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This study assessed the work-related resources and demands experienced by children’s hospice staff to help identify staff support systems and organizational practices that offer the most potential to prevent staff burnout and enhance well-being at work.
The relationships between individual and organizational characteristics, work-related resources and demands, and burnout and work engagement outcomes experienced by children’s hospice staff were explored using two surveys: the Children’s Hospice Staff survey, completed by UK children’s hospice staff, and the Children’s Hospice Organisation and Management survey, completed by the Heads of Care. We used structural equation modeling to assess the relationships between the variables derived from the survey measures and to test a model underpinned by the Job Demands-Resource (JD-R) theory.
There were 583 staff responses from 32 hospices, and 414 participants provided valid data for burnout and work engagement outcome measures. Most participants were females (95.4%), aged 51–65 years old (31.3%), and had more than 15 years of experience in life-limiting conditions (29.7%). The average score for burnout was 32.5 (SD: 13.1), and the average score for work engagement was 7.5 (SD: 1.5). The structural model validity showed good fit. Demands significantly predicted burnout (b = 4.65, p ≤ 0.001), and resources predicted work engagement (b = 3.09, p ≤ 0.001). The interaction between resources and demands only predicted work engagement (b = −0.31, p = 0.115). Burnout did not predict work engagement (b = −0.09, p = 0.194).
Significance of results
The results partly supported the JD-R model, with a clear association between resources and work engagement, even when the demands were considered. Demands were only directly associated with burnout. The findings also identified a set of the most relevant aspects related to resources and demands, which can be used to assess and improve staff psychological well-being in children’s hospices in the UK.
The claimant was born vaginally presenting as a breech baby. Earlier in the course of labour the claimant’s mother called hospital but was advised not to come into hospital at that point in time. This resulted in a delay and by the time the patient attended hospital it was too late to perform a caesarean section (CS), resulting in the circulatory collapse and consequent brain injury arising from a vaginal breech delivery.
Chapter 13 focuses more specifically on supermarket power and explore how efficiency and fairness become interdependent discourses in supermarket-supplier relations. Concentration in large grocery retail, in conjunction with associated growth in private labels and retailer control over shelf space, have generated a substantial power imbalance between big supermarket chains and the businesses that supply them. Supermarkets are said to be exploiting the imbalance to their own advantage, spawning a growing chorus of complaints from suppliers and from their representative organisations and political supporters. It has also garnered intense media, political and regulatory attention across a range of jurisdictions. This Chapter uses the analytical technique of problematisation to demonstrate how the “problem” concerning supermarket-supplier relations involves two distinct discourses relating to competition, on the one hand, and fairness, on the other. It highlights both potential tensions and interdependencies between these discourses and explores how they have been salient in both framing the aforementioned problem in public and policy debates and shaping regulatory responses. In particular, it critically examines the emergence of codes of conduct as a response to this problem drawing primarily on experience in Australia and to some extent, by way of comparison, the United Kingdom.
The authority to prescribe raises a range of important ethical concerns. This chapter provides an account of the ethical issues in independent and supplementary prescribing with an overview of ethical frameworks, medical and non-medical prescribers. The core of ethical considerations of prescribing is the imbalance of power between the prescriber and patient where there is the potential for abuse and the power to control. As such, links to governing bodies are included with specific relationships between ethics and codes to remind practitioners that objective external standards are necessary to ensure they have a frame of reference against which to judge their actions
We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.
Design and measurements:
A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.
Setting and participants:
Patients admitted to the medical/surgical ICU services were eligible.
Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28).
Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.
Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.
To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.
This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.
There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.
Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
To systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.
People living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.
Six databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.
Twenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.
The themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.
Patent systems commonly empower courts to order accused or adjudged infringers to refrain from continuing infringing conduct in the future. Some patentees file suit for the primary purpose of obtaining and enforcing an injunction against infringement by a competitor, and even in cases in which the patentee is willing to license an invention to an accused infringer for an agreed price, the indirect monetary value of an injunction against future infringement can dwarf the amount a finder of fact is likely to award as compensation for past infringement. In some of these cases, an injunction, if granted, would impose costs on accused infringers or third parties that go well beyond the more intrinsic value of the patented technology. This chapter explores the theory behind injunctive relief in patent cases, surveys the availability of this remedy in major patent systems, and suggests a general framework for courts to use when deciding whether injunctive relief is appropriate in individual cases.
Holt et al show that a lifestyle intervention did not reduce weight in people with schizophrenia. The STEPWISE trial casts a critical focus on the challenges of improving physical health in people with schizophrenia. The trial underpins efforts to maintain momentum in overcoming the unacceptable health inequalities in this population.
Small, irregular terraces on hillslopes, or terracettes, are common landscape features throughout west central China. Despite their prevalence, there is limited understanding of the nature of these topographic features, the processes that form them, and the role humans played in their formation. We used an interdisciplinary approach to investigate the geology, ecology, and cultural history of terracette development within Jiuzhaigou National Park, Sichuan Province, China. Terracettes occur on south facing, 20° slopes at 2500 m elevation, which appears to coincide with places people historically preferred to build villages. Ethnographic interviews suggest that traditional swidden agricultural cycles removed tree roots, causing the loess sediments to lose cohesion, slump, and the terrace risers to retreat uphill over time. This evidence is supported by landslide debris at terracette faces. Archaeological analysis of terracette sites reveal remains of rammed spread soil structures, bones, stone tools, and ceramics dating from at least 2200 years before present within a distinct paleosol layer. Radiocarbon and optically stimulated luminescence dating of terracette sediments ranged in age from between 1500 and 2000 14C yr BP and between 16 and 0.30"ka, respectively. These multiple lines of evidence indicate a long history of human habitation within Jiuzhaigou National Park and taken together, suggest strong links between terracette formation and human-landuse interactions.
The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.
There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.
Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation.
A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient’s treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient’s preference about their treatment regimen (χ2=6.6, P=0.036, Cramer’s V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
Although quantitative interpretation of the low-frequency electrical conductivity of ice cores from central Greenland is complicated by temperature variations of the measured core, annual layers can be recognized in sections of the core that are not impacted by non-seasonal features. Ambiguities in counting of annual layers can be minimized by comparing the electrical conductivity measurements to measurements of dust concentration and visual stratigraphy. A non-linear relationship between applied voltage and the current measured across two electrodes complicates the quantitative comparison of measurements made with different equipment, but does not affect the overall shape of the observed features.
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