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Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

OBJECTIVE This work aims to evaluate the readability of publicly available board reports from the Local Health Networks (LHNs) in South Australia and the National Health Service (NHS) Trusts in England. METHOD Publicly available board reports from the LHNs in South Australia and NHS Trusts in England were identified, screened, and evaluated from January 2020 to August 2020. RESULTS The average Flesch Reading Ease score for all LHNs reviewed ranged from 34 ± 10.2 to 57 ± 0.0 (Difficult to Fairly Difficult). In comparison, the average Flesch Reading Ease score for all the NHS Foundation Trusts ranged from 46 ± 1.7 to 60 ± 3.0 (Difficult to Standard). The average Reading Ease score for metropolitan and non-metropolitan LHNs was 43 ± 8.1 and 41 ± 6.0 (Difficult to read). In contrast, the average Reading Ease score for metropolitan and non-metropolitan NHS Trust was Fairly Difficult with 53 ± 4.2 and 50 ± 3.5 respectively. CONCLUSION The evaluation results suggest that there is scope for improving the quality of publicly available board reports from the boards reviewed in terms of their readability by the public. [ABSTRACT FROM AUTHOR]

Accumulating evidence indicates that readers monitor the congruence and accuracy of text by processes of "validation." Validation is sometimes thwarted by the embedding of inaccuracies in sentence presuppositions (the ideas assumed by the writer to be previously familiar to the reader). However, we previously demonstrated that inaccurate sentence presuppositions inflate reading time (O'Brien & Albrecht's, 1992, "consistency effect") as much as focussed (nonpresupposed) concepts, which favours successful validation of sentence presuppositions (Singer, Solar, & Spear, 2017). Certain theoretical analyses posit that validation is particularly impeded by grammatical constructions that strongly distinguish presupposed and focussed information. Therefore, in 3 experiments, we scrutinized 1 class of such constructions; namely, clefts and pseudoclefts. Subjects read brief texts that presented cleft or pseudocleft target sentences which had critical ideas that either matched or mismatched a text antecedent. Reading time was uniformly inflated by inconsistencies in sentence presuppositions by margins similar to those of focussed text ideas. This indicates that readers effectively scrutinize strongly presupposed concepts. The outcome is discussed with reference to theories that highlight either successful or unsuccessful validation. [ABSTRACT FROM AUTHOR]

The article discusses a study related to the readability of child protection medical reports in several Great Britain National Health Service (NHS) trusts and to analyze the descriptive language used by pediatricians in these reports. It also talks about the use of the Flesch–Kincaid readability tests as readability analysis tool.

Objective: To apply "user testing" to maximize readability and acceptability of a Clinical Trial Results Laypersons Summary--a new European requirement. Methods: "User testing" (using questionnaire and semistructured interview) assessed whether people could find and understand key points. Findings were used to improve content and design, prior to retesting. Participants had a range of levels of health literacy and there was a higher education group. Participants accessed the summary on screen. In round 1 we tested 12 points of information. In round 2 a revised summary addressing round 1 findings was tested, leading to a third final version. Results: In round 1, 2 of 12 points of information did not reach the target and interviews raised further format and content issues (some distracting technical explanations and inability to find or understand the 2 main study purposes). These findings informed revisions for the version tested in round 2, with 2 different points not reaching the target (inclusion criteria relating to duration of seasonal allergies and how researchers found out about participants' symptoms). Identified problems in both rounds were addressed and reflected in the final version. Despite improvements, participants did not consistently understand that summaries were intended for the public, or to only interpret results of single trials in the context of additional trials. All readers, including those with higher education, found the clear and straightforward language acceptable. Conclusions: Applying "user testing" resulted in a largely health-literate summary suitable for people across a range of backgrounds. [ABSTRACT FROM AUTHOR]

Abstract: Background: UK Hospital Trusts are charged with increasing patients’ research awareness and willingness to take part in research. This includes implementing strategies to encourage patient‐initiated enquiries about participation. Objectives: To evaluate the impact of a research statement inserted in outpatient letters in one clinical service, and to derive suggestions on potential steps towards increasing patient‐initiated recruitment. Setting: A medical outpatient clinic of a research‐active hospital trust, serving an inner‐city multi‐ethnic population across two boroughs. Methods: Pre‐intervention and post‐intervention questionnaires were administered face‐to‐face to new patients. Questionnaires included closed questions and one open comments section. Data were analysed for frequencies, with thematic coding of open‐ended responses. Results: The response rates were 87% for the pre‐intervention survey and 92% for the post‐intervention survey. In the post‐intervention survey, 85% of patients did not notice the research statement in the letter. More than half found the statement “a little unclear,” whilst one‐third considered it “clear.” Three‐quarters of respondents perceived the statement to be “a little helpful.” Only one person enquired about participating in clinical research having read the statement in the outpatient letter. Conclusion: The analysis suggests that simple, single‐solution approaches such as including research statements in outpatient letters are unlikely to be sufficient to significantly facilitate patient‐initiated recruitment. Recruitment efforts need to take into consideration the diversity of patient constituencies including the reasons they seek health care, and how patients can meaningfully access information (research literacy). [ABSTRACT FROM AUTHOR]

Introduction: Evidence suggests the current verbal risk descriptors used to communicate side effect risk in patient information leaflets (PILs) are overestimated.Objectives: The aim was to establish how people understand the verbal risk descriptors recommended for use in PILs by the European Commission (EC), and alternative verbal risk descriptors, in the context of mild and severe side effects.Methods: A cross-sectional online survey was carried out by a market research company recruiting participants aged between 18 and 65 years living in England. Data were collected between 18 March and 1 April 2016. Participants were given a hypothetical scenario regarding the risk of mild or severe medication side effects and asked to estimate how many out of 10,000 people would be affected for each of the verbal risk descriptors being tested.Results: A total of 1003 participants were included in the final sample. The risks conveyed by the EC recommended verbal risk descriptors were greatly overestimated by participants. Two distinct distributions were apparent for participant estimates of side effect risks: those for 'high risk' verbal descriptors (e.g. 'common', 'likely', 'high chance') and those for 'low risk' verbal descriptors (e.g. 'uncommon', 'unlikely', 'low chance'). Within these two groups, the distributions were near to identical regardless of what adverb (e.g. very, high, fair) or adjective (e.g. common, likely, chance) was used. The EC recommended verbal risk descriptors were more likely to be understood in accordance with their intended meanings when describing severe side effects. Very few demographic or psychological factors were consistently associated with how well participants understood the EC recommended verbal risk descriptors.Discussion: The current verbal risk descriptors used in PILs are ineffective at best and misleading at worst. Discontinuing the use of verbal risk descriptors would limit the likelihood of people overestimating the risk of side effects. [ABSTRACT FROM AUTHOR]

Aims and objectives The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups. Background Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes. Design Quantitative component of a mixed methods study using survey principles. Methods The Conditions of Work Effectiveness Questionnaire II was distributed to the total population ( n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics. Results Overall, the unit response rate was 44·1% ( n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support. Conclusions A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures. Relevance to clinical practice Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement. [ABSTRACT FROM AUTHOR]

Background: Excess winter deaths, the ratio between average daily deaths in December-March versus other months, is a measure commonly used by public health practitioners and analysts to assess health burdens associated with wintertime weather. We seek to demonstrate that this measure is fundamentally biased and can lead to misleading conclusions about health impacts associated with current and future winter climate.Methods: Time series regression analysis of 779,372 deaths from natural causes in London over 15 years (1 August 1997-31 July 2012),collapsed by day of death and linked to daily temperature values. The outcome measures were the excess winter deaths index, and daily and annual deaths attributable specifically to cold.Results: Most of the excess winter deaths are driven by cold: The excess winter deaths index decreased from 1.19 to 1.07 after excluding deaths attributable to low temperatures. Over 40% of cold-attributable deaths occurred outside of the December-March period, leading to bias in the excess winter deaths measure. Although there was no relationship between winter severity and annual excess winter deaths, there was a clear correlation with annual cold-attributable deaths.Conclusions: Excess winter deaths is not an appropriate indicator of cold-related health impacts, and its use should be discontinued. We advocate alternative measures. The findings we present bring into doubt previous claims that cold-related deaths in the UK will not reduce in future as a result of climate change. [ABSTRACT FROM AUTHOR]

Objectives Few studies have assessed the utility of the Theory of Planned Behaviour (TPB) in explaining physicians' behaviour. This study uses the TPB for explaining physicians' implementation of guidelines' prescribing recommendations. Methods We developed the questionnaire via conducting qualitative interviews and pilot study. A random sample of 155 general practitioners (GPs) in England participated in the study. Prescribing and practice data were collected from routine sources. We analysed the data using regression methods. Results TPB explained 48% of variation in reported intentions to follow guidelines' prescribing recommendations. Attitude and perceived controls, but not subjective norms, were predictors of variation in intentions. TPB belief variables significantly explained variation in effective and efficient prescribing indicators (14% and 12% respectively). Normative, control and behavioural beliefs contributed to the models. Only for efficient prescribing, the TPB items retained their significance in presence of demographic variables. We found no significant relationship between intention and prescribing. Conclusions TPB helped understanding of GPs prescribing behaviour and their intentions to implement a clinical guideline. Beliefs (e.g. normative beliefs) were better predictors of behaviour than the composite scores for their corresponding higher-level construct (e.g. indirect subjective norm). TPB models should be tested alongside randomized trials to test the assumption of causality that change in beliefs ultimately results in change in behaviour. [ABSTRACT FROM AUTHOR]

A key factor in the social exclusion of older people is poor access to information, often stemming from communication strategies that do not take account of their circumstances or needs. In recent years, there has been a series of programmes and initiatives that have sought to address the issues, from which there is much to learn. Information strategies for older people need to concentrate on improving access and quality, and require partnership working. Older people's groups need to be fully involved as partners, and effective strategies need to work through community and neighbourhood networks. [ABSTRACT FROM AUTHOR]

This paper examines visual and affective factors involved in the reading of foreign language texts. It draws on the results of a pilot study among students of post-compulsory school stage studying French in England. Through a detailed analysis of students' reactions to texts, it demonstrates that the use of ‘authentic’ documents under currently held notions of ‘authenticity’ may have a negative affective impact on learners. Authors and designers of texts make assumptions about an original, intended readership which influence visual design, assumptions which are not necessarily borne out in the foreign language learning situation. There is a need to examine texts for their format as well as their content, to move away from equating ‘authentic’ with ‘identical’ and to using electronic design to improve readability. [ABSTRACT FROM AUTHOR]

In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves. [ABSTRACT FROM PUBLISHER]

Health professionals faced with refusal of life-saving treatment may wish to override a person's wishes, especially if that person suffers from a mental disorder. Mental illness does not automatically mean a patient is incapable of making decisions of this nature. It is not always clear whether an individual is legally competent to decide whether to undergo treatment or not. This article discusses a clinical example and analyses some of the moral implications. [ABSTRACT FROM PUBLISHER]