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Background This paper presents the results of an exercise to scope the potential of a virtual network to support dissemination, collaboration and innovation among the UK research community on the topic of 'work and health and well-being'. Methods Through a search of the literature and internet searches, a database of 333 individuals and 10 organizations (stakeholders) was developed to whom an online questionnaire was sent. The questionnaire scoped the potential of a virtual network on work and health and well- being. We compared respondents' aspirations for a network with the critical management literature examining the core conditions under which networks work best. Results We identified 1435 papers, published since 2008. In the UK, 333 individuals and 10 organizations were identified as working within the broad topic of Work and Health and Well-being. Of the 110 (a 34% response) responses to our online questionnaire, the majority (80%, n = 88) stated they would be interested in joining a virtual network. Conclusions Respondents indicated a willingness to engage with the network. They had a range of ideas regarding how a network could operate, which broadly match the conditions that support network effectiveness. A virtual-enabled network would be best supplemented by opportunities for face-to-face interaction. [ABSTRACT FROM AUTHOR]

Background Frailty is an important marker of adverse outcomes for older people accessing the Emergency Department (ED). Older patients with frailty have a higher attendance rate to the ED, spend longer in the ED and have a higher rate of admission (HSE, 2017). Frailty Intervention Therapy Teams (FITT) are designed to screen and assess this population in the ED setting, with the aim of early assessment to help decrease length of stay or avoid admission. Two different FIT Teams have recently been formed within the Cork-Kerry region. The aim of this study was to evaluate staff's experience of these teams. Methods This was a mixed methods study. Structured surveys were developed to collect qualitative and quantitative data. The surveys were constructed using themes listed by Proctor et al. (2011) around implementation and service outcomes. Ward and ED staff were provided with paper surveys within the hospital setting and community staff were surveyed via post. Quantitative survey data was analysed using descriptive statistics and qualitative data was analysed with thematic content analysis. Results Data from 117 surveys was included for analysis (response rate 49%). Results showed that the majority of staff (89%) reported ED was a suitable setting for the FITT, with 85% reporting the information collected by the FITT impacted their involvement. Other themes emerging from staff's experience included timeliness, safety and comprehensive assessment. Conclusion Overall, staff reported the FITT provided a timely service that assisted with decision making and planning. This involved earlier comprehensive assessment, prompt identification of issues which lead to decreased workload for ward staff. It also created an increased volume of referrals to community and ward staff received in a timelier manner. [ABSTRACT FROM AUTHOR]

Clinical and research staff who work around magnetic resonance imaging (MRI) scanners are exposed to the static magnetic stray fields of these scanners. Although the past decade has seen strong developments in the assessment of occupational exposure to electromagnetic fields from MRI scanners, there is insufficient insight into the exposure variability that characterizes routine MRI work practice. However, this is an essential component of risk assessment and epidemiological studies. This paper describes the results of a measurement survey of shift-based personal exposure to static magnetic fields (SMF) (B) and motion-induced time-varying magnetic fields (dB/dt) among workers at 15 MRI facilities in the Netherlands. With the use of portable magnetic field dosimeters, >400 full-shift and partial shift exposure measurements were collected among various jobs involved in clinical and research MRI. Various full-shift exposure metrics for B and motion-induced dB/dt exposure were calculated from the measurements, including instantaneous peak exposure and time-weighted average (TWA) exposures. We found strong correlations between levels of static (B) and time-varying (dB/dt) exposure (r = 0.88–0.92) and between different metrics (i.e. peak exposure, TWA exposure) to express full-shift exposure (r = 0.69–0.78). On average, participants were exposed to MRI-related SMFs during only 3.7% of their work shift. Average and peak B and dB/dt exposure levels during the work inside the MRI scanner room were highest among technical staff, research staff, and radiographers. Average and peak B exposure levels were lowest among cleaners, while dB/dt levels were lowest among anaesthesiology staff. Although modest exposure variability between workplaces and occupations was observed, variation between individuals of the same occupation was substantial, especially among research staff. This relatively large variability between workers with the same job suggests that exposure classification based solely on job title may not be an optimal grouping strategy for epidemiological purposes. [ABSTRACT FROM AUTHOR]

Background The Government in England has recognized the importance of early intervention to promote positive child development and prevent maltreatment. In doing so, efforts have been made to increase the implementation of the Family Nurse Partnership (FNP) to target a greater number of families who require intensive secondary intervention. Methods This paper presents an argument that the FNP can be targeted more effectively to yield a greater return on investment. This is based on the re-analysis of data collected by the largest cohort study carried out into risk factors for child maltreatment in England. Results Currently, around 315 health visitors are estimated to be implementing this programme, projected to increase to around 585 health visitors in 2015. However, targeting the programme towards first-time, young vulnerable mothers with low socio-economic status means that around 1350 health visitors would be needed. Critically, targeting only this population is estimated to prevent only 10% of cases of child abuse and neglect. Conclusions By targeting risk factors which are less common in the general population but which are more prevalent amongst abusive families, fewer specialist health visitors would be needed to prevent a higher percentage of child maltreatment. [ABSTRACT FROM AUTHOR]

Background Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study. Methods An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism. Results Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students. Conclusions Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession. [ABSTRACT FROM PUBLISHER]

Background The physical and mental exhaustion of health care workers urgently needs to be addressed as a public health priority. Benefits of music on stress parameters have been extensively reported. Methods We carried out a systematic review to examine the efficacy of music interventions on stress parameters by selecting studies conducted in genuine care stress conditions. To approach the potential benefit of music therapy (MT) versus music medicine (MM), we followed international music-based intervention guidelines. Results Five outcomes were considered in our studies: stress, anxiety, mental workload, burnout risk and psychosomatic symptoms. Corresponding measures, including psychological, physiological questionnaires or stress biological parameters, showed significant results for the majority of them in music groups. Implications of music types, designs and limitations are discussed. Only one study compared MM and MT with an advantage for customized playlists over time. Conclusions In spite of heterogeneity, music interventions seem to significantly decrease stress parameters. The individual, customized supports with MT may be a crucial condition for this specific professional category. The impact of MT versus MM, the number of music sessions and the effect over time need to be explored. [ABSTRACT FROM AUTHOR]

Increasing cultural and linguistic diversity among children and families brings new challenges for early intervention professionals. The purpose of this study was to identify the specific roles and needs of speech-language pathologists (SLPs) who practice in early intervention settings with culturally and linguistically diverse families of d/Deaf multilingual learners (DMLs). Thirteen SLPs completed an online survey about their practices and needs. Interviews were conducted with five parents of DMLs. Results showed that SLPs have lower self-satisfaction with families of DMLs compared to mainstream families. Parents were highly satisfied with the support they received. Both groups of participants reported a need for specific tools or adaptations, especially if there was no shared language. Thematic analysis identified three themes: communication and partnership, professional resources for responding to diversity, and diversity of parental profiles. This article provides an insight into the perspectives of both professionals and culturally and linguistically diverse parents, and identifies specific aspects of early intervention services with parents of DMLs: developing partnership in the context of cultural and/or linguistic differences, discussing topics related to multilingualism, and providing highly adaptable family-centered services. [ABSTRACT FROM AUTHOR]

Objectives uncertainty pervades the complex illness trajectories experienced by older adults with multimorbidity. Uncertainty is experienced by older people, their informal carers and professionals providing care, yet is incompletely understood. We aimed to identify and synthesise systematically the experience of uncertainty in advanced multimorbidity from patient, carer and professional perspectives. Design systematic literature review of published and grey qualitative literature from 9 databases (Prospero CRD 42021227480). Participants older people with advanced multimorbidity, and informal carers/professionals providing care to this group. Exclusion criteria: early multimorbidity, insufficient focus on uncertainty. Analysis weight-of-evidence assessment was used to appraise included articles. We undertook thematic synthesis of multi-perspective experiences and response to uncertainty. Results from 4,738 unique search results, we included 44 articles relating to 40 studies. 22 focused on patient experiences of uncertainty (n  = 460), 15 on carer experiences (n  = 197), and 19 on health professional experiences (n  = 490), with 10 exploring multiple perspectives. We identified a shared experience of 'Total Uncertainty' across five domains: 'appraising and managing multiple illnesses'; 'fragmented care and communication'; 'feeling overwhelmed'; 'uncertainty of others' and 'continual change'. Participants responded to uncertainty by either active (addressing, avoiding) or passive (accepting) means. Conclusions the novel concept of 'Total Uncertainty' represents a step change in our understanding of illness experience in advanced multimorbidity. Patients, carers and health professionals experienced uncertainty in similar domains, suggesting a shared understanding is feasible. The domains of total uncertainty form a useful organising framework for health professionals caring for older adults with multimorbidity. [ABSTRACT FROM AUTHOR]

Background Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. Objective Our aim was to assess EPs' self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these needs and the utilization of this education. Our secondary aim was to assess emergency department (ED) managers' view and support for GEM education. Methods All EPs and ED managers in the Netherlands received a survey by e-mail. The questionnaires focused on EPs' needs in GEM education, EPs' utilization of GEM education and managerial support for GEM education. We used descriptive statistics to analyse needs, utilization of- and support for GEM education. Regression analyses were used to identify factors associated with EPs' need for GEM education. Results EPs reported to need better training in diagnosing, treating and communicating with older adults. Seventy percent of EPs reported no GEM education program in their hospital, and 83% reported no utilization of GEM education outside their hospital. EPs working in EDs with a possibility for geriatric consultation, and EPs aware of actual GEM education programs, had lower educational needs. Of responding managers, 86.2% reported the care for older adults as an important topic; lack of finances and time were obstacles to provide GEM education for EPs. Conclusion EPs in the Netherlands feel insufficiently educated to treat older adults. ED managers largely recognize this educational challenge. This nationwide survey underlines the need to prioritize GEM education for EPs. [ABSTRACT FROM AUTHOR]

Background This study explored barriers and facilitators to integrating health evidence into spatial planning at local authority levels and examined the awareness and use of the Public Health England 'Spatial Planning for Health' resource. Methods A sequential exploratory mixed-methods design utilized in-depth semi-structured interviews followed by an online survey of public health, planning and other built environment professionals in England. Results Views from 19 individuals and 162 survey responses revealed high awareness and use of the Spatial Planning for Health resource, although public health professionals reported greater awareness and use than other professionals. Key barriers to evidence implementation included differences in interpretation and the use of 'evidence' between public health and planning professionals, lack of practical evidence to apply locally and lack of resource and staff capacity in local authorities. Key facilitators included integrating health into the design of local plans, articulating wider benefits to multiple stakeholders and simplifying presenting evidence (regarding language and accessibility). Conclusion The Spatial Planning for Health resource is a useful resource at local authority level. Further work is needed to maximize its use by built environment professionals. Public health teams need support, capacity and skills to ensure that local health and well-being priorities are integrated into local planning documents and decisions. [ABSTRACT FROM AUTHOR]

Background The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. Aim To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. Design A prospective cross-sectional study surveying Australasian geriatricians was conducted. Setting/Participants This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. Results A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. Conclusions Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery. [ABSTRACT FROM AUTHOR]

The use of evidence-based smoking cessation interventions (SCIs) can significantly increase the number of successful smoking cessation attempts. To obtain an overview of the knowledge and viewpoints on the effectiveness and use of SCIs, a three-round online Delphi study was conducted among researchers and primary care professionals (PCPs). The four objectives of this study are to gain an overview of (i) the criteria important for recommending SCIs, (ii) the perceptions of both groups on the effectiveness of SCIs, (iii) the factors to consider when counseling different (high-risk) groups of smokers and (iv) the perceptions of both groups on the use of e-cigarettes as an SCI. We found a high level of agreement within groups on which smoker characteristics should be considered when recommending an SCI to smokers. We also found that PCPs display a lower degree of consensus on the effectiveness of SCIs. Both groups see a value in the use of special protocols for different (high-risk) groups of patients, but the two groups did not reach consensus on the use of e-cigarettes as a means to quit. Making an inventory of PCPs' needs regarding SCIs and their usage may provide insight into how to facilitate a better uptake in the primary care setting. [ABSTRACT FROM AUTHOR]

Background The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals' perceptions of facilitators and barriers to implementing this lifestyle programme into health care. Methods Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N =27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis. Results Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client's personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed. Conclusions Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change. [ABSTRACT FROM AUTHOR]

Background Nursing homes for older adults have concentrated large numbers of severe cases and deaths for coronavirus disease 2019 (COVID-19). Methods Point seroprevalence study of nursing homes to describe the demography and characteristic of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG)-positive residents and staff. Results Clinical information and blood samples were available for 9,332 residents (mean age 86.7 ± 8.1 years, 76.4% women) and 10,614 staff (mean age 45.6 ± 11.5, 86.2% women). Up to 84.4% of residents had frailty, 84.9% co-morbidity and 69.3% cognitive impairment; 65.2% of workers were health-aides. COVID-19 seroprevalence was 55.4% (95% confidence interval (CI), 54.4–56.4) for older adults and 31.5% (30.6–32.4) for staff. In multivariable analysis, frailty of residents was related with seropositivity (odds ratio (OR): 1.19, P  = 0.02). In the case of staff, age > 50 years (2.10, P  < 0.001), obesity (1.19, P  = 0.01), being a health-aide (1.94, P  < 0.001), working in a center with high seroprevalence in residents (3.49, P  < 0.001) and contact with external cases of COVID-19 (1.52, P  < 0.001) were factors associated with seropositivity. Past symptoms of COVID-19 were good predictors of seropositivity for residents (5.41, P  < 0.001) and staff (2.52, P  < 0.001). Conclusions Level of dependency influences risk of COVID-19 among residents. Individual and work factors, contacts outside the nursing home are associated with COVID-19 exposure in staff members. It is key to strengthen control measures to prevent the introduction of COVID-19 into care facilities from the community. [ABSTRACT FROM AUTHOR]

Aims To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers' (CMO) revised low-risk drinking guidelines are appropriately advised. Methods Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January–March 2017 (n  = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). Results The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P  = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P  < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. Conclusion Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients. [ABSTRACT FROM AUTHOR]

Background: Recognized disparities in quality of end‐of‐life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. Materials and Methods: A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i‐CODE) questionnaire 6–8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. Results: Of 1,683 potential participants, 914 i‐CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3–17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. Conclusion: This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). Implications for Practice: Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement. Disparities exist in the quality of end‐of‐life care. This article assesses the quality of care for dying cancer patients, as perceived by bereaved relatives, within hospitals in seven European and South American countries. [ABSTRACT FROM AUTHOR]

Facing severe under-funding and significant workforce maldistribution, the health system in Romania is challenged to provide adequate care for the ageing population. The aim of this article is to connect health labour market data of the geriatrics workforce in Romania with individual perceptions of front-line workers in geriatrics in order to better understand the 'human' factors of effective health workforce development. Comprehensive health workforce data are not available; we therefore used a rapid scoping review and interviews to combine quantitative and qualitative data sources, such as the 'Healthcare Facility Activity Report', policy documents and available reports. They show that despite a consistent increase in the overall number of geriatricians, their majority is based in Bucharest, the capital city. The initial review points to possible geriatrician burnout, caused in part by high workload. The geriatrics workforce in Romania is poorly developed. Significant efforts are still needed to create policies addressing inflows and outflows, training, maldistribution and inefficiencies related to their practice. Addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation. Two major policy recommendations emerged: an urgent need for better health workforce data in Romania and development of more effective workforce management. [ABSTRACT FROM AUTHOR]

Introduction There are increased opportunities for public health practitioners (PHPs) in England to shape alcohol availability and reduce harms through a statutory role in licensing processes in local government. However, how public health can effectively influence alcohol licence decision-making is little understood. Methods A mixed methods study was conducted to identify challenges faced by PHPs and mechanisms to strengthen their role. This involved a survey of practitioners across London local authorities (n = 18) and four focus group discussions with a range of licensing stakeholders (n = 36). Results Survey results indicated a varied picture of workload, capacity to respond to licence applications and levels of influence over decision-making among PHPs in London. Practitioners described a felt lack of status within the licence process, and difficulties using and communicating public health evidence effectively, without a health licensing objective. Strategies considered supportive included engaging with other responsible authorities and developing understanding and relationships over time. Conclusions Against political and resource constraints at local and national government levels, pragmatic approaches for strengthening public health influence over alcohol licensing are required, including promoting relationships between stakeholders and offering opportunities for PHPs to share best practice about making effective contributions to licensing. [ABSTRACT FROM AUTHOR]

Background Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. Methods We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. Results A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. Conclusions This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health. [ABSTRACT FROM AUTHOR]

Background The Ebola epidemic led to considerable media attention, which may influence public risk perception. Therefore, this study analysed the UK press response following diagnosis of a British healthcare worker (HCW) with Ebola. Methods Using the Nexis database, the frequency of Ebola-related articles in UK national newspaper articles was mapped. This was followed by a content analysis of Ebola-related articles in the four newspapers with highest UK net readership from November 2014 to February 2015. Results During the 16-week study period, 1349 articles were found. The day with the highest number of Ebola-related articles was 31 December 2014, the day after the diagnosis of Ebola in a UK HCW. Seventy-seven articles were included in the content analysis. Content analysis demonstrated a shift from West African to UK-focused articles, increased discussion of border control, UK policy decisions and criticism, and an increased number of articles with a reassuring/threatening message. Conclusions UK press coverage of Ebola increased following a HCW's diagnosis, particularly regarding discussion of screening measures. This is likely to have increased risk perception of Ebola in the UK population and may have contributed to subsequent strengthening of UK screening policy beyond World Health Organisation requirements. [ABSTRACT FROM AUTHOR]

Introduction: identifying the most at risk older people in Emergency Departments (EDs) may help guide clinical practice, and service improvement in emergency care, but little is known about how to implement such tools in practice. Methods: consensus building was used to determine the desirable characteristics of a risk stratification process, including focus groups and literature reviewing. Candidate tools were tested using clinical vignettes in semi-structured interviews with a range of clinicians working in one large ED, assessing speed of use, ease of use and agreement with clinical judgement. The primary outcome was the likelihood of future use of a given frailty tool. Results: the ideal tool characteristics included brevity (<1 min), simplicity and multidimensionality; tools selected for testing included the Identification of Seniors At Risk, Clinical Frailty Scale, PRISMA-7 and Silver Code. One hundred and twentyone staff members (43% of the total ED workforce) were recruited from one large ED in the East Midlands. Two hundred and thirty-six individual frailty tool assessments were undertaken using 1 of 10 clinical vignettes; 75% of staff stated that they would use at least one of the tools again, with no significant differences between the individual tools. The median time to complete the tool was around 1 min per patient for all four tools. There were no significant differences in timing, ease of use or agreement with clinical judgement between tools. Discussion: validated risk stratification tools are quick, simple, easy to use and 75% of staff would use the tools again in the future. [ABSTRACT FROM AUTHOR]

Background: delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients. Objective: to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia. Methods: this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach. Results: most participants did not routinely use structured approaches to incorporate patients' preferences in clinical decision-making, address conflicting prescriber advice, assess patients' adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants' avoiding ownership of multimorbidity management. Potential facilitators of improved care related to improved culture, implementation of electronic health records, greater engagement of pharmacists, nurses and patients, families in care provision, and the use of care coordinators. Conclusion: extensive shortcomings exist in team-based care for the management of multimorbidity. Delegating coordination and review responsibilities to specified HCPs may support improved overall care. [ABSTRACT FROM AUTHOR]

Background: currently, there is little evidence base for much of the care provided for older people in care homes. Given the wide range of topics that require further investigation, and limited resources, one solution is to identify the priorities for future research. Methods: a modified Delphi technique was used to identify research topics and develop consensus among care home staff participants. The survey was conducted across three rounds. Firstly to elicit topics that were considered by participants to require further research, secondly to prioritise the long list of research questions, followed by a third round to reach a consensus on the highest ranked 15 questions. Results: eighty-three participants responded to the initial survey, providing 144 questions. Following analysis and review against existing evidence, 76 research questions remained. Of note, 40/83 participants responded to the interim prioritisation round and 43/83 participants responded to the final round, which ranked the top 15 research questions by importance. Two other groups of health and social care professionals also participated in the final ranking. The results from these groups had a similar ordering to those of the original cohort of participants. Conclusion: this is the first study to establish a set of research priorities for older people in the UK care homes. It is hoped that sharing these results with clinicians, researchers and funding bodies will help to begin the process of ensuring that the future research agenda can be focused on the areas of greatest need. Further work to identify the priorities of other key stakeholders is required. [ABSTRACT FROM AUTHOR]

Background: low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients' carers. Methods: this was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings: eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions: although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting. [ABSTRACT FROM AUTHOR]

Background: understanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. We aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom. Method: transparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS, timing of delivery and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings were integrated across the data sources. Findings: we conducted two expert consultations (n = 63), a consensus survey (n = 42) and three focus groups (n = 17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to co-ordinate care, but the assignment criteria remain uncertain. Interpretation: key stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. Our findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation. [ABSTRACT FROM AUTHOR]

(Background Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. Methods All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Results Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31 %, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Conclusions Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. [ABSTRACT FROM AUTHOR]

Children with mild bilateral and unilateral hearing loss are now commonly identified early through newborn hearing screening initiatives. There remains considerable uncertainty about how to support parents and about which services to provide for children with mild bilateral and unilateral hearing loss. The goal of this study was to learn about parents' experiences and understand, from their perspectives, the impact of hearing loss in the mild range on the child's functioning. Parents of 20 children in Ontario, Canada, participated in the study. The median age of identification of hearing loss was 4.6 months (interquartile range: 3.6,10.8). Parents appreciated learning early about hearing loss, but their experiences with the early process were mixed. Parents felt that professionals minimized the importance of milder hearing loss. There was substantial uncertainty about the need for hearing aids and the findings suggest that parents need specific guidance. Parents expressed concerns about the potential impact of hearing loss on their child's development, particularly at later ages. [ABSTRACT FROM AUTHOR]

Background: the impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. Objective: the aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. Settings: participants were recruited in an outpatient clinic in Liège, Belgium. Subjects: sarcopenic subjects aged 65 years or older. Methods: the study was articulated in the following four stages: (i) Item generation--based on literature review, sarcopenic subjects' opinion, experts' opinion, focus groups; (ii) Item reduction--based on sarcopenic subjects' and experts' preferences; (iii) Questionnaire generation--developed during an expert meeting; (iv) Pretest of the questionnaire--based on sarcopenic subjects' opinion. Results: the final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in ~10 min. Conclusions: the first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test--retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire. [ABSTRACT FROM AUTHOR]

Introduction This study measured the following: violence rates against chronic pain care providers (CPCPs), character/context/risk factors for violence and CPCPs' mitigation strategies. Method An e-mail survey was sent to members of the American Society of Interventional Pain Physicians (ASIIP) to collect demographics, rates/type of violence, injury, risk mitigation, and context of violence. Correlation with demographic factors calculated using one-way ANOVA and χ2 test (Fisher test). Results Security was called by 64.85% of CPCPs and 51.52% received threats. The threats involved a gun 7.05% of the time. Injury was reported by 2.73% of CPCPs. The most common risk mitigation was discharging patient (85.33%). Others used protective equipment (16.89%) of which a significant percentage carried a gun (54%). Opioid management was the highest context for violence (89.9%; P < 0.0001). Those who practiced part-time were more likely to be harmed ( P = 0.0290). Females were less likely to be threatened ( P = 0.0507). Anesthesiology was the most threatened vs other specialties ( P = 0.0215). Urban practices were less likely to move or close the practice ( P = 0.0292). Conclusion CPCPs were at high risk for violence. Risk factors were older age, male, working part time, and anesthesiology. Risk was highest in the context of opioid management and disability. Discharging patient was the most common risk mitigation. A significant number of physicians carried firearms. [ABSTRACT FROM AUTHOR]

Objective Myofascial Pain Syndrome (MPS) is highly prevalent in pain medicine, yet there is no 'gold standard' or set of validated diagnostic criteria for clinical or research use. A survey collected clinician perspectives on MPS to foster the development of a formal case definition for empirical validation. Design International survey Methods Clinician members of the International Association for the Study of Pain and the American Academy of Pain Medicine received a survey of the symptoms and signs of MPS and expected response to treatment. Write-in fields were available for each category and to suggest relevant diagnostic studies. Results Two hundred fourteen responses were received from 4,143 surveys mailed. The most essential components of MPS were tender spots that recreate symptoms when palpated. MPS was also associated with muscle stiffness, decreased range of motion of the affected joints, worsening symptoms with stress, palpable taut band or tender nodule, and referred pain with palpation of the tender spot. Diagnostic studies are reported to be useful for ruling out other pathology, but not to confirm the presence of the condition. Conclusions These results were used to propose a set of preliminary diagnostic criteria; expert consensus for case definition and subsequent empirical validation are required for standardization in research and clinical management of MPS. [ABSTRACT FROM AUTHOR]

Aims: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Methods: Health care professionals consisting of, 409GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. Conclusion: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation. [ABSTRACT FROM AUTHOR]

Background. Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and manage ment are not targeted to physical therapists. Objective. The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. N. Kirk-Sanchez, PT, PhD, Departмent of Physical Therapy, University of Miami, Coral Gables, Florida. C.M. McDonough, PT, PhD, Department of Health Policy and Management, Health and Disabil ity Research Institute, Boston University School of Public Health, Boston, Massachusetts, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. T.E. Shubert, PT, PhD, Shubert Consulting, Chapel Hill, North Carolina. Design and Methods. The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. Results. Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. Limitations. A gap analysis supports the need for the development of a physical therapy-specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. Conclusion. This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults. [ABSTRACT FROM AUTHOR]

Background Cardiovascular disease (CVD) accounts for 30% of UK deaths. It is associated with modifiable lifestyle factors, including insufficient consumption of fruit and vegetables (F&V). Lay health trainers (LHTs) offer practical support to help people develop healthier behaviour and lifestyles. Our two-group pilot randomized controlled trial (RCT) investigated the effectiveness of LHTs at promoting a heart-healthy lifestyle among adults with at least one risk factor for CVD to inform a full-scale RCT. Methods Eligible adults (aged 21–78 years), recruited from five practices serving deprived populations, were randomized to health information leaflets plus LHTs' support for 3 months (n = 76) versus health information leaflets alone (n = 38). Results We recruited 114 participants, with 60% completing 6 month follow-up. Both groups increased their self-reported F&V consumption and we found no evidence for LHTs' support having significant added impact. Most participants were relatively less deprived, as were the LHTs we were able to recruit and train. Conclusions Our pilot demonstrated that an LHT’s RCT whilst feasible faces considerable challenges. However, to justify growing investment in LHTs, any behaviour changes and sustained impact on those at greatest need should be demonstrated in an independently evaluated, robust, fully powered RCT. [ABSTRACT FROM AUTHOR]

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Objective. To provide access to professional development opportunities for health care professionals, especially in rural Australian regions, consistent with recommendations in the Australian National Pain Strategy and state government policy. Design and Setting. A preliminary prospective, single-cohort study design, which aligned health policy with evidence-informed clinical practice, evaluated the implementation and effectiveness of an interprofessional, health care provider pain education program (hPEP) for management of nonspecific low back pain (nsLBP) in rural Western Australia. Intervention. The 6.5-hour hPEP intervention was delivered to 60 care providers (caseload nsLBP 19.8% ± 22.5) at four rural WA regions. Outcome Measures. Outcomes were recorded at baseline and 2 months post-intervention regarding attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale [HCPAIRS]), Back Pain Beliefs Questionnaire [BBQ]), and self-reported evidence-based clinical practice (knowledge and skills regarding nsLBP, rated on a 5-point Likert scale with 1 = nil and 5 = excellent). Results. hPEP was feasible to implement. At 2 months post-hPEP, responders' (response rate 53%) improved evidence-based beliefs were indicated by HC-PAIRS scores: baseline mean (SD) [43.2 (9.3)]; mean difference (95% CI) [-5.9 (-8.6 to -3.1)]; and BBQ baseline [34.3 (6.8)]; mean difference [2.1 (0.5 to 3.6)]. Positive shifts were observed for all measures of clinical knowledge and skills (P < 0.001) and increased assistance with planning lifestyle changes (P < 0.001), advice on selfmanagement (P = 0.010), and for decreased referrals for spinal imaging (P = 0.03). Conclusions. This policy-into-practice educational program is feasible to implement in rural Western Australia (WA). While preliminary data are encouraging, a further randomized controlled trial is recommended. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to determine the frequency and nature of physician, nurse, and pharmacist verbal counseling at the time of a new prescription for an opioid-acetaminophen containing medication as recalled by patients. Design. A mixed methods approach with data from cross sectional, structured interviews was used. Setting. The settings were one academic emergency department in Chicago, IL and one outpatient pharmacy at a public hospital in Atlanta, GA. Patients. One hundred forty-nine patients receiving a new prescription for an opioid-acetaminophen medication were enrolled. Methods. Interviews assessed patient recall of counseling they received from their physician, nurse, and pharmacist upon receiving the new prescription. Their responses were unitized and assigned to categories. Results. One hundred forty-nine patients were enrolled; 61.1% African American and 58.4% female. Seven major categories of responses were noted; frequencies of patient recall for counseling in these categories were reported. Four categories related to the content of the counseling discussion were 1) details of administration (patient recall counseling from: physician/nurse only 44.3%, pharmacist only 5.4%, both providers 12.8%); 2) activities to avoid and side effects (36.2%, 4.7%, 8.7%); 3) medication indication (32.9%, 4%, 4%); and 4) addictive potential (9.3%, 1.3%, 0%). Three categories describe patients' recall of the interaction in broad terms: 5) being referred to print informational material accompanying the prescription (MD/RN only 7.4%, pharmacist only 20.1%, both providers 2.7%); 6) having questions solicited (0%, 11.4%, 0%); 7) having no interaction relating to medication counseling (3.4%, 32.2%, 1.3%). Conclusions. Patients infrequently recall counseling from providers on topics that are important to prevent harm from opioid-acetaminophen prescriptions. Future patient-centered clinical research should target identifying optimal strategies to convey these critical messages. [ABSTRACT FROM AUTHOR]

Objective To evaluate the degree of knowledge about pain management and opioids use by professionals working at three pediatric units. Design This is a cross-sectional study. Setting This study was carried out at three pediatric units (pediatrics, intensive care unit, and oncology) of Hospital de Clínicas de Porto Alegre, which is a university hospital located in southern Brazil. Subject The subjects of this study include physicians, pharmacists, physiotherapists, nurses, nursing technicians, and nursing assistants. Methods Cross-sectional study carried out in a university hospital in southern Brazil. A self-applicable semi-structured questionnaire was handed out to 182 professionals from December 2011 to March 2012. Results The response rate was 67% (122); the average percentage of correct answers was 63.2 ± 1.4%. The most frequent errors were: an opioid must not be used if the cause of pain is unknown (47%; 54/115); patients often develop respiratory depression (42.3%; 22/52); and confusion about symptoms of withdrawal, tolerance, and dependency syndromes (81.9%; 95/116). Only 8.8% (10/114) reported the use of pain scales to identify pain in children. The most often cited hindrance to control pain was the difficulty to measure and spot pain in pediatric patients. Finally, 50.8% (62/122) of them did not have any previous training in pain management. Conclusions Problems in the processes of pain identification, measurement, and treatment have been found. Results suggest that there is a need for both an investment in continuing education of professionals and the development of protocols to optimize the analgesic therapy, thus preventing increased child suffering. [ABSTRACT FROM AUTHOR]

Young people have higher rates of sexually transmissible infections (STIs) than the general population. Research has shown that there is a clear link between emotional distress, depression, substance abuse and sexual risk taking behaviours in young people. ‘headspace’ is a youth mental health early intervention service operating in more than 55 locations around Australia. This setting is ideal for accessing troubled young people who are at risk of STIs and are unlikely to attend mainstream general practice services. In 2013, a partnership was formed between headspace National Office and Hunter New England Local Health District to develop a clear clinical pathway to ensure at-risk headspace clients received sexual health assessments, advice, appropriate treatment and referral as indicated. This article describes the implementation of the pathway at the national level and a control trial to measure its efficacy. Future work will involve providing sustainable sexual health training for headspace general practitioner and allied health professionals to supplement the roll-out of the pathway in headspace centres across Australia. Support will also be provided in adapting headspace environments to encourage service utilization by Aboriginal and Torres Strait Islander and gay, lesbian, bisexual, transsexual and intersex young people. [ABSTRACT FROM AUTHOR]

Background. Cervical cancer is a leading cause of cancer mortality in nearly all U.S. Affiliated Pacific Island Jurisdictions (USAPIJ); however, most jurisdictions are financially and geographically limited in their capacity to deliver routine screening. Methods. We conducted a cross-sectional survey of 72 health care providers from five of the six USAPIJ in 2011 to assess knowledge, beliefs, practices, and perceived barriers regarding routine cervical cancer screening. We compared the responses of providers from jurisdictions that were funded by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with those that were not funded. Results. Most providers reported cervical cancer prevention as a priority in their clinical practices (90.3%) and use the Papanicolaou test for screening (86.1%). Many providers reported knowledge of screening guidelines (76.4%); however, more than half reported that annual screening is most effective (56.9%). Providers in non-NBCCEDP-funded jurisdictions reported greater acceptance of visual inspection with acetic acid (93.9%) and self-sampling for human papillomavirus testing (48.5%) compared with NBCCEDP-funded jurisdictions (15.4% and 30.8% respectively). Providers from non-NBCCEDP-funded jurisdictions reported inadequate technological resources for screening women (42.4%), and approximately 25% of providers in both groups believed that screening was cost-prohibitive. Conclusion. Although cervical cancer screening is a priority in clinical practice, beliefs about annual screening, costs associated with screening, and varying levels of support for alternative screening tests pose barriers to providers throughout the USAPIJ. Further exploration of using evidence-based, lower cost, and sustainable screening technologies is warranted in addition to emphasizing timely follow-up of all positive cases. [ABSTRACT FROM AUTHOR]

Background To evaluate the organization of the new cardiovascular risk assessment programme, NHS Health Checks, in general practices. Methods All 99 general practices in two inner London boroughs were invited to participate in a cross-sectional survey by completing an online questionnaire. Results Data were analysed for 66/99 (67%) eligible practices. Training attended for delivering the Health Check included measurement methods (43%), delivering risk information (65%) and advising on lifestyle change (62%). The Framingham risk score was used by 66% of practices, the QRisk score by 12% and both by 8%. Advice given to patients identified as high risk was ‘usually’ brief at 26% of practices, advice was given verbally at 92% of practices, in written form at 74% and through interactive visual materials at 29%. Statins were ‘usually’ prescribed to high-risk patients by 34% of practices and antihypertensive drugs by 22%. The follow-up of high-risk patients was by means of a register with regular recall at 51% of general practices. Conclusions There is considerable diversity in general practices’ implementation of the NHS Health Check. A formal quality assurance process may be required in order to optimize the implementation of the NHS cardiovascular risk assessment programme. [ABSTRACT FROM PUBLISHER]

This study reports the development of The Hearing Parents' Perceptions of Health Professionals' Advice Questionnaire (HPP/HPQ). This questionnaire was designed to investigate the impact of the advice and information that parents aeceive from health professionals during the time when their child's hearing loss is identified and how parents, in turn, make initial decisions about services and interventions for their deaf child. Once developed, the HPP/HPQ was partially validated on 2 separate samples. Analysis of data from both samples supported a 14-item questionnaire, with all items loading onto a single composite factor. The implications of how this tool can be used to both help improve health professionals' services and gain an understanding of how the relationship between hearing parents and health professionals might influence developmental outcomes in deaf children are discussed. [ABSTRACT FROM AUTHOR]

The objective of the study was to determine the extent to which the FLU-FOBT Program, a colorectal cancer screening (CRCS) intervention linking the provision of fecal occult blood tests (FOBT) to the time of annual influenza vaccination, resulted in practice changes in six primary care clinics 1 year after it was introduced in a randomized controlled trial (RCT). We assessed CRCS rate changes for influenza vaccine recipients, administered brief serial clinic staff surveys and interviewed clinic leaders 1 year after the RCT. CRCS rates for influenza vaccination recipients between the ages of 50 and 75 years were 42.5% before the RCT, 54.5% immediately after the RCT and 55.8% 1 year after the RCT (P < 0.001 for difference between baseline and 1 year after RCT). Many FLU-FOBT Program components were maintained in most clinics at 1-year follow-up. Only 63% of clinic staff survey respondents (26 of 41) continued offering FOBT with influenza vaccines, but 85% (35 of 41) continued to provide mailing kits with FOBT. Many patient education materials were maintained and staff satisfaction with the intervention remained high. Clinic leaders acknowledged barriers to maintenance but also observed several beneficial practice changes. Many components of the FLU-FOBT Program were maintained, with beneficial outcomes for participating practices. [ABSTRACT FROM PUBLISHER]

Purpose. Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the "teachable moment" of cancer diagnosis to provide smoking cessation assistance. Providers and Methods. Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. Results. Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but <30% of providers reported frequently or always providing intervention to smoking patients (e.g., nicotine replacement therapy or other medications, self-help materials, and/or referrals). Only 30% of providers reported that they frequently or always followed up with patients to assess progress with quitting. Few providers (18.1%) reported high levels of confidence in their ability to counsel smoking patients. Patients' lack of motivation was identified as the most important barrier to smoking cessation. Conclusions. Although beliefs about providing cessation services to smoking patients were generally positive, few providers reported commonly providing interventions beyond advice to quit. Additional training and clinic-based interventions may improve adherence to tobacco cessation practice guidelines in the outpatient oncology setting. [ABSTRACT FROM AUTHOR]

Background This study measured the acceptability of urine-based chlamydia screening to young adults, where young adults wanted opportunistic chlamydia screening services to be located, and by whom they wanted to be offered screening. Methods A cross-sectional survey of 5685 university students and 400 young adult healthcares setting attendees (age: 18–29 years). Results Ninety-six percent of males and 93% of females said that they would find it acceptable to be offered chlamydia screening. Seventy-six percent of males and 77% of females wanted to be offered screening by a doctor or nurse. Young women would prefer female staff. Most respondents preferred that screening be located in traditional healthcare settings such as General Practices, and offered by either doctors or nurses. More than 90% of respondents did not want screening services to be located in pharmacies and almost all rejected public non-health care screening settings. Conclusions Opportunistic chlamydia screening services should be located in traditional healthcare/medical settings, and screening should be offered by doctors and nurses. [ABSTRACT FROM PUBLISHER]