scholarly journals Love Labour as a Distinct and Non-Commodifiable Form of Care Labour

2007 ◽  
Vol 55 (3) ◽  
pp. 550-570 ◽  
Author(s):  
Kathleen Lynch
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Tertiary Care ◽  
Care Work ◽  
Central Theme ◽  
Wide Range ◽  
General Care ◽  
Over Time

This paper examines the nature of love labouring and explores how it can be distinguished from other forms of care work. It provides a three fold taxonomy for analysing other-centred work, distinguishing between work required to maintain primary care relations (love labour), secondary care relations (general care work) and tertiary care relations (solidarity work). A central theme of the paper is that primary care relations are not sustainable over time without love labour; that the realization of love, as opposed to the declaration of love, requires work. Drawing on a wide range of theoretical and empirical sources, including a study of caring undertaken by the author, the paper argues that there is mutuality, commitment, trust and responsibility at the heart of love labouring that makes it distinct from general care work and solidarity work. It sets out reasons why it is not possible to commodify the feelings, intentions and commitments of love labourers to supply them on a paid basis.

Mental health and emotional well being

2009 ◽  
pp. 213-248
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Intellectual Disability ◽  
Anxiety Disorders ◽  
Secondary Care ◽  
Psychotic Disorders ◽  
Tertiary Care ◽  
Well Being ◽  
Prevalence Rates

Introduction 214 Promoting emotional well-being 216 Promoting assertiveness 218 Primary care 220 Secondary care 222 Tertiary care 224 Prevalence rates 226 Factors contributing to mental health 228 Anxiety disorders 230 Psychotic disorders 232 Organic disorders 234 Dementia (in people with intellectual disability) 236 Psychopathology 238...

Blocked ears

2020 ◽  
Vol 13 (5) ◽  
pp. 289-296
Author(s):  
Oliver J Wright ◽  
James W Wright ◽  
William G Chambers
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Clinical Approach ◽  
Wide Range

Blocked ears are a common presenting complaint in primary care, and although the cause is usually benign, a structured clinical approach and examination are essential to avoid missing more significant causes. In this article, we discuss the clinical approach, aetiology and management of the wide range of conditions that lead to the sensation of blocked ears, and provide guidance on referral to secondary care.

scholarly journals What are the Most Important Problems in Functioning Among Patients with Shoulder Pain? An Analysis of the Patient-Specific Functional Scale

2020 ◽  
Author(s):  
Yngve Røe ◽  
Tarjei Rysstad ◽  
Anne Therese Tveter ◽  
Torill Bjugan Sandbakk ◽  
Marit Jæger ◽  
...  
Keyword(s):  
Primary Care ◽  
Shoulder Pain ◽  
Secondary Care ◽  
Activity Level ◽  
International Classification Of Functioning ◽  
Patient Specific ◽  
Functional Scale ◽  
Substantial Impact ◽  
Wide Range ◽  
Functional Problems

Abstract Background Shoulder pain is a common and often persistent health condition with substantial impact on daily functioning. The primary aim of the present study was to identify important functional problems among patients with shoulder pain, using the Patient-Specific Functional Scale (PSFS). A secondary aim was to investigate differences between primary- and secondary care patients.Methods The study had a cross-sectional design and included patients seeking care for shoulder pain in a primary- and a secondary outpatient clinic. Background variables, pain, physical activity level and the PSFS, were registered with a questionnaire package. Meaningful concepts from the PSFS responses were extracted and linked to the International Classification of Functioning, Disability and Health (ICF), according to the refined linking rules. Frequency for the ICF categories was estimated for primary- and secondary care, separately. Differences between primary and secondary care were investigated by calculating confidence intervals for the sample proportions, at ICF chapter level.Results Of the total 177 patients, 84 were recruited from primary care and 93 from secondary care. The primary care sample reported functional problems linked to 226 ICF categories, while 337 in secondary care. Of the linked ICF categories 87.7% belonged to the Activities and Participation component of the ICF. Seventeen categories were identified in > 3% of the patients, of those the most frequent were: Recreation and leisure (d920), Lifting and carrying objects (d430)’, Doing housework (d640), Hand and arm use (d445) and Remunerative employment (d850). Categories included in the ICF chapters Self-care (d5) and Domestic life (d6) were significantly more frequent in the secondary care sample, while there was a trend that b7 Neuromusculoskeletal and movement-related functions were more frequent in primary care.Conclusion The present findings indicate that patients with shoulder pain report a wide range of functional problems, from basic functions related to mobility to more complex functions related to work and leisure activities. This study also discovered differences in the report of functional problems between primary and secondary care patients. The large variation in the experiences between patients supports the use of an individualised measure to support assessment of functioning among shoulder patients.Trial registration Not applicable

scholarly journals SAT0653-HPR COMMUNITY RHEUMATOLOGY SERVICE IN THE UK – WHO BENEFITS THE MOST?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1285.2-1286
Author(s):  
K. Szabo-Kocsis ◽  
M. Dare
Keyword(s):  
Primary Care ◽  
Connective Tissue ◽  
Waiting Time ◽  
Secondary Care ◽  
List Type ◽  
Ehlers Danlos Syndrome ◽  
Specialist Services ◽  
Wide Range ◽  
Set Up ◽  
The Uk

Background:Community rheumatology (CR) in the UK is a new form of rheumatologic service provision established in the last few years and run by few organisations such as Connect Health Ltd.CR is based on the principle of sharing the management of rheumatologic patients between community service and secondary care aiming to reduce the unreasonable referral flow from primary care to secondary care and to share the care of stable inflammatory patients between the services.In the traditional service model patients are referred by General Practitioners (GP) to the secondary care with a wide spectrum of conditions: from fibromyalgia through soft tissues rheumatisms to inflammatory or connective tissue diseases. Many of these patients will be discharged from the specialist service after their first visit with fibromyalgia, osteoarthritis, chronic pain syndrome or MSK diagnoses. The proportion of these patients versus those who have an inflammatory rheumatologic condition or connective tissue disease (CTD) varies significantly and can contribute to oversaturated specialist rheumatologic services with long waiting time where specialists deal with less relevant cases.Objectives:To determine how CR can improve quality of care and decrease the waiting time for appointment in secondary care rheumatology services. To set standards for referral pathways and measured outcomes of effectiveness in patient care.In the UK the regional Clinical Commissioning Groups would accept a maximum waiting time from the referral until patient treatment of up to 18 weeks and specialist services often breach that limit. This long interval may have a significant negative impact for the care of patients with rheumatological condition, reducing patient satisfaction and/or jeopardize patient safety. The solution to the above problem is the creation of CR service.Methods:Extensive search about the available resources within UK NHS system in regards CR service creation and set up. Web search, literature review in relation to CR in the UKResults:From the research different models of CR can be identified and one of these will be presented in details based on the experience of one of the largest organisation running CR services in the UK (Connect Health Ltd). This service is organised within community care set up and can accept patients referred by the primary care physicians with non-inflammatory symptoms (e.g. osteoarthritis, Ehlers - Danlos Syndrome, fibromyalgia) or PMR or gout. The service also can review stable inflammatory patients who are treated with DMARDs and are transferred from the secondary care service by their consultant. This presentation will demonstrate how CR provides safer, faster and more accessible services to the patients assisting the specialist services and allowing them to concentrate on the inflammatory and CTD patients who need faster access to these services than it is possible now. Particularly the presentation will emphasise on:Patient population coverTeam structure, their experience and trainingReferral criteria and IT set up for multidisciplinary connectionTime interval for appointment and patient feedbackImpact on the secondary care rheumatology serviceCases of misdiagnosis and inappropriate referralsCost effectiveness of the CRChallenges in the CR serviceConclusion:The CR service can be a safe addition to the specialist services taking over significant workload and provide new career opportunities for a wide range of Allied Health Professionals (AHP) for the bigger satisfaction of the patients who can access rheumatology service earlier and easier.Disclosure of Interests:None declared

Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

What do patients want? A qualitative exploration of patients’ needs and expectations regarding online access to their primary care record

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711245
Author(s):  
Gail Davidge ◽  
Caroline Sanders ◽  
Rebecca Hays ◽  
Rebecca Morris ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Thematic Analysis ◽  
Support Needs ◽  
Future Design ◽  
Wide Range ◽  
Primary Care Record ◽  
Online Access ◽  
Qualitative Exploration ◽  
Nhs Health Check ◽  
Patients Wishes

BackgroundPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access.AimTo explore patients’ views about accessing online primary care records and to find out how patients would like to interact with their records and what support they may need.MethodInterviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues.ResultsParticipants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services. Carers found accessing online records particularly useful.ConclusionConsultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

Anti-corruption in History

2017 ◽  
Keyword(s):  
Financial Institutions ◽  
Global Media ◽  
Policy Makers ◽  
The Past ◽  
Human Wellbeing ◽  
Modern Period ◽  
Legitimate Power ◽  
Wide Range ◽  
Scant Attention ◽  
Over Time

Anticorruption in History is the first major collection of case studies on how past societies and polities, in and beyond Europe, defined legitimate power in terms of fighting corruption and designed specific mechanisms to pursue that agenda. It is a timely book: corruption is widely seen today as a major problem, undermining trust in government, financial institutions, economic efficiency, the principle of equality before the law and human wellbeing in general. Corruption, in short, is a major hurdle on the “path to Denmark”—a feted blueprint for stable and successful statebuilding. The resonance of this view explains why efforts to promote anticorruption policies have proliferated in recent years. But while the subjects of corruption and anticorruption have captured the attention of politicians, scholars, NGOs and the global media, scant attention has been paid to the link between corruption and the change of anticorruption policies over time and place. Such a historical approach could help explain major moments of change in the past as well as reasons for the success and failure of specific anticorruption policies and their relation to a country’s image (of itself or as construed from outside) as being more or less corrupt. It is precisely this scholarly lacuna that the present volume intends to begin to fill. A wide range of historical contexts are addressed, ranging from the ancient to the modern period, with specific insights for policy makers offered throughout.

scholarly journals Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis

2021 ◽  
Vol 8 (1) ◽  
pp. e000501
Author(s):  
Manu K Nayar ◽  
Noor L H Bekkali ◽  
David Bourne ◽  
Sophie Young ◽  
John S Leeds ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Secondary Care ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Endoscopic Drainage ◽  
Hub And Spoke ◽  
Specialist Nurse ◽  
Icu Stay

ObjectiveSevere acute pancreatitis (SAP) is associated with high mortality (15%–30%). Current guidelines recommend these patients are best managed in a multidisciplinary team setting. This study reports experience in the management of SAP within the UK’s first reported hub-and-spoke pancreatitis network.DesignAll patients with SAP referred to the remote care pancreatitis network between 2015 and 2017 were prospectively entered onto a database by a dedicated pancreatitis specialist nurse. Baseline characteristics, aetiology, intensive care unit (ICU) stay, interventions, complications, mortality and follow-up were analysed.Results285 patients admitted with SAP to secondary care hospitals during the study period were discussed with the dedicated pancreatitis specialist nurse and referred to the regional service. 83/285 patients (29%; 37 male) were transferred to the specialist centre mainly for drainage of infected pancreatic fluid collections (PFC) in 95% (n=79) of patients. Among the patients transferred; 29 (35%) patients developed multiorgan failure with an inpatient mortality of 14% (n=12/83). The median follow-up was 18.2 months (IQR=11.25–35.51). Multivariate analysis showed that transferred patients had statistically significant longer overall hospital stay (p<0.001) but less ICU stay (p<0.012).ConclusionThis hub-and-spoke model facilitates the management of the majority of patients with SAP in secondary care setting. 29% warranted transfer to our tertiary centre, predominantly for endoscopic drainage of PFCs. An evidence-based approach with a low threshold for transfer to tertiary care centre can result in lower mortality for SAP and fewer days in ICU.

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