Room for improvement? Leadership,innovation culture and uptake of quality improvement methods in general practice

Background Leadership and innovation are currently seen as essential elements for the development and maintenance of high‐quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Method Self‐administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12‐item scale to assess leadership behaviour, a seven‐dimension self‐rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Results Sixty‐three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Conclusions Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate.     

Core strength: A new model for injury prediction and prevention

Objective  

Many work in injury prone awkward positions that require adequate flexibility and strength in trunk stabilizer muscle groups. Performance on a functional movement screen (FMS) that assessed those factors was conducted and an intervention was designed.     

A cross-sectional study of vascular risk factors in a rural South African population: data from the Southern African Stroke Prevention Initiative (SASPI)

Background  

Rural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21^st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa.     

Participatory mapping of target areas to enable operational larval source management to suppress malaria vector mosquitoes in Dar es Salaam,Tanzania

Background  

Half of the population of Africa will soon live in towns and cities where it can be protected from malaria by controlling aquatic stages of mosquitoes. Rigorous but affordable and scaleable methods for mapping and managing mosquito habitats are required to enable effective larval control in urban Africa.     

Physical activity,medical history,and risk of testicular cancer (Alberta and British Columbia,Canada)

In order to evaluate risk factors for germ cell cancers, we conducted a case-control study of 510 men with testicular cancer aged 15 to 79 years and 996 randomly selected age-matched controls in the provinces of British Columbia and Alberta, Canada. Subjects completed a mailed questionnaire providing data on education level, ethnic origin, medical history, smoking, occupation, and recreational and sports activity. The response rate among cases was 80.3 percent and among controls was 68.1 percent. After controlling for age and ethnic origin, undescended testis was associated positively with risk of testicular cancer (odds ratio [OR]=3.5; 95 percent confidence interval [CI]=2.2–5.7) as was inguinal hernia requiring surgery (OR=2.0, CI=1.3–2.9), and hydrocoele (OR=2.6, CI=1.4–5.1). Risk of testicular cancer increased with height, with subjects taller than 180 cm having a significantly increased risk compared with those 174 cm or less (OR=1.5, CI=1.1–2.1). A moderate to high level of recreational activity level was associated inversely with testicular cancer risk (OR=0.6, CI=0.5–0.8).This project was supported by the National Health Research and Development Program (6610-1340-53) and by Health Canada through a contract from the Action Plan on Health and the Environment.     

Incident-related stressors,locus of control,coping, and psychological distress among firefighters in Northern Ireland

This study was an investigation into the associations between incident-related stressors, locus of control, coping, and psychological distress in firefighters in Northern Ireland during the time of political violence. Among 248 male firefighters, greater psychological distress was associated with greater frequency of incident-related negative emotions, external locus of control, less task- and emotion-focused coping, and greater avoidance coping. It was also found that the frequency of exposure to incident-related stressors moderated the association between locus of control and psychological distress and that avoidance coping mediated the relationship between locus of control and psychological distress. Avoidance coping accounted for most of the explained variance in psychological distress. These results point to the potential value of coping-skills training in emergency personnel.     

Polymorphism of roxifiban

Roxifiban was found to exist in two polymorphic forms. The polymorphs were detected by X-ray powder diffraction and solid-state carbon nuclear magnetic resonance. A slight difference between the two polymorphs was also detected by isothermal microcalorimetry. However, no differences were observed by differential scanning calorimetry, infrared, or Raman spectroscopy. Solubility studies as a function of temperature in a discriminating solvent system permitted characterization of the thermodynamics of the polymorphs. The enthalpy of solution at 25 degrees C was 8.1 kcal/mol and 8.9 kcal/mol for Form I and Form II, respectively, and the thermodynamic transition point was 132 degrees C. The data confirm that the polymorphs are enantiotropic. Form II is the thermodynamically stable crystal form over the practical range of drug substance storage and handling and dosage form processing and storage. However, Form I has been kinetically stable after storage for more than 36 months at 25 degrees C/60% relative humidity with no conversion to Form II occurring.     

Field efficacy of thermally expelled or live potted repellent plants against African malaria vectors in western Kenya

OBJECTIVE: To estimate the effectiveness of live potted plants and thermal expulsion of plant materials in repelling African malaria vectors in traditional houses in western Kenya. METHODS: Ocimum americanum, Lantana camara and Lippia ukambensis were tested in live, intact potted form whereas leaves of Corymbia citriodora, leaves and seeds of O. kilimandscharicum and O. suave were tested by thermal expulsion from modified traditional stoves. A latin square design was applied for randomly assigning the treatment and control plants to experimental houses over different nights. RESULTS: All plant species showed significant repellency against Anopheles gambiae sensu lato Giles (Diptera: Culicidae) (81.5%An. arabiensis Patton and 18.5%An. gambiae sensu stricto Giles), the main vectors of malaria in Africa, with the highest repellency by C. citriodora (48.71%, P < 0.0001) followed by an equal level of repellency of O. kilimandscharicum and O. suave (44.54%, P = 0.001) during application of plant material by thermal expulsion. All three plant species also showed a residual effect against An. gambiae s.l. with 36-44% repellency post-application period (22.30-06.30 hours) after a period of thermal expulsion. Similarly, intact potted plants of O. americanum and L. camara repelled An. gambiae s.l. significantly (37.91%, P = 0.004; and 27.22%, P = 0.05, respectively). Thermal expulsion of leaves and seeds of O. kilimandscharicum significantly repelled An. funestus Giles, although none of the potted plants repelled this species. CONCLUSION: Both methods of application may offer cost-effective alternatives as additional means of household protection, and a useful complement to bed nets, particularly for the early part of the evening before bedtime.