scholarly journals Rates of turnover among general practitioners: a retrospective study of all English general practices between 2007 and 2019

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e049827
Author(s):  
Rosa Parisi ◽  
Yiu-Shing Lau ◽  
Peter Bower ◽  
Kath Checkland ◽  
Jill Rubery ◽  
...  
Keyword(s):  
Retrospective Study ◽  
General Practitioners ◽  
Turnover Rate ◽  
Social Deprivation ◽  
Turnover Rates ◽  
High Turnover ◽  
Practice Characteristics ◽  
General Practices ◽  
Over Time ◽  
Deprived Areas

ObjectiveTo quantify general practitioners’ (GPs’) turnover in England between 2007 and 2019, describe trends over time, regional differences and associations with social deprivation or other practice characteristics.DesignA retrospective study of annual cross-sectional data.SettingAll general practices in England (8085 in 2007, 6598 in 2019).MethodsWe calculated turnover rates, defined as the proportion of GPs leaving a practice. Rates and their median, 25th and 75th percentiles were calculated by year and region. The proportion of practices with persistent high turnover (>10%) over consecutive years were also calculated. A negative binomial regression model assessed the association between turnover and social deprivation or other practice characteristics.ResultsTurnover rates increased over time. The 75th percentile in 2009 was 11%, but increased to 14% in 2019. The highest turnover rate was observed in 2013–2014, corresponding to the 75th percentile of 18.2%. Over time, regions experienced increases in turnover rates, although it varied across English regions. The proportion of practices with high (10% to 40%) turnover within a year almost doubled from 14% in 2009 to 27% in 2019. A rise in the number of practices with persistent high turnover (>10%) for at least three consecutive years was also observed, from 2.7% (2.3%–3.1%) in 2007 to 6.3% (5.7%–6.9%) in 2017. The statistical analyses revealed that practice-area deprivation was moderately associated with turnover rate, with practices in the most deprived area having higher turnover rates compared with practices in the least deprived areas (incidence rate ratios 1.09; 95% CI 1.06 to 1.13).ConclusionsGP turnover has increased in the last decade nationally, with regional variability. Greater attention to GP turnover is needed, in the most deprived areas in particular, where GPs often need to deal with more complex health needs. There is a large cost associated with GP turnover and practices with very high persistent turnover need to be further researched, and the causes behind this identified, to allow support strategies and policies to be developed.

scholarly journals Spatial Variation in General Medical Services Income in Dublin General Practitioners

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Conor Teljeur ◽  
Alan Kelly ◽  
Tom O'Dowd
Keyword(s):  
General Practitioners ◽  
Catchment Area ◽  
The Elderly ◽  
Medical Services ◽  
Practice Characteristics ◽  
Capitation Rate ◽  
Point Of Use ◽  
Economically Deprived ◽  
Almost All ◽  
Deprived Areas

The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs). The practice GMS income in Dublin was analysed in relation to practice characteristics including the number of GPs, catchment area population, proportion of over-70-year olds in the catchment area, catchment deprivation, number of GMS GPs within 2 km, and average GMS practice income within 2 km. Practice GMS income was highest in deprived areas but is also a valuable source of income in the least deprived areas. The capitation rate for over-70-year olds provides an incentive for GPs to locate in affluent areas and potentially directs resources away from those in greater need.

scholarly journals Diatoms diversify and turn over faster in freshwater than marine environments

2018 ◽  
Author(s):  
Teofil Nakov ◽  
Jeremy Michael Beaulieu ◽  
Andrew James Alverson
Keyword(s):  
Turnover Rate ◽  
Turnover Rates ◽  
High Turnover ◽  
Diversification Rates ◽  
Extinction Rates ◽  
State Dependent ◽  
Freshwater Diatoms ◽  
Marine Realm ◽  
Turn Over ◽  
Freshwater Environments

AbstractMany clades that span the marine-freshwater boundary are disproportionately more diverse in the younger, shorter-lived, and scarcer freshwater environments than they are in the marine realm. This disparity is thought to be related to differences in diversification rates between marine and freshwater lineages. However, marine and freshwaters are not ecologically homogeneous, so the study of diversification across the salinity divide should also account for other potentially interacting variables. In diatoms, freshwater and substrate-associated (benthic) lineages are several-fold more diverse than their marine and suspended (planktonic) counterparts. These imbalances provide an excellent system to understand whether these variables interact with diversification. Using multistate hidden-state speciation and extinction models we found that freshwater lineages diversify faster than marine lineages regardless of whether they inhabit the plankton or the benthos. Freshwater lineages also had higher turnover rates (speciation + extinction), suggesting that habitat transitions impact speciation and extinction rates jointly. The plankton-benthos contrast was also consistent with state-dependent diversification, but with modest differences in diversification and turnover rates. Asymmetric, and bidirectional transitions rejected hypotheses about the plankton and freshwaters as absorbing, inescapable habitats. Our results further suggest that the high turnover rate of freshwater diatoms is related to high turnover of freshwater systems themselves.

scholarly journals Elevada Rotatividade de Carteiras e o Desempenho dos Fundos de Investimento em Ações

2014 ◽  
Vol 12 (4) ◽  
pp. 469
Author(s):  
Pedro Luiz Albertin Bono Milan ◽  
William Eid Junior
Keyword(s):  
Portfolio Management ◽  
Turnover Rate ◽  
Turnover Rates ◽  
High Turnover ◽  
Investment Funds ◽  
Market Portfolio ◽  
Active Portfolio Management ◽  
The Impact ◽  
Portfolio Return ◽  
Shed Light

The active portfolio management aims to outperformance a market portfolio return, however, there is a great discussion among academics and practitioners about the real possibilities to outperformance the market portfolio return by an actively portfolio management. This paper shed light on Brazilian market, pursuing the impact of a high portfolio turnover rate in the performance of equity mutual investment funds. The study evidence high turnover rates negatively affecting the performance of the funds. Furthermore, the performance fee and the size effect are important aspects to acces better performance.

scholarly journals Nursing Environments: Nurses Perspectives

2020 ◽  
Author(s):  
Natasha Khamisa
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
General Health ◽  
Prolonged Exposure ◽  
Turnover Rates ◽  
High Turnover ◽  
Work Related Stress ◽  
Work Related ◽  
Related Stress ◽  
Over Time

Nurses have been found to experience higher burnout levels compared with other health professionals owing to the nature of their work. High burnout levels among nurses have been attributed to their stressful working environments. Prolonged exposure to work-related stress leading to burnout has negative consequences for job satisfaction and general health of nurses. This has wider implications on the health system, such as high turnover rates and compromised patient care. There is a significant gap in research focusing on the relationship between work-related stress, burnout, job satisfaction and general health of nurses in developing countries such as South Africa. A study exploring the relationships between work-related stress, burnout, job satisfaction and general health among South African nurses over time was conducted in order to inform how best to improve nursing environments while enabling quality nursing practice and patient care. A total of 895 nurses participated in the study at baseline and 277 of these individuals were followed up with a year later. Findings showed that although stress related to security risks in the workplace predicts job satisfaction as well as general health, stress related to patient care and nursing shortages better predict job satisfaction and general health over time. Burnout better predicts job satisfaction than general health over time.

scholarly journals The Role of Competency and Succession Program to Retain Millennial Healthcare Workers (Case Study in Indonesian Small Scale Maternity Hospital)

2021 ◽  
Vol 6 (1) ◽  
pp. 198-205
Author(s):  
Mira Pratiwi ◽  
Sandra Dewi ◽  
. Hasyim
Keyword(s):  
Leadership Style ◽  
Turnover Intention ◽  
Healthcare Workers ◽  
Turnover Rate ◽  
Research Effort ◽  
Maternity Hospital ◽  
Small Scale ◽  
Leadership Traits ◽  
Turnover Rates ◽  
High Turnover

The turnover rates among millennial employees have become serious issue for many industries including healthcare industry. The negative economically outcome due to high turnover rate can vary from direct and indirect, tangible and intangible cost to the organization. The cause of high turnover rate has been explained in many literatures, which includes leadership as one of the factors. Many studies have been underlining the importance of leadership style in lowering the number of turnover. Albeit some of leadership style may be proven to be effective in certain organization, the shift of millennial characteristic pressed other scholars to analyze if current theories of leadership style may sufficient and fitting to millennial. Therefore, there has been a gap in the literature between leadership style and leadership traits. The purpose of this research is to study the relation between effective leadership traits for managing millennial and its’ impact to lower millennial healthcare workers turnover intention. Teamwork is an important aspect in millennial setting; therefore, it is used as moderator to imply if teamwork may strengthen the relation between the two previous variables. The study was held in a small-scale maternity hospital in Malang, Indonesia, with the population of 57 millennial employees. The results of this research effort may help to fill the gap in the literature about the relationship between leadership traits, teamwork, and employee’s turnover for millennial in the workplace; and will hopefully help the organization to understand better the millennial motives to stay, and to bridge understanding between employer and employees.

FAKTOR PERSONAL YANG BERHUBUNGAN DENGAN KOMITMEN ORGANISASI PERAWAT RSUD EMBUNG FATIMAH BATAM

2020 ◽  
Vol 5 (3) ◽  
pp. 875
Author(s):  
Asfri Sri Rahmadeni
Keyword(s):  
Organizational Commitment ◽  
Turnover Rate ◽  
Sampling Technique ◽  
Hospital Nurses ◽  
Test Results ◽  
Personal Factors ◽  
High Turnover ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test

<p class="Normal1"><em>Commitment is the attitude or behavior of likes or dislikes shown by someone against the organization at work. Indonesia is recorded as a nurse who has a low organizational commitment (76%) so it harms services. This phenomenon in the hospital can be seen from the indicator of the high turnover rate of nurses which reaches 30.9% which exceeds the standard &lt;5%. Many factors affect organizational commitment. The purpose of this study was to analyze the Personal Factors Associated with Organizational Commitment of Hospital Nurses. This study is a cross-sectional analytic study and purposive sampling technique with a sample of 59 nurses. Chi-Square test results obtained personal factors that have a relationship with organizational commitment Nurse Hospital is age with p = 0,000 and education with p = 0,000, personal factors not related to organizational commitment are gender p = 1,053 and years of service with p = 1,147. Hospitals should conduct research/surveys on Organizational Commitment periodically as an evaluation material in the context of the organization's development and development in the future</em>.</p>

Seizures following surgery for supratentorial extratemporal low-grade tumors in children: a multicenter retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 27-33
Author(s):  
Jonathan Roth ◽  
Or Bercovich ◽  
Ashton Roach ◽  
Francesco T. Mangano ◽  
Arvind C. Mohan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brain Tumors ◽  
Seizure Control ◽  
Seizure Activity ◽  
Refractory Epilepsy ◽  
Low Grade ◽  
Refractory Seizures ◽  
Low Rate ◽  
Over Time ◽  
New Onset

OBJECTIVEResection of brain tumors may lead to new-onset seizures but may also reduce seizure rates in patients presenting with seizures. Seizures are seen at presentation in about 24% of patients with brain tumors. For lesional epilepsy in general, early resection is associated with improved seizure control. However, the literature is limited regarding the occurrence of new-onset postoperative seizures, or rates of seizure control in those presenting with seizures, following resections of extratemporal low-grade gliomas (LGGs) in children.METHODSData were collected retrospectively from 4 large tertiary centers for children (< 18 years of age) who underwent resection of a supratentorial extratemporal (STET) LGG. The patients were divided into 4 groups based on preoperative seizure history: no seizures, up to 2 seizures, more than 2 seizures, and uncontrolled or refractory epilepsy. The authors analyzed the postoperative occurrence of seizures and the need for antiepileptic drugs (AEDs) over time for the various subgroups.RESULTSThe study included 98 children. Thirty patients had no preoperative seizures, 18 had up to 2, 16 had more than 2, and 34 had refractory or uncontrolled epilepsy. The risk for future seizures was higher if the patient had seizures within 1 month of surgery. The risk for new-onset seizures among patients with no seizures prior to surgery was low. The rate of seizures decreased over time for children with uncontrolled or refractory seizures. The need for AEDs was higher in the more active preoperative seizure groups; however, it decreased with time.CONCLUSIONSThe resection of STET LGGs in children is associated with a low rate of postoperative new-onset epilepsy. For children with preoperative seizures, even with uncontrolled epilepsy, most have a significant improvement in the seizure activity, and many may be weaned off their AEDs.

Detection of Metal Toxicity Using Natural Phytoplankton as Test Organisms in the Great Lakes

1993 ◽  
Vol 28 (1) ◽  
pp. 155-176
Author(s):  
Mohiddin Munawari ◽  
Milos Legner
Keyword(s):  
Great Lakes ◽  
Metal Toxicity ◽  
Structural Changes ◽  
System Response ◽  
Turnover Rates ◽  
High Turnover ◽  
Spectra Analysis ◽  
Test Organisms ◽  
Future Potential ◽  
Natural Phytoplankton

Abstract This paper presents an overview of techniques utilizing natural phytoplankton for the detection of metal-Induced stress in the Great Lakes. Both field and laboratory procedures are designed to evaluate either structural changes or functional response of test organisms. This up-to-date compendium provides a choice of techniques, which permits a holistic assessment of the stress caused by toxic metals. Recently introduced techniques, such as normalized size spectra analysis, flow cytometry, and the evaluation of a continuous-flow system response to metal toxicity, are discussed in more detail to explore their future potential. Owing to their key position in the food web, high turnover rates, abundance, and sensitivity to environmental perturbation, phytoplankton serve as reliable early warning indicators of ecosystem deterioration and its restoration.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046865
Author(s):  
Gorkem Sezgin ◽  
Ling Li ◽  
Johanna Westbrook ◽  
Elisabeth Wearne ◽  
Denise Azar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Observational Study ◽  
General Practitioners ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Estimating Equation ◽  
Normal Serum ◽  
Retrospective Observational Study ◽  
Test Results ◽  
General Practices

Background and objectiveSerum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.Design, setting, patients and main outcome measuresA retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.Results3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.ConclusionSerum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

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