Sharing care between hospital and the community: a critical review of developments in the UK

Recent changes in health policy in the United Kingdom have emphasized the key importance of a collaborative and multidisciplinary approach to the organization of health care. These changes have resulted in the formulation of programmes of shared care involving professionals from all areas of institutional and community practice. This paper critically explores the literature relating to shared care between hospital consultants and general practitioners (GPs) in the UK. The paper takes as its focus some clinical conditions for which shared care arrangements have been put into effect, and the implications of shared care for prescribing practice are discussed.     

Expanding the Role of the Nurse: Nurse Practitioners and Case Managers

ABSTRACT: This paper discusses the impact of health trends on the structure of nursing organisations and the function and education of the professional nurse. It is argued that these changes are promoting a demand for autonomous nursing practice in the form of nurse practitioners and nurse case managers. The challenge to the profession is viewed in terms of making current health policies work for the achievement of professional goals, rather than against them.     

The acute stroke unit as a meaningful space: The lived experience of healthcare practitioners

This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals’ flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.     

The influence of registered nurses and nurse practitioners on patient experience with primary care: results from the Canadian QUALICO-PC study

Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients’ experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams.     

Workload and job satisfaction among general practitioners: a review of the literature

The workload of general practitioners (GPs) is an important issue in health care systems with capitation payment for GPs services. This article reviews the literature on determinants and consequences of workload and job satisfaction of GPs. Determinants of workload are located on the demand side (list size and composition of the patient population) and the supply side (organization of the practice and personal characteristics of the GP). The effects of workload and job satisfaction on workstyle and quality of work have been reviewed. The length of consultations or booking intervals seems to be an important restriction for workstyle and quality of work.     

Deep and surface learning in problem-based learning: a review of the literature

In problem-based learning (PBL), implemented worldwide, students learn by discussing professionally relevant problems enhancing application and integration of knowledge, which is assumed to encourage students towards a deep learning approach in which students are intrinsically interested and try to understand what is being studied. This review investigates: (1) the effects of PBL on students’ deep and surface approaches to learning, (2) whether and why these effects do differ across (a) the context of the learning environment (single vs. curriculum wide implementation), and (b) study quality. Studies were searched dealing with PBL and students’ approaches to learning. Twenty-one studies were included. The results indicate that PBL does enhance deep learning with a small positive average effect size of .11 and a positive effect in eleven of the 21 studies. Four studies show a decrease in deep learning and six studies show no effect. PBL does not seem to have an effect on surface learning as indicated by a very small average effect size (.08) and eleven studies showing no increase in the surface approach. Six studies demonstrate a decrease and four an increase in surface learning. It is concluded that PBL does seem to enhance deep learning and has little effect on surface learning, although more longitudinal research using high quality measurement instruments is needed to support this conclusion with stronger evidence. Differences cannot be explained by the study quality but a curriculum wide implementation of PBL has a more positive impact on the deep approach (effect size .18) compared to an implementation within a single course (effect size of ?.05). PBL is assumed to enhance active learning and students’ intrinsic motivation, which enhances deep learning. A high perceived workload and assessment that is perceived as not rewarding deep learning are assumed to enhance surface learning.     

Measuring the shortage of medical practitioners in rural and urban areas in developing countries: a simple framework and simulation exercises with data from India

This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment).The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, per head of population, is relatively greater in the rural areas; this is because of the relatively large numbers of the unqualified doctors in those areas. On the other hand, a 'quality adjusted' total, with lower weights for the unqualified doctors, found little overall difference between the rural and urban areas. Third, allowance for rural-urban differences in the difficulties of access showed that the number of accessible practitioners is much lower in the rural areas. Fourth, rural-urban differences in the incidence of health hazards and estimates of the need for medical treatment also showed a marked shortage of practitioners in the rural areas.The main implication of the results is that developmental efforts in the rural areas, including improvements in transport facilities and reduction of health hazards, would help to greatly reduce the shortage of practitioners in those areas. Training programmes to improve the quality of practitioners in the rural areas are also required.     

The experience of infertility: a review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.     

Teaching and learning pathology: a critical review of the English literature

AIM: There are few publications summarising the main issues concerning pathology teaching and learning within undergraduate medical degrees. This article examines the themes that have emerged from the literature over the last 2 decades. METHOD: A literature search was performed using PubMed, which identified 86 relevant papers in the English language. RESULTS: The themes discussed in the literature included the timing and duration of pathology courses, the appropriate pathology teacher for medical students, the teaching strategies used for pathology, and the methods used to assess learning. DISCUSSION: With the gradual increase of integrated medical curricula, it is important for pathology teachers to engage in the change process and help to shape the new-style courses. One of the positive aspects of change is that it can provide an opportunity to rethink current practice. It is hoped that this paper might stimulate discussion about how pathology is taught and learnt, leading to further developments in this area.     

国内外全科医生工作满意度研究综述

全科医生作为基层医疗卫生服务的主要提供者,其服务质量和水平的提升对增进居民健康具有重要意义,而工作满意度直接影响了其医疗过程,进而影响到整个基本医疗卫生服务的供给效率和质量。因此,笔者从全科医生工作满意度这一视角入手,通过文献梳理,比较分析国内外全科医生工作满意度的测量工具、满意度水平和影响因素,从而对全科医生工作满意度的研究现状进行综述。研究发现国内全科医生工作满意度研究方法单一、内容趋于一致。在影响因素的研究中需进一步考虑加入工作自主性、工作多样性、客观工作环境等工作特征相关因素。在研究设计时考虑论证强度更高的纵向研究或队列研究。将研究结果与政策制定相结合,通过研究促进全科医生制度的完善。     

Correlates to Long-Term-Care Nurse Turnover: Survey Results from the State of West Virginia

The authors sought statistical correlates to long-term-care nurse turnover using surveys from 253 practicing nurses across 54 of 55 counties in West Virginia. A chi-square test for homogeneity showed significant relationships between select demographic variables and job-related dimensions categorized either as benefits (pay, schedule flexibility and growth opportunity, travel time to work, patient behavior, facility conditions, supervisor relations) or job-related dimensions categorized as costs (travel time to work, patient behavior, facility conditions, supervisor relations, and family needs). Five demographic characteristics: gender, education level, job title, county in West Virginia region, and facility size bore no relationship to any job-related dimension listed.     

Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom

This paper addresses shifting constructions of professional identity in the context of debates about reflexive modernisation and the changing role of professionals in the provision of primary healthcare. Data are drawn from interviews with 20 early-career general practitioners (GPs), who accounted for their orientations towards work in rather different ways from those typically reported in much primary care research. In particular, they reported high job satisfaction and success in achieving what they called 'nice work'. We argue that these GPs typify a shift in discourses of professionalism, characterised by respondents as the 'new general practice', which explicitly rejects many values attributed to 'traditional' general practice. Within the 'new general practice', professionalism has been de-coupled from some of the paradigmatic traits of traditional rhetorical accounts (such as vocation), and has significantly reframed others. Despite policy concerns that a retreat from 'vocational' professionalism will lead to reductions in service quality, we argue that this is not inevitable. The 'new general practice' resonates with the social values of reflexive modernisation, and has the potential to enable new, less paternalistic, forms of relationships with clients, although it remains to be seen whether this potential is realised in healthcare delivery.     

《抗菌药物临床应用管理办法》 —— 医疗机构抗菌药物管理的纲领

  目的  评价社会规范反馈（SNF）减少临床医生抗生素处方行为的干预效果,为减缓抗菌药物的不合理使用提供参考依据。  方法  检索中国期刊全文数据库、维普期刊全文数据库、万方数据库、PubMed数据库、Web of Science数据库、Scopus数据库和EMBASE数据库,并辅以文献追溯法收集各数据库从建库至2021年10月31日公开发表的关于SNF减少医生抗生素处方行为的相关文献,应用Stata16.0统计学软件对纳入的文献进行meta分析。  结果  最终纳入9篇英文文献,累计样本量19528例;meta分析结果显示,SNF干预可使临床医生的抗生素处方率降低4 %（RD = – 0.04,95 % CI = – 0.06～ – 0.03）;亚组分析结果显示,干预间隔 < 3个月和 ≥ 3个月、干预单元为医生和医疗机构、干预方式为信件和邮件/电子弹窗、排名方式以模糊排名的SNF干预均可降低临床医生的抗生素处方率（均P < 0.001）;敏感性分析和发表偏倚检验结果显示,本次meta分析纳入的文献存在的发表偏倚较小,结果相对稳定。  结论  SNF干预可减少临床医生的抗生素处方行为。     

Decision-making in community-based paediatric physiotherapy: a qualitative study of children, parents and practitioners

Approaches to practice based on partnership and shared decision-making with patients are now widely recommended in health and social care settings, but less attention has been given to these recommendations in children's services, and to the decision-making experiences of non-medical practitioners and their patients or clients. This study explored children's, parents' and practitioners' accounts of shared decision-making in the context of community-based physiotherapy services for children with cerebral palsy. Semi-structured interviews were conducted with 11 children with cerebral palsy living in an inner city area of northern England, and with 12 of their parents. Two focus groups were conducted with 10 physiotherapy practitioners. Data were analysed using the constant comparative method. When asked explicitly about decision-making, parents, children and practitioners reported little or no involvement, and each party saw the other as having responsibility for decisions. However, when talking in more concrete terms about their experiences, each party did report some involvement in decision-making. Practitioners' accounts focused on their responsibility for making decisions about resource allocation, and thereby, about the usefulness and intensity of interventions. Parents indicated that these practitioner-led decisions were sometimes in conflict with their aspirations for their child. Parents and children appeared to have most involvement in decisions about the acceptability and implementation of interventions. Children's involvement was more limited than parents'. While parents could legitimately curtail unacceptable interventions, children were mostly restricted to negotiating about how interventions were implemented. In these accounts the involvement of each party varied with the type of issue being decided and decision-making appeared more unilateral than shared. In advocating shared decision-making, greater understanding of its weaknesses as well as its strengths, and greater clarity about the domains that are suitable for a shared decision-making approach and the roles of different parties, would seem a helpful step.     

Professionalism and the preparation of early childhood education practitioners

The call for reform in early childhood education has resulted in proposals for improving the level of professionalism among early childhood practitioners and the establishment of credentialling systems. A further result has been the modification of state early childhood teacher certification. This paper argues that the integration of new knowledge emerging from studies of practice and child development can help raise levels of professionalism.