scholarly journals An evaluation of the clinical microsystems approach in general practice quality improvement

2020 ◽  
Vol 21 ◽  
Author(s):  
Vanessa Abrahamson ◽  
Sabrena Jaswal ◽  
Patricia M. Wilson
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Diffusion Of Innovation ◽  
Good Practice ◽  
Added Value ◽  
Normalisation Process Theory ◽  
Future Research ◽  
Sampling Frame ◽  
Clinical Microsystems ◽  
South East England

Abstract Background: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. Aim: To explore experiences of GP staff participating in a clinical microsystems programme. Design and setting: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. Method: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. Results: The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. Conclusion: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.

scholarly journals Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

2021 ◽  
Vol 10 (2) ◽  
pp. e001309
Author(s):  
Jennifer Gosling ◽  
Nicholas Mays ◽  
Bob Erens ◽  
David Reid ◽  
Josephine Exley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Service Improvement ◽  
Protected Time ◽  
Routine Work ◽  
Professional Interest ◽  
Quality And Outcomes ◽  
Nationally Representative ◽  
The Uk

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

scholarly journals The Bioactive Potential of Trawl Discard: Case Study from a Crinoid Bed Off Blanes (North-Western Mediterranean)

Marine Drugs ◽  
2021 ◽  
Vol 19 (2) ◽  
pp. 83
Author(s):  
Alfredo García-de-Vinuesa ◽  
Montserrat Demestre ◽  
Arnau Carreño ◽  
Josep Lloret
Keyword(s):  
Bioactive Compounds ◽  
Fish Habitat ◽  
Antibacterial Properties ◽  
Marine Species ◽  
Western Mediterranean ◽  
Bioactive Molecules ◽  
Added Value ◽  
Future Research ◽  
Trawl Survey ◽  
Bioactive Potential

Although knowledge of the bioactive compounds produced by species inhabiting coastal waters is increasing, little is known about the bioactive potential produced by marine species occupying deeper habitats with high biodiversity and productivity. Here, we investigate about the bioactive potential of molecules produced by species that inhabit the crinoid beds, a poorly known essential fish habitat affected by trawling, wherein large amounts of commercial and noncommercial species are discarded. Based on a trawl survey conducted in 2019, 14% of the 64 species discarded on crinoid beds produce molecules with some type of bioactive potential, including; soft corals (Alcyonium palmatum); tunicates (Ascidia mentula); bony fish, such as horse mackerel (Trachurus trachurus); European hake (Merluccius merluccius); and chondrichthyans, such as small-spotted catshark (Scyliorhinus canicula). In addition, 16% of the discarded species had congeneric species that produce compounds with bioactive potential, indicating that such species might also possess similar types of bioactive molecules. Molecules with antioxidant, antitumour, antihypertensive, and antibacterial properties were the most frequent, which could provide the basis for future research aiming to discover new marine-based drugs and compounds for other human uses. Among all species or genera that produce compounds with bioactive potential, 68% presented medium or high vulnerability to trawling. Results show that the discarded catch contains many species, which produce different bioactive compounds that represent an added-value resource. These results highlight the importance of manage properly crinoid beds, to ensure that species that produce molecules with bioactive potential inhabiting these habitats are protected.

First encounter effects in testing of highly automated vehicles during two experimental occasions – The need for recurrent testing

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jonas Andersson ◽  
Azra Habibovic ◽  
Daban Rizgary
Keyword(s):  
Driver Behavior ◽  
Added Value ◽  
Future Research ◽  
Gaze Behavior ◽  
Repeated Testing ◽  
Automated Vehicles ◽  
Automated Driving ◽  
Perceived Safety ◽  
Repeated Interaction ◽  
Over Time

Abstract To explore driver behavior in highly automated vehicles (HAVs), independent researchers are mainly conducting short experiments. This limits the ability to explore drivers’ behavioral changes over time, which is crucial when research has the intention to reveal human behavior beyond the first-time use. The current paper shows the methodological importance of repeated testing in experience and behavior related studies of HAVs. The study combined quantitative and qualitative data to capture effects of repeated interaction between drivers and HAVs. Each driver ( n = 8 n=8 ) participated in the experiment on two different occasions (∼90 minutes) with one-week interval. On both occasions, the drivers traveled approximately 40 km on a rural road at AstaZero proving grounds in Sweden and encountered various traffic situations. The participants could use automated driving (SAE level 4) or choose to drive manually. Examples of data collected include gaze behavior, perceived safety, as well as interviews and questionnaires capturing general impressions, trust and acceptance. The analysis shows that habituation effects were attenuated over time. The drivers went from being exhilarated on the first occasion, to a more neutral behavior on the second occasion. Furthermore, there were smaller variations in drivers’ self-assessed perceived safety on the second occasion, and drivers were faster to engage in non-driving related activities and become relaxed (e. g., they spent more time glancing off road and could focus more on non-driving related activities such as reading). These findings suggest that exposing drivers to HAVs on two (or more) successive occasions may provide more informative and realistic insights into driver behavior and experience as compared to only one occasion. Repeating an experiment on several occasions is of course a balance between the cost and added value, and future research should investigate in more detail which studies need to be repeated on several occasions and to what extent.

scholarly journals How well did Norwegian general practice prepare to address the COVID-19 pandemic?

2020 ◽  
Vol 8 (4) ◽  
pp. e000512
Author(s):  
Ingvild Vatten Alsnes ◽  
Morten Munkvik ◽  
W Dana Flanders ◽  
Nicolas Øyane
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Home Page ◽  
Quality Improvements ◽  
Geographical Differences ◽  
Home Office ◽  
Isolation Room ◽  
Improvement Measures ◽  
The Mean

ObjectivesWe aimed to describe the quality improvement measures made by Norwegian general practice (GP) during the COVID-19 pandemic, evaluate the differences in quality improvements based on region and assess the combinations of actions taken.DesignDescriptive study.SettingParticipants were included after taking part in an online quality improvement COVID-19 course for Norwegian GPs in April 2020. The participants reported whether internal and external measures were in place: COVID-19 sign on entrance, updated home page, access to video consultations and/or electronic written consultations, home office solutions, separate working teams, preparedness for home visits, isolation rooms, knowledge on decontamination, access to sufficient supplies of personal protective equipment (PPE) and COVID-19 clinics.ParticipantsOne hundred GP offices were included. The mean number of general practitioners per office was 5.63.ResultsMore than 80% of practices had the following preparedness measures: COVID-19 sign on entrance, updated home page, COVID-19 clinic in the municipality, video and written electronic consultations, knowledge on how to use PPE, and home office solutions for general practitioners. Less than 50% had both PPE and knowledge of decontamination. Lack of PPE was reported by 37%, and 34% reported neither sufficient PPE nor a dedicated COVID-19 clinic. 15% reported that they had an isolation room, but not enough PPE. There were no geographical differences.ConclusionsNorwegian GPs in this study implemented many quality improvements to adapt to the COVID-19 pandemic. Overall, the largest potentials for improvement seem to be securing sufficient supply of PPE and establishing an isolation room at their practices.

scholarly journals A more comprehensive approach offering instruments in one portal to facilitate higher uptake

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Rossmann ◽  
F De Bock
Keyword(s):  
Health Promotion ◽  
Best Practice ◽  
Evidence Synthesis ◽  
Good Practice ◽  
Community Setting ◽  
Comprehensive Approach ◽  
Added Value ◽  
Assessment Instruments ◽  
Policy Makers ◽  
Activity Promotion

Abstract The good practice portal of the Federal Centre for Health Education (BZgA) consists of a nationwide collection of projects and interventions to promote the health of socially disadvantaged groups at community/setting level. An exchange platform (inforo) is also offered via the operating agency, although its use is still limited. The results of the evaluation of the platform suggest that the provision of practical projects and exchange of knowledge alone is not sufficient to support policy makers and practitioners who want to promote health in the community/setting. There is a need for advice on needs assessment, selection and appropriate implementation of health promotion measures. A comprehensive approach currently being tested in the field of activity promotion for older people is the provision of a web-based “toolbox” comprising the following tools: assessment instruments for analysing the need for health promotion measures, a user-friendly intervention/project database and broader evidence synthesis documents, as well as information on project management (organisational, legal, financial). Following the example of other best practice portals, a ranking methodology was developed to make the level of effectiveness of interventions visible and the evaluation requirements transparent. Evidence synthesis documents provide an entry point to learn more generally what works in a particular area of health promotion. In order to make the “toolbox” accessible to policy-makers and practitioners, information from previous studies was used in the development with regard to content and graphical presentation. BZgA is currently working on integrating evidence into the good practice portal. The evaluation of the toolbox in a small area of health promotion will provide initial insights into the inclusion of evidence and its added value. This presentation will conclude with a discussion of possibilities for improvement, challenges and limitations of this approach.

Accessible tourism: a bibliometric review (2008–2020)

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Guanghui Qiao ◽  
Liu Ding ◽  
Linlin Zhang ◽  
Huili Yan
Keyword(s):  
English Language ◽  
Research Literature ◽  
Future Research ◽  
Sampling Frame ◽  
Multiple Sources ◽  
Knowledge Maps ◽  
Tourism Research ◽  
Content Type ◽  
The Usa ◽  
Bibliometric Review

Purpose The purpose of this paper is to reveal the knowledge evolution process, research hotspots and future trends in the accessible tourism research literature from 2008 to 2020. Design/methodology/approach A total of 213 articles on accessible tourism were selected from the core collection database of Web of Science (WoS) and analyzed using CiteSpace. Findings Over the 13-year period between 2008 and 2020, an increasing number of studies have been published concerning accessible tourism, but the overall base is still small. The research content mainly includes six modules. Among institutions, the University of Technology Sydney has published the largest number of papers. Cooperation among countries involves the USA, the United Kingdom, Australia, Portugal and China. Tourism Management is the leading journal for disseminating research on accessible tourism. Definition of “Accessible tourism” and the different scope of this phenomenon are re-discussed. In recent years, “experience” and “participation” have become the “new favorites” in accessible tourism research, which could reveal insights into future research directions. Research limitations/implications The sampling frame was defined in terms of the WoS database and even though this is an important database for global academic information, in the big data era, the authors may have to integrate information from multiple sources to comprehensively reveal and understand knowledge maps. Second, because of the operational constraints of the CiteSpace software, the authors only selected outputs published in peer-reviewed journals, excluding other published works, such as books and conference papers. Finally, because of the language restrictions of the authors, this research is limited to journals published in the English language. Practical implications Practically, the results of this study made a conclusion of accessible tourism research so that the researchers can easily know what has currently been done and what future research can do. Tourism managers can also understand the demands and the constraints of tourism for the people who have barriers to travel. They can supply more specific products for the accessible tourism and further promote the construction of barrier-free travel environments. Originality/value This paper unifies the literature on senior tourism and people with disabilities tourism, and uses CiteSpace to construct data and network visualizations, including a burst and dynamic analysis for the period covered by the sample. Furthermore, this paper proposed a more diversified accessible tourism.

Back to Basics: Developmental Catalysts of Quality Improvement in Early Education and Care

2021 ◽  
Vol 8 (2) ◽  
pp. 200-207
Author(s):  
Emily C. Hanno ◽  
Stephanie M. Jones ◽  
Nonie K. Lesaux
Keyword(s):  
Quality Improvement ◽  
Early Education ◽  
Future Research ◽  
Social And Emotional Development ◽  
Healthy Development ◽  
Social And Emotional ◽  
Early Education And Care ◽  
Education And Care ◽  
Developmental Domains

Children’s experiences in early education programs can have a profound influence on their cognitive, social, and emotional development. In these settings, interactions with educators serve as catalysts for children’s healthy development. Yet too few children today are in the types of high-quality early learning environments marked by warm, cognitively stimulating exchanges. This review summarizes research on the features of settings that promote growth in children’s skills across a range of developmental domains, then describes research documenting these features across today’s early education and care landscape. Turning to strategies for cultivating these features across the diverse early education and care system, the discussion focuses on the central role of the educator. The conclusion draws implications for ongoing public preK expansion and quality improvement efforts, as well as highlights opportunities for future research to further these efforts.

Technology adoption in the apparel industry: insight from literature review and research directions

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Md Aynul Hoque ◽  
Rajah Rasiah ◽  
Fumitaka Furuoka ◽  
Sameer Kumar
Keyword(s):  
Technology Adoption ◽  
Diffusion Of Innovation ◽  
Computer Aided Design ◽  
Reasoned Action ◽  
Apparel Industry ◽  
Research Trends ◽  
Future Research ◽  
Content Type ◽  
Adoption Research ◽  
Radiofrequency Identification

Purpose This paper aims to identify key theoretical cornerstones and research trends in the apparel industry. It also compares theoretical bases with those of the general research domain in technology adoption literature and, thus, provides future policy guidelines for practitioners and research gaps for further studies. Design/methodology/approach Documents were collected from the Web of Science (core collection) database using systematic methods. The bibliometric coupling and co-citation analyses were conducted using VOSviewer software to construct theoretical cornerstones and research trends in the apparel industry. Findings Literature in the apparel industry focuses mainly on the diffusion of innovation and the theory of reasoned action. Hence, the literature lacks investigations of technology–organization–environment and institutional theories for technology adoption in the apparel industry. This study also traces six clusters of prevalent research trends: radiofrequency identification, virtual-try on technology for e-commerce, computer-aided design, Industry 4.0 technologies, virtual-try on technology in design and information technology. Originality/value Little research is done on theoretical cornerstones on technology adoption in the apparel industry. This study looks into the theoretical bases for technology adoption, research trends in the apparel supply chain and calls for future research necessities.

scholarly journals The incidence, prevalence, and management of plantar heel pain in Dutch general practice

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703217
Author(s):  
Nadine Rasenberg ◽  
Sita MA Bierma-Zeinstra ◽  
Patrick Bindels ◽  
Johan van der Lei ◽  
Marienke Van Middelkoop
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Records ◽  
Search Algorithm ◽  
Heel Pain ◽  
Future Research ◽  
Healthcare Database ◽  
Plantar Heel Pain ◽  
Wait And See ◽  
Multiple Interventions

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.

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