Between path dependency and contingency: new challenges for the geography of port system evolution.

Seaports play a critical role as gateways and facilitators of economic interchange and logistics processes and thus have become crucial nodes in globalised production networks andmobility systems. Both the physical port infrastructure and its operational superstructure have undergone intensive evolution processes in an effort to adapt to changing economic environments, technological advances,maritime industry expectations and institutional reforms. The results, in terms of infrastructure, operator models and the role of an individual port within the port system, vary by region, institutional and economic context. While ports have undoubtedly developed in scale to respond to the changing volumes and structures in geographies of trade (Wilmsmeier, 2015), the development of hinterland access infrastructure, regulatory systems and institutional structures have in many instances lagged behind. The resulting bottlenecks reflect deficits in the interplay between the economic system and the factors defining port development (e.g. transport demand, the structure of trade, transport services, institutional capacities, etc. cf. Cullinane and Wilmsmeier, 2011). There is a wide range of case study approaches and analyses of individual ports, but analyses from a port system perspective are less common, and those that exist are seldom critical of the dominant discourse assuming the efficiency of market competition (cf. Debrie et al., 2013). This special section aims to capture the spectrum of approaches in current geography research on port system evolution. Thus, the papers reach from the traditional spatial approach (Rodrigue and Ashar, this volume) to network analysis (Mohamed-Chérif and Ducruet, this volume) to institutional discussions (Vonck and Notteboom, this volume; Wilmsmeier and Monios, this volume). The selection of papers allows an opening of discussion and reflection on current research, necessary critical analysis of the influences on port systemevolution and,most importantly, future directions. The remainder of this editorial aims to reflect on these challenges and identify the potential for future research.

Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.