scholarly journals GPs and paediatric oncology palliative care: a Q methodological study

2017 ◽  
Vol 10 (2) ◽  
pp. e11-e11 ◽  
Author(s):  
Sue Neilson ◽  
Faith Gibson ◽  
Stephen Jeffares ◽  
Sheila M Greenfield
Keyword(s):  
Palliative Care ◽  
Q Methodology ◽  
Paediatric Oncology ◽  
Diverse Range ◽  
Training Support ◽  
Team Player ◽  
Using Data ◽  
Consensus Time ◽  
The Uk ◽  
Knowledge Deficits

ObjectiveThis mixed-methods study set in the West Midlands region of the UK demonstrates the effectiveness of Q methodology in examining general practitioners' (GPs') perception of their role in children's oncology palliative care.MethodsUsing data obtained from the analysis of semistructured interviews with GPs who had cared for a child receiving palliative care at home and bereaved parents, 50 statements were identified as representative of the analysis findings. 32 GPs with a non-palliative child with cancer on their caseload were asked to rank the statements according to their level of agreement/disagreement on a grid. They were then asked to reflect and comment on the statements they most and least agreed with. The data were analysed using a dedicated statistical software package for Q analysis PQMethod V.2.20 (Schmolck 2012). A centroid factor analysis was undertaken initially with 7 factors then repeated for factors 1–6. Varimax and manual flagging was then completed.Results4 shared viewpoints were identified denoting different GP roles: the GP, the compassionate practitioner, the team player practitioner and the pragmatic practitioner. In addition consensus (time pressures, knowledge deficits, emotional toll) and disagreement (psychological support, role, experiential learning, prior relationships) between the viewpoints were identified and examined.ConclusionsQ methodology, used for the first time in this arena, identified 4 novel and distinct viewpoints reflecting a diverse range of GP perspectives. Appropriately timed and targeted GP education, training, support, in conjunction with collaborative multiprofessional working, have the potential to inform their role and practice across specialities.

scholarly journals Perceived Causes and Solutions to Soil Degradation in the UK and Norway

Land ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 131
Author(s):  
Niki Rust ◽  
Ole Erik Lunder ◽  
Sara Iversen ◽  
Steven Vella ◽  
Elizabeth A. Oughton ◽  
...  
Keyword(s):  
Soil Erosion ◽  
Soil Quality ◽  
Policy Development ◽  
Soil Degradation ◽  
Food Systems ◽  
Soil Structure ◽  
Q Methodology ◽  
Diverse Range ◽  
Systems Research ◽  
The Uk

Soil quality is declining in many parts of the world, with implications for the productivity, resilience and sustainability of agri-food systems. Research suggests multiple causes of soil degradation with no single solution and a divided stakeholder opinion on how to manage this problem. However, creating socially acceptable and effective policies to halt soil degradation requires engagement with a diverse range of stakeholders who possess different and complementary knowledge, experiences and perspectives. To understand how British and Norwegian agricultural stakeholders perceived the causes of and solutions to soil degradation, we used Q-methodology with 114 respondents, including farmers, scientists and agricultural advisers. For the UK, respondents thought the causes were due to loss of soil structure, soil erosion, compaction and loss of organic matter; the perceived solutions were to develop more collaborative research between researchers and farmers, invest in training, improve trust between farmers and regulatory agencies, and reduce soil compaction. In Norway, respondents thought soils were degrading due to soil erosion, monocultures and loss of soil structure; they believed the solutions were to reduce compaction, increase rotation and invest in agricultural training. There was an overarching theme related to industrialised agriculture being responsible for declining soil quality in both countries. We highlight potential areas for land use policy development in Norway and the UK, including multi-actor approaches that may improve the social acceptance of these policies. This study also illustrates how Q-methodology may be used to co-produce stakeholder-driven policy options to address land degradation.

Volunteering in hospice and palliative care in the United Kingdom

2018 ◽  
Author(s):  
Ros Scott
Keyword(s):  
Palliative Care ◽  
United Kingdom ◽  
Care Services ◽  
The United Kingdom ◽  
Strategic Direction ◽  
Palliative Care Services ◽  
History Of ◽  
The Uk ◽  
Hospice And Palliative Care ◽  
Changing Role

This chapter explores the history of volunteers in the founding and development of United Kingdom (UK) hospice services. It considers the changing role and influences of volunteering on services at different stages of development. Evidence suggests that voluntary sector hospice and palliative care services are dependent on volunteers for the range and quality of services delivered. Within such services, volunteer trustees carry significant responsibility for the strategic direction of the organiszation. Others are engaged in diverse roles ranging from the direct support of patient and families to public education and fundraising. The scope of these different roles is explored before considering the range of management models and approaches to training. This chapter also considers the direct and indirect impact on volunteering of changing palliative care, societal, political, and legislative contexts. It concludes by exploring how and why the sector is changing in the UK and considering the growing autonomy of volunteers within the sector.

scholarly journals A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽  
2021 ◽  
Author(s):  
Kate Williams ◽  
Samantha Hartley ◽  
Peter Taylor
Keyword(s):  
Delphi Study ◽  
Good Practice ◽  
Evidence Base ◽  
Clinical Settings ◽  
Training Support ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Uk ◽  
Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

scholarly journals Lockdown, slow down: impact of the COVID-19 pandemic on physical activity—an observational study

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001600
Author(s):  
Joanne Kathryn Taylor ◽  
Haarith Ndiaye ◽  
Matthew Daniels ◽  
Fozia Ahmed
Keyword(s):  
Physical Activity ◽  
New York ◽  
Heart Association ◽  
Evaluation Study ◽  
Activity Data ◽  
Cardiac Devices ◽  
Significant Difference ◽  
New York Heart Association ◽  
Using Data ◽  
The Uk

AimsIn response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study.MethodsThis study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of ‘stay at home’ lockdown measures in the form of ‘minutes active per day’ (min/day).ResultsData were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001).ConclusionsIn a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures.Trial registration numberNCT04177199.

Introducing Q Methodology to Program Evaluators

2021 ◽  
pp. 109821402093222
Author(s):  
Kevin Harris ◽  
Chad Oatley ◽  
Steven Mumford ◽  
Phung K. Pham ◽  
Heather Nunns
Keyword(s):  
Program Evaluation ◽  
Q Methodology ◽  
Pros And Cons ◽  
The Uk ◽  
Practical Demonstration ◽  
Recent Evaluation

This method note presents Q methodology as a useful tool for evaluators to add to their practice toolbox. Q methodology, which involves both quantitative and qualitative techniques, can help researchers and evaluators systematically understand subjectivity and the communicability of opinions and perspectives. We first provide an overview of Q methodology, followed by a brief summary of how evaluators are using Q, and an explanation of the steps for implementing Q methodology. Either by itself or with other methods, the potential uses of Q methodology in evaluation are diverse. For practical demonstration, we describe how Q methodology was used in a recent evaluation in the UK to understand stakeholder subjectivity within the program. We then reflect upon the pros and cons of using Q in program evaluation, concluding that it constitutes a worthwhile tool for evaluating complex programs.

scholarly journals The genetic architecture of structural left–right asymmetry of the human brain

2021 ◽  
Author(s):  
Zhiqiang Sha ◽  
Dick Schijven ◽  
Amaia Carrion-Castillo ◽  
Marc Joliot ◽  
Bernard Mazoyer ◽  
...  
Keyword(s):  
Brain Asymmetry ◽  
Functional Enrichment ◽  
Brain Organization ◽  
Genome Wide ◽  
Brain Expression ◽  
Using Data ◽  
Left Right Asymmetry ◽  
The Uk ◽  
Subcortical Volume

AbstractLeft–right hemispheric asymmetry is an important aspect of healthy brain organization for many functions including language, and it can be altered in cognitive and psychiatric disorders. No mechanism has yet been identified for establishing the human brain’s left–right axis. We performed multivariate genome-wide association scanning of cortical regional surface area and thickness asymmetries, and subcortical volume asymmetries, using data from 32,256 participants from the UK Biobank. There were 21 significant loci associated with different aspects of brain asymmetry, with functional enrichment involving microtubule-related genes and embryonic brain expression. These findings are consistent with a known role of the cytoskeleton in left–right axis determination in other organs of invertebrates and frogs. Genetic variants associated with brain asymmetry overlapped with those associated with autism, educational attainment and schizophrenia. Comparably large datasets will likely be required in future studies, to replicate and further clarify the associations of microtubule-related genes with variation in brain asymmetry, behavioural and psychiatric traits.

scholarly journals An audit of UK audiological practice in specialist paediatric oncology centres regarding hearing assessment of children at risk of ototoxicity due to chemotherapy

2021 ◽  
Vol 135 (1) ◽  
pp. 14-20
Author(s):  
E C M Brown ◽  
C Caimino ◽  
C L Benton ◽  
D M Baguley
Keyword(s):  
High Frequency ◽  
Good Practice ◽  
Paediatric Oncology ◽  
Chemotherapy Drugs ◽  
Team Working ◽  
Platinum Based Chemotherapy ◽  
Hearing Assessment ◽  
Self Test ◽  
The Uk ◽  
Monitoring Service

AbstractObjectivePlatinum-based chemotherapy drugs are associated with substantial ototoxicity. The hearing of children treated with these drugs should be closely monitored.MethodA questionnaire was sent out to the 19 audiology departments associated with national paediatric cancer specialist centres in the UK looking at current practice in ototoxicity monitoring.ResultsResponses were received from 17 of 19 centres (89 per cent). All offered some form of audiometric monitoring service. Extended high-frequency testing (9–20 kHz) was only utilised by 7 services (29 per cent). A majority of respondents were reluctant to consider self-test devices in paediatric ototoxicity monitoring (n = 9; 53 per cent). Provision of long-term audiological follow up is sporadic with only 4 (23 per cent) respondents keeping all children with normal hearing under review once treatment is completed.ConclusionWhile some good practice in paediatric ototoxicity was identified, opportunities exist to improve clinical practice and protocols, promote multidisciplinary team working and to utilise technologies such as extended high frequency and self-test audiometry.

scholarly journals Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair

2021 ◽  
pp. 105566562110196
Author(s):  
Alex Davies ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Scott Deacon ◽  
Alistair R.M. Cobb ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Primary Repair ◽  
Fistula Formation ◽  
The United Kingdom ◽  
Using Data ◽  
The Uk ◽  
The Relationship ◽  
Soft Edge ◽  
Intravelar Veloplasty ◽  
Pierre Robin

Objective: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. Design: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. Patients: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. Results: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( P < .001), increasing palatal soft-edge width ( P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. Conclusions: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

Sign in / Sign up

Export Citation Format

Share Document