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Escaping war and persecution during the twenty-tens, over two-million displacees made life-risking journeys into Europe. Trauma continued for those who managed to cross borders and reach new havens: grappling with migration systems, searching for decent housing, and striving for social integration. This article presents empirical findings of a multi-modal participatory mapping project conducted with refugees and asylum seekers in Southwest England, and highlights the impact of memory and deep creative mapping on the spatial practice of making-home in forced displacement. The resulting maps embody spaces of recovery; memoryscapes revealing synergies between the constructs of memory and the concept of home in exile. The project asks how a creative participatory method of mapping home through memory reconsolidation can ameliorate the trauma of displacement and aid the re-making of home. [ABSTRACT FROM AUTHOR]

This simple model, developed by conservators, assists in the challenge of making preventive conservation, housekeeping, and care of historic interiors and collections, physically and economically sustainable, in historic houses welcoming increasing volumes of visitors (a primary source of dust). It introduces objectivity into conservation advice and management decisions: how many collections care staff should each historic house ideally employ, and how large an annual budget is required to fund the non-wage costs of routine preventive and interventive conservation? Are staffing structures rational and consistent, and tailored to the individual and developing circumstances of multiple properties? Eight qualitative and quantitative criteria are each given a score from 1–4 in relation to their data ranges. The total scores for each property are converted to percentages, correlated with staffing structures, and used to estimate the requirements for daily, weekly and annual housekeeping and conservation cleaning. Selected data are used to measure housekeeping performance against weekly targets, and to rationalize the distribution of financial resources for preventive conservation and maintenance. The model can be adapted for use in any museum or heritage building which needs to assess and quantify the routine care of interiors and collections on open display to visitors. [ABSTRACT FROM AUTHOR]

The care of historic interiors in the U.K. and abroad has evolved over many centuries, from historic housekeeping documented in early manuscripts, to preventive conservation, collections care and management widely practised in museums today. This paper takes a long view of this evolution, considering the causes and instigators of change in approaches taken by public institutions and private owners of historic collections. The influence of increasing professionalisation of the heritage sector and of statutory concern for the care of items of national interest is reviewed, and practice compared in the private and public spheres, to consider the future for conservation housekeeping. [ABSTRACT FROM AUTHOR]

Background: Measuring patient experiences of healthcare is increasingly emphasized as a mechanism to measure, benchmark and drive quality improvement, clinical effectiveness and patient safety at both national and local NHS level. Person-centred coordinated care (P3C) is the conjunction of two constructs; person-centred care and care coordination. It is a complex intervention requiring support for changes to organizational structure and the behaviour of professionals and patients. P3C can be defined as: 'care and support that is guided by and organized effectively around the needs and preferences of individuals'. Despite the vast array of PRMS available, remarkably few tools have been designed that efficiently probe the core domains of P3C. This paper presents the psychometric properties of a newly developed PREM to evaluate P3C from a patient perspective.Methods: A customized EMIS search was conducted at 72 GP practices across the South West (Somerset, Devon and Cornwall) to identify 100 patients with 1 or more LTCs, and are frequent users of primary healthcare services. Partial Credit Rasch Modelling was conducted to identify dimensionality and internal consistency. Ecological validity and sensitivity to change were assessed as part of intervention designed to improve P3C in adults with multiple long-term conditions; comparisons were drawn between the P3CEQ and qualitative data.Results: Response rate for the P3CEQ was 32.82%. A two-factor model was identified. Rasch analysis confirmed unidimensionality of each factor (using infit MSQ values between 0.5 and 1.5). High internal consistency was established for both factors; For the Person-centred scale Cronbach's Alpha = 0.829, Person separation = 0.756 and for the coordination scale Cronbach's alpha = 0.783, person separation = 0.672.Conclusions: The P3CEQ is a valid and reliable measure of P3C. The P3C is considered to have strong face, construct and ecological validity, with demonstrable sensitivity to change in a primary healthcare intervention. [ABSTRACT FROM AUTHOR]

The aim of this paper is to share innovative practice. We begin by exploring the relevance of abuse to the clinical psychology workforce and describing 'Safer Recruitment' (SR) before sharing the Plymouth experience of training and integrating SR into trainee selection. [ABSTRACT FROM AUTHOR]

Summary: Aim: To understand the experiences of students and problem‐based learning (PBL) facilitators during an evidence‐based curriculum change to a PBL programme within an undergraduate medical course in South West England. Methods: Four novel PBL cases were designed and implemented, based on educational theory and evidence. Eight focus groups were undertaken with Year‐1 and ‐2 students (n = 18) and PBL facilitators (n = 14) to explore the experiences of participants. Thematic analysis and conceptual abstraction led to insights into the intended and unintended consequences of the change. Results: Participant responses to the change process were influenced by the perceived relevance and value of the change (e.g. benefit to student learning), which was shaped by individual beliefs and preferences (e.g. presumed purpose of PBL, relative value placed on different curriculum topics, and desire for uniform educational experience), and the wider education context (e.g. expectations of assessment). It appears that the three distinct elements must align for the changes to be received positively. We updated our PBL curriculum in response to new evidence Discussion: This study describes how we updated our PBL curriculum in response to new evidence, and demonstrates the importance of communicating the pedagogic rationale behind changes, and meticulous planning, preparation and alignment, even in distant parts of the curriculum. Engaging with existing views and attitudes is an essential requirement for successful curriculum change. [ABSTRACT FROM AUTHOR]

Abstract: Background: Person Centred Coordinated Care (P3C) is a UK priority for patients, carers, professionals, commissioners and policy makers. Services are developing a range of approaches to deliver this care with a lack of tools to guide implementation. Methodology: A scoping review and critical examination of current policy, key literature and NHS guidelines, together with stakeholder involvement led to the identification of domains, subdomains and component activities (processes and behaviours) required to deliver P3C. These were validated through codesign with stakeholders via a series of workshops and cognitive interviews. Results: Six core domains of P3C were identified as follows: (i) my goals, (ii) care planning, (iii) transitions, (iv) decision making (v), information and communication and (vi) organizational support activities. These were populated by 29 core subdomains (question items). A number of response codes (components) to each question provide examples of the processes and activities that can be actioned to achieve each core subdomain of P3C. Conclusion: The P3C‐OCT provides a coherent approach to monitoring progress and supporting practice development towards P3C. It can be used to generate a shared understanding of the core domains of P3C at a service delivery level, and support reorganization of care for those with complex needs. The tool can reliably detect change over time, as demonstrated in a sample of 40 UK general practices. It is currently being used in four UK evaluations of new models of care and being further developed as a training tool for the delivery of P3C. [ABSTRACT FROM AUTHOR]

Background: Fragmented care results in poor outcomes for individuals with complexity of need. Person-centred coordinated care (P3C) is perceived to be a potential solution, but an absence of accessible evidence and the lack of a scalable 'blue print' mean that services are 'experimenting' with new models of care with little guidance and support. This paper presents an approach to the implementation of P3C using collaborative action, providing examples of early developments across this programme of work, the core aim of which is to accelerate the spread and adoption of P3C in United Kingdom primary care settings.Methods: Two centrally funded United Kingdom organisations (South West Collaboration for Leadership in Applied Health Research and Care and South West Academic Health Science Network) are leading this initiative to narrow the gap between research and practice in this urgent area of improvement through a programme of service change, evaluation and research. Multi-stakeholder engagement and co-design are core to the approach. A whole system measurement framework combines outcomes of importance to patients, practitioners and health organisations. Iterative and multi-level feedback helps to shape service change while collecting practice-based data to generate implementation knowledge for the delivery of P3C. The role of the research team is proving vital to support informed change and challenge organisational practice. The bidirectional flow of knowledge and evidence relies on the transitional positioning of researchers and research organisations.Results: Extensive engagement and embedded researchers have led to strong collaborations across the region. Practice is beginning to show signs of change and data flow and exchange is taking place. However, working in this way is not without its challenges; progress has been slow in the development of a linked data set to allow us to assess impact innovations from a cost perspective. Trust is vital, takes time to establish and is dependent on the exchange of services and interactions. If collaborative action can foster P3C it will require sustained commitment from both research and practice. This approach is a radical departure from how policy, research and practice traditionally work, but one that we argue is now necessary to deal with the most complex health and social problems. [ABSTRACT FROM AUTHOR]

Objective Conduct a deep exploration of the outcomes that matter to people with a diagnosis of schizophrenia and understand from their perspective how these outcomes can be achieved. Sample and Methods In-depth qualitative interviews were conducted with 22 people with a diagnosis of schizophrenia. Interviews were analysed using thematic frameworks, and a realist informed theories of change approach. Results Our study revealed the potential causal relationships between the context of a person's life, short-term goals and long-term outcomes. We provide a nuanced and detailed exploration of outcomes that matter for people with schizophrenia in relation to self-defined well-being. Achieving life milestones, feeling safe and outcomes related to improved physical health along with employment, a positive sense of self and psychosocial outcomes, were highly valued. For short- and long-term outcomes to be achieved, individuals required medication with minimal side-effects, cognitive behavioural therapy, family/social support and meaningful activities in their lives. Well-being was influenced by life context and short- and long-term outcomes, but in a circular nature also framed what short-term goals could be achieved. Conclusions Working with people with a diagnosis of schizophrenia to identify and achieve better outcomes will necessitate a person-centred approach. This will require an appreciation of the relationship between the statutory and non-statutory resources that are available and a consideration of an individual's current well-being status. This approach acknowledges personal strengths and encourages ownership of goals and supports self-management. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is a complex, heterogeneous disorder, with highly variable treatment outcomes, and relatively little is known about what is important to patients. The aim of the study was to understand treatment outcomes informal carers perceive to be important to people with schizophrenia. Method: Qualitative interview study with 34 individuals and 8 couples who care for a person with schizophrenia/schizoaffective disorder. Interviews were transcribed verbatim and analysed by a thematic framework based approach. Results: Carers described well-recognised outcomes of importance, alongside more novel outcomes relating to: Safety (of the patient/others); insight (e.g. into non-reality of psychotic phenomena); respite from fear, distress or pain; socially acceptable behaviour; getting out of the house; attainment of life milestones; changes in personality and/or temperament; reduction of vulnerability to stress; and several aspects of physical health. Conclusions: These findings have the potential to inform the development of patient- or carer- focused outcome measures that take into account the full range of domains that carers feel are important for patients. [ABSTRACT FROM AUTHOR]

Professionalism is a core element of curricula in many disciplines but can be difficult to teach and learn. This study used audio-diary methodology to identify professionalism threshold concepts in a small group learning setting in undergraduate medicine and to understand factors that might facilitate students to ‘get’ such concepts. Fifteen students and seven tutors kept audio-diaries over two terms. Data were analysed qualitatively for content. The key themes were then cross referenced to threshold concept criteria (e.g. where language indicated that learning was troublesome, integrative or transformative). Seven potential threshold concepts were identified which centred on students’ developing professional identities including working with uncertainty, considering the bigger picture, not needing to know everything and professional culture. Reflection on workplace experiences within a small group helped students ‘get’ these concepts. The study concludes that threshold concepts and audio-diaries are useful tools for understanding lived experiences of professionalism learning. [ABSTRACT FROM AUTHOR]

Patient reports or ratings are essential for measuring the quality of patient care. Measures designed for this purpose tend to focus on the processes and structures of care rather than the outcomes of it. The latter is arguably the most valid indicator of the quality of care patients receive. Typically this information is gathered by probing patient satisfaction with treatment as part of an investigation of satisfaction with hospital care. More recently patient ratings of the outcome of treatment have been obtained to measure treatment efficacy in clinical trials. However, a more direct approach is to ask patients to assess the benefit of treatment on their current health status. We performed a structured literature review on patient reported satisfaction with outcomes of treatment and direct patient assessments of the same. The purpose of this was to identify suitable candidate questions for a short instrument to tap patient evaluations of in-patient hospital interventions. Articles were included if they dealt with patient satisfaction or patient assessment of outcomes of treatment. Articles were excluded if they dealt more generally with patient satisfaction with care. We identified 169 papers, 79 were included in the review. The findings of this review suggest that there are a number of benefits of directly asking patients to assess the outcome of hospital treatment. Importantly this approach reflects outcomes relevant to the patient and is also more likely to reflect patient report in routine clinical practice. There is also evidence that such approaches have face validity and construct validity. The problems associated with this approach (i.e. response bias), are those common to patient reported outcome surveys, but employing appropriate strategies can minimize them. Furthermore, employing a simple set of questions that asks patients to assess outcomes of treatment they receive can be time and resource efficient in comparison to administering lengthy measures. This approach could be tested for potential generic use as an evaluative measure for patients in hospital settings. [ABSTRACT FROM AUTHOR]

Objective: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. Method: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. Results: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. Conclusion: The similarities in sources of burden between the groups could be explained by a commonality of socio- cultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample. [ABSTRACT FROM AUTHOR]

Decorative art collections which remain in the places for which they were made, bought, or collected can illuminate the past by showing how objects were used. This paper explores how managers and collections care staff can establish levels of visitor access and object use which enhance the visitor experience. Conservation management plans are used to determine the significance of historic places and distinguish between their relative sensitivities. By contrast, conservation of collections tends to treat all objects as of equal significance and vulnerability to change while conservators aim to make all objects last 'forever'. The National Trust, UK, now accepts that conservation is the careful management of change. Materials have a finite life-time, and places will evolve, but experiences can be preserved. This approach depends on an ability to distinguish between robust and fragile materials, between furnishings indigenous to each property, and those brought in to supplement displays; the latter can be used more intensively to 'bring places to life'. The pleasure which visitors derive from the use of collections enhances their appreciation of museums, and in turn creates a virtuous circle where visitor numbers and income increase. Museums may have to stop exercising the precautionary principle in order to become more sustainable organizations. [ABSTRACT FROM AUTHOR]

Background: Caregiver burden in mental illness is believed to differ between ethnic groups, but few studies have examined this in schizophrenia in the UK.Aim: To measure burden in British North Indian Sikh and white British parents with a son or daughter with established schizophrenia managed in outpatient care.Method: A cross-cultural cohort study measuring family factors, patient psychopathology and levels of burden and distress.Results: Overall levels of burden were low with no significant differences between the groups. Burden subscale scores showed Indian parents were more affected by psychotic behaviours than white parents. The groups also differed on several sociodemographic variables.Conclusion: In stabilized community patients, the overall extent of burden experienced by both Indian and white parents is low and comparable. However, Indian parents were more burdened by psychotic behaviours. This may be a result of co-residence as Indian patients are more likely to live with their families. Social and economic factors in the country of residence and levels of acculturation may also influence levels of burden and the illness behaviours found most bothersome by parents. [ABSTRACT FROM PUBLISHER]

A qualitative understanding of the particles in dust and their sources helps to identify ways to reduce the accumulation of dust within historic houses. Knowing the possible sources of dust helps to suggest preventive steps. Simple low-technology methods enable rapid identification of dust deposits and require little specialist equipment. Dust samples can be collected on sticky surfaces for examination with a hand lens or microscope. The size of particles and fibres, and amount of surface coverage, can be estimated roughly using a graticule or coverage chart. An atlas of common dust components aids identification of soil dust, soot, insects, plant fragments, hair, skin, paint/plaster, clothing fibres, paper, food and mould. A mixture of fine dust is resolvable into a range of particle and fibre types. Long exposures of sticky samplers, with an estimate of the area covered by dust, indicate the rate of deposition and suggest the cleaning frequency necessary to prevent negative visitor reactions. The atlas lists suppliers and sources of information. [ABSTRACT FROM AUTHOR]

This exploratory paper aimed to shed light on the experience of first session solution-focused brief therapy (SFBT) for families who have a child with intellectual disabilities (ID). The therapist interviewed the participants, all mothers, two weeks after their initial session. The Helpful Aspects of Therapy Questionnaire ( Llewelyn, 1988 ) was used with structured recall ( Elliot and Shapiro, 1988 ), a procedure in which participants listen to excerpts from their therapeutic sessions identified by them as helpful or unhelpful. Interview transcripts were analysed by the therapist using interpretive phenomenological analysis ( Smith, 2003 ). Three superordinate themes emerged from the interviews: (1) SFBT brought to mind the idea of ‘making the best of it’. (2) Examination of wishful thinking. (3) Therapeutic relationship. In addition, self-efficacy recurred as a sub-theme throughout. The ‘miracle question’ was perceived as irrelevant by the mothers and was the most frequently cited unhelpful event. It also seemed to be associated with shifts in wishful thinking. These mothers' experiences suggest that SFBT is a useful structure for first sessions particularly as it seems to build a useful therapeutic relationship, highlights self-efficacy and may encourage helpful coping styles. [ABSTRACT FROM AUTHOR]

The article examines the economic implications of cleaning in response to the flow of visitors through historic houses. The section reflects on work carried out in properties of the National Trust for England, Wales, and Northern Ireland, which is the largest accredited museum authority in the U.K., with 175 furnished properties open to visitors for seven months each year, on average five days per week and four to five hours a day. According to the study, although it describes how control of dust influences property management and housekeeping policies in the National Trust, the outcomes are applicable to historic properties in general and to museums and galleries where significant interiors and collections are exposed to dust.

Solution-focused brief therapy (SFBT) is used in a range of child services but little is known about its application to families who have a child with severe or profound intellectual disabilities. This qualitative study examines SFBT with seven such families. It considers the content of sessions and the processes that occur from the practitioner's perspective. Participants' experiences are reported elsewhere (Lloyd & Dallos, submitted). A thematic analysis of seven initial sessions indicated that SFBT highlighted parents' competencies, goals and achievements. The ‘miracle question’ prompted a change in rapport, discussion about the impossibility of the child becoming ‘normal’ and a shift away from wishful thinking towards problem solving. In sessions processes emerged of empowerment, integration of the goals into the mothers' life narrative, understanding the child's abilities and clarification of the preferred future. These themes resonated with the literature on effective coping styles for these families. The cases suggest that SFBT can generate a useful parent-professional partnership. However, difficulties were encountered when a child with autism participated in the session. Consideration is given to the ‘miracle question’ and the inclusion of measures of self-efficacy, coping and the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Three groups of children with communication disorders were assessed using the CELF (Clinical Evaluation of Language Fundamentals). The results were used to compare the language skills of children with specific language impairment (SLI), autistic spectrum disorder (ASD) and a middle group who shared some characteristics of both SLI and ASD (Shared group). The children were aged between 5 years 10 months and 10 years 7 months. Each child was assessed on either the CELF UK 3 or the CELF Preschool, depending on their age and ability. The overall language profiles were compared and differences were found between the three groups. A more detailed analysis of the individual subtests was made, which showed that all three groups had the least difficulty with 'Listening to Paragraphs' (which involves abstracting and remembering information from two short texts). It also showed that all three groups had difficulty with 'Recalling Sentences' (which involves repeating sentences of increasing length and complexity). This paper discusses the value of using a more comprehensive range of linguistic assessments when considering the similarities and differences between groups of children within this population, it also considers the educational and clinical implications and makes suggestions for future research. [ABSTRACT FROM AUTHOR]

Objectives To examine clinicians' attitudes regarding the relative benefits and risks of conventional and atypical antipsychotic medication, and the perceived validity of the CUtLASS study. To examine the attitudes of participant clinicians' regarding the operation and administration, and the potential clinical impact of the findings. Method Two hundred and sixty-two clinicians were each sent an anonymous questionnaire, and invited to indicate whether they agreed or disagreed with each of to nine statements (from agree to disagree). Results Of the 112 clinicians who responded, 71% supported the CUtLASS study. Thirty-nine percent agreed with the statement that the clinical efficacy of atypicals was superior to conventional antipsychotics, while 27% disagreed and 34% were undecided. Thus, two-thirds of participating clinicians revealed no uncertainty on a key question being tested in the CUtLASS study. Further, the vast majority (97%) considered that atypicals were associated with less severe side effects. Conclusions In clinical studies, recruitment strategies relying on referrals from clinicians may find that some clinicians identify fewer patients than expected. This can lead to a relatively low yield of potential study subjects and possibly a selection bias. Surveys of clinicians approached to participate in clinical studies provide a potential mechanism to explore attitudes relevant to participant recruitment. [ABSTRACT FROM AUTHOR]

Museum standards for preserving cultural material need to be interpreted sensitively if they are to ensure sustainable access to fragile historic house interiors, presented as homes still in occupation. High standards of preventive conservation can be achieved by adapting traditional housekeeping practices, recorded in eighteenth- and nineteenth-century manuals. Conservators have revived methods to protect collections from physical damage, biological infestations, pollution, light, and inappropriate levels of temperature and relative humidity. To ensure that vulnerable collections are properly maintained, conservators equip historic house managers with an understanding of preventive conservation and technical information to aid monitoring and documentation, staff training and management. In conclusion, the paper emphasizes the need to establish a sustainable balance between conservation and access. [ABSTRACT FROM AUTHOR]

Examines perceived and actual barriers to dietary fat reduction in Great Britain. Intervention study designed to evaluate problems encountered by persons attempting to reduce their fat intake; Perceived barriers as a reflection of actual problems encountered; Strategies to achieve reductions in fat consumption.

Introduction: Service users may benefit from digital health services by having access to reliable health information and ways to communicate health issues, thus fostering greater engagement in self-care. The University of Plymouth's nursing students study 'Digital Professionalism' as part of an introduction to e-health in their curriculum. The University seeks to benefit local communities through direct community action. This study aims to explore the feasibility of implementing a model for students to enhance citizens' knowledge and use of the Internet for health, and to provide an opportunity for students to understand citizens in their social context. Theory/Method: A collaborative action research approach has been used to develop and trial a citizen contact model. This study has two iterative cycles using mixed methods; a third will be undertaken. The first cycle explores the proposed activity with academics, health professionals, the public, and students. The second and third cycle's trial the model, exploring its feasibility with stakeholders. Results: First cycle: Six workshops were undertaken. There was general consensus introducing a citizen contact model into the nursing curriculum was a good idea. An online survey further explored the thoughts of workshop participants and stakeholders. All 57 survey respondents agreed that the proposed activity would give students a better understanding of the thoughts and experiences of citizen contacts, and the majority 52/57 agreed citizen contacts would learn about health services. However, a number of concerns were raised including recruitment of citizen contacts, safeguarding of participants, and workloads. In October 2017, 473 first year students were invited to demonstrate one of five health websites to a friend, relative or neighbour as part of an assessment. The benefits were explored without confronting the problems of recruitment, safeguarding, and workloads. Second cycle: The recruitment of citizen contacts unknown to students and the organisation of visits has been addressed with volunteer second year adult nursing students. Three students and five citizen contacts participated in the implementation phase. Citizen contacts were recruited via a service user organisation. Reflective logs from students and questionnaires from citizen contacts are currently being collected. All participants are invited to explore their experiences in a follow-up. The model offers students the chance to visit a carer or someone living with a long-term health condition in pairs, to support them in using the Internet for health in a non-clinical setting. Discussion: Although a third cycle of collaborative action research will be undertaken offering child nursing students a similar opportunity, the model has not yet achieved unanimous support and routine implementation. However, stakeholders seem to accept the model. If we can implement the model for routine use, it could improve student and citizen learning. Collaborative action research, through a number of cycles, appears an appropriate methodology. Lessons Learned: Working with stakeholders is key to developing a feasible approach. Limitations: The model is being developed within one Higher Education Institute HEI, we cannot be sure the findings will transfer across to other HEIs. Suggestions for Future Research: Future research would trial this model at other HEIs. [ABSTRACT FROM AUTHOR]

Background: The growing number of people living with multiple long-term conditions is increasing demand on Global Health Systems at a time of fiscal constraint [1]. To meet this challenge, new models of primary care aiming at enhanced coordination and person centred care have been proposed to improve efficiency and patient outcomes by breaking with paternalistic models of health and encouraging increased self-management within the community [2]. Lack of implementable evidence and guidance has led to the development of local 'implementation experiments'. We evaluated a number of these 'experiments' across southwest England against four routines for practice developed by the Gothenburg centre for person centred care [3]. Methods: To develop theory about how best to engage people in new interventions for the development of person centred coordinated care we conducted a secondary, inductive analysis of qualitative data. This comprised of data generated from structured interviews, focus groups and observations with patients and practitioners that formed part of our service evaluations. Theory was co-produced in workshops involving patients and practitioners. Results: Our data revealed that initially some patients were suspicious of the motives for their inclusion in novel interventions, or did not understand the new model's rationale. In these cases participants found it difficult to develop a narrative routine one and some individuals declined participation. This was due to underdevelopment of programme theory and inexperience of practitioners in articulating programme aims when introducing the intervention. Evidence suggested that older individuals with more complex care needs may find it more difficult to engage with the new approach, resulting in lack of shared decision making during subsequent goal setting and care planning routines two and three. Co-production was an unintended consequence of bringing participant groups together which produced mechanisms reframing interactions and further developing participants' narratives. Developing a trusting relationship with practitioners over time also promoted engagement and was more likely to result in development of authentic, holistic narratives and goals. Discussion: Evidence shows that person centred care increases wellbeing and self-management in patients and co-production supports personalised practice [4]. This study gives exemplars of how these principles operate in practice. Personal narrative development is a significant departure from traditional health service encounters in which topics and solutions are defined by practitioners. It may be challenging for patients and practitioners. Conclusions: The establishment of a meaningful patient narrative depends on clear explanations of new interventions and the formation of relationships with practitioners trained in eliciting these conversations. This 'pre-context' is fundamental to person centred care since it establishes rules of engagement for the subsequent routines of decision-making and care planning. Lessons learned: Clarity of programme theory and staff training on effective communication and narrative development are imperative to the delivery of person centred care. Limitations: Data was limited to those agreeing to be interviewed, observed, or take part in focus groups; the views and experiences used to develop theory may not be wholly representative of more marginalised individuals. Suggestions for future research: Testing the developed theory in controlled or other welldesigned research programmes. [ABSTRACT FROM AUTHOR]

Background: To facilitate change for person‐centred care, there is a need to invest in measures to assess if and how healthcare systems are delivering care based on the principles of person‐centred care. This paper describes the first phase in developing an item bank to measure patients' experiences of person‐centred care. Aim: The aim was to translate, culturally adapt and evaluate candidate items to measure person‐centred care from the patient's perspective. Methods: The Centre for person‐centred care at Gothenburg university and the UK Person‐centred and coordinated care model informed our conceptual framework. The initial pool of item candidates originated from a previous systematic review where 855 items were identified. In this study, a mixed method design was used involving persons with experience as patients, caregivers, healthcare professionals and researchers in person‐centred care or questionnaire design (n = 84). The item analysis included two validation rounds using web questionnaires, a focus group and cognitive interviews. Results: From the initial pool, 155 items covering core domains and subdomains of person‐centred and coordinated care were selected for translation and qualitative item analysis. After translation, 44 items were excluded (duplicates). After the first validation round, 21 items were rephrased and 35 were excluded (due to low ratings, lack of comprehensibility, were duplicates or too specifically phrased). To reflect the ethical basis of person‐centred care, rewordings were also made to encompass the patient as an active partner in care and where communication and information goes two‐ways and care is co‐created. After the second round, 11 items were rephrased and 25 items were excluded (for being redundant/repetitive). Six new items were added (covering access to care, patient capabilities, mental well‐being and identifying goals). Conclusion: We have developed a first set of 57 items to proceed towards developing an item bank to measure the patient experiences of person‐centred care. [ABSTRACT FROM AUTHOR]

The increasing popularity of the term 'person‐centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person‐centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette‐based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15–35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing. [ABSTRACT FROM AUTHOR]

Background: Revitalized interest in narrative has informed some recent models of patient and person‐centred care. Yet, scarce attention has been paid to how narrative elicitation is actually used in person‐centred care practice and in which ways it is incorporated into clinical routine. Aim: We aimed to identify facilitators and barriers for narrative elicitation and setting goals in a particular example of person‐centred care practice (University of Gothenburg Centre for Person‐centred Care, GPCC) where narrative elicitation is considered as a method of setting goals for the patient. Methods: Observation of 14 admission interviews including narrative elicitation on an internal medicine ward in Sweden where person‐centred care was implemented. Five focus group vignette‐based interviews with nurses (n = 53) were conducted to assess confirmation of the emerging themes. Results: The inductive analysis resulted in three themes about the strategies to elicit patients' narratives: (a) Preparing for narrative elicitation, (b) Lingering in the patient's narrative, and (c) Co‐creating, that is, the practitioner's and third parties' engagement in the patient's narration. Even though there were obstacles to eliciting narratives and setting lifeworld goals in a medical setting, narrative elicitation was often useful to turn general and medical goals into more specific and personal goals. Conclusions: Narrative elicitation is neither a simple transition from traditional medical history taking nor a type of structured interview. It entails skills and strategies to be practiced. On the one hand, it revitalizes ethical considerations about clinical relationship building. On the other hand, it can help patients articulate lifeworld goals that are meaningful and important for themselves. [ABSTRACT FROM AUTHOR]

Accessible summary: Four people with learning disability talked about what it was like when someone they cared about had died. They said that it was important they were included, but that it was hard. They said they carried on loving the person after they died and that they missed them. Abstract: Background: Bereavement is a universal experience, yet little research has explored the lived experience of bereavement for people with learning disability (PWLD). Materials and methods: Four PWLD were interviewed about their experience of bereavement. Data were analysed using interpretative phenomenological analysis. Results: Four themes were identified: “Needing to know: Being included,” “Struggling to say: The emotional experience,” “Love after death: A continuing relationship” and “Missing their presence: The wider impact of death.” Conclusions: PWLD should have the opportunity to make informed choices about their level of involvement and to develop their emotional experience. PWLD should be supported to develop a continued bond with the deceased and the wider impact of their loss recognised. [ABSTRACT FROM AUTHOR]

Patient reports or ratings are essential for measuring the quality of patient care. Measures designed for this purpose tend to focus on the processes and structures of care rather than the outcomes of it. The latter is arguably the most valid indicator of the quality of care patients receive. Typically this information is gathered by probing patient satisfaction with treatment as part of an investigation of satisfaction with hospital care. More recently patient ratings of the outcome of treatment have been obtained to measure treatment efficacy in clinical trials. However, a more direct approach is to ask patients to assess the benefit of treatment on their current health status. We performed a structured literature review on patient reported satisfaction with outcomes of treatment and direct patient assessments of the same. The purpose of this was to identify suitable candidate questions for a short instrument to tap patient evaluations of in-patient hospital interventions. Articles were included if they dealt with patient satisfaction or patient assessment of the outcomes of treatment. Articles were excluded if they dealt more generally with patient satisfaction with care. We identified 169 papers, 79 were included in the review. The findings of this review suggest that there are a number of benefits of directly asking patients to assess the outcome of hospital treatment. Importantly this approach reflects outcomes relevant to the patient and is also more likely to reflect patient report in routine clinical practice. There is also evidence that such approaches have face validity and construct validity. The problems associated with this approach (i.e. response bias), are those common to patient reported outcome surveys, but employing appropriate strategies can minimize them. Furthermore, employing a simple set of questions that asks patients to assess the outcomes of treatment they receive can be time and resource efficient in comparison to administering lengthy measures. This approach could be tested for potential generic use as an evaluative measure for patients in hospital settings. [ABSTRACT FROM AUTHOR]

Objectives: this study aims to explore how patient safety in community dementia services is understood by caregivers, and healthcare professionals. Methods: cross-sectional analysis of guided one-to-one interviews with 10 caregivers, and 10 healthcare professionals. Results: caregivers and healthcare professionals identified a range of issues including medication errors, mis-communication between professionals, unclear service pathways and the effects of stress on caregivers' behaviour. Caregivers and professionals differed in their attitudes to balancing safety with patient autonomy and who is responsible for managing safety. Conclusions: this article helps to define the nature of safety issues in the context of community care for people with dementia. In contrast to hospital medicine, where the ideal treatment world is safe with all risks managed or minimised, in dementia some risks are actively taken in the interests of promoting autonomy. Caregivers' views differ from those of health professionals but both parties see potential for collaborative working to manage risk in this context, balancing the promotion of autonomy with the minimisation of potential harm. [ABSTRACT FROM AUTHOR]

Background and Aims: Loot boxes are purchasable randomised rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming. We aimed to measure the association between loot box engagement and socioeconomic correlates. Design The study was a cross‐sectional online survey using the recruitment platform, Prolific. Setting: United Kingdom (UK). Participants: A cohort of 16 196 UK adults (18 + years) self‐reporting as video gamers. Measurements Respondents were asked about their game‐related purchasing behaviour (including loot boxes), recent monthly spend on loot boxes and gambling engagement (gambling in any form; gambling online; playing 'social casino' games). A range of demographic variables were simultaneously captured, including age, sex, ethnicity, earnings, employment and educational attainment. Findings Overall, 17.16% of gamers in our cohort purchased loot boxes, with a mean self‐reported monthly spend of £29.12. These loot box purchasers are more likely to gamble (45.97% gamble) than people who make other types of game‐related purchases (on aggregate, 28.13% of non‐loot box purchasers gamble), and even greater still than those who do not make any game related purchases (24.38% gamble P < 0.001). Loot box engagement (as binary yes/no or as monthly spend normalised to earnings) was significantly associated with younger age (P < 0.001 and P < 0.001; respectively, for binary yes/no and monthly spend, adjusted for false discovery rate correction), male sex (P < 0.001 and P = 0.025), non‐university educational attainment (P < 0.001 and P < 0.001) and unemployment (P = 0.003 and P = < 0.001). Lower earners spent a higher proportion of monthly earnings on loot boxes (P < 0.001). Conclusions: The demographic associations of video game loot box engagement (younger age, male sex, non‐university educational attainment and unemployment) mirror those of other addictive and problematic behaviours, including disordered gambling, drug and alcohol misuse. [ABSTRACT FROM AUTHOR]

Background: Countries are adapting their health and social care systems to better meet the needs of growing populations with (multiple) chronic conditions. To guide this process, assessment of the 'patient experience' is becoming increasingly important. For this purpose, the Person‐Centred Coordinated Care Experience Questionnaire (P3CEQ) was developed in the United Kingdom, and translated into several languages. Aim: This study aimed to assess the internal and construct validity of the Dutch P3CEQ to capture the experience of person‐centred coordinated care of people with chronic conditions in the Netherlands. Participants and Methods: Adults with chronic conditions (N = 1098) completed the Dutch P3CEQ, measures of health literacy and patient activation, and reported the use and perceived quality of care services. Data analysis included Principal Component and reliability analysis (internal validity), analysis of variance and Student's T‐tests (construct validity). Results: The two‐component structure found was pretty much the same as in the UK validation study. Sociodemographic correlates also resembled those found in the United Kingdom. Women, persons who were less educated, less health‐literate or less activated experienced less person‐centred coordinated care. P3CEQ scores correlated positively with general practitioner performance scores and quality ratings of the total care received. Conclusion: The Dutch P3CEQ is a valid instrument to assess the experience of person‐centred coordinated care among people with chronic conditions in the Netherlands. Awareness of inequity and more attention to communication skills in professional training are needed to ensure that care professionals better recognize the needs of women, lower educated or less health‐literate persons, and improve their experiences of care. Patient Contribution: The P3CEQ has been developed in collaboration with a range of stakeholders. Eighteen persons with (multiple) chronic conditions participated as patient representatives and codesign experts in (four) codesign workshops. Other patient representatives participated in cognitive testing of the English‐language instrument. The usability of the P3CEQ to capture the experience of person‐centred coordinated care of older persons has been examined by interviewing 228 older European service users, including 13 living in the Netherlands, as part of the SUSTAIN project. More than a thousand persons with chronic conditions participated in the validation study of the Dutch P3CEQ. [ABSTRACT FROM AUTHOR]

Loot boxes (LBs) are video game-related purchases with a chance-based outcome. Due to similarities with gambling, they have come under increasing scrutiny from media, academics and policymakers alike. Initial evidence suggested that LB engagement might be associated with both problem gambling (PG) and problem video gaming (PVG). We therefore conducted a systematic review of the evidence for associations between LB purchasing, PG and PVG. For LB/PG, 12 of 13 publications reported a positive relationship, with a moderately sized mean effect of r =.27. For LB/PVG, the mean effect was r =.40, although this finding was drawn from only six surveys in total. For PG/PVG, the mean effect was r =.21, with only 11 of 20 studies reporting significant effects. While further evidence is required to determine the direction of causality, the strength of relationships suggests that policy action on LBs may have benefits for harm minimisation. [ABSTRACT FROM AUTHOR]

Evidence is emerging of the potential of person‐centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person‐centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care‐based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research. [ABSTRACT FROM AUTHOR]

Introduction: While several evaluation studies on (cost-)effectiveness of integrated care have been conducted in recent years, more insight is deemed necessary into integrated care from the perspective of service users. In the context of a European project on integrated care for older people living at home (SUSTAIN), this paper shares the experience and methodological reflections from applying a Patient Reported Experience Measure (PREM) on person-centred coordinated care -the P3CEQ- among this population. Methods: A combination of quantitative and qualitative data and analysis methods was used to assess the usability and the quality of applying a PREM among older people presenting complex care needs, using the P3CEQ delivery in SUSTAIN as a case study. 228 service users completed the P3CEQ and nine SUSTAIN researchers participated in a consultation about their experience administering the questionnaire. P3CEQ scores were analysed quantitatively using principal component analysis and multilevel linear regression. P3CEQ open responses and researcher notes collected when administering the questionnaire were thematically analysed. Results: Service user inclusion was high and most P3CEQ items had low non-response rates. Quantitative analysis and researcher experience indicate the relevance of faceto- face administration for obtaining such an amount of data in this population group. The presence of a carer increased inclusion of more vulnerable respondents, such as the cognitively impaired, but posed a challenge in data interpretation. Although several P3CEQ items were generally understood as intended by questionnaire developers, the analysis of open responses highlights how questions can lead to diverging and sometimes narrow interpretations by respondents. Cognitive impairment and a higher educational attainment were associated with lower levels of perceived person-centredness of care. Conclusion: This study shows essential preconditions to meaningfully collect and analyse PREM data on older peoples' experiences with integrated care: face-to-face administration away from care providers, collection of reasons for non-response and open comments providing nuances to answers, and multilevel modelling taking into account diversity in the target population. Several areas of improvement for future PREM use in this population have been identified: use of administration and coding guides, inclusion of clear and easy to understand definitions and examples illustrating what questions do and do not mean, measures of the expectations of personcentred coordinated care, and procedures ensuring sound ethical research. These methodological learnings can enhance future evaluation of integrated care from a service user perspective. [ABSTRACT FROM AUTHOR]

Introduction: Portal pyaemia is a rare phenomenon that can complicate a variety of pathologies and surgical procedures. It has a predilection for elderly and immunocompromised patients.Discussion: We present a review of the related literature and report an exceptional case of fulminant portal pyaemia, with an atypical presentation in a patient with few typical risk factors, complicating an elective surgical procedure for benign disease.Conclusion: Portal pyaemia is a condition which can lead to acute overwhelming sepsis and carries a high mortality. It should be considered a differential in abdominal sepsis when no overt abdominal source is found. [ABSTRACT FROM AUTHOR]

Primary omental mesothelioma is a malignant tumour of the mesothelial cells of the omentum, related to asbestos exposure. It is an extremely rare condition that presents both diagnostic and therapeutic challenges. We present a review of the related literature and report on a fatal case of primary omental mesothelioma in a 70 year old man, presenting with a painful abdominal mass. Radiological imaging was not diagnostic but useful in excluding other pathologies. Diagnosis relied on specific immunohistochemical analysis. The difficulty in diagnosis and management and the advanced stage of disease meant that prognosis was very poor. Our patient died within 3 weeks of diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Patient experiences of health care is becoming increasingly emphasised as a mechanism to measure, benchmark, and drive quality improvement within the UK National Health Service (1-3) and across Europe (4-6). For person-centred care to be effective, care must be coordinated across services, particularly for patients with multiple long-term conditions (LTCs) who require integrated care from multiple agencies. Person centred coordinated care (P3C) is the conjunction of two closely related constructs; person centred care and care coordination (7). Despite clear callings (4, 5, 8-11), no tool currently exists to measure P3C that is short enough for routine practice. This research aimed to develop a tool that can measure P3C and drive healthcare quality improvement - the P3C experience questionnaire (P3CEQ). Methodology: An iterative patient-oriented design process was utilised to identify questions and ensure patient acceptability (12). The measure was subject to psychometric validation ensuring measure appropriateness. Testing of the P3CEQ took place across 72 general practice sites across the South-west of the UK. The P3CEQ was subsequently used in a number of evaluations of new models of care, such as complex care hubs, to improve service integration and promote coordination between agencies. Results: Data was collected from over 2500 patients with LTCs across the South-west,UK. Patterns of response emerged in relation to number of LTCS and services used, and poorer experiences of care. Lowest scores were often associated with poor levels of coordination and care-planning. The P3CEQ was used to identify trends in experiences in P3C and identify which areas require the most improvement. This information was fed back to the complex care hubs and subsequently followed-up with further measurement. Findings indicate improvements in care areas related to care coordination. Discussion: Measurement and feedback is important component in the continued improvement of P3C in patients with LTCs. The P3CEQ was designed to measure and promote improvements in care quality for this group. The P3CEQ has been successfully used to measure and improve P3C in new models of care focused on improving service integration. The P3CEQ is able to detect differences between care models and over time. It is well received by both staff and patients and can be used to identify clear areas to drive service improvement a practice level. Having been translated into six languages it is currently being used to drive service innovation across two large-scale EU projects to improve care integration. Conclusion: The P3CEQ is a valid measure of P3C that can be used to identify key areas of P3C requiring improvement. Evidence from this research indicates that the P3CEQ can be used to cross-agency coordination and drive care quality improvements. The P3CEQ highlights the pressing need for stronger service coordination and integration in adults with LTCs. Limitations & Future research: Although the P3CEQ has a Flesch-kincaid grade level of 7.3, some users struggled to understand some of the items. Future research will focus on adapting P3CEQ to support this group, improve implementation and feedback mechanisms for wider use, and further developing the measure for international use. [ABSTRACT FROM AUTHOR]

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation. [ABSTRACT FROM AUTHOR]

Loot boxes are purchasable items in video games with a chance-based outcome. They have attracted substantial attention from academics and legislators over recent years, partly because of associations between loot box engagement and problem gambling. Some researchers have suggested that loot boxes may act as a gateway into subsequent gambling and/or problem gambling. However, such "gateway effects" have not been formally investigated. Using a survey of 1102 individuals who both purchase loot boxes and gamble, we found that 19.87% of the sample self-reported either "gateway effects" (loot boxes causally influencing subsequent gambling) or "reverse gateway effects" (gambling causally influencing subsequent loot box engagement). Both subsets of participants had higher scores for problem gambling, problem video gaming, gambling-related cognitions, risky loot boxes engagement, and impulsivity. These individuals also had a tendency for higher loot box and gambling spend; suggesting that potential gateway effects are related to measurable risks and harms. Moreover, the majority of participants reporting gateway effects were under 18 when they first purchased loot boxes. Content analysis of free text responses revealed several reasons for self-reported gateway effects, the most frequent of which were sensation-seeking, normalisation of gambling-like behaviours, and the addictive nature of both activities. Whilst the cross-sectional nature of our findings cannot conclusively establish directions of causality, thus highlighting the need for longitudinal research, we conclude that there is a case for legislation on loot boxes for harm minimisation purposes. [ABSTRACT FROM AUTHOR]