The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

An experience of attempting to apply the randomised controlled trial (RCT) design in a ‘real world’ community-based clinical setting – one family therapist’s current journey. Context, 99, 6-9.

This paper describes an early career researcher's expereince of using randomised controlled trial methodology to investigarte the effectiveness of psychotherapeutic interventions for traumatised families in a 'real world' setting.

Pastoral

This chapter argues that Milton’s Epitaphium Damonis, a neo-Latin pastoral lament on the death of Charles Diodati, is marked by the author's Petrarchan self-fashioning. This is achieved through intertextual engagement with Petrarch's Bucolicum Carmen (especially Ecls. 1 and 10). Milton as the wandering Thyrsis, undertaking a methaphorical and literal journey into the world of Italian humanism, appropriates and adapts the metaphorical departure from and return to a pastoral world now shattered by plague and death. Recourse to the quasi-Augustinian monasticism of Petrarchan neo-Latin pastoral facilitates the poem's crossing of a monastic limen via its subtle interaction with a hagiographic intertext, the Vita Sancti Deodati. Now pastoral saint and scholar become united in death and in subsequent apotheosis.

The journey of a ‘green’ micro-enterprise – The Green Planet

This teaching case explores the longitudinal evolution of a small environmental micro-enterprise, The Green Planet retail store. Exploring two decades of business history it analyses the development of this business as sustainability issues and greener consumer goods mainstreamed in society. The case presents one of the first explorations of the individual trade-offs that owners make between economic, environmental and social criteria, alongside an exploration of the role that the personal values of the owner played in the evolution of this business. Also presented is a sample of other environmental enterprises profiled alongside The Green Planet in the early 1990s. This additional dataset provides a rich resource for readers, and a number of indicative discussion themes are identified. Readers interested in topics such as marketing, business strategy, innovation, entrepreneurship, corporate social responsibility and environmental management will find this case a valuable addition to their teaching resources.

New Wave Italian Style

An investigation of the long controversy around the definition of an Italian New Wave cinema of the 1960s, this essay engages (and takes issue) with the reasons behind the critics’ reluctance to recognise its existence. After establishing a theoretical and historical framework for a transnational under- standing of the phenomenon of the European and World New Waves, it offers a reasoned analysis of the multiple industrial and artistic attempts at a generational renewal of Italian cinema that were made in Italy during the 1960s. Ultimately, the essay suggests that it would not only be appropriate, but also highly productive to reconsider the vibrant and heterogeneous young Italian cinema of the 1960s under the generational and transnational New Wave label, instead of continuing to approach the decade exclusively in the light of Neorealism.