General practitioners’ management of the long-term sick role

In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees / patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons’s model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.

Rotational moulding of thermoplastic polyester urethanes

Various grades of Thermoplastic Polyurethane (TPU) supplied by Bayer were studied to determine their suitability for the rotational moulding process. Following grinding, parts were produced using a variety of peak internal air temperatures and cooling rates. The tensile and impact properties of these parts were then analysed and it was found that both the grade and moulding conditions had a large bearing on the quality and mechanical strength of the part produced.

Characterisation of densification temperature in rotational moulding

The temperature at which densification ends for a range of blends comprising a metallocene catalysed medium density polyethylene (PE) in two different physical forms (powder and micropellets) were investigated using a novel data acquisition system (TP Picture®), developed by Total Petrochemicals [1]. The various blends were subsequently rotomoulded and test specimens prepared for mechanical analysis to establish the relationship between densification rate and bubble size / distribution on the part properties. The micropellets exhibited more rapid bubble removal times than powder.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

General practitioners’ perceptions of the barriers and solutions to good quality palliative care in dementia

The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public.

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

Patterns and predictors of help-seeking contacts with health services and general practitioner detection of suicidality prior to suicide: a cohort analysis of suicides occurring over a two-year period

Background: Contact with primary care and psychiatric services prior to suicide may be considerable, presenting
opportunities for intervention. However, there is scant knowledge on the frequency, nature and determinants of<br/>contact.
Method: Retrospective cohort study-an analysis of deaths recorded as suicide by the Northern Ireland Coroner’s
Office linked with data from General Practice patient records over a 2 year period
Results: Eighty-seven per cent of suicides were in contact with General Practice services in the 12 months before
suicide. The frequency of contact with services was considerable, particularly among patients with a common
mental disorder or substance misuse problems. A diagnosis of psychiatric problems was absent in 40 % of suicides.
Excluding suicide attempts, the main predictors of a noted general practitioner concern for patient suicidality are
male gender, frequency of consultations, diagnosis of mental illness and substance misuse.
Conclusions: Despite widespread and frequent contact, a substantial proportion of suicidal people were
undiagnosed and untreated for mental health problems. General Practitioner alertness to suicidality may be too
narrowly focused.

THIRD ANNUAL REPORT OF THE AUDUBON SOCIETY OF SOUTH CAROLINA

Annual report of the Audubon Society of South Carolina, 1 January 1910, discusses fish and game laws, bird species found in the state of South Carolina, the effects of insects on local crops, and membership information. Report also includes a color illustration of a mockingbird on the inside of the front cover.

FIFTH ANNUAL REPORT OF THE AUDUBON SOCIETY OF SOUTH CAROLINA FOR NINETEEN FIFTEEN

Annual report of the Audubon Society of South Carolina for 1915 discusses educational work performed across the state by the organization in the previous year, including exhibits, symposiums, and lectures. Report also includes membership information.

FOURTH ANNUAL REPORT OF THE AUDUBON SOCIETY OF SOUTH CAROLINA

Annual report of the Audubon Society of South Carolina, 1 January 1911, discusses hunting licensing, fish and game laws, educational bird work performed by the Charleston Museum, and membership information.

First Annual Report of the Audubon Society of South Carolina

This document initially describes the rampant disregard for game laws in the state, which caused people to write to the Audubon Society to get involved. The responded by printing and distributing pamphlets with South Carolina’s game laws to educate citizens who were possibly violating the laws out of ignorance. The society appointed new wardens to enforce the gaming laws and a list of the new wardens is included in the document. There is a description of the work the wardens are supposed to do as well as their duty and pay. The society enlisted the government to help put a stop to the disregard for the games laws and the president wrote his opinion of their reactions to the problem. The document then includes a treasurer’s report and a list of members of the society. The document ends with the secretary’s report.

Second Annual Report of the Audubon Society of South Carolina

This document initially contains a directory of the society’s officers and directors. There is then a report of the society’s objects and present condition following the first annual report. They describe their legislature campaign as well as its shortfalls. The document describes the current hunting and resident licenses in the state. A description of the fish and game commissioner is included as well as a description as to why such a position needed to be created. This document includes a description of the Society’s work since the last meeting as well as the overall attitude of the society. There is a description of various different types of birds in order to have an official description to describe the bird that correlates to the laws protecting it. There is a description of the work of the wardens as well as a report and a list of wardens who have not given a report to the society. There is a list of each county and how many non-resident licenses each county has issued along with how much income those sales generated. There are then several bills proposed by the society followed by the secretary’s report. The document then includes the treasurer’s report and a list of members.