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Building on the pioneering research of a small number of gerontologists, this paper explores the rarely trodden common ground between the academic domains of social gerontology and modern history. Through empirical research it illustrates the complex networking that exists through space and time in the relational making of people and places. Indeed, the study focuses specifically on the lived reality and ongoing significance of life on the small-town British coastal homefront during World War II. Seventeen interviews with older residents of Teignmouth, Devon, United Kingdom, investigate two points in their lives: the ‘then’ (their historical experiences during this period) and the ‘then and now’ (how they continue to reverberate). In particular, their stories illustrate the relationalities that make each of these points. The first involves residents’ unique interactions during the war with structures and technologies (such as rules, bombs and barriers) and other people (such as soldiers and outsiders) which themselves were connected to wider historical, social, political and military networks. The second involves residents’ perceptions of their own and their town's wartime histories, how this gels or conflicts with public awareness, and how this history connects to their current lives. The paper closes with some thoughts on bringing together the past, present and older people in the same scholarship. [ABSTRACT FROM PUBLISHER]

Mealtimes in residential care homes are fundamentally social occasions, providing temporal structure to the day and opportunities for conversation and companionship. Food and drink are imbued with social meanings and used to express and create relationships between people. There is a dearth of research exploring care home residents' mealtime experiences in the United Kingdom. This paper reports on particular findings from a qualitative study which investigated factors influencing nutritional care provided to residents in two different types of residential care settings in South Wales, UK. Data were generated through focus group interviews with relevant staff members (N = 15), individual interviews with managers (N = 4) and residents (N = 16) of the care homes and their informal carers (N = 10), observation of food preparation and mealtimes throughout the day, and analysis of appropriate documents. Data were analysed using thematic analysis. This paper's focus is on the ways in which care home residents' experiences and understandings of mealtimes were influenced by various environmental factors, such as the home's geographical location, physical lay-out and ambience. Moreover, the shared meaning of mealtimes for residents, informal carers and staff was constructed from each group's socio-cultural background, family experiences and memories, and was integral to residents' sense of normality, community and identity. [ABSTRACT FROM PUBLISHER]

The concept of social capital is widely used in the social sciences and has, to an extent, been applied to the lives and social networks of older lesbian, gay and bisexual (hereafter LGB) adults. Developing existing research, this paper argues that while not without its problems, the concept of social capital enriches our understanding of these networks, whilst simultaneously deconstructing the negative stereotypes surrounding homosexuality in later life. However, little attention has been paid to the social factors that mediate access and participation in lesbian and gay communities and the implications of this on the quality and experience of later life. Drawing on qualitative research conducted in the United Kingdom, this paper illustrates how biography, gender and socio-economic status are significant mediators in the development and maintenance of social capital by older LGB adults. It concludes with a set of recommendations aimed at improving the social capital of older LGB adults, together with the importance of ‘queering’ the concept itself. [ABSTRACT FROM PUBLISHER]

Liberal economists' attitudes towards the welfare state are examined to see how clearly neoliberalism can be distinguished from other forms of liberalism. Three questions are asked. First, how could Friedrich Hayek believe he could accommodate elements of the welfare state agenda set by William Beveridge and John Maynard Keynes into his thinking? Second, why did Hayek become increasingly critical of the welfare state? Third, how far did Lionel Robbins, John Jewkes, and Alan Peacock agree with him? All three might be regarded as neoliberals according to the litmus test set by Philip Mirowski and Dieter Plehwe: that is, membership of the Mont Pèlerin Society or a think tank associated with the Atlas Economic Research Foundation. Yet, Robbins, Jewkes, and Peacock are on a spectrum between Mirowski's definition of neoliberalism as a belief that freedom is to be found in the unfettered market, and classical and democratic liberals' belief that people have to be nurtured to become effective citizens and have to be protected from the market's disruptive effects. It is suggested that a nuanced approach is required in explaining why liberal economists came to believe the welfare state should make more use of markets and pricing systems for registering preferences and apportioning resources. [ABSTRACT FROM AUTHOR]

The issue of reconciling ethnic diversity with the welfare state is a subject of long-standing theoretical debate. In particular, it remains unclear to what extent a shared national identity is necessary for endorsing claims to welfare at the individual and societal levels. Surveys show that migrants are seen as the least deserving category of welfare recipients. Yet migrants’ own views are rarely considered. Based on a qualitative study, this paper explores how Polish migrants residing in London conceptualised their deservingness to British welfare benefits and social housing. It finds a strong preference for conditionality of welfare predicated on contributions through work, payment of taxes and law abidance. Such conditionality applied to both in-group and out-group members thus transcending identity-based claims. These contributions were seen as both necessary and sufficient for laying claims to the British welfare system. Solely needs-based claims were seen as problematic. [ABSTRACT FROM PUBLISHER]

AimThis paper is a report of part of a study that explored the ways in which health visitors manage uncertainty and anxiety when working with clients across cultures.BackgroundInternationally health care professionals are required to deliver a high standard of culturally appropriate care to increasingly diverse communities and yet problems persist. Research evidence informing cultural ‘competence’ is focused largely around student experience and consequently little is known about the day-to-day experiences of health professionals in diverse community settings. Anxiety and uncertainty are increasingly recognised as important emotions experienced by a variety of health care professionals when working across cultures and yet the ways in which anxiety and uncertainty is managed in practice is less well understood.DesignGrounded theory methodology was used and 21 semi-structured interviews were conducted with participating health visitors in the North East of England between May 2008 and September 2009. All participants described themselves as white.FindingsThis study identified three different positions adopted by the health visitors to manage uncertainty and anxiety in their work across cultures. Identified as, ‘Fixing a culture’, ‘Reworking the equality agenda’ and ‘Asserting the professional self’, these strategies identify the ways in which health visitors try to manage the uncertainty and anxiety they feel when working in diverse communities. All of these strategies attempt in different ways to negate cultural difference and to render culture as static and known.ConclusionGiven that health professionals report anxiety and uncertainty when working across diverse community settings, identification of the strategies used by health visitors to manage that anxiety is important for both policy and practice. New strategies need to be developed to help health professionals to manage uncertainty and anxiety in ways that promote both cultural safe care and health equity. [ABSTRACT FROM PUBLISHER]

Background: Whilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre. Method: A retrospective case note review was conducted. Mean follow up was five years. Results: Twenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy. Conclusion: Aortopexy offers an effective method of treating severe tracheomalacia due to vascular compression. [ABSTRACT FROM AUTHOR]

Objective: To explore the opinions of the UK consultant body on endoscopic Eustachian tube balloon dilatation in the context of Eustachian tube dysfunction. Method: A 10-question online survey was distributed to ENT consultants currently practising in the UK (July–September 2018). Results: A total of 137 ENT consultants responded. Twenty-three per cent reported experience of Eustachian tube balloon dilatation, with a further 10 per cent planning to start performing the procedure. Of those performing the procedure, 16 per cent had more than two years' experience. Thirty-two per cent were performing zero to five procedures a year. Eustachian tube balloon dilatation was primarily conducted to treat Eustachian tube dysfunction symptoms, as well as retraction pockets, baro-challenge-induced Eustachian tube dysfunction and otitis media with effusion. The most common reason for not undertaking Eustachian tube balloon dilatation was insufficient evidence of efficacy (65 per cent). Seventy-two per cent of consultants thought that creating a national database for audit and monitoring purposes would benefit the specialty. Conclusion: The majority of UK ENT consultants do not practise Eustachian tube balloon dilatation, citing a lack of high-level evidence to support its use. A national database for auditing and research could facilitate the creation of guidelines. [ABSTRACT FROM AUTHOR]

After decades of silencing and discrimination, people with dementia are beginning to join forces, take action and campaign for social change. Drawing on data obtained from ‘activists’ with dementia using diary interview method and participant observation, this paper considers the emergent modes of dementia activism in the context of the social movement literature, and in particular, work emphasising the role of networks in health social movements. The study identified three emergent modes of dementia activism; these were the ‘protecting-self against decline’ mode, ‘(re) gaining respect’ mode, and ‘creating connections with other people with dementia’ mode. Taken together, these modes show how a sense of elapsing time pervades this form of activism. The investigation reinforces the contention that time is a dominated force that structures human motivation and goals. Furthermore, it raises the possibility that activism can protect against decline amongst people with dementia given the appropriate temporal space. [ABSTRACT FROM PUBLISHER]

In an increasingly ageing society, its older members are receiving considerable political and policy attention. However, much remains to be learnt about public perceptions of older age, particularly the views and experiences of older individuals themselves. Drawing on qualitative interviews carried out with members of two British cohorts (N = 60) who have reached the ‘third age’, this paper discusses perceptions of age, focusing particularly on how perceived advantages and disadvantages differ by respondents' self-reported physical capability. The interviews were carried out in 2010 as part of the HALCyon (Healthy Ageing across the Life Course) collaborative research programme. Findings suggest there is some difference in the way older people view aspects of ageing by capability and that although advantages are widely perceived, physical decline and associated health concerns were the overwhelming theme across the conversations. The article concludes by making tentative suggestions to inform the positive ageing agenda and its related policies. [ABSTRACT FROM PUBLISHER]

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about significant behavioural changes, one of which is increased time spent at home. This could have important public health implications. This study aimed to explore longitudinal patterns of 'home confinement' (defined as not leaving the house/garden) during the COVID-19 pandemic, and the associated predictors and mental health outcomes. Methods: Data were from the UCL COVID-19 Social Study. The analytical sample consisted of 25 390 adults in England who were followed up for 17 months (March 2020–July 2021). Data were analysed using growth mixture models. Results: Our analyses identified three classes of growth trajectories, including one class showing a high level of persistent home confinement (the home-confined, 24.8%), one changing class with clear alignment with national containment measures (the adaptive, 32.0%), and one class with a persistently low level of confinement (the unconfined, 43.1%). A range of factors were associated with the class membership of home-confinement trajectories, such as age, gender, income, employment status, social relationships and health. The home-confined class had the highest number of depressive (diff = 1.34–1.68, p < 0.001) and anxiety symptoms (diff = 0.84–1.05, p < 0.001) at the end of the follow-up than the other two classes. Conclusions: There was substantial heterogeneity in longitudinal patterns of home confinement during the COVID-19 pandemic. People with a persistent high level of confinement had the worst mental health outcomes, calling for special attention in mental health action plans, in particular targeted interventions for at-risk groups. [ABSTRACT FROM AUTHOR]

Background: When vaccination depends on injection, it is plausible that the blood-injection-injury cluster of fears may contribute to hesitancy. Our primary aim was to estimate in the UK adult population the proportion of COVID-19 vaccine hesitancy explained by blood-injection-injury fears. Methods: In total, 15 014 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, took part (19 January–5 February 2021) in a non-probability online survey. The Oxford COVID-19 Vaccine Hesitancy Scale assessed intent to be vaccinated. Two scales (Specific Phobia Scale-blood-injection-injury phobia and Medical Fear Survey–injections and blood subscale) assessed blood-injection-injury fears. Four items from these scales were used to create a factor score specifically for injection fears. Results: In total, 3927 (26.2%) screened positive for blood-injection-injury phobia. Individuals screening positive (22.0%) were more likely to report COVID-19 vaccine hesitancy compared to individuals screening negative (11.5%), odds ratio = 2.18, 95% confidence interval (CI) 1.97–2.40, p < 0.001. The population attributable fraction (PAF) indicated that if blood-injection-injury phobia were absent then this may prevent 11.5% of all instances of vaccine hesitancy, AF = 0.11; 95% CI 0.09–0.14, p < 0.001. COVID-19 vaccine hesitancy was associated with higher scores on the Specific Phobia Scale, r = 0.22, p < 0.001, Medical Fear Survey, r = 0.23, p = <0.001 and injection fears, r = 0.25, p < 0.001. Injection fears were higher in youth and in Black and Asian ethnic groups, and explained a small degree of why vaccine hesitancy is higher in these groups. Conclusions: Across the adult population, blood-injection-injury fears may explain approximately 10% of cases of COVID-19 vaccine hesitancy. Addressing such fears will likely improve the effectiveness of vaccination programmes. [ABSTRACT FROM AUTHOR]

The article discusses the issue on building, maintaining, and repairing trust across cultures in Great Britain. According to the authors, trust is understood to be central to human and group relations, and lies at the very foundation of society and civilization. The recent research and theory highlight how trust facilitates effective organizational performance through enhancing and enabling cooperation among disparate parties, open information sharing, mutual influence and acceptance, problem solving, commitment and job satisfaction, as well as a range of individual, group and organizational performance outcomes.

Objectives: To quantify patient eligibility for cochlear implantation following National Institute for Health and Care Excellence 2019 guidelines (TA566) over five years at our institution, and identify factors influencing patients' decisions surrounding cochlear implantation referral. Methods: A multi-perspective service evaluation was conducted at a district general hospital, comprising cochlear implantation eligible patients. The main outcome measures were: eligibility numbers for 2014–2019, comparing application of TA566 versus 2009 (TA166) guidelines; and patient interview transcripts and questionnaires. Results: There was a 259 per cent average increase in cochlear implantation eligibility from 2014 to 2019. Most patients' thresholds were 80 dB HL or more at 3 kHz and 4 kHz. There are several cochlear implantation barriers, including patient-centred issues (e.g. health-related anxieties, implantation misperceptions) and external barriers (difficulty getting to regional implant centres). Motivating factors for cochlear implantation include improved quality of life and access to local cochlear implantation services. Conclusion: The TA566 guidelines have increased cochlear implantation eligibility, putting pressure on cochlear implantation centres and referring hospitals. Current referral systems have external and patient-centred implantation barriers. British cochlear implantation delivery may need rethinking to meet increasing populational demands and improve accessibility for those most vulnerable to these barriers. [ABSTRACT FROM AUTHOR]

There is concern that young people with visual impairment do not leave school adequately prepared for the workplace. Seventy young people from the UK with visual impairment (aged 16–19) took part in semi-structured interviews exploring how they define independence and how they predict they would deal with employment-based problems. Two overarching themes emerged: (1) how active/passive the young people felt they should be in solving problems (active–passive dimension), and (2) to whom (themselves or others) the young person attributed the responsibility for problems and solutions (internaliser–externaliser dimension). The results provide evidence of the importance of teaching young people disability-specific skills at school (an ‘expanded core curriculum’) which aims to maximise young people's independence while giving them a clear understanding of the accommodations to which they are entitled. [ABSTRACT FROM PUBLISHER]

For some older people and their families, live-in care offers a way of continuing to live independently at home in their local community. While research in the care industry has consistently highlighted the effects of caring on workers, little research has specifically explored the experiences of live-in carers. The current study examines the ways in which live-in carers construct their role, the different challenges they face and the strategies they use to mitigate them. Semi-structured interviews were carried out with 21 live-in carers in the United Kingdom and the data were analysed using thematic analysis. The findings suggest that carers perceive their role as complex and characterised by a heavy workload and tiredness. Participants emphasised the variability which was introduced to the role as a function of the quality of agency support, the character and condition of the client, and the carer's relationships with the client's family. Participants' accounts reflected an acknowledgement of the need to orient and respond constantly to the needs and routine of the client. While this orientation was recognised as necessary for effectively fulfilling the demands of the role, it was also linked to feelings of dislocation and loss of identity. Drawing on understandings of personal and social identity, the implications of these findings for the psychological wellbeing of live-in carers and organisational support are discussed. [ABSTRACT FROM AUTHOR]

Background: Much research effort is focused on developing an effective vaccine for combatting coronavirus disease 2019 (COVID-19). Vaccine development itself, however, will not be enough given that a sufficient amount of people will need to be vaccinated for widespread immunity. Vaccine hesitancy is on the rise, varies across countries, and is associated with conspiratorial worldview. Given the rise in COVID-19-related conspiracy theories, we aimed to examine the levels of COVID-19 vaccine hesitancy and its association with beliefs on the origin of the novel coronavirus in a cross-cultural study. Methods: We conducted an online survey in the UK (N = 1088) and Turkey (N = 3936), and gathered information on participants' willingness to vaccinate for a potential COVID-19 vaccine, beliefs on the origin of the novel coronavirus, and several behavioural and demographic predictors (such as anxiety, risk perception, government satisfaction levels) that influence vaccination and origin beliefs. Results: In all, 31% of the participants in Turkey and 14% in the UK were unsure about getting themselves vaccinated for a COVID-19 vaccine. In both countries, 3% of the participants rejected to be vaccinated. Also, 54% of the participants in Turkey and 63% in the UK believed in the natural origin of the novel coronavirus. Believing in the natural origin significantly increased the odds of COVID-19 vaccine acceptance. Conclusions: Our results point at a concerning level of COVID-19 vaccine hesitancy, especially in Turkey, and suggest that wider communication of the scientific consensus on the origin of the novel coronavirus with the public may help future campaigns targeting COVID-19 vaccine hesitancy. [ABSTRACT FROM AUTHOR]

There is a substantial amount of literature that suggests that animals, and specifically animals kept as pets, can have a positive effect on wellbeing. Research exploring the impact of animals on wellbeing in care homes mainly concerns visiting animals as well as shared communal pets. In light of the lack of research regarding personal pets in care homes, the aim of this study was to explore what the experience of keeping a personal pet in a care home means for residents' sense of wellbeing. Semi-structured interviews were conducted with seven care home residents who were currently living with their pet in a care home. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Analysis revealed four master themes deemed to be relevant to participants' wellbeing. these were: 'sense of self and identity', 'responsibility and ownership', 'motivation and desire to live' and 'feeling content in the care home'. The analysis indicated that living with a personal pet in a care home has the potential to enhance residents' wellbeing. At the same time, it also found that the benefits of keeping a personal pet may be dependent on specific circumstances, such as the attitudes of staff and fellow residents at the care home. This study indicates that it may be advisable for more care homes to accept personal pets. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the uptake of ENT UK coronavirus disease 2019 adult tonsillitis and quinsy guidelines at our tertiary centre, and assessed perceived barriers to uptake. Methods: A retrospective case series of tonsillitis and quinsy patients was analysed in two arms: before and after the introduction of new ENT UK management guidelines. A survey assessed perceptions and practice differences between ENT and emergency department doctors. Results: Each study arm examined 82 patients. Following the introduction of new ENT UK guidelines, ENT clinicians demonstrated significant changes in practice, unlike their emergency department counterparts. Survey results from emergency department doctors highlighted a lack of appreciation of guideline change and identified barriers to guideline uptake. Conclusion: The introduction of new management guidelines for tonsillitis and quinsy patients during the pandemic resulted in disparate uptake within ENT and emergency department departments at the tertiary centre. Clearer dissemination to all affected clinicians is paramount for future rapidly introduced changes to practice, to ensure clinician safety. [ABSTRACT FROM AUTHOR]

Background: As a response to the acute strain placed on the National Health Service during the first wave of coronavirus disease 2019 in the UK, a number of junior doctors including ENT trainees were redeployed to other clinical specialties. This presented these trainees with novel challenges and opportunities. Methods: A qualitative study was performed to explore these experiences, undertaking semi-structured interviews with ENT trainees between 17th and 30th July. Participants were recruited through purposeful sampling. Interview transcripts underwent thematic analysis using Dedoose software. Results: Seven ENT trainees were interviewed, ranging from specialty trainee years four to eight ('ST4' to 'ST8') in grade. Six core themes were identified: organisation of redeployment, utilisation of skill set, emotional impact of redeployment, redeployed team dynamics, concerns about safety and impact on training. Conclusion: The ENT trainees' experiences of redeployment described highlight some important lessons and considerations for future redeployments. [ABSTRACT FROM AUTHOR]

Increasing longevity and the strain on state and occupational pensions have brought into question long-held assumptions about the age of retirement, and raised the prospect of a workplace populated by ageing workers. In the United Kingdom the default retirement age has gone, incremental increases in state pension age are being implemented and ageism has been added to workplace anti-discrimination laws. These changes are yet to bring about the anticipated transformation in workplace demographics, but it is coming, making it timely to ask if the workplace is ready for the ageing worker and how the extension of working life will be managed. We report findings from qualitative case studies of five large organisations located in the United Kingdom. Interviews and focus groups were conducted with employees, line managers, occupational health staff and human resources managers. Our findings reveal a high degree of uncertainty and ambivalence among workers and managers regarding the desirability and feasibility of extending working life; wide variations in how older workers are managed within workplaces; a gap between policies and practices; and evidence that while casualisation might be experienced negatively by younger workers, it may be viewed positively by financially secure older workers seeking flexibility. We conclude with a discussion of the challenges facing employers and policy makers in making the modern workplace fit for the ageing worker. [ABSTRACT FROM AUTHOR]

Environments need to be designed such that they support successful orientation for older adults and those with dementia who often experience marked difficulties in their orientation abilities. To better understand how environments can compensate for decreasing orientation skills, voice should be given directly to those experiencing dementia to describe how they find their way and to understand their design preferences. This study explored the navigational experiences and design preferences of older adults with memory difficulties living in a retirement development. In-depth semi-structured interviews with 13 older adults experiencing memory difficulties were conducted. All participants were residents of one retirement development in the United Kingdom. Questions began broadly, for example, to describe their experiences of navigating in their living environment, before discussing any specific navigation difficulties in detail. Thematic analysis identified three main themes: highlighting environmental design that causes disorientation, strategies to overcome disorientation, and residents’ suggestions to improve the design. The design suggestions were particularly informative, heavily focusing on the importance of having memorable and meaningful spaces which were favoured more than signage as an orientation aid. The findings demonstrate the need to consider environmental design to support orientation for those with memory difficulties. Of particular importance is the use of meaningful and relevant landmarks as orientation aids which can additionally stimulate conversation and increase wellbeing. Given the range of suggestions in dementia-friendly design guidelines aimed to support orientation, it is crucial to speak directly to those living in different environments to learn how they find their way around and what design works in their environment. [ABSTRACT FROM AUTHOR]

The optimal balance between central governmental authority and the degree of autonomy of local public bodies is an enduring issue in public policy. The UK National Health Service is no exception, with NHS history, in part at least, a history of repeated cycles of centralisation and decentralisation of decision-making power. Most recently, a significant reorganisation of the NHS in 2012–13 was built around the creation of new and supposedly more autonomous commissioning organisations (Clinical Commissioning Groups – CCGs). Using Bossert's (1998) concept of ‘decision space’, we explored the experiences of local commissioners as they took on their new responsibilities. We interviewed commissioning staff from all of the CCGs in two regional health care ‘economies’, exploring their perceptions of autonomy and their experiences over time. We found significant early enthusiasm for, and perceptions of, increased autonomy tempered in the vertical dimension by increasingly onerous and prescriptive monitoring regimes, and in the horizontal dimension by the proliferation of overlapping networks, inter-organisational groups and relationships. We propose that, whatever the balance between central and local control that is adopted, complex public services require some sort of meso-level oversight from organisations able to ‘hold the ring’ between competing interests and to take a regional view of the needs of the local health system. This suggests that local organisational autonomy in such services will always be constrained. [ABSTRACT FROM PUBLISHER]

AimTo examine how the introduction of intensive community support (ICS) affected admissions to community hospital (CH) and to explore the views of patients, carers and health professionals on this transition.BackgroundICS was introduced to provide an alternative to CH provision for patients (mostly very elderly) requiring general rehabilitation.MethodRoutine data from both services were analysed to identify the number of admissions and length of stay between September 2012 and September 2014. In total, 10 patients took part in qualitative interviews. Qualitative interviews and focus groups were undertaken with 19 staff members, including managers and clinicians.FindingsThere were 5653 admissions to CH and 1710 to ICS between September 2012 and September 2014. In the five months before the introduction of ICS, admission rates to CH were on average 217/month; in the final five months of the study, when both services were fully operational, average numbers of patients admitted were: CH 162 (a 25% reduction), ICS 97, total 259 (a 19% increase). Patients and carers rated both ICS and CH favourably compared with acute hospital care. Those who had experienced both services felt each to be appropriate at the time; they appreciated the 24 h availability of staff in CH when they were more dependent, and the convenience of being at home after they had improved. In general, staff welcomed the introduction of ICS and appreciated the advantages of home-based rehabilitation. Managers had a clearer vision of ICS than staff on the ground, some of whom felt underprepared to work in the community. There was a consensus that ICS was managing less complex and dependent patients than had been envisaged.ConclusionICS can provide a feasible adjunct to CH that is acceptable to patients. More work is needed to promote the vision of ICS amongst staff in both community and acute sectors. [ABSTRACT FROM PUBLISHER]

The concept of participation, introduced through models such as the International Classification of Functioning, Disability and Health, has become increasingly important in health and social care. However, it has not been consistently defined or operationalised, and there is very limited research into participation in the context of advanced age and disability. This article reports a study which explored participation from the perspectives of community-living people aged over 80 years with physical rehabilitation needs. Using a grounded theory methodology, 11 participants aged 81–96 years were recruited from a National Health Service Trust in the United Kingdom. The main finding was that participation was experienced as the enacting of values. Values provided the motivation for specific ways of participating in life, guided actions and behaviours, and were the means through which participation was interpreted. Commonly enacted values were: connecting with others; maintaining autonomy; affirming abilities; doing the best you can; being useful; maintaining self-identity; and pursuing interests. A process was evident whereby participation was challenged by deteriorating health and losses and the participants adapted (or not) to overcome these challenges. To promote participation in advanced age, health and social care policy and practice must consider the values important to older people. Interventions should be congruent with these values and promote strategies through which they can be enacted. [ABSTRACT FROM PUBLISHER]

AimThe aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.BackgroundThere are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.MethodsAnalysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.FindingsA total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit. [ABSTRACT FROM AUTHOR]

Background: De-escalation techniques are a recommended non-physical intervention for the management of violence and aggression in mental health. Although taught as part of mandatory training for all National Health Service (NHS) mental health staff, there remains a lack of clarity around training effectiveness.Aims: To conduct a systematic review of the learning, performance and clinical safety outcomes of de-escalation techniques training.Method: The review process involved a systematic literature search of 20 electronic databases, eligibility screening of results, data extraction, quality appraisal and data synthesis.Results: A total of 38 relevant studies were identified. The strongest impact of training appears to be on de-escalation-related knowledge, confidence to manage aggression and deescalation performance (although limited to artificial training scenarios). No strong conclusions could be drawn about the impact of training on assaults, injuries, containment and organisational outcomes owing to the low quality of evidence and conflicting results.Conclusions: It is assumed that de-escalation techniques training will improve staff's ability to de-escalate violent and aggressive behaviour and improve safety in practice. There is currently limited evidence that this training has these effects. [ABSTRACT FROM AUTHOR]

Background.That delusional and delusion-prone individuals ‘jump to conclusions’ is one of the most robust and important findings in the literature on delusions. However, although the notion of ‘jumping to conclusions’ (JTC) implies gathering insufficient evidence and reaching premature decisions, previous studies have not investigated whether the evidence gathering of delusion-prone individuals is, in fact, suboptimal. The standard JTC effect is a relative effect but using relative comparisons to substantiate absolute claims is problematic. In this study we investigated whether delusion-prone participants jump to conclusions in both a relative and an absolute sense.Method.Healthy participants (n = 112) completed an incentivized probabilistic reasoning task in which correct decisions were rewarded and additional information could be requested for a small price. This combination of rewards and costs generated optimal decision points. Participants also completed measures of delusion proneness, intelligence and risk aversion.Results.Replicating the standard relative finding, we found that delusion proneness significantly predicted task decisions, such that the more delusion prone the participants were, the earlier they decided. This finding was robust when accounting for the effects of risk aversion and intelligence. Importantly, high-delusion-prone participants also decided in advance of an objective rational optimum, gathering fewer data than would have maximized their expected payoff. Surprisingly, we found that even low-delusion-prone participants jumped to conclusions in this absolute sense.Conclusions.Our findings support and clarify the claim that delusion formation is associated with a tendency to ‘jump to conclusions’. In short, most people jump to conclusions, but more delusion-prone individuals ‘jump further’. [ABSTRACT FROM AUTHOR]

BackgroundLymphoedema secondary to cancer is a relatively neglected and under-researched condition. Few studies report people's experiences of care and treatment provision when living with the condition. Current practice focuses on the physical treatment yet psychosocial needs often remain unmet. A previous study examining the patient perspective identified the theme of being ‘abandoned by medicine’. Perceived lack of support may result in a delayed adaptation and acceptance of this long-term condition and can significantly impact on psychological well-being. We explore this emerging theme alongside others in order to provide a guide to action for improvements for patient benefit.AimThe central aim was to explore women's views of their care and treatment following a diagnosis with lymphoedema secondary to cancer. This forms part of a larger study aimed at assessing appropriate screening tools to measure psychosocial distress.MethodsA mixed-methods approach was used for the main study. Here we report the qualitative component, derived from in-depth semi-structured interviews conducted in the homes of the participants (n = 14) and focus group discussions (n = 15). In addition, qualitative comments from questionnaire data from a large-scale postal survey are included (n = 104).FindingsParticipants identified considerable deficiencies in health care workers’ knowledge and awareness of lymphoedema, which subsequently impacted on the patients’ needs for information, support and understanding. Access to appropriate treatment was patchy and problems were identified with the process of obtaining compression garments, massage and other sources of help. Although lymphoedema is a long-term disfiguring condition, and much is known about how this impacts on patients’ emotional well-being, little attention was paid by health professionals to potential psychosocial consequences. In essence women had to become experts of their own condition and cope as best as they could. We provide recommendations to improve service delivery and address these unmet needs. [ABSTRACT FROM PUBLISHER]

Since 1997 ageing research in the United Kingdom (UK) has been promoted through a series of research council special programmes with an emphasis on multi-disciplinary, collaborative, user-focused research. There has been notable progress and substantial setbacks, especially a major lull in activity, and strong disciplinary biases in later programmes. Skills, expertise and influence on policy and practice, developed through early programmes, have been lost. Two philosophies of programme management have emerged: a top-down approach to the development of priorities and activities, largely reflecting a linear model of research, development and diffusion; and, a bottom-up approach strongly influenced by the priorities of users including older people, which has emphasised the role of problem-solving and social interaction between researchers and users. A comparison of these two philosophies highlights factors which contribute to successful programme implementation and valuable outcomes for society at large. These emphasise: involvement of all potential users; encouragement of champions; supporting researchers at all stages in their careers; transparency in communicating intent, progress and achievements; varied and robust knowledge transfer; and, above all else, understanding the challenges faced by individuals as they grow older. Future programmes would be assured of making significant contributions to supporting older people and an ageing society if those commissioning the programmes recognised the importance of these factors and accepted the consequent challenges for the organisation of the programmes. [ABSTRACT FROM PUBLISHER]

Policy-sensitive models of judicial behaviour, whether attitudinal or strategic, have largely passed Britain by. This article argues that this neglect has been benign, because explanations of judicial decisions in terms of the positions of individual judges fare poorly in the British case. To support this argument, the non-unanimous opinions of British Law Lords between 1969 and 2009 are analysed. A hierarchical item-response model of individual judges’ votes is estimated in order to identify judges’ locations along a one-dimensional policy space. Such a model is found to be no better than a null model that predicts that every judge will vote with the majority with the same probability. Locations generated by the model do not represent judges’ political attitudes, only their propensity to dissent. Consequently, judges’ individual votes should not be used to describe them in political terms. [ABSTRACT FROM PUBLISHER]

Background: Recruitment of adequate numbers of doctors to psychiatry is difficult.Aims: To report on career choice for psychiatry, comparing intending psychiatrists with doctors who chose other clinical careers.Method: Questionnaire studies of all newly qualified doctors from all UK medical schools in 12 qualification years between 1974 and 2009 (33 974 respondent doctors).Results: One, three and five years after graduation, 4-5% of doctors specified psychiatry as their first choice of future career. This was largely unchanged across the 35 years. Comparing intending psychiatrists with doctors who chose other careers, factors with a greater influence on psychiatrists' choice included their experience of the subject at medical school, self-appraisal of their own skills, and inclinations before medical school. In a substudy of doctors who initially considered but then did not pursue specialty choices, 72% of those who did not pursue psychiatry gave 'job content' as their reason compared with 33% of doctors who considered but did not pursue other specialties. Historically, more women than men have chosen psychiatry, but the gap has closed over the past decade.Conclusions: Junior doctors' views about psychiatry as a possible career range from high levels of enthusiasm to antipathy, and are more polarised than views about other specialties. Shortening of working hours and improvements to working practices in other hospital-based specialties in the UK may have reduced the relative attractiveness of psychiatry to women doctors. The extent to which views of newly qualified doctors about psychiatry can be modified by medical school education, and by greater exposure to psychiatry during student and early postgraduate years, needs investigation. [ABSTRACT FROM AUTHOR]

Objectives:Despite longstanding concern, provision of undergraduate ENT teaching has not improved in response to the aims of the UK General Medical Council's initiative Tomorrow's Doctors. Previous studies have demonstrated poor representation of ENT within the undergraduate curriculum. We aimed to identify current practice in order to establish undergraduate ENT experience across UK medical schools, a timely endeavour in light of the General Medical Council's new 2011–2013 education strategy.Method:Questionnaires were sent to ENT consultants, medical school deans and students. All schools with a clinical curriculum were anonymously represented. Our outcome measures were the provision of mandatory or optional ENT placements, and their duration and content.Results:A compulsory ENT placement was available to over half (53 per cent) of the students. Ten of the 26 participating schools did not offer an ENT attachment. The mean mandatory placement was 8 days. Overall, 38 per cent of students reported a satisfactory compulsory ENT placement. Most ENT consultants questioned considered that newly qualified doctors were not proficient in managing common ENT problems that did not require specialist referral.Conclusions:Little improvement in the provision of undergraduate ENT teaching was demonstrated. An increase in the proportion of students undertaking ENT training is necessary. Time and curriculum constraints on medical schools mean that optimisation of available resources is required. [ABSTRACT FROM PUBLISHER]

Introduction:The E-lefENT programme is a collaborative e-learning project developed by the Department of Health and ENTUK. Prior to its introduction, we aimed to assess current use of and attitudes towards e-learning amongst UK otolaryngology trainees.Method:A web-based questionnaire was distributed to UK otolaryngology trainees via regional programme directors.Results:A total of 117 responses was received (35 per cent response rate). Most trainees reported increasing exposure to e-learning throughout their training and rated their current computer literacy skills highly, although satisfaction with current e-learning resources was found to vary widely for a variety of reasons.Conclusion:Meeting the educational needs of otolaryngology trainees in the current era continues to be a challenge. Most trainees are already familiar with e-learning, although the quality and delivery of available websites is currently variable. The majority of trainees who responded seemed receptive to the implementation of a free, otolaryngology-specific e-learning resource. [ABSTRACT FROM PUBLISHER]

While John Bale (1495-1563), in his contributions to the 1549 text "The Laboryouse Journey & Serche of Johan Leylande," attempted to mark a decisive break in England's literary history by radically differentiating, in Bale's view, the light of England's evangelical present from the darkness of its Catholic past, he felt compelled to deal with the persistence of the darkness he saw embodied by his contemporaries' treatment of English texts. Bale understood this treatment in an economic sense, insistently playing on the terms commodity and profit, which were invoked similarly by a moral economic discourse and an emerging politico-economic discourse articulated by Sir Thomas Smith (1513-77). Thus English literary texts appear in Bale's construction of national community both as trade-objects that circulate in an international economy, and as ideal tokens of English identity itself. [ABSTRACT FROM AUTHOR]

Encouraging individuals' adaptability to more flexible patterns of work and learning, and promoting greater self-management of employment security are central to UK policies aiming to improve employability and social inclusion. Little is known, however, about the responses to these issues of those deemed to have employability problems. This article presents the results of a qualitative phase of research with young people not in work, education or training to determine the extent to which these policy-espoused concepts of adaptability and self-management were reflected in their attitudes and jobsearch activity. The findings indicate generally negative attitudes and avoidance in jobsearch towards working outside a traditional ideal of standard, permanent employment and also towards improving prospects by updating skills. Reasons included a disincentive to enter training or temporary work due to short-term risks to benefit status, but more significant concerns reflected the increasing problem of the `churning' of low-skilled youth between work and welfare. It is argued that inconsistencies between policy dictums about how the unemployed should behave in order to receive benefits and how they should behave in order to become more employable are not conducive to long- term employability and may actually contradict the aims of `active' labour market policies. [ABSTRACT FROM AUTHOR]

The article presents the authors' comments on patterns of attitudinal tolerance in Great Britain and its impact on the status of political freedom. They comment on the comparison of attitudinal tolerance among members of the public and Members of Parliament to explore the role of political elites in managing political freedom in a democracy. They say, majority of citizens will not allow a member of their least-liked group to run for public office.

The article presents the authors' comments on reasons why more women should be elected to positions of power in Great Britain. They think that Parliamentary democracy requires increased female representation on the grounds of symbolic equity. They state that gender differences in attitudes can be understood, but not gender differences in behavior. Based on previous studies, they say that Parliamentary women candidates are more sympathetic than men to liberal concerns in their parties.

The article discusses the morality in Great Britain which involve the mid-Victorian's attitudes toward the mystery, daemonic, and the irrational. The mid-Victorian attitude toward mystery, the daemonic, and the irrational, and the change which this attitude represented from the attitude of earlier Romantics was concisely and precisely expressed by Matthew Arnold in his letter written in 1865.