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Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

This paper draws on two experiences of undertaking comparative research in England, Sweden and Italy, and offers a discussion of the kinds of dilemmas raised in relation to language and meaning surfaced by these. Its primary focus is to examine the reflexive construction of meaning, both in relation generally to the workings of an international research team and, more specifically, how such construction of meaning impacts on the process of qualitative interviewing across linguistic and cultural boundaries. The article argues that a culture of reflexive research practice is helpful for approaching national differences, to facilitate understanding in internationally mixed research teams and to support and empower participants in research, in second languages and differing cultures. Overall, the paper attempts to advance some tentative ideas that other international researchers may be able to consider and deploy in relation to their own research ambitions. [ABSTRACT FROM AUTHOR]

Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's 'pillars' institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence. [ABSTRACT FROM AUTHOR]

This paper explores telecare manager and other 'stakeholder' perspectives on the nature, extent and impact of family and other unpaid/informal carers' involvement in the provision of telecare equipment and services for older people. Data used in the paper are derived from a larger study on telecare provision by local councils in England. The paper aims to add to the growing evidence about carers' engagement with electronic assistive technology and telecare, and considers this in the context of typologies of professionals' engagement with carers. How carers are involved in telecare provision is examined primarily from the perspectives of senior managers responsible for telecare services who responded to an online survey and/or were interviewed in 2016 as part of a wider study. The perspectives of three unpaid carers were captured in a separate strand of the main study, which comprised more detailed case study interviews within four selected councils. Thematic and comparative analysis of both qualitative and quantitative survey data revealed the varied involvements and responsibilities that carers assumed during the telecare provision process, the barriers that they needed to overcome and their integration in local council strategies. Findings are discussed in the context of Twigg and Atkin's typology of carer support. They suggest that carers are mainly perceived as 'resources' and involvement is largely taken for granted. There are instances in which carers can be seen as 'co-workers': this is mainly around responding to alerts generated by the telecare user or by monitored devices, but only in those councils that fund response services. Though some participants felt that telecare devices could replace or 'supersede' hands-on care that involved routine monitoring of health and wellbeing, it was also acknowledged that its use might also place new responsibilities on carers. Furthermore, the study found that meeting carers' own rights as 'co-clients' was little acknowledged. [ABSTRACT FROM AUTHOR]

Background: Two to 4% of emergency hospital admissions are caused by preventable adverse drug events. The estimated costs of such avoidable admissions in England were £530 million in 2015. The data-driven quality improvement in primary care (DQIP) intervention was designed to prompt review of patients vulnerable from currently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) and anti-platelets and was found to be effective at reducing this prescribing. A process evaluation was conducted parallel to the trial, and this paper reports the analysis which aimed to explore response to the intervention delivered to clusters in relation to participants' perceptions about which intervention elements were active in changing their practice.Methods: Data generation was by in-depth interview with key staff exploring participant's perceptions of the intervention components. Analysis was iterative using the framework technique and drawing on normalisation process theory.Results: All the primary components of the intervention were perceived as active, but at different stages of implementation: financial incentives primarily supported recruitment; education motivated the GPs to initiate implementation; the informatics tool facilitated sustained implementation. Participants perceived the primary components as interdependent. Intervention subcomponents also varied in whether and when they were active. For example, run charts providing feedback of change in prescribing over time were ignored in the informatics tool, but were motivating in some practices in the regular e-mailed newsletter. The high-risk NSAID and anti-platelet prescribing targeted was accepted as important by all interviewees, and this shared understanding was a key wider context underlying intervention effectiveness.Conclusions: This was a novel use of process evaluation data which examined whether and how the individual intervention components were effective from the perspective of the professionals delivering changed care to patients. These findings are important for reproducibility and roll-out of the intervention.Trial Registration: ClinicalTrials.gov, NCT01425502 . [ABSTRACT FROM AUTHOR]

Nursing has a gendered and religious history where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealized notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing's professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis, we focus on the nurses' apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as 'slaves' or 'martyrs' in the health care system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse's role. We argue that a remnant of a quasi-religious ethic within the profession makes it acceptable for nurses to talk about self-sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in, a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions. [ABSTRACT FROM AUTHOR]

The two reclassifications of cannabis in England & Wales in 2004 and 2009 have been subjected to a series of academic analyses which have largely been centred on either the relationship to evidence, or in terms of the implications and realities of policing and health under the changes. However, despite the wealth of attention on this area, there have been relatively few attempts to understand these policy movements through broader criminological theoretical frameworks. One recent exception is Shiner's (2015) utilisation of Garland's (2001) concept of 'structured ambivalence'. This paper seeks to test this application through drawing upon an alternative source of evidence, namely, a series of 'elite' qualitative interviews, and using Kingdon's (1995) Multiple Streams model to make sense of the policy processes. In doing so, it largely corroborates Shiner's conclusions whilst also further illuminating particular agentic aspects and their intertwining with other structural and cultural forces which led to the reclassifications. These findings demonstrate the value of triangulating evidential sources and advances knowledge about the role of individuals in pursuing policy agendas within a broader shifting political climate. This provides greater scope to further test and understand how structured ambivalence manifests itself in other cultural contexts and policy domains. [ABSTRACT FROM AUTHOR]

Background: Health services research is expected to involve service users as active partners in the research process, but few examples report how this has been achieved in practice in trials. We implemented a model to involve service users in a multi-centre randomised controlled trial in pre-hospital emergency care. We used the generic Standard Operating Procedure (SOP) from our Clinical Trials Unit (CTU) as the basis for creating a model to fit the context and population of the SAFER 2 trial.Methods: In our model, we planned to involve service users at all stages in the trial through decision-making forums at 3 levels: 1) strategic; 2) site (e.g. Wales; London; East Midlands); 3) local. We linked with charities and community groups to recruit people with experience of our study population. We collected notes of meetings alongside other documentary evidence such as attendance records and study documentation to track how we implemented our model.Results: We involved service users at strategic, site and local level. We also added additional strategic level forums (Task and Finish Groups and Writing Days) where we included service users. Service user involvement varied in frequency and type across meetings, research stages and locations but stabilised and increased as the trial progressed.Conclusion: Involving service users in the SAFER 2 trial showed how it is feasible and achievable for patients, carers and potential patients sharing the demographic characteristics of our study population to collaborate in a multi-centre trial at the level which suited their health, location, skills and expertise. A standard model of involvement can be tailored by adopting a flexible approach to take account of the context and complexities of a multi-site trial.Trial Registration: Current Controlled Trials ISRCTN60481756. Registered: 13 March 2009. [ABSTRACT FROM AUTHOR]

Background: Delivering health care negatively influences the environment and contributes to climate change. This study examined how nursing students in England and Sweden can make changes in clinical practice to enhance environmental sustainability. Method: Third-year undergraduate nursing students at English and Swedish universities responded to open-ended questions on the Sustainability Attitudes in Nursing Survey. Data were analyzed using inductive content analysis. Results: Students in both countries identified lack of confidence as the main barrier to challenging unsustainable practice, followed by a resistance to change in practice. English students predominantly changed their own behavior or influenced the practice of others. Swedish students either changed their own behavior or their own attitudes to sustainability. Conclusion: There is a need to ensure students have confidence to act as change agents to enhance sustainable practice in the clinical environment. [J Nurs Educ. 2022;61(7):390–393.] [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To evaluate the implementation of an integrated multidisciplinary Movement Disorder Clinic using a model of knowledge translation. A mixed methods design was used to evaluate implementation outcomes. After recognising poor referral rates to allied health, Movement Disorder Clinic team-members identified implementation barriers. Team- and process-level implementation strategies were designed and tailored to address these barriers. The primary outcome measure was the change in the proportion of patients referred to allied health, determined by comparing pre- and post-implementation documentation audits. Secondary outcome measures included clinician and consumer surveys to identify ongoing implementation barriers and stakeholder satisfaction. Documentation from 90 medical records was included in the audits (post-intervention n = 45). There was a significant improvement in the referral rates to allied health from 53% to 84% (mean improvement 31%, p = 0.003, Fisher's exact test). However, documentation of disease education decreased by 38% (p = 0.000, Fisher's exact test). Movement Disorder Clinic team-members identified three main barriers to ongoing implementation: "memory and automaticity", "environmental context and resources" and "beliefs about capabilities". Thirty-seven consumer surveys were completed, showing high levels of satisfaction (86%) but ongoing educational needs (51%). Implementation of an integrated multidisciplinary Movement Disorder Clinic was facilitated by a knowledge translation framework, leading to improved allied health referral rates and high levels of staff and consumer satisfaction, but unmet educational needs of consumers. Future research in the field of multidisciplinary healthcare for people with movement disorders is needed to determine the impact of these changes on patients' healthcare outcomes. Multidisciplinary integrated healthcare models may lead to better outcomes in progressive diseases such as Parkinson's disease, however, can be challenging to implement. A knowledge translation framework facilitated successful implementation of an integrated multidisciplinary Movement Disorders Clinic, leading to significantly improved rates of appropriate referrals to allied health, and staff and consumer satisfaction. Team-members identified three main barriers to ongoing implementation – "memory and automaticity", "environmental context and resources," and "beliefs about capabilities" – which may impact sustainability and should be considered in future implementation efforts. [ABSTRACT FROM AUTHOR]

Background: The workplace has been identified as an ideal setting for health interventions. However, few UK-based workplace intervention studies have been published. Fewer still focus on the practicalities and implications when running an intervention within the workplace setting. The objective of this paper was to qualitatively determine the perceived behaviour changes of participants in a free fruit at work intervention. Understanding the dynamics of a workplace intervention and establishing any limitations of conducting an intervention in a workplace setting were also explored.Methods: Twenty-three face-to-face interviews were conducted with individuals receiving free fruit at work for 18 weeks (74 % female). The worksite was the offices of a regional local government in the North East of England. Analysis was guided theoretically by Grounded Theory research and the data were subjected to content analysis. The transcripts were read repeatedly and cross-compared to develop a coding framework and derive dominant themes.Results: Topics explored included: the workplace food environment; the effect of the intervention on participants and on other related health behaviours; the effect of the intervention on others; participant's fruit consumption; reasons for not taking part in the intervention; expectations and sustainability post-intervention; and how to make the workplace healthier. Five emergent themes included: the office relationship with food; desk based eating; males and peer support; guilt around consumption of unhealthy foods; and the type of workplace influencing the acceptability of future interventions.Conclusion: Exploring the perceptions of participants offered valued insights into the dynamics of a free fruit workplace intervention. Findings suggest that access and availability are both barriers and facilitators to encouraging healthy eating in the workplace. [ABSTRACT FROM AUTHOR]

Background: Operational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs' experiences of work, they remain under-explored in primary care.Aim: To identify operational failures in the primary care work environment and to examine how they influence GPs' work.Design and Setting: Qualitative interview study in the East of England.Method: Semi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.Results: GPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook 'compensatory labour' to fulfil their duties of coordinating and safeguarding patients' care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.Conclusion: Operational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive. [ABSTRACT FROM AUTHOR]

Background: There is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.Aim: To explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and Setting: A qualitative primary care interview study in the East of England.Method: Semi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.Results: The authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.Conclusion: Type 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward. [ABSTRACT FROM AUTHOR]

Purpose: To assess the experience and attitudes of dental professionals towards smoking cessation and, in particular, to explore perceived barriers limiting their involvement in this area of practice.Materials and Methods: A combined quantitative and qualitative methodology was employed in South Essex, an area in South East England. In the first phase a questionnaire survey was conducted with all general dental practitioners on the South Essex Health Authority dental list to assess their current involvement in smoking cessation and their general attitudes to this area of clinical care. In the second phase, ten focus group interviews were conducted with dental teams to uncover in greater depth views towards smoking cessation and, in particular, the barriers preventing progress.Results: A 60% response rate (n = 149) was achieved for the postal questionnaire and 52 dental team members participated in the focus groups. The questionnaire survey revealed that the majority of the sample reported asking their patients about smoking (90%) and recording this information in their clinical notes (75%). However, a relatively low number indicated active involvement in assisting smokers to stop (30%) or referring them for more detailed support (24%). The focus groups uncovered a range of fundamental barriers limiting greater involvement in smoking cessation. The key issues included a fatalistic and negative concept of prevention; perceived lack of relevance of smoking cessation to dentistry; patient hostility; and organizational factors within the practice setting.Conclusion: Future action to encourage the provision of smoking cessation in dental practices needs to address the range of barriers that currently limit involvement in this area of clinical practice. [ABSTRACT FROM AUTHOR]

Background: Identification of patients at the end-of-life is the first step in care planning and many general practices have Palliative Care Registers. There is evidence that these largely comprise patients with cancer diagnoses, but little is known about the identification process.Objective: To explore the barriers that hinder GPs from identifying and registering patients on Palliative Care Registers.Methods: An exploratory qualitative approach was undertaken using semi-structured interviews with GPs in South West England. GPs were asked about their experiences of identifying, registering and discussing end-of-life care with patients. Interviews were audio recorded, transcribed and analysed thematically.Results: Most practices had a Palliative Care Register, which were mainly composed of patients with cancer. They reported identifying non-malignant patients at the end-of-life as challenging and were reluctant to include frail or elderly patients due to resource implications. GPs described rarely using prognostication tools to identify patients and conveyed that poor communication between secondary and primary care made prognostication difficult. GPs also detailed challenges around talking to patients about end-of-life care.Conclusions: Palliative Care Registers are widely used by GPs for patients with malignant diagnoses, but seldom for other patients. The findings from our study suggest that this arises because GPs find prognosticating for patients with non-malignant disease more challenging. GPs would value better communication from secondary care, tools for prognostication and training in speaking with patients at the end-of-life enabling them to better identify non-malignant patients at the end-of-life. [ABSTRACT FROM AUTHOR]

Background: The incidence of self-harm in young people in primary care is increasing dramatically, and many young people who self-harm visit their GP surgery as a first point of contact for help.Objective: To explore with young people, GPs and practice nurses (PNs): (i) why young people present with self-harm to primary care and (ii) whether young people, GPs and PNs can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place.Methods: Participatory action research with GPs, PNs and young people employed mixed methods to collect statistical and narrative data. Statistics from 285 young people's medical records were captured, including more detailed analyses of a random sample of 75 of these records. A series of 24 focus groups with a total of 45 GPs, PNs and young people, with an average number of eight participants in each group, was conducted. Statistical data were subject to descriptive and inferential analyses, and thematic analysis was applied to the transcripts from the focus groups.Results and Conclusion: The type of self-harm young people presented with influenced whether they would see a GP or PN. While self-help materials were welcomed and deemed helpful, young people, GPs and PNs were ambivalent about using these in short consultations where time was an overriding constraint. More research is needed on the feasibility of adopting self-help assisted interventions in GP surgeries. [ABSTRACT FROM AUTHOR]

Social identification and team performance literatures typically focus on the relationship between individual differences in identification and individual‐level performance. By using a longitudinal multilevel approach, involving 369 members of 45 sports teams across England and Italy, we compared how team‐level and individual‐level variance in social identification together predicted team and individual performance outcomes. As hypothesized, team‐level variance in identification significantly predicted subsequent levels of both perceived and actual team performance in cross‐lagged analyses. Conversely, individual‐level variance in identification did not significantly predict subsequent levels of perceived individual performance. These findings support recent calls for social identity to be considered a multilevel construct and highlight the influence of group‐level social identification on group‐level processes and outcomes, over and above its individual‐level effects. [ABSTRACT FROM AUTHOR]

Violence against women students is increasingly recognized as a significant public health and human rights issue. The Intervention Initiative is a facilitated bystander intervention educational program commissioned by Public Health England for use by all English universities to prevent violence, abuse, and coercion. The success of the program with first-year law students at a large university in the South West of England was evaluated through course evaluation feedback and in a questionnaire study. Student experience was exceptionally good across all measures. In paired sample t tests, prosocial bystander behavior did not increase significantly from pretest to post-test immediately after taking part in the program. Rape myth acceptance, domestic abuse myth acceptance, and denial decreased significantly (p < .001; d > .599). Bystander efficacy, readiness to help, and responsibility increased significantly (p < .001; d = .408-.703), and intent to help increased significantly (p = .007, d = .248). Exposure to a concurrent social marketing campaign on campus had a significant strengthening effect on improvement of attitudes to rape myths (p = .010) but not any other outcome measures. No significant backlash was identified. [ABSTRACT FROM AUTHOR]

Building on work on post-Fordist affect, we argue that the group-based and person-centered forms of production in mining and milling, respectively, produce contingent conceptualizations of culture, identity, and personhood and, in turn, of dying and death. The “communal solidarism” characteristic of post-mining milieu engenders senses of dying and death entailing a communal merging of erstwhile individual selfhoods. In post-milling milieu dying and death are conceptualized as individuated, but subject to social evaluation. The evaluative criterion in this regard is ability to “perform” dying and death in ways that reflect the valorized essence of local culture, identity, and personhood, “resilient autonomy.” [ABSTRACT FROM AUTHOR]

Background: Biomedical research can have impacts on patient care at research-active hospitals. We qualitatively evaluated the impact of the Oxford Biomedical Research Centre (Oxford BRC), a university-hospital partnership, on the effectiveness and efficiency of healthcare in local hospitals. Effectiveness and efficiency are conceptualised in terms of impacts perceived by clinicians on the quality, quantity and costs of patient care they deliver.Methods: First, we reviewed documentation from Oxford BRC and literature on the impact of research activity on patient care. Second, we interviewed leaders of the Oxford BRC's research to identify the direct and indirect impacts they expected their activity would have on local hospitals. Third, this information was used to inform interviews with senior clinicians responsible for patient care at Oxford's acute hospitals to discover what impacts they observed from research generally and from Oxford BRC's research work specifically. We compared and contrasted the results from the two sets of interviews using a qualitative approach. Finally, we identified themes emerging from the senior clinicians' responses, and compared them with an existing taxonomy of mechanisms through which quality of healthcare may be affected in research-active settings.Results: We were able to interview 17 research leaders at the Oxford BRC and 19 senior clinicians at Oxford's acute hospitals. The research leaders identified a wide range of beneficial impacts that they expected might be felt at local hospitals as a result of their research activity. They expected the impact of their research activity on patient care to be generally positive. The senior clinicians responsible for patient care at those hospitals presented a more mixed picture, identifying many positive impacts, but also a smaller number of negative impacts, from research activity, including that of the Oxford BRC. We found the existing taxonomy of benefit types to be helpful in organising the findings, and propose modifications to further improve its usefulness.Conclusions: Impacts from research activity on the effectiveness and efficiency of patient care at the local acute hospitals, as perceived by senior clinicians, were more often beneficial than harmful. The Oxford BRC contributed to those impacts. [ABSTRACT FROM AUTHOR]

Caring is a positive social act, but can it result in negative attitudes towards those cared for, and towards others from their wider social group? Based on intergroup contact theory, we tested whether care workers' (CWs) positive and negative contact with old-age care home residents (CHRs) predicts prejudiced attitudes towards that group, and whether this generalises to other older people. Fifty-six CWs were surveyed about their positive and negative contact with CHRs and their blatant and subtle attitudes (humanness attributions) towards CHRs and older adults. We tested indirect paths from contact with CHRs to attitudes towards older adults via attitudes towards CHRs. Results showed that neither positive nor negative contact generalised blatant ageism. However, the effect of negative, but not positive, contact on the denial of humanness to CHRs generalised to subtle ageism towards older adults. This evidence has practical implications for management of CWs' work experiences and theoretical implications, suggesting that negative contact with a subgroup generalises the attribution of humanness to superordinate groups. Because it is difficult to identify and challenge subtle prejudices such as dehumanisation, it may be especially important to reduce negative contact. © 2016 The Authors. Journal of Community & Applied Social Psychology Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: Hospital discharge is a vulnerable transitional stage in patient care. This qualitative study investigated the views of healthcare professionals and patients about the threats to safe hospital discharge with aim of identifying contributory and latent factors. The study was undertaken in two regional health and social care systems in the English National Health Service, each comprising three acute hospitals, community and primary care providers and municipal social care services. The study focused on the threats to safe discharge for hip fracture and stroke patients as exemplars of complex care transitions.Methods: A qualitative study involving narrative interviews with 213 representative stakeholders and professionals involved in discharge planning and care transition activities. Narratives were analysed in line with 'systems' thinking to identify proximal (active) and distal (latent) factors, and the relationships between them.Results: Three linked categories of commonly and consistently identified threat to safe discharge were identified: (1) 'direct' patient harms comprising falls, infection, sores and ulceration, medicines-related issues, and relapse; (2) proximal 'contributing' factors including completion of tests, assessment of patient, management of equipment and medicines, care plan, follow-up care and patient education; and distal 'latent' factors including discharge planning, referral processes, discharge timing, resources constraints, and organisational demands.Conclusion: From the perspective of stakeholders, the study elaborates the relationship between patient harms and systemic factors in the context of hospital discharge. It supports the importance of communication and collaboration across occupational and organisational boundaries, but also the challenges to supporting such communication with the inherent complexity of the care system. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to (i) explore how health professionals and managers who work with young people seek to define developmentally appropriate healthcare (DAH), (ii) identify the range of conceptual dimensions present in their definitions and (iii) explore the controversies embedded in their characterisations of DAH.Methods: A qualitative multisite ethnographic study was conducted across three hospitals in England. We undertook face-to-face semi-structured interviews with health professionals and managers; and non-participant observation in clinics, wards and meetings. Anonymised field notes and interview transcripts were analysed using thematic analysis. The theme 'conceptualisations of DAH' was then further analysed, and the resulting themes categorised to form conceptual dimensions.Results: We recruited 192 participants and conducted 65 interviews (41 with health professionals and 24 with managers) and approximately 1600 hours of non-participant observations (involving 103 health professionals and 72 managers). Despite the wide range of definitions provided by participants, five conceptual dimensions of DAH were identified: (i) biopsychosocial development and holistic care, (ii) acknowledgement of young people as a distinct group, (iii) adjustment of care as the young person develops, (iv) empowerment of the young person by embedding health education and health promotion and (v) interdisciplinary and interorganisational work. Also, some controversies were identified within most dimensions.Conclusions: This study illustrates the lack of a generalised definition of DAH for young people among UK health professionals and managers, and presents a set of five core dimensions that can inform future research to help define and evaluate DAH for young people. [ABSTRACT FROM AUTHOR]

Background: Effective recruitment is an essential element of successful research but notoriously difficult to achieve. This article examines health care professionals' views on the factors influencing decision-making regarding referral to a stroke rehabilitation trial.Methods: Semi-structured interviews and a card-sorting task were undertaken with stroke service staff in acute and community hospital trusts. Data analysis used a thematic framework approach.Results: Twenty-seven qualified health care professionals from 12 (6 acute and 6 community) hospital trusts and one charity participated. Four main factors emerged: patient-related, professional views, the organisation and research logistics, which all contributed to staff's decision about whether to refer patients to a trial. Clinicians identified patient-related factors as the most frequent influence and considered themselves the patients' advocate. They used their knowledge of the patient to anticipate the patients' reaction to possible participation and tended to only refer those whom they perceived would respond positively. Participants also identified experience of research, a sense of ownership of the project and a positive view of the intervention being evaluated as factors influencing referral. The need to prioritise clinical matters, meet managerial demands and cope with constant change were organisational factors impacting negatively on referral. Staff often simply forgot about recruitment in the face of other higher priorities. Quick, simple, flexible research processes that were closely aligned with existing ways of working were felt to facilitate recruitment.Conclusions: Patient- and professional-related factors were the most frequent influence on clinicians' recruitment decisions, which often had a 'gate-keeping' effect. Managerial and clinical responsibility to juggle multiple (often higher) priorities was also an important factor. To facilitate recruitment, researchers need to develop strategies to approach potential participants as directly as possible to enable them to make their own decisions about participation; ensure that research processes are as quick and simple as possible; align with existing clinical pathways and systems; and give regular reminders and ongoing support to promote recruitment.Trial Registration: ISRCTN, 98287938 . Registered 6 May 2015. [ABSTRACT FROM AUTHOR]

Background: Junior doctors do most inpatient prescribing, with a relatively high error rate, and locally had reported finding prescribing very stressful.Objective: To develop an intervention to improve Foundation Year 1 (FY1) doctors' experience of prescribing, and evaluate their satisfaction with the intervention and perceptions of its impact.Methods: Based on findings of a focus group and questionnaire, we developed a pocket Dose Reference Card ("Dr-Card") for use at the point of prescribing. This summarised common drugs and dosing schedules and was distributed to all new FY1 doctors in a London teaching trust. A post-intervention questionnaire explored satisfaction and perceived impact.Results: Focus group participants (n = 12) described feeling anxious and time pressured when prescribing; a quick reference resource for commonly prescribed drug doses was suggested. Responses to the exploratory questionnaire reinforced these findings. Following Dr-Card distribution, the post-intervention questionnaire revealed that 29/38 (76 %) doctors were still using it 2 months after distribution and 38/38 (100%) would recommend ongoing production.Conclusions: FY1 doctors reported feeling stressed and time pressured when prescribing; this was perceived to contribute to error. A pocket card presenting common drugs and doses was well-received, perceived to be useful, and recommended for on-going use. [ABSTRACT FROM AUTHOR]

Background: Safe care in general practice for people living with HIV requires early diagnosis of undetected infection and safe co-prescribing with antiretroviral therapy (ART).Aim: To evaluate safe co-prescribing in general practice patients who are taking ART, and to describe missed diagnostic opportunities for undiagnosed HIV infection in primary care.Design and Setting: Retrospective case-notes review in general practices within NHS City and Hackney Primary Care Trust (PCT), London, UK.Method: All general practices in NHS City and Hackney PCT were invited to participate. Patients known to be HIV positive were identified using Read Codes. Each practice undertook retrospective case-notes reviews on specialist correspondence, coding of ART, prescribing of common contraindicated drug pairings, and missed opportunities for HIV diagnosis.Results: In total, 31/44 (70.5%) practices participated, and 1022 people living with HIV were identified. Practices had received HIV clinic letters for 698 of those 1022 (68.3%) patients in the previous 12 months. Of the 787 patients known to be prescribed ART, only 413 (52.5%) had correct drug codes recorded; 32/787 (4.1%) were receiving specified contraindicated drug pairings. In total, 89 patients were eligible for their case-notes to undergo a retrospective review of occurrences that took place pre-diagnosis. In the 2 years preceding diagnosis, these 89 had attended 716 face-to-face GP consultations, of which 123 (17.2%) were for indicator conditions. Fifty-one of these patients (57.3%) presented at least once with an indicator condition (interquartile range 1-3; median 2).Conclusion: In a large-scale evaluation of GP records of people living with HIV, gaps in ART recording and co-prescribing were identified, and evidence demonstrated missed opportunities for diagnosis within general practice. Specialists and generalists must communicate better to enhance safe prescribing and reduce delayed diagnosis. [ABSTRACT FROM AUTHOR]

Background: Different NHS patient empowerment policies have been adopted in England and Greece; the voluntary sector development and its influence also differ. Although various aspects of patient empowerment have been explored in England, the patient empowerment systems' application is under-researched. In Greece, the few relevant attempts looking at patients' experiences focus on patient satisfaction, with only one study exploring the public hospitals managers' perspectives on user involvement. However, patient empowerment questions may be similar in both countries. Aims and Objectives: The study aimed to explore and compare the general patient empowerment settings in the two countries, with main objectives to: a. identify and explore the relationships of national voluntary and governmental organisations, b. explore the cross-national challenges and facilitators, and make cross-national recommendations. Methodology: This is a cross-national comparative research study. A 'diagnostic analysis' approach, an assessment of potential and actual barriers and facilitators, including the context and potential change, was chosen. The methods used were:- a. a network analysis of national voluntary and governmental organisations; b. semi-structured interviews with key representatives of these, and c. documentary analysis. Results: The network analysis revealed the potential of English organisations to influence more people, with extensive memberships and stronger interrelationship between them than the Greek organisations. Different levels of awareness, knowledge and perceptions of application of the national patient empowerment policies, systems and mechanisms were identified; being generally good in England, limited in Greece. Variable general information provision, with good verbal information in England, and limited, written and verbal, information in Greece was also identified. Although the commonest cross-national perceived challenges were organisational, the Greek culture, professional systems and attitudes were also challenges in Greece. National relevant policies and professional attitudes in England, and integrated working in Greece were perceived facilitators. Changes in professional attitudes and cultures, information awareness / provision, and national drivers were common cross-national facilitators. Greek participants called for better function of patient empowerment systems within hospitals; while hearing the patients 'voice' and non-tokenism were highlighted in England. Conclusions: Notwithstanding its limitations, this analysis identified factors and complexities likely to influence patient empowerment change. The influence of the voluntary sector and well-developed policies in England was evident, while in Greece there was lack of knowledge and awareness. Nonetheless, it seems that the need for better non-tokenistic systems is cross-national. [ABSTRACT FROM AUTHOR]

This article compares child welfare workers' perspectives on Black and Minority Ethnic parents in England and Norway. It is based on in-depth semi-structured interviews with forty-seven front line child welfare workers conducted in 2008. We found that Norwegian and English child welfare workers' perspectives of minority parents significantly differ along two dimensions: workers' expectations about the role that minority parents should play in the lives of their children, and their assumptions about parents' relationship with the child welfare system. Norwegian workers embrace a racism-blind, individualistic, change-oriented perspective that views minority parents as responsible service users. Workers conceive of parents and children as individuals with different struggles and needs and classify minority parents primarily as service users with responsibilities towards their children. They expect parents to become bi-lingual and bi-cultural to facilitate their children's access to the opportunities provided by the Norwegian education and child welfare systems. English workers demonstrate an anti-racist and culturally sensitive, holistic and defensive perspective that categorises minority parents and children as clients. They think of minority children and parents as families (as opposed to individuals) of colour who encounter racism and prejudice. English workers do not expect bi-cultural competency from immigrant parents. [ABSTRACT FROM PUBLISHER]

Background: Evidence-based practice requires the development of measures which are suitable for everyday clinical use ('feasible'). There is no consensus as to how to establish feasibility.Method: The feasibility of a new assessment - the Threshold Assessment Grid (TAG) - for use when making referrals to mental health services was tested by training mental health teams in using the TAG and other standardised assessments, asking referrers to ten mental health services in London also to complete a TAG, surveying TAG users, and evaluating a feedback meeting at which TAG data were presented.Results: One hundred and one (61%) mental health staff received training, and 445 (74%) referrers of 600 patients completed TAGs. Sixty-five (65%) questionnaires from TAG users were completed, and 24 (80%) people attending feedback meetings evaluated the TAG. These allowed the extent to which the TAG is brief, simple, relevant, acceptable, available and valuable to be investigated.Conclusion: The TAG exhibited good feasibility when used by mental health staff, and moderate feasibility when used by referrers. This approach can be used to investigate the feasibility of other standardised assessments. [ABSTRACT FROM AUTHOR]

Background: Chronic pain has emerged as a disease in itself, affecting a growing number of people. Effective patient-provider communication is central to good pain management because pain can only be understood from the patient's perspective. We aimed to develop a user-centered tool to improve patient-provider communication about chronic pain and assess its feasibility in real-world settings in preparation for further evaluation and distribution.Methods: To identify and prioritize patient treatment goals for chronic pain, strategies to improve patient-provider communication about chronic pain, and facilitate implementation of the tool, we conducted nominal group technique meetings and card sorting with patients with chronic pain and experienced providers (n = 12). These findings informed the design of the PainAPP tool. Usability and beta-testing with patients (n = 38) and their providers refined the tool and assessed its feasibility, acceptability, and preliminary impact.Results: Formative work revealed that patients felt neither respected nor trusted by their providers and focused on transforming providers' negative attitudes towards them, whereas providers focused on gathering patient information. PainAPP incorporated areas prioritized by patients and providers: assessing patient treatment goals and preferences, functional abilities and pain, and providing patients tailored education and an overall summary that patients can share with providers. Beta-testing involved 38 patients and their providers. Half of PainAPP users shared their summaries with their providers. Patients rated PainAPP highly in all areas. All users would recommend it to others with chronic pain; nearly all trusted the information and said it helped them think about my treatment goals (94%), understand my chronic pain (82%), make the most of my next doctor's visit (82%), and not want to use opioids (73%). Beta-testing revealed challenges delivering the tool and summary report to patients and providers in a timely manner and obtaining provider feedback.Conclusions: PainAPP appears feasible for use, but further adaptation and testing is needed to assess its impact on patients and providers.Trial Registration: This study was approved by the University of New England Independent Review Board for the Protection of Human Subjects in Research (012616-019) and was registered with ClinicalTrials.gov (protocol ID: NCT03425266) prior to enrollment. The trial was prospectively registered and was approved on February 7, 2018. [ABSTRACT FROM AUTHOR]