The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

scholarly journals Elderspeak in Acute Hospitals? The Role of Context, Cognitive and Functional Impairment

2020 ◽  
pp. 016402752094909
Author(s):  
Eva-Luisa Schnabel ◽  
Hans-Werner Wahl ◽  
Christina Streib ◽  
Thomas Schmidt
Keyword(s):  
Functional Impairment ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Computer Assisted ◽  
Stereotype Activation ◽  
Individual Level ◽  
Acute Hospitals ◽  
Level Information ◽  
Recorded Data

Older adults are often exposed to elderspeak, a specialized speech register linked with negative outcomes. However, previous research has mainly been conducted in nursing homes without considering multiple contextual conditions. Based on a novel contextually-driven framework, we examined elderspeak in an acute general versus geriatric German hospital setting. Individual-level information such as cognitive impairment (CI) and audio-recorded data from care interactions between 105 older patients ( M = 83.2 years; 49% with severe CI) and 34 registered nurses ( M = 38.9 years) were assessed. Psycholinguistic analyses were based on manual coding (κ = .85 to κ = .97) and computer-assisted procedures. First, diminutives (61%), collective pronouns (70%), and tag questions (97%) were detected. Second, patients’ functional impairment emerged as an important factor for elderspeak. Our study suggests that functional impairment may be a more salient trigger of stereotype activation than CI and that elderspeak deserves more attention in acute hospital settings.

scholarly journals Feasibility of laparoscopic abdominal wall reconstruction in an outpatient community-hospital setting using cPTFE prosthetic mesh: a prospective, multicenter case series

2016 ◽  
Vol 44 (6) ◽  
pp. 1506-1513
Author(s):  
Terry Unruh ◽  
Joseph Adjei Boachie ◽  
Eduardo Smith-Singares
Keyword(s):  
Community Hospital ◽  
Abdominal Wall Reconstruction ◽  
Hospital Setting ◽  
Case Series ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Community Hospitals ◽  
Patient Reported ◽  
Secondary Endpoints

Objective This study investigated the use of prosthetic condensed polytetrafluoroethylene (cPTFE) for laparoscopic ventral hernia repair (LVHR) in an outpatient community-hospital setting. Methods Patients underwent LVHR with cPTFE at one of three community hospitals. Primary endpoint was hernia recurrence at 1-year postoperatively. Secondary endpoints included pain, surgical site infection, medical/surgical complications, and patient-reported outcomes. Results This study included 65 females and 52 males, aged 46.6 ± 13.2 years (mean ± SD; range 18–84 years). Mean prosthetic size was 413.8 ± 336.11 cm2 (range 165–936 cm2). Mean follow-up was 30 months (range 12–46 months). Hernia recurrence rate was 4.3%. Rate of hospitalization in the first postoperative week was 2.6%. Early and late secondary endpoint complication rates were 24.8% and 27.4%, respectively; pain was the most common complication, followed by seroma (8.5%). Conclusions Outpatient LVHR using cPTFE is feasible in community hospitals. Complication rates were similar to previous reports, and the seroma rate was markedly lower.

Science Parks from a University Perspective

2001 ◽  
Vol 15 (3) ◽  
pp. 211-218
Author(s):  
Malcolm Parry
Keyword(s):  
Local Community ◽  
Low Cost ◽  
Social Business ◽  
Science Parks ◽  
Science Park ◽  
The Social ◽  
Learning Region ◽  
The Impact ◽  
Changing Role

In the context of the changing role of universities and the increasing emphasis on their function in the regional economy, the author assesses the establishment and development of the UK's science parks from the universities' perspective. Identifying the science park as a key instrument for the successful engagement of a university with its local community, he looks at the impact of parks on the processes of invention, innovation, technology transfer, commercialization and enterprise. He then outlines the three strategies available to a university for involvement in science park development – from high to low cost and high to low control. Finally, the author considers the influences on successful park development of the social, business and technological environments. He concludes that the mission of universities, together with their changing role, requires them to be the cohesive force in the learning region. The science park is a means of turning this concept into reality.

scholarly journals 11 * REDUCING INAPPROPRIATE ADMISSIONS OF OLDER PEOPLE INTO ACUTE HOSPITALS: THE ROLE OF A RAPID ACCESS CLINIC IN A COMMUNITY HOSPITAL

2014 ◽  
Vol 43 (suppl 1) ◽  
pp. i3-i3 ◽  
Author(s):  
D. Y. Koduah ◽  
D. Inegbenebor ◽  
J. Ambepitiya ◽  
M. Khan ◽  
F. Mlinaku ◽  
...  
Keyword(s):  
Older People ◽  
Community Hospital ◽  
Rapid Access ◽  
Acute Hospitals ◽  
Inappropriate Admissions ◽  
Rapid Access Clinic

scholarly journals Completeness of Prenatal Records in Community Hospital Charts

2018 ◽  
Author(s):  
Nedra W ◽  
Laura B. Strange ◽  
Sara M. Kennedy ◽  
Katrina D. Burson ◽  
Gina L. Kilpatrick
Keyword(s):  
Intensive Care ◽  
Medical Care ◽  
Medical Records ◽  
Laboratory Tests ◽  
Community Hospital ◽  
Medical Condition ◽  
Medical Conditions ◽  
Community Hospitals ◽  
Newborn Intensive Care ◽  
Common Laboratory

We describe the completeness of prenatal data in maternal delivery records and the prevalence of selected medical conditions and complications among patients delivering at community hospitals around Atlanta, Georgia. Medical charts for 199 maternal-infant dyads (99 infants in normal newborn nurseries and 104 infants in newborn intensive care nurseries) were identified by medical records staff at 9 hospitals and abstracted on site. Ninety-eight percent of hospital charts included prenatal records, but over 20 percent were missing results for common laboratory tests and prenatal procedures. Forty-nine percent of women had a pre-existing medical condition, 64 percent had a prenatal complication, and 63 percent had a labor or delivery complication. Missing prenatal information limits the usefulness of these records for research and may result in unnecessary tests or procedures or inappropriate medical care.

The Javanese Kijaji: the Changing Role of a Cultural Broker

1960 ◽  
Vol 2 (2) ◽  
pp. 228-249 ◽  
Author(s):  
Clifford Geertz
Keyword(s):  
Local Community ◽  
Community Organization ◽  
White Collar ◽  
Political Elite ◽  
The Other ◽  
Mutual Understanding ◽  
Large Cities ◽  
The One ◽  
Changing Role

One of the most serious problems facing the post-revolutionary Indonesian political élite has turned out to be the maintenance of mutual understanding between themselves and the mass of the peasant population. The attempt to build up a modern national state out of a plurality of distinct regional cultures has been hampered by the difficulty of communication between people still largely absorbed in those cultures and the metropolitan-based nationalist leadership more oriented to the international patterns of intelligentsia culture common to ruling groups in all the new Bandung countries. On the one hand, the activist white-collar nationalists of the large cities are attempting to construct an integrated Indonesian state along generally western parliamentary lines; on the other, the peasants of the Javanese, Sundanese, Achenese, Buginese, etc. culture areas cling to the patterns of local community organization and belief with which they are intimately familiar.

scholarly journals Factors affecting the changing role of GP clinicians in community hospitals: a qualitative interview study in England

2019 ◽  
Vol 69 (682) ◽  
pp. e329-e335
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Angela Ellis-Paine ◽  
Jon Glasby ◽  
Helen Tucker
Keyword(s):  
Personal Development ◽  
Community Hospital ◽  
Clinical Skills ◽  
Qualitative Interviews ◽  
Significant Shift ◽  
Community Hospitals ◽  
Factors Affecting ◽  
Qualitative Interview Study ◽  
Hospital Work

BackgroundGPs were a key driving force for the development of a network of community hospitals across England, and have provided medical cover for most of them. However, during the past decade there has been a significant shift, with the dominant trend appearing to be one of declining GP involvement.AimTo explore how and why the role of GPs within community hospitals in England is changing.Design and settingQualitative study in a sample of nine diverse community hospitals in England.MethodQualitative interviews with community hospital clinical staff.ResultsIn all, 20 interviews were conducted and two models of medical care observed: GPs employed by a practice and trust-employed doctors. Interviewees confirmed the trend towards declining GP involvement, with the factors driving change identified as being GP workload and recruitment challenges, a change from ‘step-up’ admissions from the community to ‘step-down’ admissions from acute hospitals, fewer local patients being admitted, increased medical acuity of patients admitted, increased burden of medical support required, and inadequate remuneration. The majority of doctors viewed community hospital work in a positive light, welcoming the opportunities for personal development and to acquire new clinical skills. GPs viewed community hospital work as an extension of primary care, adding to job satisfaction.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital work.

scholarly journals Communities as ‘renewable energy’ for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030243
Author(s):  
Angela Ellis Paine ◽  
Daiga Kamerāde ◽  
John Mohan ◽  
Deborah Davidson
Keyword(s):  
Focus Groups ◽  
Patient Experience ◽  
Community Hospital ◽  
Well Being ◽  
Healthcare Services ◽  
Multidisciplinary Teams ◽  
Community Hospitals ◽  
Community Stakeholders ◽  
Charity Commission

ObjectiveTo examine the forms, scale and role of community and voluntary support for community hospitals in England.DesignA multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.SettingCommunity hospitals in England and their surrounding communities.ParticipantsCharity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).ResultsCommunities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.ConclusionsCommunities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or ‘renewable’.

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