstein, A M; Marmot, M G; Henly, P J; Owen, R W; Hill, M J; Thompson, M H

1989-07-01

South Asian immigrants to England and Wales have low mortality from colon cancer and high mortality from coronary heart disease compared with the general population. In a survey of a predominantly Gujarati population in northwest London, both vegetarians and nonvegetarians had similar total dietary fat intake to the native British population but higher dietary fiber intake. Total fecal bile acid and neutral animal sterol concentrations were lower in South Asians than in a native British comparison group. Sixty-two percent of South Asians excreted detectable quantities of free primary bile acids, which were not present in stools from native British subjects. The ratio of fecal coprostanol to total neutral animal sterols was also lower in South Asians. Low risk of colon cancer in this population may be related to reduced microbial activity in the bowel and low levels of tumor-promoting secondary bile acids.

Medicare financing and redistribution in british columbia, 1992 and 2002.

PubMed

McGrail, Kimberlyn

2007-05-01

Equity in healthcare in British Columbia is defined as the provision of services based on need rather than ability to pay and a separation of contributions to financing from the use of services. Physician and hospital services in Canada are financed mainly through general tax revenues, and there is a perception that this financing is progressive. This paper uses Gini coefficients, concentration indexes and Kakwani indexes of progressivity to assess the progressivity of medicare financing in British Columbia in 1992 and 2002. It also measures the overall redistributive effect of medicare services, considering both contributions to financing and use of hospital and physician services. The conclusion is that medicare does redistribute across income groups, but this redistribution is the result solely of the positive correlation between health status and income; financing is nearly proportionate across income groups, but use is higher among lower-income groups. Informed public debate requires a better understanding of these concepts of equity.

Ethnic variations in pathways into early intervention services for psychosis.

PubMed

Ghali, Sharif; Fisher, Helen L; Joyce, John; Major, Barnaby; Hobbs, Lorna; Soni, Sujata; Chisholm, Brock; Rahaman, Nikola; Papada, Peggy; Lawrence, Jo; Bloy, Sally; Marlowe, Karl; Aitchison, Katherine J; Power, Paddy; Johnson, Sonia

2013-04-01

Ethnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories. To explore ethnic differences in the nature and duration of pathways into early intervention services. In a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services. Duration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies. Variations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.

Military medicine and the ethics of war: British colonial warfare during the Seven Years War (1756-63).

PubMed

Charters, Erica

2010-01-01

This article examines 18th-century European warfare, tracing the first formal codifications of conventions of war, frequently introduced by military physicians and initially regarding the treatment of the sick and wounded. It outlines to what extent these conventions were followed in practice, particularly in the challenging environment of American irregular warfare, with a focus on the most well-known incident of "biological warfare" in the period: the deliberate spread of smallpox by British officers among Amerindians in 1763. More broadly, it demonstrates that the history of military medicine provides a fruitful method with which to uncover assumptions about the ethics of war.

SALMON RECOVERY: A CASE STUDY OF CONTESTED ISSUES IN ECOLOGICAL SCIENCE AND POLICY

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

Continua or Chimera?

ERIC Educational Resources Information Center

Booth, Tony

1994-01-01

This article looks at two concepts in the British 1993 draft Code of Practice concerning students with special needs: the concepts of a "continuum of needs" and a "continuum of provision." Issues involved in connecting the two continua are addressed, including whether service delivery decisions should be based on severity of…

Residency research requirements and the CanMEDS-FM scholar role

PubMed Central

Koo, Jonathan; Bains, Jason; Collins, Marisa B.; Dharamsi, Shafik

2012-01-01

Abstract Objective To explore the perspectives of family medicine residents and recent family medicine graduates on the research requirements and other CanMEDS scholar competencies in family practice residency training. Design Semistructured focus groups and individual interviews. Setting Family practice residency program at the University of British Columbia in Vancouver. Participants Convenience sample of 6 second-year family medicine residents and 6 family physicians who had graduated from the University of British Columbia family practice residency program within the previous 5 years. Methods Two focus groups with residents and individual interviews with each of the 6 recently graduated physicians. All interviews were audiotaped, transcribed, and analyzed for thematic content. Main findings Three themes emerged that captured key issues around research requirements in family practice training: 1) relating the scholar role to family practice, 2) realizing that scholarship is more than simply the creation or discovery of new knowledge, and 3) addressing barriers to integrating research into a clinical career. Conclusion Creation of new medical knowledge is just one aspect of the CanMEDS scholar role, and more attention should be paid to the other competencies, including teaching, enhancing professional activities through ongoing learning, critical appraisal of information, and learning how to better contribute to the dissemination, application, and translation of knowledge. Research is valued as important, but opinions still vary as to whether a formal research study should be required in residency. Completion of residency research projects is viewed as somewhat rewarding, but with an equivocal effect on future research intentions. PMID:22859631

Contemporary training practices in elite British powerlifters: survey results from an international competition.

PubMed

Swinton, Paul A; Lloyd, Ray; Agouris, Ioannis; Stewart, Arthur

2009-03-01

The primary objective of this study was to investigate current powerlifting training methods in light of anecdotal evidence purporting increased similarity with the explosive training practices of weightlifters. The study also assessed the prevalence of contemporary training practices frequently recommended for powerlifters in the popular literature. A 20-item survey was distributed to 32 elite British powerlifters at an International competition. The subject group included multiple national, international, and commonwealth champions and record holders. Based on 2007 competition results, the average Wilks score of the group was 450.26 +/- 34.7. The response rate for the surveys was 88% (28 of 32). The survey was sectioned into 6 areas of inquiry: a) repetition speed, b) explosive training load, c) resistance materials used, d) adjunct power training methods, e) exercise selection, and f) training organization. The results demonstrate that the majority of powerlifters train with the intention to explosively lift maximal and submaximal loads (79 and 82%, respectively). Results revealed that 39% of the lifters regularly used elastic bands and that 57% incorporated chains in their training. Evidence for convergence of training practices between powerlifters and weightlifters was found when 69% of the subjects reported using the Olympic lifts or their derivatives as part of their powerlifting training. Collectively, the results demonstrate that previous notions of how powerlifters train are outdated. Contemporary powerlifters incorporate a variety of training practices that are focused on developing both explosive and maximal strength.

Cultural differences in parental feeding practices and children's eating behaviours and their relationships with child BMI: a comparison of Black Afro-Caribbean, White British and White German samples.

PubMed

Blissett, J; Bennett, C

2013-02-01

Childhood obesity rates differ between cultural groups in Europe. Parents influence their children's weight status and eating behaviours through feeding practices. We investigated cultural differences in feeding practices and eating behaviours and their relation to child weight in three groups that differed in cultural background and geographical location. Fifty-two White German (WG) families, in Germany (44 mothers, mean age 33.8 years), 79 White British (WB) families, in the UK (74 mothers, mean age 37.8) and 40 Black Afro-Caribbean (BAC) families, in the UK (34 mothers, mean age 31.8) participated in this study of 2-12-year-old children. Parents completed questionnaires assessing feeding practices and eating behaviours; children were measured and weighed by experimenters. MANCOVAs indicated that BAC parents used the highest levels of restrictive feeding practices and the lowest levels of monitoring, and their children showed the highest levels of food-approach behaviours. WG parents used the lowest levels of pressure to eat. Partial correlations showed that food-approach behaviours were correlated with child BMI in BAC and WG families but not in WB families. Parental restriction was associated with child Body Mass Index (BMI) in BAC families only. There are both similarities and differences in feeding practices and eating behaviours and their relationships with child weight in different cultural groups. Findings highlight the importance of being aware of cultural differences when carrying out research with multi-cultural samples in Europe.

Making short-term international medical volunteer placements work: a qualitative study.

PubMed

Elnawawy, Omnia; Lee, Andrew C K; Pohl, Gerda

2014-06-01

International medical volunteering has grown in recent decades. It has the potential to benefit and harm the volunteer and host countries; but there is a paucity of literature on the impacts of international medical volunteering and a need to find ways to optimise the benefits of such placements. In this study, one example of international medical volunteering was examined involving British GPs on short-term placements in Nepal. The intention was to explore the expectations and experiences of the local health workers, volunteers, and host organisation to try and understand what makes volunteer placements work. Qualitative study of key informant interviews. Stakeholders of a short-term international medical volunteer (IMV) placement programme in Nepal. Key informant interviews were carried out via face-to-face or telephone/internet interviews with five previous volunteers, three representatives from a non-governmental organisation providing placements, and five local health workers in Nepal who had had contact with the IMVs. Interviews were recorded, transcribed, and analysed using standard thematic framework approaches. All the stakeholders had their own specific motives for participating in the IMV programme. The relationship between volunteers and the Nepalese health workers was complex and characterised by discrepant and occasionally unrealistic expectations. Managing these different expectations was challenging. Contextual issues and cultural differences are important considerations in medical volunteer programmes, and this study highlights the importance of robust preparation pre-placement for the volunteer and host to ensure positive outcomes. © British Journal of General Practice 2014.

One-to-one teaching with pictures--flashcard health education for British Asians with diabetes.

PubMed Central

Hawthorne, K; Tomlinson, S

1997-01-01

BACKGROUND: Type 2 diabetes is up to four times more common in British Asians, but they know little about its management and complications. AIM: To design and evaluate a structured pictorial teaching programme for Pakistani Moslem patients in Manchester with type 2 diabetes. METHOD: A randomized controlled trial of pictorial flashcard one-to-one education in 201 patients attending a hospital outpatient clinic or diabetic clinics in ten general practices in Manchester. Patients' knowledge, self-caring skills and attitudes to diabetes were measured on four topics before the structured teaching, and compared with results six months later. RESULTS: All parameters of knowledge were increased in the study group; for example, percentage scores for correctly identifying different food values increased from 57% to 71% (Analysis of Variance (ANOVA) adjusted difference +11.8%) and knowledge of one diabetic complication from 18% to 78%. Self-caring behaviour improved, with 92% of patients doing regular glucose tests at six months compared with 63% at the start. Attitudinal views were more resistant to change, with patients still finding it hard to choose suitable foods at social occasions. Haemoglobin A1c control improved by 0.34% over six months (ANOVA adjusted difference, 95% CI -0.8% to +0.1%). CONCLUSION: It is concluded that this health education programme can empower Asian diabetics to take control of their diets, learn to monitor and interpret glucose results, and understand the implications of poor glycaemic control for diabetic complications. PMID:9219407

Differences between diploma and baccalaureate dental hygiene education in British Columbia: a qualitative perspective.

PubMed

Sunell, S; McFarlane, Rdd; Biggar, H C

2017-08-01

The British Columbia Ministry of Health in Canada approved a new registration category for dental hygienists in 2012. This category included four abilities that registrants were required to demonstrate at a 4th-year baccalaureate degree level. To identify the differences, if any, between diploma and bachelor's degree education with regard to the 4 legislated abilities focused on the process of care for clients with complex needs and/or disabling conditions including client safety, referrals and interprofessional collaboration. Registrants who had entered practice with a diploma and then gained a baccalaureate degree were invited to participate in an online survey including closed- and open-ended questions. The study was a mixed-method design where the qualitative data were nested concurrently in the open-ended questions; the data were analysed through thematic analysis using grounded theory methods. Respondents (n = 123; 51%) indicated their client care had improved with baccalaureate education due to increased knowledge, increased understanding and increased abilities to make judgements with a particular emphasis on evidence-based decisions. These more advanced abilities provided them with increased confidence for taking action particularly in interprofessional contexts and increased the quality of their decision-making thus leading to better care for clients. Respondents described their dental hygiene services as generally being of a higher standard and specifically in the 4 legislated abilities as a direct result of baccalaureate education. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

So You Want to Be an Advisor

DTIC Science & Technology

2006-04-01

Football League’s kickers on the sidelines, practicing and practicing kicks into a net. On summer days in Major League baseball , throw- ing “on the side... case the new iraqi armed Forces, that has proven to be tremendously challenging and rewarding. My role was a very small one. i was a little cog...doesn’t look each private in the eye. Though the iraqis inherited a similar approach during the British League of nations Mandate era of 1920-1932

Application of prescribing recommendations in older people with reduced kidney function: a cross-sectional study in general practice.

PubMed

Wood, Su; Petty, Duncan; Glidewell, Liz; Raynor, Dk Theo

2018-05-01

Kidney function reduces with age, increasing the risk of harm from increased blood levels of many medicines. Although estimated glomerular filtration rate (eGFR) is reported for prescribing decisions in those aged ≥65 years, creatinine clearance (Cockcroft-Gault) gives a more accurate estimate of kidney function. To explore the extent of prescribing outside recommendations for people aged ≥65 years with reduced kidney function in primary care and to assess the impact of using eGFR instead of creatinine clearance to calculate kidney function. A cross-sectional survey of anonymised prescribing data in people aged ≥65 years from all 80 general practices (70 900 patients) in a north of England former primary care trust. The prevalence of prescribing outside recommendations was analysed for eight exemplar drugs. Data were collected for age, sex, actual weight, serum creatinine, and eGFR. Kidney function as creatinine clearance (Cockcroft-Gault) was calculated using actual body weight and estimated ideal body weight. Kidney function was too low for recommended prescribing in 4-40% of people aged ≥65 years, and in 24-80% of people aged ≥85 years despite more than 90% of patients having recent recorded kidney function results. Using eGFR overestimated kidney function for 3-28% of those aged ≥65 years, and for 13-58% of those aged ≥85 years. Increased age predicted higher odds of having a kidney function estimate too low for recommended prescribing of the study drugs. Prescribing recommendations when kidney function is reduced are not applied for many people aged ≥65 years in primary care. Using eGFR considerably overestimates kidney function for prescribing and, therefore, creatinine clearance (Cockcroft-Gault) should be assessed when prescribing for these people. Interventions are needed to aid prescribers when kidney function is reduced. © British Journal of General Practice 2018.

Walking prescription of 10 000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice.

PubMed

Fayehun, Ayorinde F; Olowookere, Olufemi O; Ogunbode, Adetola M; Adetunji, Adedotun A; Esan, Arinola

2018-02-01

In clinical practice, translating the benefits of a sustained physically active lifestyle on glycaemic control in patients with type 2 diabetes mellitus (T2DM) is difficult. A walking prescription may be an effective alternative. To examine the effect of a 10 000 steps per day prescription on glycaemic control of patients with T2DM. Forty-six adults with T2DM attending a general outpatient clinic were randomised into two equal groups. The intervention group was given goals to accumulate 10 000 steps per day for 10 weeks, whereas the control group maintained their normal activity habits. Daily step count was measured with waist-mounted pedometer and baseline and endline average steps per day. Glycosylated haemoglobin (HbA1c), anthropometric, and cardiovascular measurements were also obtained. An intention-to-treat analysis was done. The average baseline step count was 4505 steps per day for all participants, and the average step count in the intervention group for the last 4 weeks of the study period was higher by 2913 steps per day (95% confidence interval [CI] = 1274 to 4551, F (2, 37.7) = 18.90, P <0.001). Only 6.1% of the intervention group participants achieved the 10 000 steps per day goal. The mean baseline HbA1c was 6.6% (range = 5.3 to 9.0). Endline HbA1c was lower in the intervention group than in the control group (mean difference -0.74%, 95% CI = -1.32 to -0.02, F = 12.92, P = 0.015) after adjusting for baseline HbA1c. There was no change in anthropometric and cardiovascular indices. Adherence to 10 000 steps per day prescription is low but may still be associated with improved glycaemic control in T2DM. Motivational strategies for better adherence would improve glycaemic control. © British Journal of General Practice 2018.

Do procedural skills workshops during family practice residency work?

PubMed

MacKenzie, Mark S; Berkowitz, Jonathan

2010-08-01

To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. Survey involving self-assessment of procedural skills experience and competence. British Columbia. Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.

The use of smartphone health apps and other mobile health (mHealth) technologies in dietetic practice: a three country study.

PubMed

Chen, J; Lieffers, J; Bauman, A; Hanning, R; Allman-Farinelli, M

2017-08-01

Smartphone health applications (apps) and other mobile health (mHealth) technologies may assist dietitians in improving the efficiency of patient care. The present study investigated the use of health apps and text messaging in dietetic practice and formulated intervention recommendations for supporting app uptake by dietitians based on the behavioural 'COM-B' system, where interactions between capability, opportunity and motivation influence behaviour. A 52-item online survey tool, taking 20 min to complete, was developed and piloted, with questions exploring the use of health apps and text messaging in dietetic practice, types of apps dietitians recommended and that patients used, and barriers and enablers to app use in dietetic practice. The Australian, New Zealand and British dietetic associations distributed the survey to their members. A 5% response rate was achieved internationally, with 570 completed responses included for further analysis. Health apps, namely nutrition apps, were used by 62% of dietitians in their practice, primarily as an information resource (74%) and for patient self-monitoring (60%). The top two nutrition apps recommended were MyFitnessPal ® (62%) and the Monash University Low FODMAP Diet ® (44%). Text messaging was used by 51% of respondents, mainly for appointment-related purposes (84%). Although the reported use of smartphone health apps in dietetic practice is high, health apps and other mHealth technologies are not currently being used for behaviour change, nor are they an integral part of the nutrition care process. Dietetic associations should provide training, education and advocacy to enable the profession to more effectively engage with and implement apps into their practice. © 2017 The British Dietetic Association Ltd.

‘Looking as Little Like Patients as Persons Well Could’: Hypnotism, Medicine and the Problem of the Suggestible Subject in Late Nineteenth-Century Britain

PubMed Central

Chettiar, Teri

2012-01-01

During the late nineteenth century, many British physicians rigorously experimented with hypnosis as a therapeutic practice. Despite mounting evidence attesting to its wide-ranging therapeutic uses publicised in the 1880s and 1890s, medical hypnosis remained highly controversial. After a decade and a half of extensive medical discussion and debate surrounding the adoption of hypnosis by mainstream medical professionals – including a thorough inquiry organised by the British Medical Association – it was decisively excluded from serious medical consideration by 1900. This essay examines the complex question of why hypnosis was excluded from professional medical practice by the end of the nineteenth century. Objections to its medical adoption rarely took issue with its supposed effectiveness in producing genuine therapeutic and anaesthetic results. Instead, critics’ objections were centred upon a host of social and moral concerns regarding the patient’s state of suggestibility and weakened ‘will-power’ while under the physician’s hypnotic ‘spell’. The problematic question of precisely how far hypnotic ‘rapport’ and suggestibility might depart from the Victorian liberal ideal of rational individual autonomy lay at the heart of these concerns. As this essay demonstrates, the hypnotism debate was characterised by a tension between physicians’ attempts to balance their commitment to restore patients to health and pervasive middle-class concerns about the rapid and ongoing changes transforming British society at the turn of the century. PMID:23002303

Prevalence of fatigue and chronic fatigue syndrome in a primary care practice.

PubMed

Bates, D W; Schmitt, W; Buchwald, D; Ware, N C; Lee, J; Thoyer, E; Kornish, R J; Komaroff, A L

1993-12-27

Our goals were to determine the prevalence of unusual, debilitating fatigue and the frequency with which it was associated with the chronic fatigue syndrome (CFS) or other physical or psychological illness in an outpatient clinic population. We prospectively evaluated a cohort of 1000 consecutive patients in a primary care clinic in an urban, hospital-based general medicine practice. The study protocol included a detailed history, physical examination, and laboratory and psychiatric testing. Five patients who came because of CFS studies were excluded. Of the remaining 995, 323 reported fatigue, and 271 (27%) complained of at least 6 months of unusual fatigue that interfered with their daily lives. Of the 271, self-report or record review revealed a medical or psychiatric condition that could have explained the fatigue in 186 (69%). Thus, 85 (8.5%) of 995 patients had a debilitating fatigue of at least 6 months' duration, without apparent cause. Of these patients, 48 refused further evaluation, and 11 were unavailable for follow-up; 26 completed the protocol. Three of the 26 were hypothyroid, and one had a major psychiatric disorder. Of the remaining 22 patients, three met Centers for Disease Control and Prevention criteria for CFS, four met British criteria, and 10 met the Australian case definition. The point prevalences of CFS were thus 0.3% (95% confidence interval [CI], 0% to 0.6%), 0.4% (95% CI, 0% to 0.8%), and 1.0% (95% CI, 0.4% to 1.6%) using the Centers for Disease Control and Prevention, British, and Australian case definitions, respectively. These estimates were conservative, because they assumed that none of the patients who refused evaluation or were unavailable for follow-up would meet criteria for CFS. While chronic, debilitating fatigue is common in medical outpatients, CFS is relatively uncommon. Prevalence depends substantially on the case definition used.

THE SALMON 2100 PROJECT: OPTIONS TO PROTECT, RESTORE, ANE ENHANCE SALMON ALONG THE WEST COAST OF NORTH AMERICA

EPA Science Inventory

The primary goal of the Salmon 2100 Project is to identify practical options that have a high probability of maintaining biologically significant, sustainable populations of wild salmon in California, Oregon, Washington, Idaho, and British Columbia. The Project does not support o...

Continuing Education and the Adult Curriculum.

ERIC Educational Resources Information Center

Griffin, Colin

1979-01-01

Discusses the gulf between adult education theory and practices and looks at other British papers and reports on adult and continuing education issues and policies. Argues that insufficient thought has been given to adult education content and to the difficulty of integrating institutions with traditionally different types of curriculum. (MF)

Bright Lights: Stories of Success and Excellence from BC Elementary Schools.

ERIC Educational Resources Information Center

British Columbia Dept. of Education, Victoria.

This document profiles 16 elementary schools in British Columbia that are creating excitement about learning through innovative and creative practices. The schools and their activities are: Westwood Elementary School (Port Coquitlam)--a 1-day "mini-conference" to show students how math is relevant in daily life; Henderson Elementary…

Communicating effectively with deaf patients.

PubMed

McAleer, Monica

This article explores the communication needs of deaf patients who use British Sign Language as their first or preferred language. It would appear that these needs are not being met, particularly in acute hospital settings. Practical advice is provided for nurses to improve the quality of care that deaf patients receive.

Classroom Groups in Theory and Practice.

ERIC Educational Resources Information Center

Boydell, Deanne

1979-01-01

This article examines some British classroom studies and raises further research questions on small group instruction (SGI) as a teaching tool. Considered are teachers' use of SGI; its efficacy for cognitive, language, and social development; and student-to-student interaction patterns in relation to seating, sex, and ability mix. (SJL)

The EFQM Excellence Model for Deploying Quality Management: A British-Russian Journey

ERIC Educational Resources Information Center

Steed, Carol; Maslow, Dmitry; Mazaletskaya, Anna

2005-01-01

This paper describes how the Excellence Model[R] developed by the European Foundation for Quality Management (EFQM) can be used and applied within higher education, with practical examples accompanying the Model in a Russian University to raise management quality. (Contains 5 figures, 2 tables, and 1 footnote.)

Occupational Therapy Approaches for Secondary Special Needs: Practical Classroom Strategies.

ERIC Educational Resources Information Center

Jenkinson, Jill; Hyde, Tessa; Ahmad, Saffia

This reference manual on uses of occupational therapy techniques in British secondary schools is intended to help therapists to identify students' problems and then apply alternative strategies to improve classroom performance. Following an introductory chapter, chapter 1 defines 13 critical foundation skills (e.g., gross motor coordination, fine…

Another Vision of Progressivism: Marion Richardson's Triumph and Tragedy.

ERIC Educational Resources Information Center

Smith, Peter

1996-01-01

Profiles the career and contributions of English art teacher Marion Richardson (1892-1946). A dynamic and assertive woman, Richardson's ideas and practices changed British primary and secondary art teaching for many years. She often used "word pictures" (narrative descriptions of scenes or emotions) to inspire her students. (MJP)

Staging Legitimacy: Theorising Identity Claims in Anti-Homophobia Theatre-in-Education

ERIC Educational Resources Information Center

Greer, Stephen

2011-01-01

This paper offers a queer-theory inflected reading of identity practices in British Theatre-in-Education (TIE) work seeking to address sexual identity and, more specifically, homophobic bullying. Noting the potentially unmarked or socially invisible quality of queer identities, this discussion seeks to reconsider the status of "coming…

Teaching Spoken Discourse Markers Explicitly: A Comparison of III and PPP

ERIC Educational Resources Information Center

Jones, Christian; Carter, Ronald

2014-01-01

This article reports on mixed methods classroom research carried out at a British university. The study investigates the effectiveness of two different explicit teaching frameworks, Illustration--Interaction--Induction (III) and Present--Practice--Produce (PPP) used to teach the same spoken discourse markers (DMs) to two different groups of…

The Research Student's Guide to Success.

ERIC Educational Resources Information Center

Cryer, Pat

This practical guide offers a British perspective to beginning, pursuing, and completing a research degree and is designed to aid graduate students in addressing a wide range of new and unfamiliar roles, expectations, and needs. Some issues addressed are specific to foreign students. An introductory section describes the guide's rationale and…

Teaching Economics. Second Edition.

ERIC Educational Resources Information Center

Lee, Norman, Ed.

The purpose of this book is to review the place of economics education in the curriculum and to investigate the significance of developments in educational theory and practice for the teaching of economics. It consists of a collection of studies on different aspects of economics education, prepared by 24 contributors from British and North…

Dreaming, Stealing, Dancing, Showing Off.

ERIC Educational Resources Information Center

Lavender, Peter; Taylor, Chris

2002-01-01

Lessons learned from British projects to delivery literacy, numeracy, and English as a second language through community agencies included the following: (1) innovation and measured risks are required to attract hard-to-reach adults; (2) good practice needs to be shared; and (3) projects worked best when government funds were managed by community…

Application of Number. Teaching and Learning.

ERIC Educational Resources Information Center

Bove, Francis

This basic math skills teaching and learning guide contains practical advice and resources for British vocational teachers who have little formal mathematics education training and for beginning teachers. The document has five sections on these topics dealing with numeracy instruction: (1) overview of the basic skill and its application to other…

Library Services to Distance Learners in the Commonwealth: A Reader.

ERIC Educational Resources Information Center

Watson, Elizabeth F., Ed.; Jagannathan, Neela, Ed.

The provision of good library services is a crucial factor in determining the quality of distance education. This collection of articles acquaints readers with distance librarianship as it is practiced in developed and developing countries throughout the British Commonwealth. The reader includes: "Introduction" (Michael Wooliscroft);…

Educating Our Black Children: New Directions and Radical Approaches.

ERIC Educational Resources Information Center

Majors, Richard, Ed.

This collection of papers from U.S. and British contributors focuses on positive social inclusion policy and practice for black students. There are 15 chapters in five parts. Part 1, "Tackling Historical and Contemporary Education Problems," includes: (1) "Racism, Policy and the (Mis)Education of Black Children" (David…

Structuring a Clinical Learning Environment for a Hybrid-PBL Dental Curriculum.

ERIC Educational Resources Information Center

MacNeil, M. A. J.; Walton, Joanne N.; Clark, D. Christopher; Tobias, David L.; Harrison, Rosamund L.

1998-01-01

Describes the evolution and implementation of a joint medical-dental problem-based learning (PBL) curriculum at the University of British Columbia's medical and dental schools, featuring development of an integrated care clinic. Issues in structuring the new curriculum are discussed, including management of the clinic's group practices, affective…

Reference-based pricing: will other provinces follow the BC lead?

PubMed

Mullens, A

1998-01-27

REFERENCE-BASED PRICING has had a major impact on medical practice in British Columbia. Anne Mullens discusses the new system's first 2 years. She says physicians outside BC should pay attention, because RBP may be heading their way. It is set to land in Australia next month.

Extravagant Aims, Distorted Practice

ERIC Educational Resources Information Center

Porter, James

2009-01-01

In the decades after the Second World War, the British Government had a democratic, independent and locally administered education service that was recognised as crucial to the post-war political, moral and economic recovery of the country. However, since that time, the independence of schools and local communities has been increasingly usurped,…

Action in Ergonomics

ERIC Educational Resources Information Center

Training Officer, 1975

1975-01-01

A discussion with James Crowley of British Steel Corporation on the changing face of ergonomics in practice today and yesterday examines the influence of experimental psychology on the method of study and data collection. The broadening scope of ergonomics from only safety concerns to cost effectiveness and the computer are analyzed. (Author/JB)

Strategies for Adult Education. Practices in Western Europe.

ERIC Educational Resources Information Center

Titmus, Colin

European case studies on strategies for adult education are presented as representative or exemplary approaches to universal access. Each is described within a historical and social context: the British Community Colleges and the Open University; the Swedish Study Circles; the Evening Folk High School in Germany; the social-cultural animation…

Best Practice Guide: A Resource for Receiving Institutions

ERIC Educational Resources Information Center

British Columbia Council on Admissions and Transfer, 2008

2008-01-01

This guide has been developed primarily for institutions in the British Columbia (BC) Transfer System interested in seeking designation as receiving institutions. Institutions are encouraged to consult this guide and use those sections most relevant to their needs. Areas discussed include: (1) Policy, Procedure and Record-Keeping; (2) Transfer and…

Diary of a parliamentary intern.

PubMed

2017-10-21

Two years ago I started my internship at the House of Lords. It was a leap of faith that took me far away from the familiar world of small animal clinical practice. Now, as I sit to write my final diary piece, I wonder: was it all worth it? British Veterinary Association.

Rewards for Inventors: A Review of Current Practice in UK Universities.

ERIC Educational Resources Information Center

Handscombe, R. D.

1996-01-01

Since the British government began allowing universities to exploit the products of their research, universities have developed cash reward systems for inventors. For many researchers, job satisfaction and peer recognition appear more important than monetary rewards. The money is often reinvested in further research. (SK)

Rebuilding Attendance Practices with Youth: The Role of Social Mediation

ERIC Educational Resources Information Center

Vellos, Renira E.; Vadeboncoeur, Jennifer A.

2015-01-01

This article highlights the experiences of students and educators from a larger sociocultural study of participation and engagement at a senior alternative high school programme in British Columbia, Canada. Drawing on participant observation, active interviews and document analysis, school attendance was remediated as a meaningful social practice…

Ornamental Gentlemen: Literary Curiosities and Queer Romanticisms

ERIC Educational Resources Information Center

Robinson, Michael Edward

2010-01-01

The figure of the "bibliomaniacal" book collector with his "curious" malady--a "passion for collecting...that infects weak minds," according to Isaac D'Israeli (1766-1848)--serves as the focus of this dissertation about nineteenth-century British poetry and prose. More than a psychological condition or cultural practice, the bibliomaniac's…

Transfer Credit Assessment: A Survey of Institutional Practices

ERIC Educational Resources Information Center

British Columbia Council on Admissions and Transfer, 2015

2015-01-01

Assessing credits that transfer students bring to an institution may require a significant amount of institutional resources. The increased mobility of students among post-secondary institutions in British Columbia (BC), and the need to ensure efficient admission processes for both the student and the institution, makes transfer credit assessment…

Personal Contacts and the Adoption of Innovations.

ERIC Educational Resources Information Center

Alleyne, E. Patrick; Verner, Coolie

A study undertaken among commercial strawberry growers in the Fraser Valley of British Columbia, Canada, sought to define the network of personal contacts as used by the farmers in obtaining information relevant to growing practices. Growers were divided into four adopter categories: laggards, late majority, early majority, and innovator-early…

Critical Studies: A Trojan Horse for an Alternative Cultural Agenda?

ERIC Educational Resources Information Center

Swift, John

1993-01-01

Asserts that the introduction of the term "critical studies" to British art education reflects art educators' views that the practice of art alone is insufficient to gain a full experience and coincides with a political will to return to traditional forms of content and knowledge. (CFR)

Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence.

PubMed

Lepping, P; Steinert, T; Needham, I; Abderhalden, C; Flammer, E; Schmid, P

2009-09-01

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.

Health Gain through Screening--Coronary Heart Disease and Stroke: Developing Primary Health Care Services for People with Intellectual Disability.

ERIC Educational Resources Information Center

Wells, M. B.; Turner, S.; Martin, D. M.; Roy, A.

1997-01-01

A study of 120 British adults with intellectual disability found they had higher risk factors of developing coronary heart disease and stroke than the general population. There was a greater incidence of obesity and considerably lower physical activity levels than the general population. Several also had abnormal cholesterol readings. (CR)

Teenage Career Aspirations and Adult Career Attainment: The Role of Gender, Social Background and General Cognitive Ability

ERIC Educational Resources Information Center

Schoon, Ingrid; Polek, Elzbieta

2011-01-01

In this paper we examine the associations between gender, family background, general cognitive ability (g), teenage career aspirations, and career attainment in mid adulthood drawing on two large representative samples of the British population born in 1958 (N = 6,474) and in 1970 (N = 5,081). A developmental-contextual model of career development…

Learning Patient Safety in Academic Settings: A Comparative Study of Finnish and British Nursing Students' Perceptions.

PubMed

Tella, Susanna; Smith, Nancy-Jane; Partanen, Pirjo; Turunen, Hannele

2015-06-01

Globalization of health care demands nursing education programs that equip students with evidence-based patient safety competences in the global context. Nursing students' entrance into clinical placements requires professional readiness. Thus, evidence-based learning activities about patient safety must be provided in academic settings prior to students' clinical placements. To explore and compare Finnish and British nursing students' perceptions of learning about patient safety in academic settings to inform nursing educators about designing future education curriculum. A purpose-designed instrument, Patient Safety in Nursing Education Questionnaire (PaSNEQ) was used to examine the perceptions of Finnish (n = 195) and British (n = 158) nursing students prior to their final year of registration. Data were collected in two Finnish and two English nursing schools in 2012. Logistic regressions were used to analyze the differences. British students reported more inclusion (p < .001) of "gaining knowledge," "training skills," and "highlighting affirmative attitudes and motivation" related to patient safety in their programs. Both student groups considered patient safety education to be more valuable for their own learning than what their programs had provided. Training patient safety skills in the academic settings were the strongest predictors for differences (odds ratio [OR] = 34.69, 95% confidence interval [CI] 7.39-162.83), along with work experience in the healthcare sector (OR = 3.02, 95% CI 1.39-6.58). To prepare nursing students for practical work, training related to clear communication, reporting errors, systems-based approaches, interprofessional teamwork, and use of simulation in academic settings requires comprehensive attention, especially in Finland. Overall, designing patient safety-affirming nursing curricula in collaboration with students may enhance their positive experiences on teaching and learning about patient safety. An international collaboration between educators could help to develop and harmonize patient safety education and to better prepare nurses for practice in the global context. © 2015 Sigma Theta Tau International.

Self- and other-estimates of multiple abilities in Britain and Turkey: a cross-cultural comparison of subjective ratings of intelligence.

PubMed

Furnham, Adrian; Arteche, Adriane; Chamorro-Premuzic, Tomas; Keser, Askin; Swami, Viren

2009-12-01

This study is part of a programmatic research effort into the determinants of self-assessed abilities. It examined cross-cultural differences in beliefs about intelligence and self- and other-estimated intelligence in two countries at extreme ends of the European continent. In all, 172 British and 272 Turkish students completed a three-part questionnaire where they estimated their parents', partners' and own multiple intelligences (Gardner (10) and Sternberg (3)). They also completed a measure of the 'big five' personality scales and rated six questions about intelligence. The British sample had more experience with IQ tests than the Turks. The majority of participants in both groups did not believe in sex differences in intelligence but did think there were race differences. They also believed that intelligence was primarily inherited. Participants rated their social and emotional intelligence highly (around one standard deviation above the norm). Results suggested that there were more cultural than sex differences in all the ratings, with various interactions mainly due to the British sample differentiating more between the sexes than the Turks. Males rated their overall, verbal, logical, spatial, creative and practical intelligence higher than females. Turks rated their musical, body-kinesthetic, interpersonal and intrapersonal intelligence as well as existential, naturalistic, emotional, creative, and practical intelligence higher than the British. There was evidence of participants rating their fathers' intelligence on most factors higher than their mothers'. Factor analysis of the ten Gardner intelligences yield two clear factors: cognitive and social intelligence. The first factor was impacted by sex but not culture; it was the other way round for the second factor. Regressions showed that five factors predicted overall estimates: sex (male), age (older), test experience (has done tests), extraversion (strong) and openness (strong). Results are discussed in terms of the growing literature in the field.

Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges.

PubMed

Skivington, Kathryn; Smith, Mathew; Chng, Nai Rui; Mackenzie, Mhairi; Wyke, Sally; Mercer, Stewart W

2018-05-21

Social prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health. To investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals. Qualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas. Audiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically. Participants identified some benefits of collaborative working, particularly the CLPs' ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management. Although the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as 'magic bullets'. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care. © British Journal of General Practice 2018.

Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study.

PubMed

Diwakar, Lavanya; Cummins, Carole; Ryan, Ronan; Marshall, Tom; Roberts, Tracy

2017-04-01

Adrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified. To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012. Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database. Children and young people aged between 0-17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12). A total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%. The number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed. © British Journal of General Practice 2017.

A survey of the role of the UK physicist in nuclear medicine: a report of a joint working group of the British Institute of Radiology, British Nuclear Medicine Society, and the Institute of Physics and Engineering in Medicine.

PubMed

Tindale, W B; Thorley, P J; Nunan, T O; Lewington, V; Shields, R A; Williams, N R

2003-01-01

Guidelines for the provision of physics support to nuclear medicine were published in 1999 by a joint working group of the British Institute of Radiology, the British Nuclear Medicine Society, and the Institute of Physics and Engineering in Medicine. Following publication of the guidelines, a survey was conducted by the working group to gather data on the actual level of physicist support in UK hospitals of different types and on the activities undertaken by physicists. The data were collected in the 12 months following the publication of guidelines and cover different hospital models and seven UK regions. The results provide evidence that many of the smaller units - small teaching hospitals and, particularly, small district general hospitals - have insufficient physics support. Although, on average, there is good agreement between the guidelines and the survey data for medium and large district general hospitals, there is wide variation in the level of physics provision between hospitals delivering apparently similar services. This emphasizes the need for national guidelines, against which institutions may be bench-marked and which may be used as a recommendation for the staffing levels necessary to ensure services are delivered safely and standards are not compromised. The complexity and variety of workload is an important factor in determining the level of physics support. As services develop, it is vital that this aspect is recognized to ensure that appropriate resources are available for the required physics input, even if any new service represents only a modest clinical throughput in terms of patient numbers.

Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK.

PubMed

Ball, Helen L; Moya, Eduardo; Fairley, Lesley; Westman, Janette; Oddie, Sam; Wright, John

2012-01-01

In the UK, infants of South Asian parents have a lower rate of sudden infant death syndrome (SIDS) than White British infants. Infant care and life style behaviours are strongly associated with SIDS risk. This paper describes and explores variability in infant care between White British and South Asian families (of Bangladeshi, Indian or Pakistani origin) in Bradford, UK (the vast majority of which were Pakistani) and identifies areas for targeted SIDS intervention. A cross-sectional telephone interview study was conducted involving 2560 families with 2- to 4-month-old singleton infants enrolled in the Born in Bradford cohort study. Outcome measures were prevalence of self-reported practices in infant sleeping environment, sharing sleep surfaces, breast feeding, use of dummy or pacifier, and life style behaviours. We found that, compared with White British infants, Pakistani infants were more likely to: sleep in an adult bed (OR = 8.48 [95% CI 2.92, 24.63]); be positioned on their side for sleep (OR = 4.42 [2.85, 6.86]); have a pillow in their sleep environment (OR = 9.85 [6.39, 15.19]); sleep under a duvet (OR = 3.24 [2.39, 4.40]); be swaddled for sleep (OR = 1.49 [1.13, 1.97]); ever bed-share (OR = 2.13 [1.59, 2.86]); regularly bed-share (OR = 3.57 [2.23, 5.72]); ever been breast-fed (OR = 2.00 [1.58, 2.53]); and breast-fed for 8+ weeks (OR = 1.65 [1.31, 2.07]). Additionally, Pakistani infants were less likely to: sleep in a room alone (OR = 0.05 [0.03, 0.09]); use feet-to-foot position (OR = 0.36 [0.26, 0.50]); sleep with a soft toy (OR = 0.52 [0.40, 0.68]); use an infant sleeping bag (OR = 0.20 [0.16, 0.26]); ever sofa-share (OR = 0.22 [0.15, 0.34]); be receiving solid foods (OR = 0.22 [0.17, 0.30]); or use a dummy at night (OR = 0.40 [0.33, 0.50]). Pakistani infants were also less likely to be exposed to maternal smoking (OR = 0.07 [0.04, 0.12]) and to alcohol consumption by either parent. No difference was found in the prevalence of prone sleeping (OR = 1.04 [0.53, 2.01]). Night-time infant care therefore differed significantly between South Asian and White British families. South Asian infant care practices were more likely to protect infants from the most important SIDS risks such as smoking, alcohol consumption, sofa-sharing and solitary sleep. These differences may explain the lower rate of SIDS in this population. © 2011 Blackwell Publishing Ltd.

Disparities in new graduate transition from multiple stakeholder perspectives.

PubMed

Adamack, Monica; Rush, Kathy L

2014-09-01

The purpose of this qualitative study was to understand multiple stakeholder perspectives of new graduate (NG) transition programs. It was part of a larger mixed-methods study (2011) designed to provide a comprehensive assessment of new graduate nurse transition best practices, across six British Columbia health authorities. Data collection involved individual interviews with academic nurse educators (n=4) and separate focus groups with new graduate (n=48) and front-line nurse leaders (n=69). Disparity emerged as the overriding theme and described differences between stakeholder group perspectives, between expectations and reality, and within and across programs. Four disparities emerged: entry-level education and practice, perspectives on employment and career planning, transition program elements and support. Despite general satisfaction with undergraduate preparation, theory-practice gaps were identified. New Graduates experienced misalignments between their employment expectations and their realities. The employed student nurse program in which many new graduates had participated did not always yield employment, but when it did, differences in transitional expectations arose between new graduates and leaders. There was considerable variation across and within provincial new graduate programs with respect to orientation, supernumerary time and preceptorship characteristics, including lack of training. Disparities arose in the nature, amount of and access to support and the monitoring of new graduate progress. Findings reinforced organizational complexities and the importance of communication across education and practice sectors. This paper uncovers the tensions between the perspectives of new graduates and nurse leaders about transitional programs and opens the opportunity to collaborate in aligning the perspectives.

On applying cognitive psychology.

PubMed

Baddeley, Alan

2013-11-01

Recent attempts to assess the practical impact of scientific research prompted my own reflections on over 40 years worth of combining basic and applied cognitive psychology. Examples are drawn principally from the study of memory disorders, but also include applications to the assessment of attention, reading, and intelligence. The most striking conclusion concerns the many years it typically takes to go from an initial study, to the final practical outcome. Although the complexity and sheer timescale involved make external evaluation problematic, the combination of practical satisfaction and theoretical stimulation make the attempt to combine basic and applied research very rewarding. © 2013 The British Psychological Society.

The Emerging British Verticillium longisporum Population Consists of Aggressive Brassica Pathogens.

PubMed

Depotter, Jasper R L; Rodriguez-Moreno, Luis; Thomma, Bart P H J; Wood, Thomas A

2017-11-01

Verticillium longisporum is an economically important fungal pathogen of brassicaceous crops that originated from at least three hybridization events between different Verticillium spp., leading to the hybrid lineages A1/D1, A1/D2, and A1/D3. Isolates of lineage A1/D1 generally cause stem striping on oilseed rape (Brassica napus), which has recently been reported for the first time to occur in the United Kingdom. Intriguingly, the emerging U.K. population is distinct from the north-central European stem striping population. Little is known about the pathogenicity of the newly emerged U.K. population; hence, pathogenicity tests were executed to compare British isolates to previously characterized reference strains. In addition to the model plant Arabidopsis thaliana, the pathogenicity of four British isolates was assessed on four cultivars of three Brassica crop species: oilseed rape (Quartz and Incentive), cauliflower (Clapton), and Chinese cabbage (Hilton). To this end, vascular discoloration of the roots, plant biomass accumulations, and fungal stem colonization upon isolate infection were evaluated. The British isolates appeared to be remarkably aggressive, because plant biomass was significantly affected and severe vascular discoloration was observed. The British isolates were successful stem colonizers and the extent of fungal colonization negatively correlated with plant biomass of cauliflower and Quartz oilseed rape. However, in Quartz, the fungal colonization of A1/D1 isolates was significantly lower than that of the virulent reference isolate from lineage A1/D3, PD589. Moreover, despite levels of stem colonization similar to those of A1/D1 strains, PD589 did not cause significant disease on Incentive. Thus, A1/D1 isolates, including British isolates, are aggressive oilseed rape pathogens despite limited colonization levels in comparison with a virulent A1/D3 isolate.

Ethnicity and the diagnosis gap in liver disease: a population-based study.

PubMed

Alazawi, William; Mathur, Rohini; Abeysekera, Kushala; Hull, Sally; Boomla, Kambiz; Robson, John; Foster, Graham R

2014-11-01

Liver disease is a major cause of morbidity and mortality worldwide. Large numbers of liver function tests (LFTs) are performed in primary care, with abnormal liver biochemistry a common finding. Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver injury. Metabolic syndrome, common in people from South Asia, is an important risk factor for NAFLD. It is hypothesised that a large gap exists between numbers of patients with abnormal LFTs and those with recorded liver diagnoses, and that NAFLD is more common among adults of South Asian ethnic groups. A cross-sectional study of 690,683 adults in coterminous general practices in a region with high ethnic diversity. Data were extracted on LFTs, liver disease, and process of care measures from computerised primary care medical records. LFTs were performed on 218,032 patients, of whom 31 627 had elevated serum transaminases. The prevalence of abnormal LFTs was highest among individuals of Bangladeshi ethnicity. Of the patients with abnormal LFTs, 88.4% did not have a coded liver diagnosis. NAFLD was the most frequently recorded liver disease and was most common among Bangladeshi patients. In a multivariate analysis, independent risk factors for NAFLD included Bangladeshi ethnicity, diabetes, raised BMI, hypertension, and hypercholesterolaemia. Abnormal LFTs are common in the population, but are underinvestigated and often remain undiagnosed. Bangladeshi ethnicity is an important independent risk factor for NAFLD. © British Journal of General Practice 2014.

Helpful strategies for GPs seeing patients with medically unexplained physical symptoms: a focus group study.

PubMed

Aamland, Aase; Fosse, Anette; Ree, Eline; Abildsnes, Eirik; Malterud, Kirsti

2017-08-01

Patients with long-lasting and disabling medically unexplained physical symptoms (MUPS) are common in general practice. GPs have previously described the challenges regarding management and treatment of patients with MUPS. To explore GPs' experiences of the strategies perceived as helpful when seeing patients with MUPS. Three focus group interviews with a purposive sample of 24 experienced GPs were held in southern Norway. Discussions were audiotaped and transcribed. Systematic text condensation was used for analysis. Several strategies were considered helpful during consultations with patients with MUPS. A comprehensive outline of the patient's medical past and present could serve as the foundation of the dialogue. Reviewing the patient's records and sharing relevant information with them or conducting a thorough clinical examination could offer 'golden moments' of trust and common understanding. A very concrete exchange of symptoms and diagnosis interpretation sometimes created a space for explanations and action, and confrontations could even strengthen the alliance between the GP and the patient. Bypassing conventional answers and transcending tensions by negotiating innovative explanations could help patients resolve symptoms and establish innovative understanding. GPs use tangible, down-to-earth strategies in consultations with patients with MUPS. Important strategies were: thorough investigation of the patient's symptoms and story; sharing of interpretations; and negotiation of different explanations. Sharing helpful strategies with colleagues in a field in which frustration and dissatisfaction are not uncommon can encourage GPs to develop sustainable responsibility and innovative solutions. © British Journal of General Practice 2017.

Behaviour change opportunities at mother and baby checks in primary care: a qualitative investigation of the experiences of GPs.

PubMed

Talbot, Hannah; Strong, Emily; Peters, Sarah; Smith, Debbie M

2018-04-01

Pregnancy is widely recognised as a 'teachable moment' for healthy behaviour change and the postnatal period has been identified as the opportune time to initiate this change. In the UK, all women are offered a routine health check at 6-8 weeks postpartum with their GP. This provides a potential opportunity to facilitate long-term behaviour change discussions. To explore GPs' views and experiences of using the postnatal check as a health-related behaviour change opportunity. A qualitative, inductive study in general practice. Semi-structured telephone interviews were conducted with 18 GPs. Audiorecorded interviews were transcribed verbatim and analysed using thematic analysis. One theme emerged from the data: the postnatal check is an unrealised opportunity to facilitate health-related behaviour change. This theme was organised into three subthemes: opportunity for health-related behaviour change; role responsibility; and patient-led versus GP-led behaviour change. Although GPs recognise the postnatal check as a potential opportunity for health-related behaviour change, it is underutilised as they do not perceive this to be the purpose of the check and are uncertain as to their role in facilitating lifestyle changes. To enable this long-term lifestyle behaviour change opportunity to be utilised more fully, further research is needed to understand women's expectations of the postnatal checks and the scope for further recommendations, guidance, and communication training around behaviour change. © British Journal of General Practice 2018.

Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study.

PubMed

Hughes, Tom; Cardno, Alastair; West, Robert; Marino-Francis, Federica; Featherstone, Imogen; Rolling, Keeley; Locker, Alice; McLintock, Kate; House, Allan

2016-02-01

Bipolar disorder is not uncommon, is associated with high disability and risk of suicide, often presents with depression, and can go unrecognised. To determine the prevalence of unrecognised bipolar disorder among those prescribed antidepressants for depressive or anxiety disorder in UK primary care; whether those with unrecognised bipolar disorder have more severe depression than those who do not; and the accuracy of a screening questionnaire for bipolar disorder, the Mood Disorder Questionnaire (MDQ), in this setting. Observational primary care study of patients on the lists of 21 general practices in West Yorkshire aged 16-40 years and prescribed antidepressant medication. Participants were recruited using primary care databases, interviewed using a diagnostic interview, and completed the screening questionnaire and rating scales of symptoms and quality of life. The prevalence of unrecognised bipolar disorder was 7.3%. Adjusting for differences between the sample and a national database gives a prevalence of 10.0%. Those with unrecognised bipolar disorder were younger and had greater lifetime depression. The predictive value of the MDQ was poor. Among people aged 16-40 years prescribed antidepressants in primary care for depression or anxiety, there is a substantial proportion with unrecognised bipolar disorder. When seeing patients with depression or anxiety disorder, particularly when they are young or not doing well, clinicians should review the life history for evidence of unrecognised bipolar disorder. Some clinicians might find the MDQ to be a useful supplement to non-standardised questioning. © British Journal of General Practice 2016.

Turn exchange rhythm in English dialogues

NASA Astrophysics Data System (ADS)

Fon, Janice

2005-09-01

This study looked at the relationship between rhythm and exchange type in British English, a stress-timed language, and Singaporean English, a syllable-timed language, using a spontaneous speech corpus. Exchange intervals (EIs), or the time difference between the end of one speaker and the beginning of another, were measured and exchanges of different types were labeled. Results showed that, in a dialogue, EIs were generally limited to a narrow range. However, within this range, EIs had at least four functions. First, EIs were reflective of the cognitive load and functioned as a way to differentiate various exchange types. Those requiring more cognitive resources, such as question-and-answer pairs, generally needed longer EIs than those not as cognitively loaded, such as backchanneling pairs. Second, EIs were indicative of linguistic rhythm. Singaporean English tended to have shorter EIs than British English. Third, EIs were reflective of politeness. The degree of politeness correlated negatively with EI. Shorter EIs showed a higher degree of respect. Finally, EIs were also indicative of the level of insecurity of a speaker, which was best reflected by gender differences. Females in general had longer EIs than males.

Soaps and Detergents--A 'Social' Treatment.

ERIC Educational Resources Information Center

Rust, S. C.

1979-01-01

Describes how social aspects of science can be incorporated into teaching soap and detergents in British secondary chemistry and general science courses. Historical background to the use and production of soap and the development of detergents are also presented. (HM)

Symbols for the General British English Vowel Sounds

ERIC Educational Resources Information Center

Lewis, J. Windsor

1975-01-01

Deals with the critique of Hans G. Hoffmann saying that the new phonetic symbols contained in A. S. Hornby's "Advanced Learner's Dictionary" (Oxford University Press, London, 1974) are harder to learn than the older system of transcription. (IFS/WGA)

The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France.

PubMed

Grange, F; Barbe, C; Mas, L; Granel-Brocard, F; Lipsker, D; Aubin, F; Velten, M; Dalac, S; Truchetet, F; Michel, C; Mitschler, A; Arnoult, G; Buemi, A; Dalle, S; Reuter, G; Bernard, P; Woronoff, A S; Arnold, F

2012-12-01

Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma. To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants. A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness. Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs. GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.

The patient, the doctor, and the patient's loyalty: a qualitative study in French general practice.

PubMed

Gérard, Laura; François, Mathilde; de Chefdebien, Marine; Saint-Lary, Oliver; Jami, Alain

2016-11-01

The term loyalty can be defined as the attachment that characterises someone who consistent in their feelings, affections, or habits. By introducing the Declaration of General Practitioner (or preferred doctor declaration) in 2004, France adopted a formal incentive for patients to be faithful to their doctor since it entailed optimal coverage of medical care by their national health insurance There has been no research evaluating the impact of this measure and to determine the components of doctor-patient loyalty. To explore what builds and maintains patients' loyalty to their GP. Qualitative study based on semi-structured interviews close to Paris (the département of Yvelines'), France. Twenty-eight patients were interviewed in five surgeries of self-employed GPs with different demographics. Interviews were transcribed and a thematic analysis conducted to categorise the data. Phenomenological analysis was used to analyse the transcripts. Patient loyalty is based mainly on trust. Trust can be reinforced by certain comforting factors such as the ability to listen, a sense of carefulness, and the quality of care. Loyalty is both a dynamic construct and a relational exchange subject to various influences. Patients find advantages in being loyal. The model of the 'family doctor' has always been the archetype of loyalty for several generations within one family. A GP's inability to meet all of the patient's requirements is not necessarily a determining factor in breaking the patient's loyalty. Loyalty is more complex than commonly assumed and involves dimensions of trust, listening, quality of care, availability, and familiarity. The observations drawn out from this study warrant a larger scale investigation. © British Journal of General Practice 2016.

Effect of stepped care on health outcomes in patients with osteoarthritis: an observational study in Dutch general practice.

PubMed

Smink, Agnes J; van den Ende, Cornelia H M; Vliet Vlieland, Thea P M; Bijlsma, Johannes W J; Swierstra, Bart A; Kortland, Joke H; Voorn, Theo B; Teerenstra, Steven; Schers, Henk J; Dekker, Joost; Bierma-Zeinstra, Sita M A

2014-09-01

A stepped care strategy (SCS) to improve adequate healthcare use in patients with osteoarthritis was developed and implemented in a primary care region in the Netherlands. To assess the association between care that is in line with the SCS recommendations and health outcomes. Data were used from a 2-year observational study of 313 patients who had consulted their GP because of osteoarthritis. Care was considered 'SCS-consistent' if all advised modalities of the previous steps of the SCS were offered before more advanced modalities of subsequent steps. Pain and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (range 0-100); active pain coping with the Pain Coping Inventory (range 10-40); and self-efficacy with the Dutch General Self-Efficacy Scale (range 12-48). Crude and adjusted associations between SCS-consistent care and outcomes were estimated with generalised estimating equations. No statistically significant differences were found in changes over a 2-year period in pain and physical function between patients who received SCS-inconsistent care (n = 163) and patients who received SCS-consistent care (n = 117). This was also the case after adjusting for possible confounders, that is, -4.3 (95% confidence interval [CI] = -10.3 to 1.7) and -1.9 (95% CI = -7.0 to 3.1), respectively. Furthermore, no differences were found in changes over time between groups in self-efficacy and pain coping. The results raised several important issues that need to be considered regarding the value of the SCS, such as the reasons that GPs provide SCS-inconsistent care, the long-term effects of the SCS, and the effects on costs and side effects. © British Journal of General Practice 2014.

Association of primary care factors with hospital admissions for epilepsy in England, 2004-2010: National observational study.

PubMed

Calderón-Larrañaga, Amaia; Soljak, Michael; Cowling, Thomas E; Gaitatzis, Athanasios; Majeed, Azeem

2014-09-01

There has been little research on the accessibility and quality of primary care services for epilepsy and emergency hospital admissions for epilepsy. We examined time trends in admissions for epilepsy in England between 2004-2005 and 2010, and the association of admission rates with population and primary care factors. The units of analysis were the registered populations of 8622 general practices. We used negative binomial regression to model indicators from the Quality and Outcomes Framework, the UK's primary care pay for performance scheme, to measure the accessibility and quality of care for epilepsy, and supply of general practitioners, after adjustment for population factors. The mean indirectly standardised admission rate decreased from 122.9 to 102.6 (-16.5%; P<0.001) over the study period, while the mean percentage of patients seizure free increased from 65.3% to 74.9% (P<0.001). In the multivariable analysis, a one unit increase in the percentage of seizure free adult patients on epilepsy drugs predicted a 0.20% decrease (IRR=0.9980; 95% CI: 0.9974-0.9986) in admission rate. The percentage of patients who were able to book a GP appointment over two days ahead predicted a 0.12% decrease (IRR=0.9988; 95% CI: 0.9982-0.9994). The deprivation score of practice populations (IRR=1.0179; P<0.001) and general practitioner supply (IRR=1.0022; P<0.001) were both positively associated with admission rates. Patient access to primary care appointments and percentage of patients who have been recorded as seizure free for 12 months were associated with lower admission rates. However the effect sizes are small relative to that of population deprivation. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Socioeconomic status and weight control practices in British adults

PubMed Central

Wardle, J; Griffith, J

2001-01-01

STUDY OBJECTIVE—Attitudes and practices concerning weight control in British adults were examined to test the hypothesis that variation in concern about weight and deliberate weight control might partly explain the socioeconomic status (SES) gradient in obesity. Higher SES groups were hypothesised to show more weight concern and higher levels of dieting.
SETTING—Data were collected as part of the monthly Omnibus Survey of the Office of National Statistics in March 1999.
PARTICIPANTS—A stratified, probability sample of 2690 households was selected by random sampling of addresses in Britain. One randomly selected person in each household was interviewed at their home.
MAIN RESULTS—As predicted, higher SES men and women had higher levels of perceived overweight, monitored their weight more closely, and were more likely to be trying to lose weight. Higher SES groups also reported more restrictive dietary practices and more vigorous physical activity.
CONCLUSIONS—The results are consistent with the idea that part of the protection against weight gain in higher SES groups could be a higher frequency of weight monitoring, a lower threshold for defining themselves as overweight, and a greater likelihood of deliberate efforts at weight control.


Keywords: socioeconomic status; weight control; obesity PMID:11160173

Exercise behaviour and attitudes among fourth-year medical students at the University of British Columbia.

PubMed

Holtz, Kaila A; Kokotilo, Kristen J; Fitzgerald, Barbara E; Frank, Erica

2013-01-01

To describe the physical activity (PA) levels and counseling attitudes of Canadian undergraduate medical students. Online or paper survey. The University of British Columbia (UBC). Fourth-year medical students at UBC from 2007 to 2010. Physical activity levels, relationship between exercise behaviour and attitudes toward counseling, and student perception of training in the area of exercise prescription. A total of 546 out of 883 students participated in the survey (62% response rate). Sixty-four percent of students met the Canadian Society for Exercise Physiology 2011 recommendations for PA. Attitudes toward healthy living were related to PA levels, but the rate of counseling patients about exercise was not; however, students who engaged in more strenuous PA were more likely to perceive exercise counseling as being highly relevant to future clinical practice (P = .018). Overall, 69% of students perceived exercise counseling to be highly relevant to clinical practice, but 86% thought that their training in this area was less than extensive. Fourth-year UBC medical students engage in more strenuous PA than average age-matched Canadians, which affects their attitudes toward perceived future counseling practices. Encouraging more student participation in strenuous PA and encouraging academic training in the area of exercise counseling might be important next steps in preparing future physicians to effectively prescribe exercise to their patients.

Stories of stones and bones: disciplinarity, narrative and practice in British popular prehistory, 1911-1935.

PubMed

Rees, Amanda

2016-09-01

This paper explores how three central figures in the field of British prehistory - Sir Arthur Keith, Sir Grafton Elliot Smith and Louis Leakey - deployed different disciplinary practices and narrative devices in the popular accounts of human bio-cultural evolution that they produced during the early decades of the twentieth century. It shows how they used a variety of strategies, ranging from virtual witness through personal testimony to tactile demonstration, to ground their authority to interpret the increasingly wide range of fossil material available and to answer the bewildering variety of questions that could be asked about them. It investigates the way in which they positioned their own professional expertise in relation to fossil interpretation, particularly with regard to the - sometimes controversial - use they made of concepts, evidence and practices drawn from other disciplines. In doing so, they made claims that went beyond their original disciplinary boundaries. The paper argues that while none of these writers were able, ultimately, to support the wider claims they made regarding human prehistory, the nature of these claims deserves much closer attention, particularly with respect to the public role that historians of science can and should play in relation to present-day calls for greater interdisciplinarity.

Review of fire test methods and incident data for portable electric cables in underground coal mines

NASA Astrophysics Data System (ADS)

Braun, E.

1981-06-01

Electrically powered underground coal mining machinery is connected to a load center or distribution box by electric cables. The connecting cables used on mobile machines are required to meet fire performance requirements defined in the Code of Federal Regulations. This report reviews Mine Safety and Health Administration's (MSHA) current test method and compares it to British practices. Incident data for fires caused by trailing cable failures and splice failures were also reviewed. It was found that the MSHA test method is more severe than the British but that neither evaluated grouped cable fire performance. The incident data indicated that the grouped configuration of cables on a reel accounted for a majority of the fires since 1970.

Manipulating the Maritime Cultural Landscape: Vernacular Boats and Economic Relations on Nineteenth-Century Achill Island, Ireland

NASA Astrophysics Data System (ADS)

Meide, Chuck; Sikes, Kathryn

2014-06-01

Resistance to British control of Ireland's maritime landscape under the United Kingdom of Great Britain and Ireland (1800-1922) was highly localized, enacted in part through Irish choices in boat construction and patterns of movement at sea. British naval authorities overseeing Achill Island in County Mayo used both coercive and conciliatory means to replace Irish subsistence fishing from regional vernacular boats with commercial fishing from larger non-local vessels reliant upon piers and dredged harbors. These changes encouraged islanders' dependency upon imported food and wage-based employment performed under Protestant surveillance. Indigenous boats including curraghs and yawls played central roles in Irish resistance to these changes, through the assertion of traditional lifeways and practices.

Ergonomic risk factors associated with clinical dentistry.

PubMed

Rucker, Lance M; Sunell, Susanne

2002-02-01

Ergonomics has formed an integral aspect of dental education at the University of British Columbia since the early 1980s. However, studies continued to indicate that dentists are at risk for developing musculoskeletal problems. This provided the impetus for a study of the risk factors associated with these problems. The data analyzed from 421 survey respondents in British Columbia indicate that indeed dentists are experiencing musculoskeletal pain and discomfort. However, the data also suggest that dentists can recognize and identify their own postures, practicing positions, and the equipment usage patterns that are associated with increased risks of experiencing musculoskeletal pain and discomfort. Such recognition is the first critical step to avoiding or neutralizing ergonomic habits and work environment layouts that might otherwise unnecessarily shorten professional clinical careers.

Highlights from the British Society for Heart Failure 20th Annual Autumn Meeting: three decades of heart failure.

PubMed

Abel, Alexandra AI

2018-05-16

The 20th Annual Autumn Meeting of the British Society for Heart Failure took place on the 23-24 November 2017 at the Queen Elizabeth II Conference Centre, London, UK. Over 800 delegates were in attendance: a multidisciplinary league of professionals who treat patients with heart failure, including specialist nurses, trainees, cardiologists, geriatricians, pharmacists and general practitioners. The theme of the conference was 'three decades of heart failure' and celebrated the success of modern heart failure management. This report highlights the 'three decades' session, the clinical trials update, and the main discussion points from heart failure question time.

GPs' understanding and practice of safety netting for potential cancer presentations: a qualitative study in primary care.

PubMed

Evans, Julie; Ziebland, Sue; MacArtney, John I; Bankhead, Clare R; Rose, Peter W; Nicholson, Brian D

2018-05-08

Safety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care. To understand the reality of safety netting for cancer in contemporary primary care. A qualitative study of GPs in Oxfordshire primary care. In-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison. GPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues' practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting. GPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload. © British Journal of General Practice 2018.

Information needs of parents for acute childhood illness: determining ‘what, how, where and when’ of safety netting using a qualitative exploration with parents and clinicians

PubMed Central

Jones, Caroline H D; Neill, Sarah; Lakhanpaul, Monica; Roland, Damian; Singlehurst-Mooney, Hayley; Thompson, Matthew

2014-01-01

Objective To explore the views of parents and clinicians regarding the optimal content, format and delivery of safety netting information for acute childhood illness. Design Qualitative study including semistructured focus groups and interviews. Setting First contact care settings, community centres, children's centres and nurseries in the Midlands, UK. Participants 27 parents from a travelling community, Asian British community and white British community. Sixteen clinicians including 10 doctors and 6 nurses from a general practice surgery, an out-of-hours service and two emergency departments (paediatric and combined adult and paediatric). Results Participants described a need for safety netting to contain information on signs and symptoms of serious and common illnesses, illness management and where and when to seek help. Resources should be basic, simple to use and contain simple symbols. A key criterion was professional endorsement of resources. Internet-based information was desired which is reliable, consistent and up-to-date. Participants described a need for different types of information: that which could be delivered during consultations, as well as more general information for parents to access before consulting a healthcare professional. Face-to-face education, written materials and digital media were suggested delivery mechanisms. Audiovisual material was preferred by families with low literacy. Participants commonly suggested internet-based and phone-based resources, but the travelling community was less comfortable with these approaches. Conclusions A multifaceted and tailored approach to safety netting is needed so that effective resources are available for parents with varying information needs, literacy levels and ability to use information technology. We have identified key aspects of content, quality criteria, format and delivery mechanisms for safety netting information from the perspectives of clinicians and parents. Resources should be coproduced with parents and clinicians to ensure that they are valued and utilised by both groups. PMID:24430877

Beyond capital? The challenge for sociology in Britain.

PubMed

Holmwood, John

2014-12-01

This article offers a 'local', British, reading of Piketty's landmark book, Capital in the Twenty-First Century, suggesting that the challenge it offers to sociological approaches to inequality is more fundamental than hitherto recognized. The variations in 'national trajectories' exposed by Piketty reveal Britain to be anomalous in terms of standard approaches to the path dependencies embedded in different welfare regimes. Using the recent work of Monica Prasad on 'settler capitalism' in the USA and the tax and debt-finance regime associated with it, the article suggests that colonialism and empire and its postwar unravelling has had deep consequences for British social stratification, albeit largely neglected by British sociologists. Finally, it points to the fact that the form of tax and debt-finance regime that has become reinforced in Britain is at the heart of recent radical reforms to higher education. These are the currently unexplicated conditions of our future practice as sociologists and, therefore, an obstacle to building a critical sociology on the foundations laid out by Piketty. © London School of Economics and Political Science 2014.

Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.

PubMed

van der Heijden, J P; de Keizer, N F; Bos, J D; Spuls, P I; Witkamp, L

2011-11-01

Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed. This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP). Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology. One thousand, eight hundred and twenty GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included. In the group of patients where the GP used teleconsultation to prevent a referral (n =26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n =10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4·6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%. Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

A comparison of widowhood and well-being among older Greek and British-Australian migrant women.

PubMed

Panagiotopoulos, Georgia; Walker, Ruth; Luszcz, Mary

2013-12-01

The impact of widowhood on well-being has been well-documented, but to date has not focused extensively on the experience of older migrants who have aged in a foreign land. This study aimed to examine the well-being of older migrant widows from two groups in South Australia: British-born (n=61) and Greek-born (n=60) Australian migrants, who had been widowed, on average, 13 years. All participants completed a self-report questionnaire in their preferred language. Three indicators of current well-being (self-rated health, depression and loneliness) as well as variables expected to differ cross-culturally, and potentially influence well-being (mourning rituals; continuing bonds to one's spouse; religiosity; social support) were measured. Greek-born widows displayed higher levels of mourning rituals, continuing bonds and religiosity than the British. Both groups perceived similarly high levels of familial social support. Greek widows also reported worse self-rated health, and increased symptoms of depression and loneliness compared to the British. This paper suggests that the detrimental impact of widowhood on well-being may be greater for non-English speaking migrants who are ageing outside of their country of origin, and who, despite residing in an English-speaking host country for several decades, have retained the linguistic, cultural and religious practices and traditions of their home country. © 2013.

European Union’s Military Crisis Management: Challenges and Perspectives

DTIC Science & Technology

2012-06-08

respond quickly and decisively, but “the curious alchemy of German leadership, Italian support for it, British limitation of it, [and] French ambition...EUROPEAN UNION’S MILITARY CRISIS MANAGEMENT: CHALLENGES AND PERSPECTIVES A thesis presented to the Faculty of the U.S. Army...Command and General Staff College in partial fulfillment of the requirements for the degree MASTER OF MILITARY ART AND SCIENCE General Studies

Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current U.K. specialist practice and a call for clinical guidelines.

PubMed

Titchener, Andrew G; Booker, Simon J; Bhamber, Nivraj S; Tambe, Amol A; Clark, David I

2015-11-01

Tennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice. Cross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH). 271 of 1047 eligible members responded (25.9%); consultant surgeons constituted the largest group (232/271, 85%). 131 respondents (48%) use corticosteroid injections as their first-line treatment for tennis elbow. 206 respondents (77%) believed that corticosteroid injections are not potentially harmful in the treatment of tennis elbow, while 31 (11%) did not use them in their current practice. In light of recent evidence of the potential harmful effects of corticosteroid therapy, 136 (50%) had not changed their practice while 108 (40.1%) had reduced or discontinued their use. 43 respondents (16%) reported having used platelet-rich plasma injections. Recent high-quality evidence that corticosteroids may delay recovery in tennis elbow appears to have had a limited effect on current practice. Treatment is not uniform among specialists and a proportion of them use platelet-rich plasma injections. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Peer Review: Structured, Informal, Confidential, Helpful!

ERIC Educational Resources Information Center

Cassidy, Alice; Lee, Jack

2011-01-01

This paper describes an introductory workshop, Preparing to be a Peer Reviewer, presented at the University of British Columbia (UBC) to give hands-on practice to faculty members and others in order to provide formative peer review upon request. This workshop, which was designed at the request of a faculty member, is complemented by an Advanced…

The Disengaged Noncustodial Father: Implications for Social Work Practice with the Divorced Family.

ERIC Educational Resources Information Center

Kruk, Edward

1994-01-01

Canadian and British study examined impact of divorce on noncustodial fathers' disengagement. Results from 80 noncustodial fathers generated two distinct profiles of noncustodial fathers and marked discontinuity between pre- and postdivorce father-child relationships. Findings suggest transition period from point of divorce to 6-12 months after…

Groupwork with Learning Disabilities: Creative Drama. A Winslow Practical Manual.

ERIC Educational Resources Information Center

Chesner, Anna

This British book discusses the value of creative drama for people with learning disabilities, offers some basic principles of working with people with learning disabilities, and describes a variety of approaches to drama. An introduction discusses the optimal size of a creative drama group, the kind of work space needed, equipment, membership,…

Cognitive-Affective Predictors of the Uptake & Sustained Adherence to Lymphedema Symptom Minimization Practices in Breast Cancer Survivors

DTIC Science & Technology

2007-08-01

physical and psychological functioning and quality of life (Passik & McDonald 1998; Erickson, Pearson, et al., 2001; Brenes , Mihalko, et al., 2001...year after radical and conservative surgery for breast cancer. British Journal of Cancer, 74, 2024-2031. 7. Brenes , G.A., Mihalko, S.L

Science, Technology, and Society: Some Philosophical Reflections on a Grade 11 Course.

ERIC Educational Resources Information Center

Gardner, Paul L.

1993-01-01

Speculates on factors that may influence the lack of status of a "Science and Technology" course for grade 11 in British Columbia. Suggests that Aristotelian conceptions of the superiority of pure science over practical knowledge affect the status of school subjects. Questions the course's portrayal of the nature of technology and…

Does the Students' Preferred Pedagogy Relate to Their Ethnicity: UK and Asian Experience

ERIC Educational Resources Information Center

Winch, Junko

2016-01-01

An increasing number of international students, whose culture of teaching and learning practices are very different from UK students, are studying at British universities. This study investigates multicultural students' preferences using two different teaching approaches in the 2009/2010 academic year, which is explained in the framework of this…