1,720,995 research outputs found
Electronic consultation in primary care between providers and patients: systematic Review
No full textBackground: Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain.Objective: this study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care.Methods: a systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis.Results: this review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes.Conclusions: E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow
A qualitative exploration of patients' experiences, needs, and expectations regarding online access to their primary care record
No full textObjectives: primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients? needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need. Design: focus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.Setting: focus groups and interviews were conducted in community settings in the UK. Participants: fifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else. Results: participants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated. Conclusions: discussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service
The Ethical Implications of Spirituality in Residential Care for Older People (ETHoS Project)
Full text linkDemographic changes, political, social, and migration trends are changing the care demand in the United Kingdom. This is reflected in residential care for older people, especially regarding the spiritual needs of residents. Attention to spiritual and religious diversity is limited in residential care for older people and the implementation of diverse spiritual care is under-explored. Furthermore, knowledge and education regarding spirituality is limited among staff members in residential care. This study aimed to understand the ethical implications of ‘spirituality’ in residential care for older people. Qualitative research with an ethnographic approach was conducted in four care homes each with a different cultural or spiritual background. This comprised participant observation, semi-structured interviews with residents with capacity and focus groups with staff. Prior to the interviews, residents were asked to bring an artefact which had to give or represent a sense of wellbeing. It functioned as a conversation starter and gave insight into older people's ideas of spirituality. Finally, an e-Delphi process was conducted with an expert panel to explore knowledge and advice relating to spirituality in residential care for older people.Spiritual needs are the needs that resonate to someone's 'core being'. Barriers to good spiritual care were assumptions made by care home staff regarding residents' spiritual needs, moral dissonance relating to fears of taking risks, and a lack of advocacy for residents. Spiritual wellbeing was enhanced by creating a care home culture of intimacy, hospitality and intersectional awareness. This study raises awareness of the importance and diversity of spiritual needs of older people in residential care. The findings of this study inform care home managements, care home staff, nursing students and policy makers on how to improve spiritual care for older people in residential care. A reflective toolkit was produced to help care home staff think about the space for spirituality in their care home. This is the first of its kind and has the potential to help support care home staff and management to reflect upon how spirituality can be best incorporated into the care home culture through enhancing connectedness and understanding individual residents
What do patients want?:A qualitative exploration of patients’ needs and expectations regarding online access to their primary care record.
No full textBackground: Primary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access. Aims: 1. To explore patients’ views about accessing online primary care records 2. To find out how patients would like to interact with their records and what support they may need.Method: Interviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues. Results: Participants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services. Carers found accessing online records particularly useful.Conclusions: Consultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.<br/
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research
No full textBackground: Obesity-related stigma likely influences how obese people interact with health-care professionals and access health care.Aim: To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients.Search strategy: A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals.Inclusion Criteria: Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically.Data Extraction: Data were extracted focusing on obesity, stigma and access to health-care services. All included studies were subject to critical appraisal to assess the quality of the research.Findings: Thirty studies were identified. All the studies reported obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures.Conclusion: Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health-care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health-care interactions and decision making
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