The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Contact tracing investigation after professional exposure to tuberculosis in a Swiss hospital using both tuberculin skin test and IGRA.

SETTING: A 950 bed teaching hospital in Switzerland. AIM: To describe the result of a contact investigation among health care workers (HCW) and patients after exposure to a physician with smear-positive pulmonary tuberculosis in a hospital setting using standard tuberculin skin tests (TST) and Interferon-gamma release assay (IGRA). METHOD: HCW with a negative or unknown TST at hiring had a TST two weeks after the last contact with the index case (T0), repeated six weeks later if negative (T6). All exposed HCW had a T-SPOT.TB at T0 and T6. Exposed patients had a TST six weeks after the last contact, and a T-SPOT.TB if the TST was positive. RESULTS: Among 101 HCW, 17/73 (22%) had a positive TST at T0. TST was repeated in 50 at T6 and converted from negative to positive in eight (16%). Twelve HCW had a positive T-SPOT.TB at T0 and ten converted from negative to positive at T6. Seven HCW with a positive T-SPOT.TB reverted to negative at T6 or at later controls, most of them with test values close to the cut-off. Among 27 exposed patients tested at six weeks, ten had a positive TST, five of them confirmed by a positive T-SPOT.TB. CONCLUSIONS: HCW tested twice after exposure to a case of smear-positive pulmonary TB demonstrated a possible conversion in 10% with T-SPOT and 16% with TST. Some T-SPOT.TB reverted from positive to negative during the follow-up, mostly tests with a value close to the cut-off. Due to the variability of the test results, it seems advisable to repeat the test with values close to the cut-off before diagnosing the presence of a tuberculous infection.

The UK Professional Standards Framework for teaching and supporting learning in higher education

The UK Professional Standards Framework (UK PSF) for teaching and supporting learning, launched in February 2006, is a flexible framework which uses a descriptor-based approach to professional standards. There are three standard descriptors each of which is applicable to a number of staff roles and to different career stages of those engaged in teaching and supporting learning. The standard descriptors are underpinned by areas of professional activity, core knowledge and professional values. The framework provides a reference point for institutions and individuals as well as supporting ongoing development within any one standard descriptor.

Academic Integrity Guidelines - Professional Values

Explanatory notes on why academic integrity is important for students in their professional and personal development.

Bibliography profiling of undergraduate theses in a professional psychology program

The bibliographic profile of 125 undergraduate (licentiate) theses was analyzed, describing absolute quantities of several bibliometric variables, as well as within-document indexes and average lags of the references. The results show a consistent pattern across the years in the 6 cohorts included in the sample (2001-2007), with variations, which fall within the robust confi dence intervals for the global central tendency. The median number of references per document was 52 (99% CI 47-55); the median  percentage of journal articles cited was 55%, with a median age for journal references of 9 years. Other highlights of the bibliographic profile were the use of foreign language references (median 61%), and low reliance on open web documents (median 2%). A cluster analysis of the bibliometric indexes resulted  in a typology of 2 main profiles, almost evenly distributed, one of them with the makeup of a natural science bibliographic profile and the second within the style of the humanities. In general, the number of references, proportion of papers, and age of the references are close to PhD dissertations and Master theses, setting a rather high standard for undergraduate theses.

Referral letters in oral medicine: standard versus non-standard letters

Usually referral letters are the only means of communication between general practitioners and specialists in the health area. However, they are inadequate if important basic data are omitted. The aim of this study was to compare the content of standard and non-standard letters. A total of 1956 files from the Oral Medicine Service were consecutively evaluated (March 1996 to September 2000). Key items were considered for analysis and the results were stored in a database using the Epinfo 6.04 program. The X-2 test (a=0.05) was applied to the results. of the 1956 files examined, 34% (662) had a referral letter, 31% of them being standard letters and 69% non-standard letters. Most standard letters (87%) were from professionals of public health institutions. Most percent discrepancies between standard and non-standard letters were observed for patient address (14.90 vs 1.32%), patient age (54.81 vs 9.47%), chief complaint (32.21 vs 8.37%), fundamental lesion (29.33 vs 13.66%), and symptoms (27.81 vs 15.42%,,). Statistically significant differences were observed for patient age, professional referring the patient, chief complaint, and site of the lesion. The quality and quantity of the information differed significantly between the two types of letters. The standard letters were more complete and contained information commonly absent in the non-standard letters. We suggest the use of standard letters for improving the quality of communication among professionals.

Rapid hamstrings/quadriceps strength capacity in professional soccer players with different conventional isokinetic muscle strength ratios

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Left atrial remodeling, early repolarization pattern, and inflammatory cytokines in professional soccer players

OBJECTIVES: Although regular physical exercise clearly reduces cardiovascular morbidity risk, long-term endurance sports practice has been recognized as a risk factor for atrial fibrillation (AF). However, the mechanisms how endurance sports can lead to AF are not yet clear. The aim of our present study was to investigate the influence of long-term endurance training on vagal tone, atrial size, and inflammatory profile in professional elite soccer players. METHODS: A total of 25 professional major league soccer players (mean age 24+/-4 years) and 20 sedentary controls (mean age 26+/-3 years) were included in the study and consecutively examined. All subjects underwent a sports cardiology check-up with physical examination, electrocardiography, echocardiography, exercise testing on a bicycle ergometer, and laboratory analysis [standard laboratory and cytokine profile: interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, IL-8, IL-10]. RESULTS: Athletes were divided into two groups according to presence or absence of an early repolarization (ER) pattern, defined as a ST-segment elevation at the J-point (STE) >/=0.1mm in 2 leads. Athletes with an ER pattern showed significantly lower heart rate and an increased E/e' ratio compared to athletes without an ER pattern. STE significantly correlated with E/e' ratio as well as with left atrial (LA) volume. The pro-inflammatory cytokines IL-6, IL-8, TNF-alpha as well as the anti-inflammatory cytokine IL-10 were significantly elevated in all soccer players. However, athletes with an ER pattern had significantly higher IL-6 plasma levels than athletes without ER pattern. Furthermore, athletes with "high" level IL-6 had significantly larger LA volumes than players with "low" level IL-6. CONCLUSIONS: Athletes with an ER pattern had significantly higher E/e' ratios, reflecting higher atrial filling pressures, higher LA volume, and higher IL-6 plasma levels. All these factors may contribute to atrial remodeling over time and thus increase the risk of AF in long-term endurance sports.

Evaluación del rendimiento de jugadores y equipos de fútbol de nivel de élite en diferentes contextos situacionales = Evaluation on Match Performances of Professional Football Players and Teams under Different Situational Conditions = 不同情境条件下高水平足球运动员和运动队的比赛表现分析

El análisis del rendimiento en deportes juega un papel esencial en el fútbol profesional. Aunque el estudio del análisis del juego en fútbol se ha utilizado desde diferentes ámbitos y situaciones, todavía existen diferentes aspectos y componentes del juego que siguen sin estar estudiados. En este sentido existen diferentes aspectos que deben de superar los estudios previos centrados en el componente descriptivo tales como el uso de variables/ indicadores de rendimiento que no se han definido ni estudiado, la validez de los métodos observaciones que no han sido testados con los softwares específicos en fútbol, la aplicación y utilidad de los resultados, así como las limitaciones del estudio de las variables situacionales/contextuales. Con el objetivo de cubrir las citadas limitaciones se han diseñado 6 estudios independientes e inter-relacionados que tratan de estudiar los aspectos anteriormente referidos. El primer estudio evalua la fiabilidad inter-observadores de las estadísticas de juego de la empresa privada OPTA Sportsdata, estos datos son la muestra de estudio de la presente tesis doctoral. Dos grupos de observadores experimentados se requieren para analizar un partido de la liga española de manera independiente. Los resultados muestran que los eventos de equipos y porteros codificados por los inter-operadores alcanzan un acuerdo muy bueno (valores kappa entre 0.86 y 0.94). La validez inter-observadores de las acciones de juego y los datos de jugadores individuales se evaluó con elevados niveles de acuerdo (valores del coeficiente de correlación intraclase entre 0.88 hasta 1.00, el error típico estandarizado variaba entre 0.00 hasta 0.37). Los resultados sugieren que las estadísticas de juego registradas por los operadores de la empresa OPTA Sportsdata están bien entrenados y son fiables. El segundo, tercer y cuarto estudio se centran en resaltar la aplicabilidad del análisis de rendimiento en el fútbol así como para explicar en profundidad las influencias de las variables situacionales. Utilizando la técnica de los perfiles de rendimiento de jugadores y equipos de fútbol se puede evaluar y comparar de manera gráfica, fácil y visual. Así mismo, mediante esta técnica se puede controlar el efecto de las variables situacionales (localización del partido, nivel del equipo y del oponente, y el resultado final del partido). Los perfiles de rendimiento de porteros (n = 46 porteros, 744 observaciones) y jugadores de campo (n = 409 jugadores, 5288 observaciones) de la primera division professional de fútbol Española (La Liga, temporada 2012-13), los equipos (n = 496 partidos, 992 observaciones) de la UEFA Champions League (temporadas 2009-10 a 2012-13) fueron analizados registrando la media, desviación típica, mediana, cuartiles superior e inferior y el recuento de valores de cada indicador de rendimiento y evento, los cuales se presentaron en su forma tipificada y normalizada. Los valores medios de los porteros de los equipos de diferentes niveles de La Liga y de los equipos de diferente nivel de la UEFA Champions League cuando jugaban en diferentes contextos de juego y situaciones (variables situacionales) fueron comparados utilizando el ANOVA de un factor y la prueba t para muestras independientes (localización del partido, diferencias entre casa y fuera), y fueron establecidos en los perfiles de red después de unificar todos los registros en la misma escala derivada con valores estandarizados. Mientras que las diferencias de rendimiento entre los jugadores de los mejores equipos (Top3) y los peores (Bottom3) fueron comparados mediante el uso de diferencias en la magnitud del tamaño del efecto. El quinto y el sexto estudio analizaban el rendimiento del fútbol desde un punto de vista de predicción del rendimiento. El modelo linear general y el modelo lineal general mixto fue empleado para analizar la magnitud de las relaciones de los indicadores y estadísticas de juego con el resultado final del partido en función del tipo de partido (partidos ajustados o todos los partidos) en la fase de grupos de la Copa del Mundo 2014 de Brasil (n = 48 partidos, 38 partidos ajustados) y La Liga 2012-13 (n = 320 partidos ajustados). Las relaciones fueron evaluadas mediante las inferencias en la magnitud de las diferencias y se expresaron como partidos extra ganados o perdidos por cada 10 partidos mediante la variable calculada en 2 desviaciones típicas. Los resultados mostraron que, para los 48 partidos de la fase de grupos de la Copa del Mundo 2014, nueve variables tuvieron un efecto positive en la probabilidad de ganar (tiros, tiros a puerta, tiros de contraataque, tiros dentro del área, posesión de balón, pases en corto, media de secuencia de pases, duelos aéreos y entradas), cuatro tuvieron efectos negativos (tiros bloqueados, centros, regates y tarjetas amarillas), y otras 12 variables tenían efectos triviales o poco claros. Mientras que los 38 partidos ajustados, el efecto de duelos aéreos y tarjetas amarillas fueron triviales y claramente negativos respectivamente. En la La Liga, existió un efecto moderado positive para cada equipo para los tiros a puerta (3.4 victorias extras por cada 10 partidos; 99% IC ±1.0), y un efecto positivo reducido para tiros totales (1.7 victorias extrsa; ±1.0). Los efectos de la mayoría de los eventos se han relacionado con la posesión del balón, la cual obtuvo efectos negativos entre equipos (1.2 derrotas extras; ±1.0) pero un efecto positivo pequeño entra equipos (1.7 victorias extras; ±1.4). La localización del partido mostró un efecto positive reducido dentro de los equipos (1.9 victorias extras; ±0.9). Los resultados obtenidos en los perfiles y el modelado del rendimiento permiten ofrecer una información detallada y avanzada para el entrenamiento, la preparación previa a los partidos, el control de la competición y el análisis post-partido, así como la evaluación e identificación del talento de los jugadores. ABSTRACT Match performance analysis plays an important role in the modern professional football. Although the research in football match analysis is well-developed, there are still some issues and problems remaining in this field, which mainly include the lack of operational definitions of variables, reliability issues, applicability of the findings, the lack of contextual/situational variables, and focusing too much on descriptive and comparative analysis. In order to address these issues, six independent but related studies were conducted in the current thesis. The first study evaluated the inter-operator reliability of football match statistics from OPTA Sportsdata Company which is the data resourse of the thesis. Two groups of experienced operators were required to analyse a Spanish league match independently in the experiment. Results showed that team events and goalkeeper actions coded by independent operators reached a very good agreement (kappa values between 0.86 and 0.94). The inter-operator reliability of match actions and events of individual outfield players was also tested to be at a high level (intra-class correlation coefficients ranged from 0.88 to 1.00, standardised typical error varied from 0.00 to 0.37). These results suggest that the football match statistics collected by well-trained operators from OPTA Sportsdata Company are reliable. The second, third and fourth study aims to enhance the applicability of football match performance analysis and to explore deeply the influences of situational variables. By using a profiling technique, technical and tactical performances of football players and teams can be interpreted, evaluated and compared more easily and straightforwardly, meanwhile, influences and effects from situational variables (match location, strength of team and opposition, and match outcome) on the performances can be properly incorporated. Performance profiles of goalkeepers (n = 46 goalkeepers, 744 full match observations) and outfield players (n = 409 players, 5288 full match observations) from the Spanish First Division Professional Football League (La Liga, season 2012-13), teams (n = 496 matches, 992 observations) from UEFA Champions League (seasons 2009-10 to 2012-13) were set up by presenting the mean, standard deviation, median, lower and upper quartiles of the count values of each performance-related match action and event to represent their typical performances and spreads. Means of goalkeeper from different levels of team in La Liga and teams of different strength in UEFA Champions League when playing under different situational conditions were compared by using one-way ANOVA and independent sample t test (for match location, home and away differences), and were plotted into the same radar charts after unifying all the event counts by standardised score. While differences between the performances of outfield players from Top3 and from Bottom3 teams were compared by magnitude-based inferences. The fifth and sixth study aims to move from the descriptive and comparative football match analysis to a more predictive one. Generalised linear modelling and generalised mixed linear modelling were undertaken to quantify relationships of the performance-related match events, actions and variables with the match outcome in different types of games (close games and all games) in the group stage of 2014 Brazil FIFA World Cup (n = 48 games, 38 close games) and La Liga 2012-13 (n = 320 close games). Relationships were evaluated with magnitude-based inferences and were expressed as extra matches won or lost per 10 matches for an increase of two standard deviations of a variable. Results showed that, for all the 48 games in the group stage of 2014 FIFA World Cup, nine variables had clearly positive effects on the probability of winning (shot, shot on target, shot from counter attack, shot from inside area, ball possession, short pass, average pass streak, aerial advantage, and tackle), four had clearly negative effects (shot blocked, cross, dribble and red card), other 12 variabless had either trivial or unclear effects. While for the 38 close games, the effects of aerial advantage and yellow card turned to trivial and clearly negative, respectively. In the La Liga, there was a moderate positive within-team effect from shots on target (3.4 extra wins per 10 matches; 99% confidence limits ±1.0), and a small positive within-team effect from total shots (1.7 extra wins; ±1.0). Effects of most other match events were related to ball possession, which had a small negative within-team effect (1.2 extra losses; ±1.0) but a small positive between-team effect (1.7 extra wins; ±1.4). Game location showed a small positive within-team effect (1.9 extra wins; ±0.9). Results from the established performance profiles and modelling can provide detailed and straightforward information for training, pre-match preparations, in-match tactical approaches and post-match evaluations, as well as for player identification and development. 摘要 比赛表现分析在现代足球中起着举足轻重的作用。尽管如今对足球比赛表现分析的研究已经相对完善，但仍有很多不足之处。这些不足主要体现在：研究中缺乏对研究变量的清晰定义、数据信效度缺失、研究结果的实用性受限、比赛情境因素缺失以及过于集中在描述性和对比性分析等。针对这些问题，本论文通过六个独立而又相互联系的研究，进一步对足球比赛表现分析进行完善。 第一个研究对本论文的数据源--OPTA Sportsdata公司的足球比赛数据的信效度进行了实验检验。实验中，两组数据收集人员被要求对同一场西班牙足球甲级联赛的比赛进行分析。研究结果显示，两组收集人员记录下的球队比赛事件和守门员比赛行为具有高度的一致性(卡帕系数介于0.86和0.94)。收集人员输出的外场球员的比赛行为和比赛事件也具有很高的组间一致性(ICC相关系数介于0.88和1.00，标准化典型误差介于0.00和0.37)。实验结果证明了OPTA Sportsdata公司收集的足球比赛数据具有足够高的信效度。 第二、三、四个研究旨在提升足球比赛表现分析研究结果的实用性以及深度探讨比赛情境因素对足球比赛表现的影响。通过对足球运动员和运动队的比赛技战术表现进行档案创建，可以对运动员和运动队的比赛表现进行简直接而直观的呈现、评价和对比，同时，情境变量(比赛场地、球队和对手实力、比赛结果)对比赛表现的影响也可以被整合到表现档案中。本部分对2012-13赛季西班牙足球甲级联赛的参赛守门员(n = 46球员人次，744比赛场次)和外场球员(n = 409球员人次, 5288比赛场次)以及2009-10至2012-13赛季欧洲足球冠军联赛的参赛球队(n = 496比赛场次)的比赛技战术表现进行了档案创建。在表现档案中，各项比赛技战术指标的均值、标准差、中位数和大小四分位数被用来展现守门员、外场球员和球队的普遍表现和表现浮动性。方差分析(ANOVA)被用来对西甲不同水平球队的守门员、欧冠中不同水平球队在不同比赛情境下的普遍表现(各项指标的均值)进行对比，独立样本t检验被用来对比主客场比赛普遍表现的差异。数据量级推断(magnitude-based inferences)的方法则被用来对西甲前三名和最后三名球队外场球员的普遍表现进行对比分析。所有来自不同水平球队的运动员和不同水平运动队的各项比赛指标皆被转换成了标准分数，从而能把他们在各种不同比赛情境下的普遍表现(各项比赛指标的均值)投到相同的雷达图中进行直观的对比。 第五和第六个研究目的在于进行预测性足球比赛表现分析，从而跨越之前固有的描述性和对比性分析。广义线性模型和广义混合线性模型被用来对2014年巴西世界杯小组赛(n = 48 比赛场次，38小分差场次)和2012-13赛季西甲联赛(n = 320小分差场次)的比赛中各表现相关比赛事件、行为和变量与比赛结果(胜、平、负)的关系进行建模。模型中的关系通过数据量级推断(magnitude-based inferences)的方法来界定，具体表现为某个变量增加两个标准差对比赛结果的影响(每10场比赛中额外取胜或失利的场数)。研究结果显示，在2014年巴西世界杯小组赛的所有48场比赛中，9个变量(射门、射正、反击中射门、禁区内射门、控球、短传、连续传球平均次数、高空球争抢成功率和抢断)与赢球概率有清晰的正相关关系，4个变量(射门被封堵、传中、过人和红牌)与赢球概率有清晰的负相关关系，其他12个被分析的变量与赢球概率的相关关系微小或不清晰。而在38场小分差比赛中，高空球争抢成功率由正相关变为微小关系，黄牌则由微小关系变为清晰的负相关。在西甲联赛中，每一支球队增加两个标准差的“射正球门”可以给每10场比赛带来3.4场额外胜利(99%置信区间±1.0场)，而所有球队作为一个整体，每增加两个标准差的“射正球门”可以给每10场比赛带来1.7场额外胜利(99%置信区间±1.0场)。其他大多数比赛相关事件与比赛结果的相关关系与“控球”相关联。每一支球队增加两个标准差的“控球”将会给每10场比赛带来1.2场额外失利(99%置信区间±1.0场)，而所有球队作为一个整体，每增加两个标准差的“控球”可以给每10场比赛带来1.7场额外胜利(99%置信区间±1.4场)。与客场比赛相对，主场能给球队带来1.9 /10场额外胜利(99%置信区间±0.9场)。 比赛表现档案和模型中得出的研究结果可以为俱乐部、足球队、教练组、表现分析师和运动员提供详细而直接的参考信息。这些信息可用于训练指导、赛前备战、赛中技战术调整和赛后技战术表现分析，也可运用于足球运动员选材、培养和发展。

Mock-ups in design : the implications of utlizing [sic] a mock-up review process in professional practice

The purpose of this research is to examine the use of a mock-up review process in interior design projects to better understand the implications of using such a process within the standard professional practice model. The research consisted of interviewing design professionals who utilize mock-ups as part of their standard of practice. These interviews were centered around two groups - those working in shipbuilding, where mock-ups have a long history, and those working in land-based projects, where mock-up use is rare. Analysis of the interviews indicated a positive relationship between mock-up use and collaboration, innovation, and problem solving. The interviews also brought to light concerns on behalf of all the professionals surveyed about the current practice model in land-based building design and construction projects within the United States. The positive relationships shown in the thesis support further research to explore how mock-ups can be best utilized in interior design.

PROFESSIONAL LIABILITY OF AMATEURS: THE CONTEXT OF SPORTS COACHING

The developing intersection between the law of negligence and sports coaching in the UK provides a profoundly distinctive context, as compared to that of the more traditional learned professions, in which to critically examine the issue of professional liability. More specifically, detailed consideration of the Bolam test in the context of sports coaching, where the majority of coaches are volunteers, reinforces the Bolam doctrine as a control mechanism designed to protect both claimants and defendants alike. Importantly, a fuller analysis of related jurisprudence, even in instances where defendant coaches lack a formal qualification, and/or may not have engaged in considered and reasoned decision-making, reveals the potential for the Bolam test to operate as a quasi-defence, thereby safeguarding coaches from negligence liability. Nonetheless, in discharging this heightened standard of care incumbent upon them, coaches must ensure that the coaching practices adopted are regular, approved, and capable of withstanding robust and logical scrutiny. Ultimately, this article’s analysis of the principles of professional liability, in the specific circumstances of sports coaching, should prove to be of appreciably wider interest and utility for practitioners specialising in personal injury law.

Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.