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Sample records for nhs postal questionnaire

  1. Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

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    Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

    2015-01-01

    Objective: To investigate the experience of users of out of hours general practitioner services in England, UK. Design: Population based cross sectional postal questionnaire survey. Setting: General Practice Patient Survey 2012-13. Main outcome measures: Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial)...

  2. An appraisal of the utility or futility of ENT consultant postal questionnaires.

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    Ryan, Stephen; Saunders, J; Clarke, E; Fenton, J E

    2013-03-01

    Despite an increase in ENT postal questionnaires, the quality of their methodology has been questioned (Ramphul et al. in J Laryngol Otol 119:175-178, 1). This retrospective study examined whether quality and utility of such questionnaires published since 2005 has improved. Seventeen consultant postal questionnaires published between 2005 and 2012 were reviewed. Quality of questionnaires was assessed using a 30-point score based on compliance with 15 criteria previously established to evaluate postal questionnaire study-design (Ramphul et al. in J Laryngol Otol 119:175-178, 1). Citation rates were used as an indicator of utility. The specific comments made in each citing paper was reviewed providing information on whether questionnaire findings (a) had an impact on clinical practice, (b) were the citing comments positive, (c) negative or (d) non-specific. Recurrent methodological flaws were identified in all questionnaires. The average score assigned was 44 %, versus 32 % previously reported (Ramphul et al. in J Laryngol Otol 119:175-178, 1) (P questionnaires. Citations were general non-specific referencing with no clear indication that questionnaire findings positively impacted clinical practice. In conclusion, although the quality of ENT postal questionnaire has improved since the original study (Ramphul et al. in J Laryngol Otol 119:175-178, 1), important recurring methodological flaws still exist. The poor utility, based on low citation rates, also reflects the continued deficiencies in design quality. It is recommended that authors of questionnaire-based research should ensure that guidelines for questionnaire design are adhered in order to improve the validity of findings and hence impact on clinical practice.

  3. Application of summative content analysis to a postal questionnaire.

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    Griffiths, Thomas Howard

    2016-01-01

    Content analysis of replies to closed questions in questionnaires can be undertaken to understand remarks that may explain the responses, provide illustrative examples of issues raised in the questionnaire, define new issues or issues of importance that were not covered in the questionnaire and inform the design of new questions in future surveys. To discuss the usefulness of summative content analysis to free text in postal questionnaires. Content analysis provides useful comparative insights between two respondent groups in the case example provided. Five themes emerged: poor understanding of the concept of 'patient lateral transfer work technique' and the direct instrument nursing observation (DINO) instrument's key directions; outcomes of patient transfer; positive responses; manual handling risk; and poor translation into English of DINO. Respondents need an opportunity to clarify their responses to questionnaires using free text, to provide insight into their understanding of the question being asked, understanding of the concept or construct being discussed, and data triangulation through the confirmation of item responses and free-text comments. Responses to questions in a postal questionnaire and the opportunity for free-text commentary by respondents enable the identification of hidden meanings behind tickbox responses to questions.

  4. Use of the Liverpool Elbow Score as a postal questionnaire for the assessment of outcome after total elbow arthroplasty.

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    Ashmore, Alexander M; Gozzard, Charles; Blewitt, Neil

    2007-01-01

    The Liverpool Elbow Score (LES) is a newly developed, validated elbow-specific score. It consists of a patient-answered questionnaire (PAQ) and a clinical assessment. The purpose of this study was to determine whether the PAQ portion of the LES could be used independently as a postal questionnaire for the assessment of outcome after total elbow arthroplasty and to correlate the LES and the Mayo Elbow Performance Score (MEPS). A series of 51 total elbow replacements were reviewed by postal questionnaire. Patients then attended the clinic for assessment by use of both the LES and the MEPS. There was an excellent response rate to the postal questionnaire (98%), and 44 elbows were available for clinical review. Good correlation was shown between the LES and the MEPS (Spearman correlation coefficient, 0.84; P PAQ portion of the LES and the MEPS (Spearman correlation coefficient, 0.76; P PAQ component and the MEPS, suggesting that outcome assessment is possible by postal questionnaire.

  5. A comparison of a postal survey and mixed-mode survey using a questionnaire on patients' experiences with breast care.

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    Zuidgeest, Marloes; Hendriks, Michelle; Koopman, Laura; Spreeuwenberg, Peter; Rademakers, Jany

    2011-09-27

    The Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients' perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode survey) can possibly compensate for these weaknesses and provide an alternative to a postal survey. To examine whether there are differences between a mixed-mode survey and a postal survey in terms of respondent characteristics, response rate and time, quality of data, costs, and global ratings of health care or health care providers (general practitioner, hospital care in the diagnostic phase, surgeon, nurses, radiotherapy, chemotherapy, and hospital care in general). Differences between the two surveys were examined in a sample of breast care patients using the Consumer Quality Index Breast Care questionnaire. We selected 800 breast care patients from the reimbursement files of Dutch health insurance companies. We asked 400 patients to fill out the questionnaire online followed by a paper reminder (mixed-mode survey) and 400 patients, matched by age and gender, received the questionnaire by mail only (postal survey). Both groups received three reminders. The respondents to the two surveys did not differ in age, gender, level of education, or self-reported physical and psychological health (all Ps > .05). In the postal survey, the questionnaires were returned 20 days earlier than in the mixed-mode survey (median 12 and 32 days, respectively; P survey (€2 per questionnaire). Moreover, there were fewer missing items (3.4% versus 4.4%, P = .002) and fewer invalid answers (3.2% versus 6.2%, P survey than in the postal survey. The answers of the two respondent groups on the global ratings did not

  6. A Comparison of a Postal Survey and Mixed-Mode Survey Using a Questionnaire on Patients’ Experiences With Breast Care

    Science.gov (United States)

    Hendriks, Michelle; Koopman, Laura; Spreeuwenberg, Peter; Rademakers, Jany

    2011-01-01

    Background The Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients’ perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode survey) can possibly compensate for these weaknesses and provide an alternative to a postal survey. Objective To examine whether there are differences between a mixed-mode survey and a postal survey in terms of respondent characteristics, response rate and time, quality of data, costs, and global ratings of health care or health care providers (general practitioner, hospital care in the diagnostic phase, surgeon, nurses, radiotherapy, chemotherapy, and hospital care in general). Methods Differences between the two surveys were examined in a sample of breast care patients using the Consumer Quality Index Breast Care questionnaire. We selected 800 breast care patients from the reimbursement files of Dutch health insurance companies. We asked 400 patients to fill out the questionnaire online followed by a paper reminder (mixed-mode survey) and 400 patients, matched by age and gender, received the questionnaire by mail only (postal survey). Both groups received three reminders. Results The respondents to the two surveys did not differ in age, gender, level of education, or self-reported physical and psychological health (all Ps > .05). In the postal survey, the questionnaires were returned 20 days earlier than in the mixed-mode survey (median 12 and 32 days, respectively; P survey (€2 per questionnaire). Moreover, there were fewer missing items (3.4% versus 4.4%, P = .002) and fewer invalid answers (3.2% versus 6.2%, P survey than in the postal survey. The answers of the two respondent

  7. A randomized trial found online questionnaires supplemented by postal reminders generated a cost-effective and generalizable sample but don't forget the reminders.

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    Loban, Amanda; Mandefield, Laura; Hind, Daniel; Bradburn, Mike

    2017-12-01

    The objective of this study was to compare the response rates, data completeness, and representativeness of survey data produced by online and postal surveys. A randomized trial nested within a cohort study in Yorkshire, United Kingdom. Participants were randomized to receive either an electronic (online) survey questionnaire with paper reminder (N = 2,982) or paper questionnaire with electronic reminder (N = 2,855). Response rates were similar for electronic contact and postal contacts (50.9% vs. 49.7%, difference = 1.2%, 95% confidence interval: -1.3% to 3.8%). The characteristics of those responding to the two groups were similar. Participants nevertheless demonstrated an overwhelming preference for postal questionnaires, with the majority responding by post in both groups. Online survey questionnaire systems need to be supplemented with a postal reminder to achieve acceptable uptake, but doing so provides a similar response rate and case mix when compared to postal questionnaires alone. For large surveys, online survey systems may be cost saving. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Impact of NHS Direct on other services: the characteristics and origins of its nurses \\ud

    OpenAIRE

    Morrell, C.J.; Munro, J.F.; O'Cathain, A.; Warren, K.; Nicholl, J.

    2002-01-01

    OBJECTIVE:: To characterise the NHS Direct nurse workforce and estimate the impact of NHS Direct on the staffing of other NHS nursing specialties. \\ud \\ud METHOD: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000. \\ud \\ud RESULTS: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came f...

  9. How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

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    Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

    2005-01-01

    Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

  10. A randomised controlled trial to assess the effectiveness of offering study results as an incentive to increase response rates to postal questionnaires [ISRCTN26118436

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    Torgerson David J

    2005-10-01

    Full Text Available Abstract Background Postal questionnaires are widely used to collect outcome data on participants. However, a poor response to questionnaires will reduce the statistical power of the study and may introduce bias. A meta analysis of ten trials offering study results, largely in the fields of education and marketing, was shown to be ineffective, with the odds ratio for response with offering research findings is 0.92 (95% CI 0.75 to 1.11. However uncertainty still exists as it is uncertain whether results from such trials can be extrapolated to that of a health care setting. The aim of this study was to assess whether offering participants study results increases the response rates to postal questionnaires. Methods 1038 women aged over 70 years were remotely randomised by computer in a 3:1 ratio. 250 participants did not receive the offer of knowing the results of the trial and 788 participants were offered the results of the trial in a postal questionnaire. The main outcome measure was response rate. Chi square test was used to evaluate the overall differences in response rate between the two groups. An adjusted analysis, adjusting for whether the participant was taking calcium and age was also undertaken. Results The response rates were not significantly different Odds Ratio 0.88 (95% confidence intervals 0.48 to 1.63 p = 0.69. Conclusion Offering study results to women living in the community aged over 70 does not increase response rates to postal questionnaires. Although researchers have an ethical obligation to offer participants study results, since 10% of women did not wish to receive the results, investigators should give participants the option to opt out of receiving the study's results.

  11. SMS text pre-notification and delivery of reminder e-mails to increase response rates to postal questionnaires in the SUSPEND trial: a factorial design, randomised controlled trial.

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    Starr, Kathryn; McPherson, Gladys; Forrest, Mark; Cotton, Seonaidh C

    2015-07-08

    Patient-reported outcomes are vital in informing randomised controlled trials (RCTs) and health-care interventions and policies from the patient's perspective. However, participant non-response may introduce bias and can affect the generalisability of the trial. This study evaluates two interventions aimed at increasing response rates to postal questionnaires within a large, UK-wide RCT: pre-notification via short messenger service (SMS) text prior to sending the initial mailing of trial questionnaires versus no pre-notification; for non-responders to the initial mailing of the questionnaires, an e-mail reminder (containing a hyperlink to complete the questionnaire online) versus a postal reminder. This study is a 2 × 2 partial factorial design RCT nested within an RCT of medical expulsive therapy for ureteric stone disease. Participants who supplied a mobile telephone number were randomly assigned to receive an SMS text pre-notification of questionnaire delivery or no pre-notification. Those who supplied an e-mail address were randomly assigned to receive a questionnaire reminder by e-mail or post. Participants could be randomly assigned to the pre-notification comparison or the reminder comparison or both. The primary outcome measure was response rate at each questionnaire time point. Four hundred eighteen participants were randomly assigned to the SMS pre-notification comparison (80% were male, and the mean age was 41 years with a standard deviation (SD) of 11.1). The intervention had no effect on response rate at either questionnaire time point. In subgroup analyses, SMS pre-notification increased response rates in women but only at the first questionnaire time point. One hundred nineteen participants were randomly assigned to the reminder comparison (80% were male, and the mean age was 42 years with an SD of 12.1). There was no difference in response rate in those who received an e-mail reminder compared with those who received a postal reminder. SMS text pre

  12. Supporting staff in employment: the emotional wellbeing of staff in an NHS psychiatric hospital.

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    Patterson, I D; Bell, J S

    2000-09-01

    The objective of this study was to assess the emotional wellbeing of a broad sample of NHS employees in a psychiatric setting; to seek their views on sources of distress; and to identify preferred ways of dealing with it. A cross-sectional postal survey, employing two questionnaires: GHQ-28, and a semi-structured questionnaire. These were sent to a nominal 50% sample (n = 599). The population was the staff of a large Scottish psychiatric service. A 47.9% response rate was achieved; 32.9% of respondents exceeded a cut-off score of four on the GHQ-28. Neither occupational, group nor gender effects were significant on this measure. The reporting of emotionally-distressing problems affecting their performance was found to be more common amongst doctors; males, overall, showed a non-significant trend towards having been affected more than females by such problems; and older staff (above 45) were affected significantly more often than younger staff. Almost a third of staff were unaware of the availability of an internal organisational resource (the Occupational Health service). NHS Trusts should ensure the culture at work is appropriate from a preventative point of view and be aware that factors outwith the workplace can affect employees emotional wellbeing and performance. Preventative and supportive measures to minimise psychological distress in the workforce should be considered; the Scottish Needs Assessment Programme: Mental Health in the Workplace offers useful guidance.

  13. Is overseas volunteering beneficial to the NHS? The analysis of volunteers' responses to a feedback questionnaire following experiences in low-income and middle-income countries.

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    Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

    2017-10-16

    Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the 'working with others' domain. There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers' essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers' continued professional development. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless

  14. Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries

    Science.gov (United States)

    Yeomans, Daniel; Le, Grace; Pandit, Hemant; Lavy, Chris

    2017-01-01

    Introduction Locally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas. Methods 88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF. Results 85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the ‘working with others’ domain. Discussion There is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers’ essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers’ continued professional development. PMID:29042388

  15. Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys.

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    Kazzazi, Fawz; Haggie, Rebecca; Forouhi, Parto; Kazzazi, Nazar; Malata, Charles M

    2018-01-01

    Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the "Total Design Method," initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women. A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008-2014 (inclusive) at Addenbrooke's University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified "Total Design Method." Participants were sent packs and reminders according to our designed schedule. Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years. In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%.

  16. Effect of questionnaire length, personalisation and reminder type on response rate to a complex postal survey: randomised controlled trial

    Science.gov (United States)

    2011-01-01

    Background Minimising participant non-response in postal surveys helps to maximise the generalisability of the inferences made from the data collected. The aim of this study was to examine the effect of questionnaire length, personalisation and reminder type on postal survey response rate and quality and to compare the cost-effectiveness of the alternative survey strategies. Methods In a pilot study for a population study of travel behaviour, physical activity and the environment, 1000 participants sampled from the UK edited electoral register were randomly allocated using a 2 × 2 factorial design to receive one of four survey packs: a personally addressed long (24 page) questionnaire pack, a personally addressed short (15 page) questionnaire pack, a non-personally addressed long questionnaire pack or a non-personally addressed short questionnaire pack. Those who did not return a questionnaire were stratified by initial randomisation group and further randomised to receive either a full reminder pack or a reminder postcard. The effects of the survey design factors on response were examined using multivariate logistic regression. Results An overall response rate of 17% was achieved. Participants who received the short version of the questionnaire were more likely to respond (OR = 1.48, 95% CI 1.06 to 2.07). In those participants who received a reminder, personalisation of the survey pack and reminder also increased the odds of response (OR = 1.44, 95% CI 1.01 to 1.95). Item non-response was relatively low, but was significantly higher in the long questionnaire than the short (9.8% vs 5.8%; p = .04). The cost per additional usable questionnaire returned of issuing the reminder packs was £23.1 compared with £11.3 for the reminder postcards. Conclusions In contrast to some previous studies of shorter questionnaires, this trial found that shortening a relatively lengthy questionnaire significantly increased the response. Researchers should consider the trade off

  17. The effect of postal questionnaire burden on response rate and answer patterns following admission to intensive care: a randomised controlled trial

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    Robert Hatch

    2017-03-01

    Full Text Available Abstract Background The effects of postal questionnaire burden on return rates and answers given are unclear following treatment on an intensive care unit (ICU. We aimed to establish the effects of different postal questionnaire burdens on return rates and answers given. Methods Design: A parallel group randomised controlled trial. We assigned patients by computer-based randomisation to one of two questionnaire packs (Group A and Group B. Setting: Patients from 26 ICUs in the United Kingdom. Inclusion criteria: Patients who had received at least 24 h of level 3 care and were 16 years of age or older. Patients did not know that there were different questionnaire burdens. The study included 18,490 patients. 12,170 were eligible to be sent a questionnaire pack at 3 months. We sent 12,105 questionnaires (6112 to group A and 5993 to group B. Interventions: The Group A pack contained demographic and EuroQol group 5 Dimensions 3 level (EQ-5D-3 L questionnaires, making four questionnaire pages. The Group B pack also contained the Hospital Anxiety and Depression Score (HADS and the Post-Traumatic Stress Disorder Check List-Civilian (PCL-C questionnaires, making eight questionnaire pages in total. Main outcome measure: Questionnaire return rate 3 months after ICU discharge by group. Results In group A, 2466/6112 (40.3% participants responded at 3 months. In group B 2315/ 5993 (38.6% participants responded (difference 1.7% CI for difference 0–3.5% p = 0.053. Group A reported better functionality than group B in the EQ-5D-3 L mobility (41% versus 37% reporting no problems p = 0.003 and anxiety/depression (59% versus 55% reporting no problems p = 0.017 domains. Conclusions In survivors of intensive care, questionnaire burden had no effect on return rates. However, questionnaire burden affected answers to the same questionnaire (EQ-5D-3 L. Trial registration ISRCTN69112866 (assigned 02/05/2006.

  18. Does a monetary incentive improve the response to a postal questionnaire in a randomised controlled trial? The MINT incentive study

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    Mt-Isa Shahrul

    2009-06-01

    Full Text Available Abstract Background Sending a monetary incentive with postal questionnaires has been found to improve the proportion of responders, in research in non-healthcare settings. However, there is little research on use of incentives to improve follow-up rates in clinical trials, and existing studies are inconclusive. We conducted a randomised trial among participants in the Managing Injuries of the Neck Trial (MINT to investigate the effects on the proportion of questionnaires returned and overall non-response of sending a £5 gift voucher with a follow-up questionnaire. Methods Participants in MINT were randomised to receive either: (a a £5 gift voucher (incentive group or (b no gift voucher (no incentive group, with their 4 month or 8 month follow-up questionnaire. We recorded, for each group, the number of questionnaires returned, the number returned without any chasing from the study office, the overall number of non-responders (after all chasing efforts by the study office, and the costs of following up each group. Results 2144 participants were randomised, 1070 to the incentive group and 1074 to the no incentive group. The proportion of questionnaires returned (RR 1.10 (95% CI 1.05, 1.16 and the proportion returned without chasing (RR 1.14 (95% CI 1.05, 1.24 were higher in the incentive group, and the overall non-response rate was lower (RR 0.68 (95% CI 0.53, 0.87. Adjustment for injury severity and hospital of recruitment to MINT made no difference to these results, and there were no differences in results between the 4-month and 8-month follow up questionnaires. Analysis of costs suggested a cost of £67.29 per additional questionnaire returned. Conclusion Monetary incentives may be an effective way to increase the proportion of postal questionnaires returned and minimise loss to follow-up in clinical trials. Trial registration number ISRCTN61305297

  19. Job evaluation for clinical nursing jobs by implementing the NHS JE system.

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    Kahya, Emin; Oral, Nurten

    2007-10-01

    The purpose of this paper was to evaluate locally all the clinical nursing jobs implementing the NHS JE system in four hospitals. The NHS JE was developed by the Department of Health in the UK in 2003-2004. A job analysis questionnaire was designed to gather current job descriptions. It was distributed to each of 158 clinical nurses and supervisor nurses in 31 variety clinics at four hospitals in one city. The questionnaires were analysed to evaluate locally all the identified 94 nursing jobs. Fourteen of 19 nursing jobs in the medical and surgical clinics can be matched to the nurse national job in the NHS JE system. The results indicated that two new nursing jobs titled nurse B and nurse advanced B should be added to the list of national nursing jobs in the NHS JE system.

  20. Management of dental trauma in primary care: a postal survey of general dental practitioners.

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    Jackson, N G; Waterhouse, P J; Maguire, A

    2005-03-12

    To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to

  1. Acurácia de informações sobre classes de medicamentos obtidas com questionário postal aplicado a idosos - Rio de Janeiro, RJ Accuracy of drug class information obtained from a postal questionnaire to elderly respondents

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    Maria Estrella L. Vasconcelos

    2009-12-01

    Full Text Available OBJETIVOS: verificar a confiabilidade e a validade das informações sobre medicamentos obtidas em questionário postal, respondido por idosos, sendo a entrevista face a face o padrão-ouro. MÉTODOS: estudo seccional (Perfil de Utilização de Medicamentos por Aposentados Brasileiros, onde foram utilizadas duas abordagens (postal e domiciliar para coleta de informações de aposentados pelo Instituto Nacional do Seguro Social (INSS com sessenta anos de idade ou mais. Foram utilizadas também as estatísticas kappa (simples (k, ajustado (PABAK e ponderado, índices de correlação intra-classe, indicadores de sensibilidade e especificidade, e o gráfico de Luiz et al. RESULTADOS: 234 idosos (M = 42%; F = 58% responderam às duas abordagens (média = 71,7 anos. A concordância entre postal e entrevista domiciliar foi excelente (k = 0,94 para hipoglicemiantes; muito boa (k = 0,83-0,82 para inibidores da enzima conversora de angiotensina e anti-hipertensivos; boa (k = 0,71 para diuréticos; e razoável (k = 0,47 para antiinflamatórios não esteróides. A concordância foi boa (k = 0,61 para o número total de medicamentos usados. A validade da abordagem postal foi elevada, às vezes total, para os fármacos empregados no tratamento do diabetes (sensibilidade e especificidade = 100%, seguidos dos anti-hipertensivos. Os menores valores obtidos foram para antiinflamatórios não esteróides (sensibilidade = 64%; especificidade = 88%. CONCLUSÃO: a abordagem postal pode ser usada para se obter informações acuradas sobre classes de medicamentos usados por população com idade igual ou superior a 60 anos, considerando idosos com perfil social semelhante ao dos beneficiários do INSS.OBJECTIVES: to determine the reproducibility and validity of information on medication obtained in a postal questionnaire, with face-to-face interviews providing the gold standard. METHODS: cross-sectional study (Perfil de Utilização de Medicamentos por Aposentados

  2. UK doctors and equal opportunities in the NHS: national questionnaire surveys of views on gender, ethnicity and disability.

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    Lambert, Trevor; Surman, Geraldine; Goldacre, Michael

    2014-10-01

    To seek doctors' views about the NHS as an employer, our surveys about doctors' career intentions and progression, undertaken between 1999 and 2013, also asked whether the NHS was, in their view, a good 'equal opportunities' employer for women doctors, doctors from ethnic minority groups and doctors with disabilities. Surveys undertaken in the UK by mail and Internet. UK medical graduates in selected graduation years between 1993 and 2012. Respondents were asked to rate their level of agreement with three statements starting 'The NHS is a good equal opportunities employer for…' and ending 'women doctors', 'doctors from ethnic minorities' and 'doctors with disabilities'. Of first-year doctors surveyed in 2013, 3.6% (78/2158) disagreed that the NHS is a good equal opportunities employer for women doctors (1.7% of the men and 4.7% of the women); 2.2% (44/1968) disagreed for doctors from ethnic minorities (0.9% of white doctors and 5.8% of non-white doctors) and 12.6% (175/1387) disagreed for doctors with disabilities. Favourable perceptions of the NHS in these respects improved substantially between 1999 and 2013; among first-year doctors of 2000-2003, combined, the corresponding percentages of disagreement were 23.5% for women doctors, 23.1% for doctors from ethnic minorities and 50.6% for doctors with disabilities. Positive views about the NHS as an equal opportunities employer have increased in recent years, but the remaining gap in perception of this between women and men, and between ethnic minority and white doctors, is a concern. © The Royal Society of Medicine.

  3. Sun safety knowledge and practice in UK postal delivery workers.

    Science.gov (United States)

    Houdmont, J; Davis, S; Griffiths, A

    2016-06-01

    Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK. To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group. Postal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics. A total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics. There is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine.

  4. 78 FR 76333 - New Postal Product

    Science.gov (United States)

    2013-12-17

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2011-4; Order No. 1901] New Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service... not materially affect the cost coverage'' of the product. Id. The Postal Service seeks to incorporate...

  5. NHS-A isoform of the NHS gene is a novel interactor of ZO-1.

    Science.gov (United States)

    Sharma, Shiwani; Koh, Katrina S Y; Collin, Caitlin; Dave, Alpana; McMellon, Amy; Sugiyama, Yuki; McAvoy, John W; Voss, Anne K; Gécz, Jozef; Craig, Jamie E

    2009-08-15

    Mutations in the NHS (Nance-Horan Syndrome) gene lead to severe congenital cataracts, dental defects and sometimes mental retardation. NHS encodes two protein isoforms, NHS-A and -1A that display cell-type dependent differential expression and localization. Here we demonstrate that of these two isoforms, the NHS-A isoform associates with the cell membrane in the presence of intercellular contacts and it immunoprecipitates with the tight junction protein ZO-1 in MDCK (Madin Darby Canine Kidney) epithelial cells and in neonatal rat lens. The NHS-1A isoform however is a cytoplasmic protein. Both Nhs isoforms are expressed during mouse development. Immunolabelling of developing mouse with the anti-NHS antibody that detects both isoforms revealed the protein in the developing head including the eye and brain. It was primarily expressed in epithelium including neural epithelium and certain vascular endothelium but only weakly expressed in mesenchymal cells. In the epithelium and vascular endothelium the protein associated with the cell membrane and co-localized with ZO-1, which indirectly indicates expression of the Nhs-A isoform in these structures. Membrane localization of the protein in the lens vesicle similarly supports Nhs-A expression. In conclusion, the NHS-A isoform of NHS is a novel interactor of ZO-1 and may have a role at tight junctions. This isoform is important in mammalian development especially of the organs in the head.

  6. 76 FR 47275 - Postal Service Initiative on Retail Postal Locations

    Science.gov (United States)

    2011-08-04

    .... Id. The RAO initiative applies to postal retail facilities across the country, without limit to geography or population, and is driven by Headquarters. The Commission finds that because the Postal Service... be applied in the RAO initiative. Id. at 19-23. \\3\\ See 39 CFR Part 241. The Request and all...

  7. 39 CFR 601.104 - Postal purchasing authority.

    Science.gov (United States)

    2010-07-01

    ... in writing local buying authority throughout the Postal Service. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Postal purchasing authority. 601.104 Section 601.104 Postal Service UNITED STATES POSTAL SERVICE PROCUREMENT SYSTEM FOR THE U.S. POSTAL SERVICE...

  8. 78 FR 43246 - New Postal Product

    Science.gov (United States)

    2013-07-19

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2013-15; Order No. 1779] New Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service... competitive products by market dominant products. Id. II. Notice of Filing Interested persons may submit...

  9. Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands.

    NARCIS (Netherlands)

    Fikkers, B.G.; Fransen, G.A.J.; Hoeven, J.G. van der; Briede, I.S.; Hoogen, F.J.A. van den

    2003-01-01

    OBJECTIVE: To assess the frequency, timing, technique, and follow-up of tracheostomy for long-term ventilated patients in different intensive care units (ICUs) in The Netherlands. DESIGN AND SETTING: Postal questionnaire, survey on retrospective data. A questionnaire was sent to all ( n=63) ICUs

  10. Anaesthetic management of the airway in The Netherlands : a postal survey

    NARCIS (Netherlands)

    Borg, PAJ; Stuart, C; Dercksen, B; Eindhoven, GB

    2001-01-01

    Backgound and objective A postal survey was conducted in order to investigate current practice in airway management amongst Dutch anaesthetists and to investigate the role of recent training and the role of an 'Access to the Airway' airway management course. Methods A questionnaire containing 27

  11. 78 FR 76863 - New Postal Product

    Science.gov (United States)

    2013-12-19

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2014-12; Order No. 1905] New Postal Product AGENCY... Competitive Multi-Service Agreements with Foreign Postal Operators 1 (MC2010-34) product on the competitive product list. Notice at 3. \\1\\ Notice of United States Postal Service of Filing Functionally Equivalent...

  12. 75 FR 43581 - New Postal Product

    Science.gov (United States)

    2010-07-26

    ... Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing... the competitive product list. The Postal Service has also filed related contracts. This notice... Paragraphs I. Introduction The Postal Service seeks to add a new product, Global Plus 1A, to the competitive...

  13. 78 FR 79024 - New Postal Product

    Science.gov (United States)

    2013-12-27

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2011-50; Order No. 1922] New Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service... new product name. Id. at 1 n.1. Attachment A--a redacted copy of the amendment to the existing...

  14. 75 FR 53353 - New Postal Product

    Science.gov (United States)

    2010-08-31

    ... will permit the Postal Service to create pricing for any combination of products in an equivalent... Agreements with Foreign Postal Operators be added as a new product to the competitive product list. Id. at 8... POSTAL REGULATORY COMMISSION [Docket Nos. MC2010-34 and CP2010-95; Order No. 517] New Postal...

  15. The calculation of costs of postal network and universal postal service based on standard and average cost principles

    Directory of Open Access Journals (Sweden)

    Blagojević Mladenka Z.

    2017-01-01

    Full Text Available The provision of universal postal service involves high costs for operator, especially in rural areas. The aim of this paper is to propose and test tool for managing the cost of providing universal postal service and maintaining the postal network in order to facilitate understanding of the problem in the sector. The proposed approach use standard prices and standard quantities (the redefined number of postal units, the number of employees, etc. as well as average costs for calculation of the costs of the universal postal service and postal network. The methodology provides the efficiency analysis, benchmarking and identification of causes of poor performance of management and resource allocation. It can be used for postal operators that do not have modern accounting systems.

  16. Enhanced invitation methods to increase uptake of NHS health checks: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Forster, Alice S; Burgess, Caroline; McDermott, Lisa; Wright, Alison J; Dodhia, Hiten; Conner, Mark; Miller, Jane; Rudisill, Caroline; Cornelius, Victoria; Gulliford, Martin C

    2014-08-30

    NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated. The project is a three-arm randomized controlled trial to test the hypothesis that enhanced invitation methods, using the Question-Behaviour Effect (QBE), will increase uptake of NHS Health Checks compared with a standard invitation. Participants comprise individuals eligible for an NHS Health Check registered in two London boroughs. Participants are randomized into one of three arms. Group A receives the standard NHS Health Check invitation letter, information sheet, and reminder letter at 12 weeks for nonattenders. Group B receives a QBE questionnaire 1 week before receiving the standard invitation, information sheet, and reminder letter where appropriate. Group C is the same as Group B, but participants are offered a £5 retail voucher if they return the questionnaire. Participants are randomized in equal proportions, stratified by general practice. The primary outcome is uptake of NHS Health Checks 6 months after invitation from electronic health records. We will estimate the incremental health service cost per additional completed Health Check for trial groups B and C versus trial arm A, as well as evaluating the impact of the QBE questionnaire, and questionnaire plus voucher, on the socioeconomic inequality in uptake of Health Checks.The trial includes a nested comparison of two methods for implementing allocation, one implemented manually at general practices and the other implemented automatically through the information systems used to generate invitations for the Health Check. The research will provide evidence on whether asking individuals to complete a preliminary questionnaire, by using the QBE, is effective

  17. Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals: a questionnaire study.

    Directory of Open Access Journals (Sweden)

    Kathrin Cresswell

    Full Text Available ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.A descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.We obtained responses from 85 of 108 NHS staff (78.7% response rate. At least 6% (n = 10 of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4 have no plans of implementing, and 34% (n = 55 are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy

  18. Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey.

    Science.gov (United States)

    Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

    2015-04-29

    To investigate the experience of users of out of hours general practitioner services in England, UK. Population based cross sectional postal questionnaire survey. General Practice Patient Survey 2012-13. Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users' experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users' experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider. The overall response rate was 35%; 971,232/2,750,000 patients returned surveys. Data from 902,170 individual service users were mapped through their registered practice to one of 86 providers of out of hours GP care with known organisation type. Commercial providers of out of hours GP care were associated with poorer reports of overall experience of care, with a mean difference of -3.13 (95% confidence interval -4.96 to -1.30) compared with not for profit providers. Asian service users reported lower scores for all three experience outcomes than white service users (mean difference for overall experience of care -3.62, -4.36 to -2.89), as did service users who were unable to take time away from work compared with service users who did not work (mean difference for overall experience of care -4.73, -5.29 to -4.17). Commercial providers of out of hours GP care were associated with poorer experience of care. Targeted interventions aimed at improving experience for patients from ethnic minorities and

  19. 75 FR 27375 - Postal Rate Case Management

    Science.gov (United States)

    2010-05-14

    ... POSTAL REGULATORY COMMISSION [Docket No. PI2010-3; Order No. 456] Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It has scheduled a technical conference...

  20. 78 FR 76332 - New Postal Product

    Science.gov (United States)

    2013-12-17

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing recent Postal Service filings requesting the addition of Priority Mail Contract 71 to the competitive product... Contract 71 to the competitive product list.\\1\\ The Postal Service asserts [[Page 76333

  1. Five-year workplace wellness intervention in the NHS.

    Science.gov (United States)

    Blake, Holly; Zhou, Dingyuan; Batt, Mark E

    2013-09-01

    Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace. A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to encourage employees to make healthy lifestyle choices and sustained behaviour changes. An employee questionnaire survey was distributed at baseline (n = 1,452) and at five years (n = 1,134), including measures of physical activity, BMI, diet, self-efficacy, social support, perceived general health and mood, smoking behaviours, self-reported sickness absence, perceived work performance and job satisfaction. Samples were comparable at baseline and follow-up. At five years, significantly more respondents actively travelled (by walking or cycling both to work and for non-work trips) and more were active while at work. Significantly more respondents met current recommendations for physical activity at five years than at baseline. Fewer employers reported 'lack of time' as a barrier to being physically active following the intervention. Significantly lower sickness absence, greater job satisfaction and greater organisational commitment was reported at five years than at baseline. Improvements in health behaviours, reductions in sickness absence and improvements in job satisfaction and organisational commitment were observed following five years of a workplace wellness intervention for NHS employees. These findings suggest that health-promoting programmes should be embedded within NHS infrastructure.

  2. 76 FR 11823 - New Postal Products

    Science.gov (United States)

    2011-03-03

    ... Postal Service filing concerning proposed changes to First-Class Mail Parcel Product offerings. These.... \\1\\ Request of the United States Postal Service Under Section 3642, February 24, 2011 (Request). The Postal Service explains that commercial First-Class Mail Parcels refers to the First-Class Mail...

  3. 75 FR 65675 - New Postal Product

    Science.gov (United States)

    2010-10-26

    ... United States Postal Service of Filing Canada Post Group--United States Postal Service Contractual... United States by surface transportation and Xpresspost, a Canadian service for documents, packets, and... tender surface parcels and Xpresspost to the Postal Service at negotiated prices rather than the default...

  4. 75 FR 11452 - New Postal Product

    Science.gov (United States)

    2010-03-11

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Final rule. SUMMARY: The Commission is adding special postal services to the product lists. This action is consistent with changes in a postal reform law. Republication of the product lists is also consistent with a statutory provision. The Commission...

  5. 76 FR 67496 - New Postal Product

    Science.gov (United States)

    2011-11-01

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2012-1; Order No. 919] New Postal Product AGENCY... to the Inbound Competitive Multi-Service Agreements with Foreign Postal Operators 1 product. \\1... Operators 1 to the Competitive Product List and Approving Included Agreement, September 29, 2010 (Order No...

  6. 77 FR 4376 - New Postal Product

    Science.gov (United States)

    2012-01-27

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 38 to the competitive product list... 38 to the competitive product list.\\1\\ Priority mail contracts enable the Postal Service to provide...

  7. 77 FR 67839 - New Postal Product

    Science.gov (United States)

    2012-11-14

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Priority Mail Contract 48 to the competitive product... Mail Contract 48 to the competitive product list.\\1\\ The Postal Service indicates that the instant...

  8. 75 FR 7201 - New Postal Product

    Science.gov (United States)

    2010-02-18

    ... Postal Product AGENCY: Postal Regulatory Commission. ACTION: Final rule. SUMMARY: The Commission is adding Priority Mail Contract 24 to the Competitive Product List. This action is consistent with changes in a postal reform law. Republication of the lists of market dominant and competitive products is...

  9. 78 FR 79023 - New Postal Product

    Science.gov (United States)

    2013-12-27

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing requesting the addition of Priority Mail Contract 73 to the competitive product... supporting information to add Priority Mail Contract 73 to the competitive product list.\\1\\ The Postal...

  10. 75 FR 166 - Postal Product Price Changes

    Science.gov (United States)

    2010-01-04

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2009-49; Order No. 371] Postal Product Price Changes...-filed Postal Service request to change prices for a Global Plus 2 contract. This notice provides an...: On December 21, 2009, the Postal Service filed a notice that prices for the Global Plus 2 contract at...

  11. 75 FR 44819 - New Postal Product

    Science.gov (United States)

    2010-07-29

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service filing to add Priority Mail Contract 27 to the competitive product list. The... to add Priority Mail Contract 27 to the competitive product list.\\1\\ The Postal Service asserts that...

  12. 78 FR 37851 - New Postal Product

    Science.gov (United States)

    2013-06-24

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2013-68; Order No. 1750] New Postal Product AGENCY... filing concerning the addition of Global Expedited Package Services 3 Contract to the competitive product... GEPS 3 product. Notice at 2. \\1\\ Notice of United States Postal Service of Filing a Functionally...

  13. 78 FR 76334 - New Postal Product

    Science.gov (United States)

    2013-12-17

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2013-13; Order No. 1900] New Postal Product AGENCY...'' of the product. Id. The Postal Service seeks to incorporate by reference the Application for Non... and Order Concerning the Addition of Parcel Select Contract 6 to the Competitive Product List, October...

  14. Digital transformation, business models and the postal industry

    OpenAIRE

    Kollara, Nandkumar Harshan

    2017-01-01

    For many decades, the postal industry offered postal services and in parallel, had a monopoly over the national postal markets. Recently, the postal industry endured a phase where their national postal markets were subjected to liberalisation by the respective nations. This was due to various reasons such as inefficiencies of the postal services, ambiguous monopoly legislations, mounting pressure from competitors, and changing nature of customer demands. The liberalisation of the European Uni...

  15. 39 CFR 221.7 - Postal Service emblem.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Postal Service emblem. 221.7 Section 221.7 Postal... Service emblem. The Postal Service emblem, which is identical with the seal, is registered as a trademark and service mark by the U.S. Patent Office. Except for the emblem on official stationery, the emblem...

  16. 77 FR 36585 - Postal Rate Changes

    Science.gov (United States)

    2012-06-19

    ... Service notice of rate and changes affecting Inbound Air Parcel Post at Universal Postal Union (UPU) rates... United States Postal Service of Filing Changes in Rates Not of General Applicability and Application for... the Postal Service's explanation of Inbound Air Parcel Post (at UPU Rates) provided in the initial...

  17. 78 FR 13713 - New Postal Product

    Science.gov (United States)

    2013-02-28

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Express Mail Contract 14 to the competitive product list... 14 to the competitive product list.\\1\\ The Postal Service asserts that Express Mail Contract 14 is a...

  18. 77 FR 1957 - New Postal Product

    Science.gov (United States)

    2012-01-12

    ... Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently filed Postal Service request to add Global Plus 2C Contracts to the competitive product..., consisting of two Global Plus 2C agreements, to the competitive products list.\\1\\ The new product covers...

  19. 77 FR 2098 - New Postal Product

    Science.gov (United States)

    2012-01-13

    ... Postal Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Global Plus 1C agreements to the competitive product... of two Global Plus 1C agreements, to the competitive product list.\\1\\ The instant agreements are set...

  20. 78 FR 63519 - New Postal Product

    Science.gov (United States)

    2013-10-24

    ... Docket No. MC2014-1. \\1\\ Request of the United States Postal Service to Add Parcel Select and Parcel... recently-filed Postal Service request to add Parcel Select & Parcel Return Service Contract 5 to the...., the Postal Service filed a formal request and associated supporting information to add Parcel Select...

  1. 76 FR 80412 - New Postal Product

    Science.gov (United States)

    2011-12-23

    ... POSTAL REGULATORY COMMISSION Docket No. CP2012-4; Order No. 1057] New Postal Product AGENCY... Agreement within the Inbound Competitive Multi-Service Agreement with a Foreign Postal Operators 1 product... explaining why, after the change, competitive products in total will be in compliance with 39 U.S.C. 3633(a...

  2. 75 FR 4593 - New Postal Product

    Science.gov (United States)

    2010-01-28

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2010-20; Order No. 397] New Postal Product AGENCY... Service request to add GEPS 2 (CP2009-50) to the Competitive Product List. The Postal Service has also... Global Expedited Package Services 2 to the Competitive Product List, August 28, 2009 (Order No. 290). \\4...

  3. 78 FR 65014 - New Postal Product

    Science.gov (United States)

    2013-10-30

    ... POSTAL REGULATORY COMMISSION [Docket No. MC2014-3 and CP2014-3; Order No. 1860] New Postal Product... competitive product list. This notice informs the public of the filing, invites public comment, and takes... Mail Express & Priority Mail Contract 15 to the competitive product list.\\1\\ The Postal Service asserts...

  4. 76 FR 55619 - Performance Measurement for Special Postal Services

    Science.gov (United States)

    2011-09-08

    ..., Corporate & Postal Business Law, United States Postal Service to Shoshana M. Grove, Secretary, Postal... & Postal Business Law, United States Postal Service. III. Background of Postal Service Proposals A...), Public Law 109-435, 120 Stat. 3198 (2006). The proposed rules described herein would establish reporting...

  5. 39 CFR 221.1 - The United States Postal Service.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false The United States Postal Service. 221.1 Section 221.1 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION GENERAL ORGANIZATION § 221.1 The United States Postal Service. The United States Postal Service was established as an...

  6. Combining Internet-Based and Postal Survey Methods in a Survey among Gynecologists: Results of a Randomized Trial.

    Science.gov (United States)

    Ernst, Sinja Alexandra; Brand, Tilman; Lhachimi, Stefan K; Zeeb, Hajo

    2018-04-01

    To assess whether a combination of Internet-based and postal survey methods (mixed-mode) compared to postal-only survey methods (postal-only) leads to improved response rates in a physician survey, and to compare the cost implications of the different recruitment strategies. All primary care gynecologists in Bremen and Lower Saxony, Germany, were invited to participate in a cross-sectional survey from January to July 2014. The sample was divided into two strata (A; B) depending on availability of an email address. Within each stratum, potential participants were randomly assigned to mixed-mode or postal-only group. In Stratum A, the mixed-mode group had a lower response rate compared to the postal-only group (12.5 vs. 20.2 percent; RR = 0.61, 95 percent CI: 0.44-0.87). In stratum B, no significant differences were found (15.6 vs. 16.2 percent; RR = 0.95, 95 percent CI: 0.62-1.44). Total costs (in €) per valid questionnaire returned (Stratum A: 399.72 vs. 248.85; Stratum B: 496.37 vs. 455.15) and per percentage point of response (Stratum A: 1,379.02 vs. 861.02; Stratum B 1,116.82 vs. 1,024.09) were higher, whereas variable costs were lower in mixed-mode compared to the respective postal-only groups (Stratum A cost ratio: 0.47, Stratum B cost ratio: 0.71). In this study, primary care gynecologists were more likely to participate by traditional postal-only than by mixed-mode survey methods that first offered an Internet option. However, the lower response rate for the mixed-mode method may be partly due to the older age structure of the responding gynecologists. Variable costs per returned questionnaire were substantially lower in mixed-mode groups and indicate the potential for cost savings if the sample population is sufficiently large. © Health Research and Educational Trust.

  7. 39 CFR 211.2 - Regulations of the Postal Service.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Regulations of the Postal Service. 211.2 Section 211.2 Postal Service UNITED STATES POSTAL SERVICE ORGANIZATION AND ADMINISTRATION APPLICATION OF REGULATIONS § 211.2 Regulations of the Postal Service. (a) The regulations of the Postal Service consist of...

  8. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Science.gov (United States)

    Brealey, Stephen D; Atwell, Christine; Bryan, Stirling; Coulton, Simon; Cox, Helen; Cross, Ben; Fylan, Fiona; Garratt, Andrew; Gilbert, Fiona J; Gillan, Maureen GC; Hendry, Maggie; Hood, Kerenza; Houston, Helen; King, David; Morton, Veronica; Orchard, Jo; Robling, Michael; Russell, Ian T; Torgerson, David; Wadsworth, Valerie; Wilkinson, Clare

    2007-01-01

    Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105) compared with 88.0% (389 of 442) for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study. PMID:17326837

  9. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Directory of Open Access Journals (Sweden)

    Orchard Jo

    2007-02-01

    Full Text Available Abstract Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105 compared with 88.0% (389 of 442 for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%. Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009 with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study.

  10. ORGANIZATIONAL DEVELOPMENT IN THE FIELD OF POSTAL SERVICES

    Directory of Open Access Journals (Sweden)

    Sirbu Janetta

    2013-07-01

    The evaluation of organizational development at the County Postal Office in Cluj was made by applying a questionnaire on organizational development that consists of 60 descriptive statements, answered by four of the organization\\'s management and 56 employees with executive positions. Following the results obtained from the questionnaires there has been showed that the organization is in phase two of development that is leadership development. The applied management style starts to be on odds with reality and triggers the crisis of autonomy, which requires delegation of authority and responsibilities to as many employees as possible, involvement and encouragement of initiatives of the staff. After analyzing the questionnaire responses, it was revealed that the organization is in the second phase of development, respectively development through leadership, requiring an authorized leader to streamline the activity and to create major necessary budgeting systems of reward and communication.

  11. Developing an explicit strategy towards social responsibility in the NHS: a case for including NHS managers in this strategy.

    Science.gov (United States)

    Merali, Faruk

    2006-01-01

    To explore the concept of corporate social responsibility (CSR) within the UK National Health Service (NHS) and to examine how it may be developed to positively influence the psyche, behaviour and performance of NHS managers. Primary research based upon semi-structured individual face to face interviews with 20 NHS managers. Theoretical frameworks and concepts relating to organisational culture and CSR are drawn upon to discuss the findings. The NHS managers see themselves as being driven by altruistic core values. However, they feel that the public does not believe that they share the altruistic NHS value system. The study is based on a relatively small sample of NHS managers working exclusively in London and may not necessarily represent the views of managers either London-wide or nation-wide. It is suggested that an explicit recognition by the NHS of the socially responsible commitment of its managers within its CSR strategy would help challenge the existing negative public image of NHS managers and in turn improve the managers' self esteem and morale. This paper addresses the relative lacunae in research relating to public sector organisations (such as the NHS) explicitly including the role and commitment of its staff within the way it publicises its CSR strategy. This paper would be of interest to a wide readership including public sector and NHS policy formulators, NHS practitioners, academics and students.

  12. Morocco : French postal administration after 1912 and Morocco's postal services during the First World War

    NARCIS (Netherlands)

    Dietz, A.J.

    2017-01-01

    An earlier version of (parts of) APH 5 was published as African Studies Centre Leiden Working Paper 125 / 2016: "A postal history of the First World War in Africa and its aftermath - German colonies/postal areas : V Morocco", written by Ton Dietz.

  13. Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

    Directory of Open Access Journals (Sweden)

    McEwen Andy

    2010-07-01

    Full Text Available Abstract Background UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions. Methods Electronic questionnaire survey of 185 UK Stop Smoking Services Managers. Results Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate. Of these, 58.3% (n = 56 ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%, group (73%, and individual (54%. Just under half (48%, n = 27 offered nicotine replacement therapy (NRT, 21.4% (n = 12 bupropion; 19.6% (n = 11 varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22 believed that the government focus on four-week quit rates, and 42.9% (14 services believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care. Conclusions Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

  14. 39 CFR 1.1 - Establishment of the U.S. Postal Service.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Establishment of the U.S. Postal Service. 1.1 Section 1.1 Postal Service UNITED STATES POSTAL SERVICE THE BOARD OF GOVERNORS OF THE U.S. POSTAL SERVICE POSTAL POLICY (ARTICLE I) § 1.1 Establishment of the U.S. Postal Service. The U.S. Postal Service is...

  15. 77 FR 304 - New Postal Product

    Science.gov (United States)

    2012-01-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 37 to the competitive product list... competitive product list.\\1\\ Priority mail [[Page 305

  16. Redefining NHS complaint handling--the real challenge.

    Science.gov (United States)

    Seelos, L; Adamson, C

    1994-01-01

    More and more organizations find that a constructive and open dialogue with their customers can be an effective strategy for building long-term customer relations. In this context, it has been recognized that effective complaint-contact handling can make a significant contribution to organizations' attempts to maximize customer satisfaction and loyalty. Within the NHS, an intellectual awareness exists that effective complaint/contact handling can contribute to making services more efficient and cost-effective by developing customer-oriented improvement initiatives. Recent efforts have focused on redefining NHS complaint-handling procedures to make them more user-friendly and effective for both NHS employees and customers. Discusses the challenges associated with opening up the NHS to customer feedback. Highlights potential weaknesses in the current approach and argues that the real challenge is for NHS managers to facilitate a culture change that moves the NHS away from a long-established defensive complaint handling practice.

  17. 39 CFR 762.43 - Issuance of substitute disbursement postal money order.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Issuance of substitute disbursement postal money...; DISBURSEMENT POSTAL MONEY ORDERS DISBURSEMENT POSTAL MONEY ORDERS Issuance of Substitutes for Lost, Destroyed, Mutilated, and Defaced Disbursement Postal Money Orders § 762.43 Issuance of substitute disbursement postal...

  18. 77 FR 2676 - Competitive Postal Products

    Science.gov (United States)

    2012-01-19

    ... could give the Postal Service an artificial competitive advantage. The Commission gave considerable... POSTAL REGULATORY COMMISSION 39 CFR Part 3015 [Docket No. RM2012-3; Order No. 1108] Competitive... Commission is initiating a review to determine whether competitive products provide the appropriate minimum...

  19. 75 FR 34074 - Postal Pricing Methods

    Science.gov (United States)

    2010-06-16

    ... Methods AGENCY: Postal Regulatory Commission. ACTION: Notice of proposed rulemaking. SUMMARY: The... price sensitivity (elasticity) to volumes actually mailed during the rebate program. This method is... indicated by the market elasticity. Mitchell Comments at 4-6. Postal Service method. In its data collection...

  20. Influenza and pneumococcal vaccine uptake among nursing home residents in Nottingham, England: a postal questionnaire survey

    Directory of Open Access Journals (Sweden)

    Vivancos Roberto

    2008-05-01

    Full Text Available Abstract Background Previous studies have shown influenza vaccine uptake in UK nursing home residents to be low. Very little information exists regarding the uptake of pneumococcal vaccine in this population. The formulation of policies relating to the vaccination of residents has been proposed as a simple step that may help improve vaccine uptake in care homes. Methods A postal questionnaire was sent to matrons of all care homes with nursing within the Greater Nottingham area in January 2006. Non respondents were followed up with up to 3 phone calls. Results 30% (16/53 of respondents reported having a policy addressing influenza vaccination and 15% (8/53 had a policy addressing pneumococcal vaccination. Seasonal influenza vaccine coverage in care homes with a vaccination policy was 87% compared with 84% in care homes without a policy (p = 0.47. The uptake of pneumococcal vaccination was found to be low, particularly in care homes with no vaccination policy. Coverage was 60% and 32% in care homes with and without a vaccination policy respectively (p = 0.06. This result was found to be statistically significant on multivariate analysis (p = 0.03, R = 0.46 Conclusion The uptake of influenza vaccine among care home residents in the Nottingham region is relatively high, although pneumococcal vaccine uptake is low. This study shows that there is an association between pneumococcal vaccine uptake and the existence of a vaccination policy in care homes, and highlights that few care homes have vaccination policies in place.

  1. 76 FR 77271 - Competitive Product Postal Price Changes

    Science.gov (United States)

    2011-12-12

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2012-2; Order No. 997] Competitive Product Postal Price... recently-filed Postal Service request for a change in competitive products prices. The changes will take... and justification for the changes, the effective date, and a schedule of the changed rates. The price...

  2. 77 FR 58422 - New Postal Product

    Science.gov (United States)

    2012-09-20

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 43 to the competitive product list... request and associated supporting information to add Priority Mail Contract 43 to the competitive product...

  3. 77 FR 60727 - New Postal Product

    Science.gov (United States)

    2012-10-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service Contract 20 is a...

  4. 78 FR 43245 - New Postal Product

    Science.gov (United States)

    2013-07-19

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Priority Mail Contract 61 to the competitive product... the competitive product list.\\1\\ It asserts that Priority Mail Contract 61 is a competitive product...

  5. 77 FR 60726 - New Postal Product

    Science.gov (United States)

    2012-10-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... 19 to the competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service...

  6. 77 FR 60725 - New Postal Product

    Science.gov (United States)

    2012-10-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service Contract 16 is a...

  7. 77 FR 60729 - New Postal Product

    Science.gov (United States)

    2012-10-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service Contract 17 is a...

  8. 75 FR 45174 - New Postal Product

    Science.gov (United States)

    2010-08-02

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... competitive product list. The Postal Service has also filed a related contract. This notice addresses... product list within the Mail Classification Schedule (MCS).\\1\\ This product grouping would create a niche...

  9. 77 FR 58421 - New Postal Product

    Science.gov (United States)

    2012-09-20

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 42 to the competitive product list... request and associated supporting information to add Priority Mail Contract 42 to the competitive product...

  10. 77 FR 60728 - New Postal Product

    Science.gov (United States)

    2012-10-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service Contract 18 is a...

  11. 77 FR 305 - New Postal Product

    Science.gov (United States)

    2012-01-04

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... competitive product list. This notice addresses procedural steps associated with the filing. DATES: Comments... Services-Non- Published Rates 3 (GEPS-NPR 3) to the competitive product list.\\1\\ The Postal [[Page 306...

  12. 77 FR 51583 - New Postal Product

    Science.gov (United States)

    2012-08-24

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... competitive product list.\\1\\ The Postal Service asserts that First- Class Package Service Contract 15 is a...

  13. 75 FR 65386 - New Postal Product

    Science.gov (United States)

    2010-10-22

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2011-19; Order No. 562] New Postal Product AGENCY... product list. This notice addresses procedural steps associated with this filing. DATES: Comments are due... GEPS 1 as a product, also authorized functionally equivalent agreements to be included within the...

  14. 78 FR 39783 - New Postal Product

    Science.gov (United States)

    2013-07-02

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add a new product to the competitive product list. This document... and associated supporting information to add Priority Mail Contract 60 to the competitive product list...

  15. 78 FR 77172 - New Postal Product

    Science.gov (United States)

    2013-12-20

    ... Counsel, at 202-789-6820. SUPPLEMENTARY INFORMATION: Table of Contents I. Introduction II. Contents of Filing III. Commission Action IV. Ordering Paragraphs I. Introduction On December 13, 2013, the Postal..., 3. II. Contents of Filing The Postal Service's filing consists of the Notice, financial workpapers...

  16. Improving clinical leadership and management in the NHS

    Directory of Open Access Journals (Sweden)

    Nicol ED

    2012-08-01

    Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service

  17. 78 FR 59382 - New Postal Product

    Science.gov (United States)

    2013-09-26

    ... relevant to the customer's mailing profile, and cost coverage projections. Id. The Postal Service asks the... recently-filed Postal Service request to add a new product to the competitive product list. This document... due: September 27, 2013. ADDRESSES: Submit comments electronically by accessing the ``Filing Online...

  18. 77 FR 67840 - New Postal Product

    Science.gov (United States)

    2012-11-14

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent... competitive product list. This notice informs the public of the filing, invites public comment, and takes... to add First-Class Package Service Contract 26 to the competitive product list.\\1\\ The Postal Service...

  19. 77 FR 58185 - New Postal Product

    Science.gov (United States)

    2012-09-19

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2012-56; Order No. 1464] New Postal Product AGENCY... Service request to add a Global Expedited Package Services contract to the competitive product list. This... contracts are small- or medium-size businesses that mail products directly to foreign destinations using...

  20. 75 FR 45176 - New Postal Product

    Science.gov (United States)

    2010-08-02

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add Priority Mail Contract 25 to the competitive product list. The... associated supporting information to add Priority Mail Contract 25 to the competitive product list.\\1\\ The...

  1. 77 FR 50729 - New Postal Product

    Science.gov (United States)

    2012-08-22

    ... POSTAL REGULATORY COMMISSION [Docket Nos. MC2012-44; Order No. 1435] New Postal Product AGENCY... Service request for two related changes to the product lists. The changes involve removing one product from the market dominant product list and adding a nearly identical product to the competitive product...

  2. 78 FR 26405 - New Postal Product

    Science.gov (United States)

    2013-05-06

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Priority Mail Contract 58 to the competitive product... 58 to the competitive product list.\\1\\ It asserts that Priority Mail Contract 58 is a competitive...

  3. 78 FR 29784 - New Postal Product

    Science.gov (United States)

    2013-05-21

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2013-62; Order No. 1716] New Postal Product AGENCY... filing concerning the addition of Global Expedited Package Services 3 Contract to the competitive product... GEPS 3 product on grounds of functional equivalence to a previously approved baseline agreement. Id. at...

  4. 75 FR 7296 - New Postal Product

    Science.gov (United States)

    2010-02-18

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2010-23; Order No. 405] New Postal Product AGENCY... Service request to add a Global Expedited Package Services 2 contract to the Competitive Product List... established GEPS 1 as a product, also authorized functionally equivalent agreements to be included within the...

  5. 78 FR 13714 - New Postal Product

    Science.gov (United States)

    2013-02-28

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Priority Mail Contract 55 to the competitive product... 55 to the competitive product list.\\1\\ It asserts that Priority Mail Contract 55 is a competitive...

  6. 78 FR 70084 - New Postal Product

    Science.gov (United States)

    2013-11-22

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent Postal Service filing concerning the addition of Priority Mail Contract 65 to the competitive product... information to add Priority Mail Contract 65 to the competitive product list.\\1\\ It asserts that Priority Mail...

  7. 78 FR 79022 - New Postal Product

    Science.gov (United States)

    2013-12-27

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent... product list. This notice informs the public of the filing, invites public comment, and takes other... Mail Express Contract 16 to the competitive product list.\\1\\ The Postal Service asserts that Priority...

  8. 78 FR 65016 - New Postal Product

    Science.gov (United States)

    2013-10-30

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing recent Postal Service filings requesting the addition of Priority Mail Contract 66 to the competitive product... Contract 66 to the competitive product list.\\1\\ It is the successor agreement to the contract approved in...

  9. 75 FR 65533 - New Postal Product

    Science.gov (United States)

    2010-10-25

    ... consideration of the Request pertaining to the proposed Express Mail Contract 9 product and the related contract...-filed Postal Service filing to add Express Mail Contract 9 to the competitive product list. The Postal Service has also filed a related contract. This notice addresses procedural steps associated with the...

  10. 75 FR 12805 - New Postal Product

    Science.gov (United States)

    2010-03-17

    ... Docket No. CP2010-26 for consideration of matters related to the contract identified in the Postal... Service request to include a new contract within the existing Global Expedited Package Services 2 (GEPS 2) product. The Postal Service characterizes the referenced contract as a successor to a current contract...

  11. 75 FR 72846 - New Postal Product

    Science.gov (United States)

    2010-11-26

    ...\\ Request of the United States Postal Service to Add Parcel Return Service Contract 2 to the Competitive... recently-filed Postal Service request to add Parcel Return Service Contract 2 to the competitive product... Service filed a formal request and associated supporting information to add Parcel Return Service Contract...

  12. 78 FR 40203 - New Postal Product

    Science.gov (United States)

    2013-07-03

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recently-filed Postal Service request to add a new product to the competitive product list. This document... Rate Boxes--Non-Published Rates (PMI RRB-NPR) to the competitive product list.\\1\\ It provides a related...

  13. 78 FR 4478 - New Postal Product

    Science.gov (United States)

    2013-01-22

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2013-42; Order No. 1623] New Postal Product AGENCY... within the Global Plus 2C product on the grounds of functional equivalence to previously approved.... Id. at 1. Background. The Commission added Global Plus 2 to the competitive product list, based on...

  14. 78 FR 963 - New Postal Product

    Science.gov (United States)

    2013-01-07

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent... 4 to the competitive product list. This notice informs the public of the filing, invites public... product list.\\1\\ The Postal Service states that the addition is necessary due to changes in the non...

  15. 77 FR 1089 - New Postal Product

    Science.gov (United States)

    2012-01-09

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2012-9; Order No. 1096] New Postal Product AGENCY... Service request to add a Global Direct Contracts 1 contract to the competitive product list. This notice... believes that the instant Agreement should be included within the Global Direct Contracts 1 product because...

  16. 76 FR 4138 - New Postal Product

    Science.gov (United States)

    2011-01-24

    ... POSTAL REGULATORY COMMISSION [Docket No. CP2011-58; Order No. 652] New Postal Product AGENCY..., which established GREP Contracts 1 as a product, also authorized functionally equivalent agreements to be included within the product, provided that they meet the requirements of 39 U.S.C. 3633. Id. at 1...

  17. 75 FR 3383 - New Postal Product

    Science.gov (United States)

    2010-01-21

    ... is adding Express Mail Contract 7 to the Competitive Product List. This action is consistent with a postal reform law. Republication of the lists of market dominant and competitive products is also.... Introduction The Postal Service seeks to add a new product identified as Express Mail [[Page 3384

  18. Linking NHS data for pediatric pharmacovigilance: Results of a Delphi survey.

    Science.gov (United States)

    Hopf, Y M; Francis, J; Helms, P J; Haughney, J; Bond, C

    2016-01-01

    Adverse drug events are a major cause of patient safety incidents. Current systems of pharmacovigilance under-report adverse drug reactions (ADRs), especially in children, leading to delays in their identification. This is of particular concern, as children especially have an increased vulnerability to ADRs. The objective was to seek consensus among healthcare professionals (HCPs) about barriers and facilitators to the linkage of routinely collected health data for pediatric pharmacovigilance in Scotland. A Delphi survey was conducted with a random sample of HCPs including nurses, pharmacists and doctors, working in primary or secondary care, in Scotland. Participants were identified from sampling frames of the target professionals such as an NHS workforce list for general practitioners and recruited by postal invitation. A total of 819 HCPs were invited to take part. Those agreeing to participate were given the option of completing the questionnaires online or as hard copy. Reminders were sent twice at a fortnightly interval. Questions content included description of professional role as well as testing for the willingness to support the proposed project and was informed by the Theoretical Domains Framework of Behavior Change (TDF) and earlier qualitative work. Three Delphi rounds were administered, including a first round for item generation. 121 of those invited agreed to take part (15%). The first round of the Delphi study included 21 open questions and generated over a 1000 individual statements from 61 participants that returned the questionnaires (50.4%). These were rationalized to 149 items for the second round in which participants rated their views on the importance (or not) of each item on a 9-point Likert scale (strongly disagree - strongly agree). After the third round, there was consensus on items that focused on professional standards, and practical requirements, overall there was support for data linkage and a multi-professional approach. It would

  19. Identification of the gene for Nance-Horan syndrome (NHS).

    Science.gov (United States)

    Brooks, S P; Ebenezer, N D; Poopalasundaram, S; Lehmann, O J; Moore, A T; Hardcastle, A J

    2004-10-01

    The disease intervals for Nance-Horan syndrome (NHS [MIM 302350]) and X linked congenital cataract (CXN) overlap on Xp22. To identify the gene or genes responsible for these diseases. Families with NHS were ascertained. The refined locus for CXN was used to focus the search for candidate genes, which were screened by polymerase chain reaction and direct sequencing of potential exons and intron-exon splice sites. Genomic structures and homologies were determined using bioinformatics. Expression studies were undertaken using specific exonic primers to amplify human fetal cDNA and mouse RNA. A novel gene NHS, with no known function, was identified as causative for NHS. Protein truncating mutations were detected in all three NHS pedigrees, but no mutation was identified in a CXN family, raising the possibility that NHS and CXN may not be allelic. The NHS gene forms a new gene family with a closely related novel gene NHS-Like1 (NHSL1). NHS and NHSL1 lie in paralogous duplicated chromosomal intervals on Xp22 and 6q24, and NHSL1 is more broadly expressed than NHS in human fetal tissues. This study reports the independent identification of the gene causative for Nance-Horan syndrome and extends the number of mutations identified.

  20. The first missense mutation of NHS gene in a Tunisian family with clinical features of NHS syndrome including cardiac anomaly.

    Science.gov (United States)

    Chograni, Manèl; Rejeb, Imen; Jemaa, Lamia Ben; Châabouni, Myriam; Bouhamed, Habiba Chaabouni

    2011-08-01

    Nance-Horan Syndrome (NHS) or X-linked cataract-dental syndrome is a disease of unknown gene action mechanism, characterized by congenital cataract, dental anomalies, dysmorphic features and, in some cases, mental retardation. We performed linkage analysis in a Tunisian family with NHS in which affected males and obligate carrier female share a common haplotype in the Xp22.32-p11.21 region that contains the NHS gene. Direct sequencing of NHS coding exons and flanking intronic sequences allowed us to identify the first missense mutation (P551S) and a reported SNP-polymorphism (L1319F) in exon 6, a reported UTR-SNP (c.7422 C>T) and a novel one (c.8239 T>A) in exon 8. Both variations P551S and c.8239 T>A segregate with NHS phenotype in this family. Although truncations, frame-shift and copy number variants have been reported in this gene, no missense mutations have been found to segregate previously. This is the first report of a missense NHS mutation causing NHS phenotype (including cardiac defects). We hypothesize also that the non-reported UTR-SNP of the exon 8 (3'-UTR) is specific to the Tunisian population.

  1. 75 FR 65532 - New Postal Product

    Science.gov (United States)

    2010-10-25

    .... MC2011-2 and CP2011-3 for consideration of the Request pertaining to the proposed Priority Mail Contract...-filed Postal Service filing to add Priority Mail Contract 28 to the competitive product list. The Postal Service has also filed a related contract. This notice addresses procedural steps associated with the...

  2. 75 FR 65531 - New Postal Product

    Science.gov (United States)

    2010-10-25

    .... MC2011-3 and CP2011-4 for consideration of the Request pertaining to the proposed Priority Mail Contract...-filed Postal Service filing to add Priority Mail Contract 29 to the competitive product list. The Postal Service has also filed a related contract. This notice addresses procedural steps associated with the...

  3. Clinical audit of core podiatry treatment in the NHS.

    Science.gov (United States)

    Farndon, Lisa; Barnes, Andrew; Littlewood, Keith; Harle, Justine; Beecroft, Craig; Burnside, Jaclyn; Wheeler, Tracey; Morris, Selwyn; Walters, Stephen J

    2009-03-13

    Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. 1047 patients completed both questionnaires, with an age range from 26-95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories - better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the evidence base for podiatry.

  4. Clinical audit of core podiatry treatment in the NHS

    Directory of Open Access Journals (Sweden)

    Burnside Jaclyn

    2009-03-01

    Full Text Available Abstract Background Core podiatry involves treatment of the nails, corns and callus and also giving footwear and foot health advice. Though it is an integral part of current podiatric practice little evidence is available to support its efficacy in terms of research and audit data. This information is important in order to support the current NHS commissioning process where services are expected to provide data on standards including outcomes. This study aimed to increase the evidence base for this area of practice by conducting a multi-centre audit in 8 NHS podiatry departments over a 1-year period. Methods The outcome measure used in this audit was the Podiatry Health Questionnaire which is a self completed short measure of foot health including a pain visual analogue scale and a section for the podiatrist to rate an individual's foot health based on their podiatric problems. The patient questionnaire was completed by individuals prior to receiving podiatry care and then 2 weeks after treatment to assess the effect of core podiatry in terms of pain and foot health. Results 1047 patients completed both questionnaires, with an age range from 26–95 years and a mean age of 72.9 years. The podiatrists clinical rating at baseline showed 75% of patients had either slight or moderate podiatric problems. The differences in questionnaire and visual analogue scores before and after treatment were determined according to three categories – better, same, worse and 75% of patients' scores either remained the same or improved after core podiatry treatment. A student t-test showed a statistical significant difference in pre and post treatment scores where P Conclusion Core podiatry has been shown to sustain or improve foot health and pain in 75% of the patients taking part in the audit. Simple outcome measures including pain scales should be used routinely in podiatric practice to assess the affect of different aspects of treatments and improve the

  5. Human resource management in the delivery of postal items

    Directory of Open Access Journals (Sweden)

    Kujačić Momčilo D.

    2015-01-01

    Full Text Available Delivery of postal items is the last phase in the postal conveyance process. This phase involved up to 57% in total costs of postal items conveyance. In order to reduce the costs of delivery phase, postal organizations apply different methods and techniques. Legal and technological regulations, various restrictions regarding the selection and deployment of employees influence the choice of appropriate methods. Also, the principle of availability of the universal postal service is an essential factor in defining the optimal model. In this paper, the model for assessing and planning of the number of employees in the delivery service observed postal operator has been proposed, with respect to the principles of productivity and accessibility constraints of the universal postal service. This paper will analyze the impact of daily fluctuations in the number of full-time employees and the possibility of hiring a part-time workers in the days with increased traffic volume in the delivery of items, when usually the items from large customers are delivered.

  6. 39 CFR 762.28 - Release of original disbursement postal money orders.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Release of original disbursement postal money... and Processing of Disbursement Postal Money Orders § 762.28 Release of original disbursement postal money orders. An original Disbursement Postal Money Order may be released to a responsible endorser only...

  7. 75 FR 9523 - New Postal Product

    Science.gov (United States)

    2010-03-03

    ... obligations or new requirements on any party to the contract. The docket referenced in the caption should be... adding Global Direct Contracts 1 to the Competitive Product List. This action is consistent with a postal.... Introduction The Postal Service seeks to add a new product identified as Global Direct Contracts 1 to the...

  8. NHS market liberalisation and the TTIP agreement.

    Science.gov (United States)

    Regan, Paul; Ball, Elaine

    2016-07-01

    Governments over the past three decades have undermined the founding principles of the NHS through reforms and market liberalisation. With greater involvement of commercial interests in health care, the NHS will become less democratic and transparent. Recent reforms, which were intended to improve productivity, quality and cost efficiency, have left the NHS exposed to the unwieldy model of market liberalisation and the attrition of public health care. The role of community nurses has been particularly destabilised by commissioning, as their work is difficult to measure. The advent of the Transatlantic Trade and Investment Partnership could further undermine the NHS to the benefit of international commercial interests.

  9. 77 FR 27491 - New Postal Product

    Science.gov (United States)

    2012-05-10

    ..., April 30, 2012 (Request). Request. In support of its Request, the Postal Service filed six attachments... exceed 85 percent of the total volume of pieces mailed. Id. Valassis has agreed to initiate mailings... 1,000,000 pieces during the following 12 months or pay the Postal Service a one-time fee of $100,000...

  10. Part-time work and job sharing in health care: is the NHS a family-friendly employer?

    Science.gov (United States)

    Branine, Mohamed

    2003-01-01

    This paper examines the nature and level of flexible employment in the National Health Service (NHS) by investigating the extent to which part-time work and job sharing arrangements are used in the provision and delivery of health care. It attempts to analyse the reasons for an increasing number of part-timers and a very limited number of job sharers in the NHS and to explain the advantages and disadvantages of each pattern of employment. Data collected through the use of questionnaires and interviews from 55 NHS trusts reveal that the use of part-time work is a tradition that seems to fit well with the cost-saving measures imposed on the management of the service but at the same time it has led to increasing employee dissatisfaction, and that job sharing arrangements are suitable for many NHS employees since the majority of them are women with a desire to combine family commitments with career prospects but a very limited number of employees have had the opportunity to job share. Therefore it is concluded that to attract and retain the quality of staff needed to ensure high performance standards in the provision and delivery of health care the NHS should accept the diversity that exists within its workforce and take a more proactive approach to promoting a variety of flexible working practices and family-friendly policies.

  11. Effect of prize draw incentive on the response rate to a postal survey of obstetricians and gynaecologists: A randomised controlled trial. [ISRCTN32823119

    Directory of Open Access Journals (Sweden)

    Clark T Justin

    2004-06-01

    Full Text Available Abstract Background Response rates to postal questionnaires are falling and this threatens the external validity of survey findings. We wanted to establish whether the incentive of being entered into a prize draw to win a personal digital assistant (PDA would increase the response rate for a national survey of consultant obstetricians and gynaecologists. Methods A randomised controlled trial was conducted. This involved sending a postal questionnaire to all Consultant Obstetricians and Gynaecologists in the United Kingdom. Recipients were randomised to receiving a questionnaire offering a prize draw incentive (on response or no such incentive. Results The response rate for recipients offered the prize incentive was 64% (461/716 and 62% (429/694 in the no incentive group (relative rate of response 1.04, 95% CI 0.96 – 1.13 Conclusion The offer of a prize draw incentive to win a PDA did not significantly increase response rates to a national questionnaire survey of consultant obstetricians and gynaecologists.

  12. 76 FR 67500 - Postal Service Price Adjustment

    Science.gov (United States)

    2011-11-01

    ... available data from the Bureau of Labor Statistics provides the Postal Service with inflation-based price... includes a brief introductory section, three enumerated parts, and three attachments. The Postal Service also submitted separate workpapers supporting the planned changes. The introductory section includes...

  13. 78 FR 12801 - New Postal Product; Negotiated Service Agreement

    Science.gov (United States)

    2013-02-25

    ... the United States Postal Service to Add Parcel Return Service Contract 3 to Competitive Product List... Commission is noticing a recently-filed Postal Service request to add Parcel Return Service Contract 3 to the....30 et seq., the Postal Service filed a request and associated supporting information to add Parcel...

  14. Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

    Science.gov (United States)

    Baos, Sarah; Brigden, Amberly; Anderson, Emma; Hollingworth, William; Price, Simon; Mills, Nicola; Beasant, Lucy; Gaunt, Daisy; Garfield, Kirsty; Metcalfe, Chris; Parslow, Roxanne; Downing, Harriet; Kessler, David; Macleod, John; Stallard, Paul; Knoop, Hans; Van de Putte, Elise; Nijhof, Sanne; Bleijenberg, Gijs; Crawley, Esther

    2018-02-22

    Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

  15. 39 CFR 762.30 - Disbursement postal money orders issued to incompetent payees.

    Science.gov (United States)

    2010-07-01

    ... shall be forwarded to the Money Order Division, Postal Data Center, P.O. Box 14963, St. Louis, MO 63182... 39 Postal Service 1 2010-07-01 2010-07-01 false Disbursement postal money orders issued to... OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS DISBURSEMENT POSTAL MONEY ORDERS Endorsements, Payment...

  16. 39 CFR 762.31 - Disbursement postal money orders issued to deceased payees.

    Science.gov (United States)

    2010-07-01

    ... should be returned to the Money Order Division, Postal Data Center, P.O. Box 14963, St. Louis, MO 63182... 39 Postal Service 1 2010-07-01 2010-07-01 false Disbursement postal money orders issued to... OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS DISBURSEMENT POSTAL MONEY ORDERS Endorsements, Payment...

  17. 76 FR 25381 - Postal Service Market Test

    Science.gov (United States)

    2011-05-04

    ... POSTAL REGULATORY COMMISSION [Docket No. MT2009-4; Order No. 720] Postal Service Market Test... test, pending Commission action on anticipated request for permanent status. This document grants a one... temporarily extend its Collaborative Logistics market test under 39 U.S.C. 3641(d).\\1\\ The Commission...

  18. 76 FR 52718 - Complaint About Postal Services

    Science.gov (United States)

    2011-08-23

    ... Pleadings III. Statutory Alternatives for Commission Action IV. Analysis and Written Determination V....C. 403(c). Id. at 12. II. Postal Service Pleadings On June 7, 2011, the Postal Service filed a...)(1)(B). \\8\\ The statute does not specify the precise nature of the proceedings. IV. Analysis and...

  19. Nance-Horan syndrome protein, NHS, associates with epithelial cell junctions.

    Science.gov (United States)

    Sharma, Shiwani; Ang, Sharyn L; Shaw, Marie; Mackey, David A; Gécz, Jozef; McAvoy, John W; Craig, Jamie E

    2006-06-15

    Nance-Horan syndrome, characterized by congenital cataracts, craniofacial, dental abnormalities and mental disturbances, is an X-linked disorder with significant phenotypic heterogeneity. Affected individuals have mutations in the NHS (Nance-Horan syndrome) gene typically resulting in premature truncation of the protein. This report underlines the complexity of the regulation of the NHS gene that transcribes several isoforms. We demonstrate the differential expression of the two NHS isoforms, NHS-A and NHS-1A, and differences in the subcellular localization of the proteins encoded by these isoforms. This may in part explain the pleiotropic features of the syndrome. We show that the endogenous and exogenous NHS-A isoform localizes to the cell membrane of mammalian cells in a cell-type-dependent manner and that it co-localizes with the tight junction (TJ) protein ZO-1 in the apical aspect of cell membrane in epithelial cells. We also show that the NHS-1A isoform is a cytoplasmic protein. In the developing mammalian lens, we found continuous expression of NHS that became restricted to the lens epithelium in pre- and postnatal lens. Consistent with the in vitro findings, the NHS-A isoform associates with the apical cell membrane in the lens epithelium. This study suggests that disturbances in intercellular contacts underlie cataractogenesis in the Nance-Horan syndrome. NHS is the first gene localized at TJs that has been implicated in congenital cataracts.

  20. Overseeing oversight: governance of quality and safety by hospital boards in the English NHS.

    Science.gov (United States)

    Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos

    2015-01-01

    To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and

  1. Application of Pareto's Method in Analysing Postal Service Quality

    Directory of Open Access Journals (Sweden)

    Elizabeta Kovač-Striko

    2012-10-01

    Full Text Available The basic aim of control in postal traffic is to insure high-quality se1vices for customers. The paper presents the analysisof quality control in collecting postal items, based on the dataobtained during the control performed by the internal ControlService in the postal centre for international traffic Zagreb. Thepaper also offers some measures for the improvement of thequality of services.

  2. The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

    Directory of Open Access Journals (Sweden)

    Wye Lesley

    2009-03-01

    Full Text Available Abstract Background The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services. Methods We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations. Results Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources. Conclusion To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

  3. 78 FR 67951 - Price Cap Rules for Certain Postal Rate Adjustments; Corrections

    Science.gov (United States)

    2013-11-13

    ... POSTAL REGULATORY COMMISSION 39 CFR Part 3010 [Docket No. RM2013-2; Order No. 1786] Price Cap Rules for Certain Postal Rate Adjustments; Corrections AGENCY: Postal Regulatory Commission. ACTION: Correcting amendments. SUMMARY: The Postal Regulatory Commission published a document in the Federal Register...

  4. 39 CFR 762.29 - Endorsement of disbursement postal money orders by payees.

    Science.gov (United States)

    2010-07-01

    ... authorization, the financial organization may use an endorsement substantially as follows: Credit to the account... 39 Postal Service 1 2010-07-01 2010-07-01 false Endorsement of disbursement postal money orders by...; DISBURSEMENT POSTAL MONEY ORDERS DISBURSEMENT POSTAL MONEY ORDERS Endorsements, Payment, Guaranties, Warranties...

  5. Morality and Markets in the NHS

    Directory of Open Access Journals (Sweden)

    Barnabas J Gilbert

    2014-12-01

    Full Text Available Since its establishment in 1948, the history of the National Health Service (NHS has been characterized by organisational turbulence and system reform. At the same time, progress in science, medicine and technology throughout the western world have revolutionized the delivery of healthcare. The NHS has become a much loved, if much critiqued, national treasure. It is against this backdrop that the role of this state-funded health service has been brought into moral question. Certainly, the challenges facing healthcare policy-makers are numerous and complex, but in the wake of the Health and Social Care Act (2012, no issue is more divisive than that of market-based reform. Here we explore the turbulent history of the NHS, from its foundation to the birth of the healthcare marketplace. We explore arguments for and against the healthcare market and resolve that, amid an evolving economic and moral framework, the NHS must ensure that its original tenets of equity and autonomy remain at its core. We propose a values-explicit, systems-based approach to renew focus on both the processes and the outcomes of care.

  6. Identification of three novel NHS mutations in families with Nance-Horan syndrome.

    Science.gov (United States)

    Huang, Kristen M; Wu, Junhua; Brooks, Simon P; Hardcastle, Alison J; Lewis, Richard Alan; Stambolian, Dwight

    2007-03-27

    Nance-Horan Syndrome (NHS) is an infrequent and often overlooked X-linked disorder characterized by dense congenital cataracts, microphthalmia, and dental abnormalities. The syndrome is caused by mutations in the NHS gene, whose function is not known. The purpose of this study was to identify the frequency and distribution of NHS gene mutations and compare genotype with Nance-Horan phenotype in five North American NHS families. Genomic DNA was isolated from white blood cells from NHS patients and family members. The NHS gene coding region and its splice site donor and acceptor regions were amplified from genomic DNA by PCR, and the amplicons were sequenced directly. We identified three unique NHS coding region mutations in these NHS families. This report extends the number of unique identified NHS mutations to 14.

  7. Use staff wisely to save NHS money.

    Science.gov (United States)

    Moore, Alison

    2015-12-09

    The NHS could save up to £ 2 billion a year by improving workflow and containing workforce costs, according to Labour peer Lord Carter's review of NHS efficiency. Changes in areas such as rostering and management of annual leave must avoid increasing the pressure on staff.

  8. Layers And Processes In The Model Of Technological Postal System

    Directory of Open Access Journals (Sweden)

    Madleňáková Lucia

    2015-12-01

    Full Text Available The paper include important aspects of layer model of postal technological system such as makes the possibility to define rules for regulating, technical and technological requirements and interfaces to communicate with other postal systems. The current postal reform is mainly attributable to release of network access and ensuring full interoperability between technological systems. Not only to ensure the development and protection of competition but also in respect to the conservation of requirements to provide the universal service, which is the performance of public interest. There is a space here to examine the postal system, not only from a procedural point of view, but to be viewed as an open communication system. It is possible to find there the commonalities with other communication sector branches and to handle the technological postal system in more layers; similarly as the electronic communication systems are handled. Model of layer postal system, based not only on the processes but on layers functionality, will enable to identify communication protocols and interfaces determining interoperability. It also opens the question of appropriate regulation model.

  9. 39 CFR 232.1 - Conduct on postal property.

    Science.gov (United States)

    2010-07-01

    ... promotion of social welfare but do not participate or intervene in any political campaign on behalf of any candidate or political party for any public office. (ii) Absolutely no partisan or political literature may... that will protect Postal Service property. (3) Postal Inspectors, Office of Inspector General Criminal...

  10. 77 FR 64362 - Postal Rate and Classification Changes

    Science.gov (United States)

    2012-10-19

    .... Promotions As part of this filing, the Postal Service seeks approval of six promotions during calendar year.... Table 6--First-Class Mail Price Changes Percent First-class mail product change Single-Piece Letters and...-piece letter mail (including the Forever stamp), increases by one cent under the Postal Service's plan...

  11. 39 CFR 4.5 - Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Assistant Postmasters General, General Counsel, Judicial Officer, Chief Postal Inspector. 4.5 Section 4.5 Postal Service UNITED STATES POSTAL SERVICE THE... Counsel, a Judicial Officer, a Chief Postal Inspector, and such number of officers, described in 39 U.S.C...

  12. 39 CFR 762.25 - Reclamation of amounts of paid disbursement postal money orders.

    Science.gov (United States)

    2010-07-01

    ... paid disbursement postal money orders. The Postal Service shall have the right to demand refund from the presenting bank of the amount of a paid Disbursement Postal Money Order if after payment the... another for a deceased payee where the right to the proceeds of such Disbursement Postal Money Orders...

  13. Model-Based Control for Postal Automation and Baggage Handling

    NARCIS (Netherlands)

    Tarau, A.N.

    2010-01-01

    In this thesis we focus on two specific transportation systems, namely postal automation and baggage handling. Postal automation: During the last decades the volume of magazines, catalogs, and other plastic wrapped mail items that have to be processed by post sorting centers has increased

  14. Benchmarking clinical photography services in the NHS.

    Science.gov (United States)

    Arbon, Giles

    2015-01-01

    Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession.

  15. Human trafficking and health: a cross-sectional survey of NHS professionals’ contact with victims of human trafficking

    Science.gov (United States)

    Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

    2015-01-01

    Objectives (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals’ knowledge and confidence to respond to human trafficking. Design A cross-sectional survey. Setting Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. Participants 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Measures Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. Results 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. Conclusions NHS professionals working in secondary care are in contact with potential

  16. Non-price competition in NHS secondary care contracting: empirical results.

    Science.gov (United States)

    Gray, Keith; Bailey, Mark F

    2008-01-01

    The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non-price competitive behaviour. A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques. The analysis suggests that: those NHS Trusts offering volume discounts, non-price competitive incentives or having a strong belief in performance being by "payment by results" criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non-price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost-sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts. This paper fills a gap in the area of non-price competition in English NHS acute secondary care contracting.

  17. From Hippocrates to Commodities: three models of NHS governance: NHS governance, regulation, Mid Staffordshire inquiry, health care as a commodity.

    Science.gov (United States)

    Newdick, Christopher

    2014-01-01

    A series of inquiries and reports suggest considerable failings in the care provided to some patients in the NHS. Although the Bristol Inquiry report of 2001 led to the creation of many new regulatory bodies to supervise the NHS, they have never enjoyed consistent support from government and the Mid Staffordshire Inquiry in 2013 suggests they made little difference. Why do some parts of the NHS disregard patients' interests and how we should we respond to the challenge? The following discusses the evolution of approaches to NHS governance through the Hippocratic, Managerial and Commercial models, and assesses their risks and benefits. Apart from the ethical imperative, the need for effective governance is driven both by the growth in information available to the public and the resources wasted by ineffective systems of care. Appropriate solutions depend on an understanding of the perverse incentives inherent in each model and the need for greater sensitivity to the voices of patients and the public. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals. permissions@oup.com.

  18. COORDINATES OF POSTAL SERVICES MARKET IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Cristinel CONSTANTIN

    2012-01-01

    Full Text Available This paper contains a research regarding the actual status of Romanian postal services market both from legislative and economic point of view in the context of EU integration. The main objectives of this research were to identify the position of Romanian postal services among the EU member countries and to analyse the competitive environment on the local market in order to find future development strategies for the local companies. The outcomes of our research show a wrong position of Romanian postal sector both regarding the number of permanent offices and financial results of local competitors. The lateness of structural reforms could be a barrier for the future market liberalisation with serious consequences from the social point of view. In this context, a high implication of authorities is expected in order to ensure the adoption of EU regulation with a minimum of negative effects both for population and service providers.

  19. Liberalisation versus national protectionism: the European liberalised postal market: finalisation by whom?

    NARCIS (Netherlands)

    Versteegh, L.

    2010-01-01

    The new European Postal Directive of 2008 provides the postal market with new opportunities as it allows for the gradual development of competition of services of general interests in Europe. However, the directive leaves room for uncertainties and the full opening of the postal market is hampered

  20. Medical leadership arrangements in English healthcare organisations: findings from a national survey and case studies of NHS trusts.

    Science.gov (United States)

    Dickinson, Helen; Ham, Chris; Snelling, Iain; Spurgeon, Peter

    2013-11-01

    This project sought to describe the involvement of doctors in leadership roles in the NHS and the organisational structures and management processes in use in NHS trusts. A mixed methods approach was adopted combining a questionnaire survey of English NHS trusts and in-depth case studies of nine organisations who responded to the survey. Respondents identified a number of challenges in the development of medical leadership, and there was often perceived to be an engagement gap between medical leaders and doctors in clinical roles. While some progress has been made in the development of medical leadership in the NHS in England, much remains to be done to complete the journey that started with the Griffiths Report in 1983. We conclude that a greater degree of professionalism needs to be brought to bear in the development of medical leadership. This includes developing career structures to make it easier for doctors to take on leadership roles; providing training, development and support in management and leadership at different stages of doctors' careers; and ensuring that pay and other rewards are commensurate with the responsibilities of medical leaders. The time commitment of medical leaders and the proportion of doctors in leadership roles both need to increase. The paper concludes considering the implications of these findings for other health systems. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. IMatter: validation of the NHS Scotland Employee Engagement Index.

    Science.gov (United States)

    Snowden, Austyn; MacArthur, Ewan

    2014-11-08

    Employee engagement is a fundamental component of quality healthcare. In order to provide empirical data of engagement in NHS Scotland an Employee Engagement Index was co-constructed with staff. 'iMatter' consists of 25 Likert questions developed iteratively from the literature and a series of validation events with NHS Scotland staff. The aim of this study was to test the face, content and construct validity of iMatter. Cross sectional survey of NHS Scotland staff. In January 2013 iMatter was sent to 2300 staff across all disciplines in NHS Scotland. 1280 staff completed it. Demographic data were collected. Internal consistency of the scale was calculated. Construct validity consisted of concurrent application of factor analysis and Rasch analysis. Face and content validity were checked using 3 focus groups. The sample was representative of the NHSScotland population. iMatter showed very strong reliability (α = 0.958). Factor analysis revealed a four-factor structure consistent with the following interpretation: iMatter showed evidence of high reliability and validity. It is a popular measure of staff engagement in NHS Scotland. Implications for practice focus on the importance of coproduction in psychometric development.

  2. 75 FR 58449 - Postal Rates

    Science.gov (United States)

    2010-09-24

    ... feel free to discuss the merits of the current Bulk Metered Mail (BMM) base category as well as a... American Postal Workers Union, AFL-CIO in that docket express a more general desire to re- evaluate and...

  3. U.S. Postal Service: Deteriorating Financial Outlook Increases Need for Transformation

    National Research Council Canada - National Science Library

    2002-01-01

    .... The combined effect of these events and the current economic slowdown have served to further exacerbate USPS's financial difficulties by decreasing postal revenues, while postal costs continued...

  4. An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).

    Science.gov (United States)

    Warriner, Sian; Crane, Catherine; Dymond, Maret; Krusche, Adele

    2018-05-26

    An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS). To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS. The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8-9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice. An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention. NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire. All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015

  5. The Postal Acceptance Rule in the Digital Age

    OpenAIRE

    Al Ibrahim, Marwan; Ababneh, Ala’eldin; Tahat, Hisham

    2007-01-01

    This article examines the application of the postal acceptance rule to email acceptances. Differentviews have been argued against the application of traditional rule like the postal acceptance rule, which wasestablished in 1818 as a legal norm in contract formation to modern communications like the email. The paperpresents the arguments and rationale behind the application of this rule and contends its applicability to themodern communication via e-mail. The paper posits that email is not an ...

  6. Attendance at NHS mandatory training sessions.

    Science.gov (United States)

    Brand, Darren

    2015-02-17

    To identify factors that affect NHS healthcare professionals' attendance at mandatory training sessions. A quantitative approach was used, with a questionnaire sent to 400 randomly selected participants. A total of 122 responses were received, providing a mix of qualitative and quantitative data. Quantitative data were analysed using statistical methods. Open-ended responses were reviewed using thematic analysis. Clinical staff value mandatory training sessions highly. They are aware of the requirement to keep practice up-to-date and ensure patient safety remains a priority. However, changes to the delivery format of mandatory training sessions are required to enable staff to participate more easily, as staff are often unable to attend. The delivery of mandatory training should move from classroom-based sessions into the clinical area to maximise participation. Delivery should be assisted by local 'experts' who are able to customise course content to meet local requirements and the requirements of different staff groups. Improved arrangements to provide staff cover, for those attending training, would enable more staff to attend training sessions.

  7. 75 FR 52378 - International Product Change-United States Postal Service Inbound Market-Dominant Multi-Service...

    Science.gov (United States)

    2010-08-25

    ... POSTAL SERVICE International Product Change--United States Postal Service Inbound Market-Dominant... Inbound Market-Dominant Multi- Service Agreements to the Market-Dominant Products List pursuant to 39 U.S... the Postal Regulatory Commission to Add Market-Dominant Multi-Service Agreements with Foreign Postal...

  8. Identification of three novel NHS mutations in families with Nance-Horan syndrome

    OpenAIRE

    Huang, Kristen M.; Wu, Junhua; Brooks, Simon P.; Hardcastle, Alison J.; Lewis, Richard Alan; Stambolian, Dwight

    2007-01-01

    Purpose Nance-Horan Syndrome (NHS) is an infrequent and often overlooked X-linked disorder characterized by dense congenital cataracts, microphthalmia, and dental abnormalities. The syndrome is caused by mutations in the NHS gene, whose function is not known. The purpose of this study was to identify the frequency and distribution of NHS gene mutations and compare genotype with Nance-Horan phenotype in five North American NHS families. Methods Genomic DNA was isolated from white blood cells f...

  9. The NHS: the story so far (1948-2010).

    Science.gov (United States)

    Shapiro, Jonathan

    2010-08-01

    The NHS has long held a paradoxical position in the national psyche: a constant, reassuring presence that seems to be in a state of continual flux. This is partly because while the service is based in the public sector (with its reputation for risk aversion and change at a glacial pace), it is also exposed to the ever present currents of political pressure. Equally important is the changing nature of both medical technology and public expectation, each of which exert constant and inexorable pressures on the service. This article will briefly describe the story of the NHS from its inception in 1948 to the present day, with an emphasis on developments over the last 20 years. During this time the notion of organising healthcare has developed and formed the focus of much of the change in systems across the developed world. The narrative will highlight some of the major challenges that the NHS will face over the next few years, and introduce the series about the future of the NHS that will appear in this journal signposting some of the topics that will be followed up in these articles.

  10. 76 FR 12141 - New Postal Product and New Price Category

    Science.gov (United States)

    2011-03-04

    ... Service will be available with Express Mail, Priority Mail and Parcel Select for commercial and online customers only. The Postal Service includes the following attachments with its Request: Attachment A... Commission is noticing a recently-filed Postal Service request to add Competitive Ancillary Services to the...

  11. 76 FR 395 - New Postal Product

    Science.gov (United States)

    2011-01-04

    ... INFORMATION: Table of Contents I. Introduction II. Notice of Filing III. Ordering Paragraphs I. Introduction... Sample Showcase box, including marketing, assembling, and tendering the box for delivery by the Postal...

  12. Managment of electronic services of the Serbian postal system by benchmarking index

    Directory of Open Access Journals (Sweden)

    Dupljanin Đorđije D.

    2014-01-01

    Full Text Available The aim of this paper is analys of the state of electronic services within the postal system in Serbia in order to improve the management of this services. As an indicator of the state of development we can use benchmarking index of development of postal e-services. Benchmarking index is created by PCA (Principal Component Analysis method in statistical software Minitab which has been designed for PCA. The development of electronic economy has influence on postal system to improve postal electronic services. In conclusion we can say those who make the decisions and management experts have to define appropriate strategy of e-services.

  13. Measuring progress towards a primary care-led NHS.

    Science.gov (United States)

    Miller, P; Craig, N; Scott, A; Walker, A; Hanlon, P

    1999-07-01

    The push towards a 'primary care-led' National Health Service (NHS) has far-reaching implications for the future structure of the NHS. The policy involves both a growing emphasis on the role of primary care practitioners in the commissioning of health services, and a change from hospital to primary and community settings for a range of services and procedures. Although the terminology has changed, this emphasis remains in the recent Scottish Health Service White Paper and its English counterpart. To consider three questions in relation to this policy goal. First, does the evidence base support the changes? Secondly, what is the scale of the changes that have occurred? Thirdly, what are the barriers to the development of a primary care-led NHS? Programme budgets were compiled to assess changes over time in the balance of NHS resource allocation with respect to primary and secondary care. Total NHS revenue expenditure for the 15 Scottish health boards was grouped into four blocks or 'programmes': primary care, secondary care, community services, and a residual. The study period was 1991/2 to 1995/6. Expenditure data were supplied by the Scottish Office. Ambiguity of definitions and the absence of good data cause methodological difficulties in evaluating the scale and the appropriateness of the shift. The data that are available suggest that, at the aggregate level, there have been changes over time in the balance of resource allocation between care settings: relative investment into primary care has increased. It would appear that this investment is relatively small and from growth money rather than a 'shift' from secondary care. In addition, the impact of GP-led commissioning is variable but limited. General practitioners' (GPs') attitudes to the policy suggest that progress towards a primary care-led NHS will continue to be patchy. The limited shift to date, alongside evidence of ambivalent attitudes to the shift on the part of GPs, suggest that this is a policy

  14. New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands

    NARCIS (Netherlands)

    Florijn, Ralph J.; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J. J. M.; Mannens, Marcel M. A. M.; Tijmes, Nel; Brooks, Simon P.; Hardcastle, Alison J.; Bergen, Arthur A. B.

    2006-01-01

    Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the

  15. An investigation into dental digital radiography in dental practices in West Kent following the introduction of the 2006 NHS General Dental Services contract.

    Science.gov (United States)

    Mauthe, Peter W; Eaton, Kenneth A

    2011-04-01

    The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners' (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006. Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient. Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these 'mainly private' GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 'mainly NHS' GDPs reported using digital radio-graphic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more. In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radio graphy. Mainly private GDPs were more likely to use digital radiography than

  16. Human trafficking and health: a cross-sectional survey of NHS professionals' contact with victims of human trafficking.

    Science.gov (United States)

    Ross, Claire; Dimitrova, Stoyanka; Howard, Louise M; Dewey, Michael; Zimmerman, Cathy; Oram, Siân

    2015-08-20

    (1) To estimate the proportion of National Health Service (NHS) professionals who have come into contact with trafficked people and (2) to measure NHS professionals' knowledge and confidence to respond to human trafficking. A cross-sectional survey. Face-to-face mandatory child protection and/or vulnerable adults training sessions at 10 secondary healthcare provider organisations in England, and meetings of the UK College of Emergency Medicine. 782/892 (84.4%) NHS professionals participated, including from emergency medicine, maternity, mental health, paediatrics and other clinical disciplines. Self-completed questionnaire developed by an expert panel. Questionnaire asks about prior training and contact with potential victims of trafficking, perceived and actual human trafficking knowledge, confidence in responding to human trafficking, and interest in future human trafficking training. 13% participants reported previous contact with a patient they knew or suspected of having been trafficked; among maternity services professionals this was 20.4%. However, 86.8% (n=679) reported lacking knowledge of what questions to ask to identify potential victims and 78.3% (n=613) reported that they had insufficient training to assist trafficked people. 71% (n=556), 67.5% (n=528) and 53.4% (n=418) lacked confidence in making appropriate referrals for men, women and children, respectively, who had been trafficked. 95.3% (n=746) of respondents were unaware of the scale of human trafficking in the UK, and 76.5% (n=598) were unaware that calling the police could put patients in more danger. Psychometric analysis showed that subscales measuring perceived knowledge, actual knowledge and confidence to respond to human trafficking demonstrated good internal consistency (Cronbach's αs 0.93, 0.63 and 0.64, respectively) and internal correlations. NHS professionals working in secondary care are in contact with potential victims of human trafficking, but lack knowledge and confidence in

  17. The purpose, design and administration of a questionnaire for data collection

    International Nuclear Information System (INIS)

    Marshall, Gill

    2005-01-01

    This paper considers the use of questionnaires as a data collection tool. A range of issues will be discussed, including whether previously validated questionnaires already exist for utilisation, the advantages and disadvantages of employing questionnaires, optimum design features including the wording and language used and the ordering of questions, distribution methods, ways of maximizing response rates and managing non-responses, reliability and validity, the benefits of piloting the questionnaire and approval before the questionnaire is used. Questionnaire-based research is increasing evident within the NHS and elsewhere and from this presentation it is clear that a range of issues must be taken into account so that collected data can be gathered effectively in a format that can be appropriately used

  18. Understanding the roles of NHS trust board members.

    Science.gov (United States)

    Deffenbaugh, J

    1996-01-01

    The establishment of NHS trust boards on a business format was a recent innovation resulting from the NHS reforms. In order to realize benefits for patients, it is essential that boards operate effectively. Explores within the framework of corporate governance, the practical implications of board member roles. Drawing on experience of strategy formulation at board level, analyses and clarifies the roles, and presents recommendations to increase board effectiveness.

  19. 39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

  20. Socioeconomic differences in smoking in an urban Swedish population. The bias introduced by non-participation in a mailed questionnaire

    DEFF Research Database (Denmark)

    Boström, G; Hallqvist, J; Haglund, B J

    1993-01-01

    Stockholm Health of the Population Study is a cross-sectional study carried out from 1984-85. Postal questionnaires, telephone interviews and health interviews were used to get information from a sample of 5,199 persons, 18-64 years of age, on health status, risk exposures, healthcare consumption...... and social factors. Non-participation with respect to the postal questionnaire was 36.8%. With subsequent telephone interviews and an invitation to a health interview, non-participation was reduced to 17.8%. The estimated prevalence of daily smoking increased from 36.1% to 38.7. The non-responders had...... reached by telephone had a prevalence of smoking, which was twice as high as for the responders of the questionnaire (62.5 and 26.8%, respectively). In the younger age-group, non-responders had the same socioeconomic pattern in smoking as the responders. Independent of socioeconomic group...

  1. Propuesta de un sistema integral para una empresa de servicios postales

    OpenAIRE

    Ancajima Navarro, Julia Noemi; Ancajima Navarro, Julia Noemi; Ancajima Navarro, Julia Noemi

    2013-01-01

    El servicio postal es un sistema dedicado a transportar alrededor del mundo documentos escritos, así como paquetes de tamaño pequeño o mediano (encomiendas). Todo envió a través del sistema postal es llamado correo o correspondencia. Los paquetes y las cartas son "envíos postales" que se pueden transportar por tierra, mar o aire, cada uno con tarifas diferentes. Las cartas y documentos son inviolables hasta que son entregadas al destinatario. La aparición del ferrocarril entre 1840 y 18...

  2. Lessons from 2012: What the NHS Can Learn from Britain's Olympic Success.

    Science.gov (United States)

    Maile, Edward J; Blake, Alastair M

    2013-01-01

    The 2012 London Olympic and Paralympic Games were widely regarded as an organisational and sporting success for the United Kingdom. Therefore, it is prudent to consider what other large, public endeavours might learn from the Games' success. Team GB worked to develop a positive team culture based around shared values. This is something the National Health Service (NHS) could learn from, as an organisation which can appear to lack this culture. The NHS should also work harder to adopt evidence-based practices, and to adopt them quickly, as is often the case in sport. Sport is the ultimate example of transparent results reporting, and the NHS ought to consider systematic reporting of risk-adjusted performance data, which may drive improved performance. The NHS should pay attention to the experiences of successful Olympic sports with centralised centres of excellence, and to medical data which suggests that better outcomes result from centres of excellence. The NHS and wider government should look to Olympic athletes and place more emphasis on prevention of disease by encouraging positive lifestyle choices. Finally, the NHS should develop private sector partnerships carefully. We must look to gather knowledge and ideas from every area of life in pursuit of excellence in the NHS. Experience of the Olympics offers a number of instructive lessons.

  3. A model of organisational dysfunction in the NHS.

    Science.gov (United States)

    Pope, Rachael

    2013-01-01

    This paper explores the reasons for the sometimes seemingly irrational and dysfunctional organisational behaviour within the NHS. It seeks to provide possible answers to the persistent historical problem of intimidating and negative behaviour between staff, and the sometimes inadequate organisational responses. The aim is to develop a model to explain and increase understanding of such behaviour in the NHS. This paper is conceptual in nature based upon a systematic literature review. The concepts of organisational silence, normalised organisational corruption, and protection of image, provide some possible answers for these dysfunctional responses, as does the theory of selective moral disengagement. The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to "knowing". The persistence and tolerance of negative behaviour is a corruption and is not healthy or desirable. Organisations need to embrace the identity of a listening and learning organisation; a "wise" organisation. The "Elephant in the room" of persistent negative behaviour has to be acknowledged; the silence must be broken. There is a need for cultures of "respect", exhibiting "intelligent kindness". A model has been developed to increase understanding of dysfunctional organisational behaviour in the NHS primarily for leaders/managers of health services, health service regulators and health researchers/academics. Research, with ethical approval, is currently being undertaken to test and develop the conceptual model to further reflect the complexities of the NHS culture.

  4. Medical Tourism: A Cost or Benefit to the NHS?

    Science.gov (United States)

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    ‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  5. Medical tourism: a cost or benefit to the NHS?

    Directory of Open Access Journals (Sweden)

    Johanna Hanefeld

    Full Text Available 'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS; interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health

  6. Medical tourism: a cost or benefit to the NHS?

    Science.gov (United States)

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

  7. Customer care in the NHS.

    Science.gov (United States)

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

  8. Comparative analysis of customer satisfaction in postal and banking services

    Directory of Open Access Journals (Sweden)

    Ratković Milijanka

    2017-01-01

    Full Text Available The goal of this study is a comparative analysis of customer satisfaction towards postal and banking services in Serbia. In addition, this paper should provide guidance on how managements of the Post Office and the Bank should behave on the market. The survey was conducted throughout the whole Serbian territory. The subject of the research is to measure the perception of postal and banking services, in order to assess the quality of services and the impact of expectations on the level of perceived quality. Testing and final conclusions about the level of quality of postal and banking services was carried out on the basis of the existing literature and modified SERVQUAL model.

  9. Guide to the design and application of online questionnaire surveys.

    Science.gov (United States)

    Regmi, Pramod R; Waithaka, Elizabeth; Paudyal, Anjana; Simkhada, Padam; van Teijlingen, Edwin

    2016-12-01

    Collecting research data through traditional approaches (face-to-face, postal or telephone survey) can be costly and time consuming. The emerging data collection approach based on internet/e-based technologies (e.g. online platforms and email), is a relatively cost effective survey alternative. These novel data collection strategies can collect large amounts of data from participants in a short time frame. Similarly, they also seem to be feasible and effective in collecting data on sensitive issues or with samples they are generally hard to reach, for example, men who have sex with men (MSM) or migrants. As a significant proportion of the population currently in the world are digitally connected, the shift from postal (paper-pencil) or telephone towards online survey use in research is in the interests of researchers in academia as well as in the commercial world. However, compared to designing and executing paper version of the questionnaire, there is limited literature to help a starting researcher with the design and a use of online questionnaires. This short paper highlights issues around: a) methodological aspect of online questionnaire survey; b) online survey planning and management; and c) ethical concerns that may arise while using this option. We believe that this paper will be useful for researchers who want to gain knowledge or apply this approach in their research.

  10. Utilização de medicamentos por aposentados brasileiros: 2 - Taxa de resposta e preenchimento de questionário postal em Belo Horizonte, Minas Gerais, Brasil Use of medication by Brazilian retirees: 2 - Response rate and item completeness in a postal survey in Belo Horizonte, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    Andréia Queiroz Ribeiro

    2008-09-01

    Full Text Available São descritos a taxa de resposta e o preenchimento de questionários auto-administrados num inquérito postal sobre o perfil de utilização de medicamentos por aposentados e pensionistas do INSS, de 60 anos ou mais de idade no Município de Belo Horizonte, Minas Gerais, Brasil, em 2003. Os questionários foram enviados duas vezes para os endereços de 800 indivíduos sorteados por amostragem aleatória simples, com base no banco de dados do INSS. A taxa de resposta ao inquérito postal foi de 47,8% e não houve diferença significativa tanto entre participantes e não participantes quanto entre respondentes iniciais e tardios em relação às características selecionadas. Para a maioria das variáveis sócio-demográficas e de saúde, os percentuais de omissão de respostas não ultrapassaram 5%, tanto no total da amostra, quanto em cada um dos subgrupos de respondentes. As informações mais omitidas ocorreram para as variáveis relativas ao uso de medicamentos, com destaque para a não-utilização de medicamentos que deveriam ser usados, a dose e laboratório fabricante do medicamento. Nossos resultados indicam que o detalhamento de aspectos relacionados ao uso de medicamentos deve ser reconsiderado em questionários de autopreenchimento.This paper reports on the response rate and completeness of item response in a self-administered postal survey questionnaire on use of medication by retirees 60 years or older under the Brazilian Social Security System, in Belo Horizonte, Minas Gerais State, in 2003. Questionnaires were sent in two rounds to 800 postal addresses of subjects selected by simple random sampling. The response rate was 47.8%, and there were no significant differences in the selected characteristics between respondents and non-respondents, or between early and late respondents. For almost all socio-demographic and health variables, item omission was less than or equal to 5% for both the entire sample and early or late responders

  11. A novel NHS mutation causes Nance-Horan Syndrome in a Chinese family.

    Science.gov (United States)

    Tian, Qi; Li, Yunping; Kousar, Rizwana; Guo, Hui; Peng, Fenglan; Zheng, Yu; Yang, Xiaohua; Long, Zhigao; Tian, Runyi; Xia, Kun; Lin, Haiying; Pan, Qian

    2017-01-07

    Nance-Horan Syndrome (NHS) (OMIM: 302350) is a rare X-linked developmental disorder characterized by bilateral congenital cataracts, with occasional dental anomalies, characteristic dysmorphic features, brachymetacarpia and mental retardation. Carrier females exhibit similar manifestations that are less severe than in affected males. Here, we report a four-generation Chinese family with multiple affected individuals presenting Nance-Horan Syndrome. Whole-exome sequencing combined with RT-PCR and Sanger sequencing was used to search for a genetic cause underlying the disease phenotype. Whole-exome sequencing identified in all affected individuals of the family a novel donor splicing site mutation (NM_198270: c.1045 + 2T > A) in intron 4 of the gene NHS, which maps to chromosome Xp22.13. The identified mutation results in an RNA processing defect causing a 416-nucleotide addition to exon 4 of the mRNA transcript, likely producing a truncated NHS protein. The donor splicing site mutation NM_198270: c.1045 + 2T > A of the NHS gene is the causative mutation in this Nance-Horan Syndrome family. This research broadens the spectrum of NHS gene mutations, contributing to our understanding of the molecular genetics of NHS.

  12. 75 FR 7634 - New Postal Product

    Science.gov (United States)

    2010-02-22

    ... public that the Postal Service has filed a request to add International Business Reply Service... entered into two additional International Business Reply Service (IBRS) Contracts.\\1\\ Additionally, the... to Establish Successor Instruments as Baseline International Business Reply Service Competitive...

  13. What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service

    Science.gov (United States)

    Brookes, Gavin; Baker, Paul

    2017-01-01

    Objective To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation. Design Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback. Participants Contributors posting comments about the NHS between March 2013 and September 2015. Results Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback. Conclusions Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The

  14. New mutations in the NHS gene in Nance-Horan Syndrome families from the Netherlands.

    Science.gov (United States)

    Florijn, Ralph J; Loves, Willem; Maillette de Buy Wenniger-Prick, Liesbeth J J M; Mannens, Marcel M A M; Tijmes, Nel; Brooks, Simon P; Hardcastle, Alison J; Bergen, Arthur A B

    2006-09-01

    Mutations in the NHS gene cause Nance-Horan Syndrome (NHS), a rare X-chromosomal recessive disorder with variable features, including congenital cataract, microphthalmia, a peculiar form of the ear and dental anomalies. We investigated the NHS gene in four additional families with NHS from the Netherlands, by dHPLC and direct sequencing. We identified an unique mutation in each family. Three out of these four mutations were not reported before. We report here the first splice site sequence alteration mutation and three protein truncating mutations. Our results suggest that X-linked cataract and NHS are allelic disorders.

  15. 39 CFR 111.2 - Availability of the Mailing Standards of the United States Postal Service, Domestic Mail Manual.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Availability of the Mailing Standards of the United States Postal Service, Domestic Mail Manual. 111.2 Section 111.2 Postal Service UNITED STATES POSTAL SERVICE POST OFFICE SERVICES [DOMESTIC MAIL] GENERAL INFORMATION ON POSTAL SERVICE § 111.2...

  16. 76 FR 54510 - New Postal Product

    Science.gov (United States)

    2011-09-01

    ... Service request to enter into an additional agreement under the ``International Business Reply Service... into an additional International Business Reply Service (IBRS) Competitive contract.\\1\\ The Postal... International Business Reply Service Competitive Contract 3 Negotiated Service Agreement, August 19, 2011...

  17. 76 FR 11532 - New Postal Product

    Science.gov (United States)

    2011-03-02

    ... filing concerning an additional International Business Reply Service (IBRS) Competitive Contract 3. It..., that it has entered into an additional International Business Reply Service (IBRS) Competitive contract...-59, Request of the United States Postal Service to Add International Business Reply Service...

  18. Five-year workplace wellness intervention in the NHS

    OpenAIRE

    Blake, Holly; Zhou, Dingyuan; Batt, Mark E.

    2013-01-01

    aims:\\ud Poor health and well-being has been observed among NHS staff and has become a key focus in current public health policy. The objective of this study was to deliver and evaluate a five-year employee wellness programme aimed at improving the health and well-being of employees in a large NHS workplace.\\ud method:\\ud A theory-driven multi-level ecological workplace wellness intervention was delivered including health campaigns, provision of facilities and health-promotion activities to e...

  19. An Assessment of Customer Behaviours Regarding the Romanian Postal Services

    Directory of Open Access Journals (Sweden)

    Cristinel Constantin

    2015-09-01

    Full Text Available During the time the long distance communication has been one of the most important needs of the humanity. In the absence of telecommunication the postal services have been the main way of sending messages between people and other entities. Taking into account the importance of this market we assessed the nowadays coordinates of the Romanian postal market by conducting a research meant to identify the trends of postal services, the stage of competition and the customers’ behaviours regarding these services. The results show that the market is in developing process, with an increasing number of competitors but with a low number of significant competitors able to provide services on a large scale. In this context, the National Company Posta Romana remains the main market player but its positions are strongly threatened by private competitors especially on those market segments with high profitability. In order to defend its positions the national company has to put in practice proper marketing strategies focused mainly on the development of partnerships both with the senders and recipients of different postal deliveries, especially those ones with a higher attractiveness for the competitors.

  20. Occupational stress and its predictors in radiographers

    Energy Technology Data Exchange (ETDEWEB)

    Rutter, D.R. [Centre for Research in Health Behaviour, Department of Psychology, University of Kent, Keynes College, Canterbury CT2 7NP (United Kingdom)], E-mail: d.r.rutter@kent.ac.uk; Lovegrove, M.J. [Department of Allied Health Professions, London South Bank University, London SE1 0AA (United Kingdom)

    2008-05-15

    Purpose: The purpose of this study was to establish the level of occupational stress in UK NHS radiographers, and to examine its causes. A total of more than 1600 radiographers sampled nationally completed a postal questionnaire. Four groups were represented - mammography, diagnostics, radiotherapy, and ultrasound - and both junior staff and superintendents were examined. Method: The questionnaire measured role ambiguity, role conflict, work problems, social support from colleagues, and perceived stress. Results: Levels of perceived stress were high in all four groups. The mean was significantly lower in the mammography group than the others, however, and junior staff reported lower levels than superintendents. Role ambiguity, role conflict and work problems all contributed significantly to stress, but the effects were sometimes buffered by social support from colleagues. Conclusion: The implications of the findings are discussed for theory and for policy and practice: occupational stress was predicted by intrinsic features of the job; the levels were similar to those reported by other NHS professionals; and the pattern of findings suggests possible ways to intervene to reduce it.

  1. Occupational stress and its predictors in radiographers

    International Nuclear Information System (INIS)

    Rutter, D.R.; Lovegrove, M.J.

    2008-01-01

    Purpose: The purpose of this study was to establish the level of occupational stress in UK NHS radiographers, and to examine its causes. A total of more than 1600 radiographers sampled nationally completed a postal questionnaire. Four groups were represented - mammography, diagnostics, radiotherapy, and ultrasound - and both junior staff and superintendents were examined. Method: The questionnaire measured role ambiguity, role conflict, work problems, social support from colleagues, and perceived stress. Results: Levels of perceived stress were high in all four groups. The mean was significantly lower in the mammography group than the others, however, and junior staff reported lower levels than superintendents. Role ambiguity, role conflict and work problems all contributed significantly to stress, but the effects were sometimes buffered by social support from colleagues. Conclusion: The implications of the findings are discussed for theory and for policy and practice: occupational stress was predicted by intrinsic features of the job; the levels were similar to those reported by other NHS professionals; and the pattern of findings suggests possible ways to intervene to reduce it

  2. Tackling racism in the NHS.

    Science.gov (United States)

    Dean, Erin

    2016-11-30

    Essential facts Trade union Unite has developed a policy briefing on a new toolkit to combat racism in the NHS. It can help nurses and other staff tackle racial discrimination in health, with black and minority ethnic (BME) nurses often treated unequally compared with their white colleagues.

  3. Hopewell Furnace NHS : alternative transportation study

    Science.gov (United States)

    2009-12-31

    This study assesses the potential for an alternative transportation system (ATS) at Hopewell Furnace National Historic Site (NHS). The Volpe Center investigated internal circulation and potential partnerships with local historic, cultural, and recrea...

  4. 76 FR 22157 - Postal Service Rate Adjustment

    Science.gov (United States)

    2011-04-20

    ... identifies Greg Dawson, Manager of Pricing Strategy, as the official responsible for responding to any... program is an example of the increased pricing flexibility under the Postal Accountability and Enhancement...

  5. 75 FR 45175 - New Postal Product

    Science.gov (United States)

    2010-08-02

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... to the competitive product list. This notice addresses procedural steps associated with the filing... that Order No. 86, which established GEPS 1 as a product, also authorized functionally equivalent...

  6. 77 FR 61307 - New Postal Product

    Science.gov (United States)

    2012-10-09

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... dominant product list to the competitive product list as ``Lightweight Parcel Select,'' a subcategory of... Granting Request to Transfer Commercial Standard Mail Parcels to the Competitive Product List, March 2...

  7. 76 FR 10410 - New Postal Product

    Science.gov (United States)

    2011-02-24

    ... recently-filed Postal Service request to add International Business Reply Service (IBRS) Competitive... International Business Reply Service (IBRS) Competitive Contract 3 to the competitive product list and... International Business Reply Service Competitive Contract 3 to the Competitive Products List and Notice of...

  8. 75 FR 5236 - New Postal Product

    Science.gov (United States)

    2010-02-02

    ... Description] Premium Stamped Stationery [Reserved for Product Description] Premium Stamped Cards [Reserved for... determine whether such an agreement (1) Improves the net financial position of the Postal Service or... Descriptions First-Class Mail [Reserved for Class Description] Single-Piece Letters/Postcards [Reserved for...

  9. Postal audit in dental radiodiagnostics

    International Nuclear Information System (INIS)

    Novak, L.; Kroutilikova, D.

    2001-01-01

    According to Czech laws dental intraoral X-ray machines are classified as s imple sources of ionizing radiation . Consequently , their use is licensed on condition that an adequate quality assurance program is realized. In general, the programme is based on acceptance tests, status tests and constancy tests. The particular methods are specified in the recommendation [1] published by State Office for Nuclear Safety .Both the acceptance and status tests involve in situ measurements to control parameters of the X-ray machine and the developing process. Only persons who were licensed for such handling can do these measurements. The yearly status tests are very detailed and several years ' experience showed it might be advantageous to have a simpler method additionally available for purposes of the state supervision. Such a method is supposed as a postal audit. It should be simple enough to make the operation of the state supervision more effective but it also should provide sufficient information on radiation protection of the patients. Besides it should enable to prolong the period for the status tests ultimately .As for the postal audit, a small package containing a proper dosimetric set would be sent directly to the dentist who would treat it according to instructions. This paper describes such method that was developed in the National Radiation Protection Institute (NRPI) and results of pilot study that was carried out to test the method. The described method will be a helpful tool for the operation of the state supervision in the dental radiodiagnostics. The method will be implemented into the existing system of controls from 2002. Due to its simplicity and a quite rich content of information allows to check a big amount of the dental workplaces at once. It is supposed that one half of all Czech X-ray units will be checked in this way every year performed on state costs. It means 175 audits per month approximately. In this way, the operation of the quality

  10. Policy and organizational implications of gender imbalance in the NHS.

    Science.gov (United States)

    Miller, Karen

    2007-01-01

    The purpose of the paper is to examine the policy and organizational implications of gender imbalance in management, which research suggests exists in the NHS. The research in this paper involved a qualitative approach with an analysis of elite interviews conducted with a non-random sample of officials involved in health policy and interviews with a random sample of senior managers in NHS Scotland. The research formed part of a larger study, which explored the enablers and inhibitors to female career progression in various Scottish sectors. The paper finds that gender imbalance in management exists in the NHS. This is manifested in a masculine organizational context, leadership and policy decision-making process, which have implications for female career advancement opportunities and subsequently access to macro policy decisions. The paper involved a sample (30 percent) of senior managers and examined policy processes in NHS Scotland. To improve the external validity of the findings further research should be conducted in NHS organizations in England and Wales. The findings in the paper suggest that gender imbalance in management and a masculine organizational context and leadership style within the NHS create a less than conducive environment for female employees. This has practical implications in terms of levels of part-time employment, career progression and attrition rates. The paper adds to the debate of gender and organizational studies by examining the health sector, which has high levels of female employment but low levels of female representation at senior management levels. The paper therefore adds to an often-neglected area of study, women in leadership and senior managerial positions. The paper is original in its approach by examining the micro and meso organizational dimensions which impact on women's ability to influence macro health policy.

  11. 29 CFR 4.122 - Contracts for operation of postal contract stations.

    Science.gov (United States)

    2010-07-01

    ... Application of the McNamara-O'Hara Service Contract Act Specific Exclusions § 4.122 Contracts for operation of postal contract stations. The Act, in paragraph (7) of section 7, exempts from its provisions “any... 29 Labor 1 2010-07-01 2010-07-01 true Contracts for operation of postal contract stations. 4.122...

  12. 75 FR 12445 - New Postal Product

    Science.gov (United States)

    2010-03-16

    ... Commission is adding International Business Reply Service Competitive Contract 2 to the Competitive Product List. This action is consistent with a postal reform law. Republication of the Market Dominant and... identified as International Business Reply Service Competitive Contract 2 to the Competitive Product [[Page...

  13. 75 FR 57995 - New Postal Product

    Science.gov (United States)

    2010-09-23

    ... contract for future functional equivalence analyses of the GEPS 3 product. \\1\\ Notice of United States... Schedule language for the GEPS product. The Postal Service identifies customer-specific information and... Service asserts that ``[b]ecause the agreements incorporate the same cost attributes and methodology, the...

  14. 75 FR 54401 - New Postal Product

    Science.gov (United States)

    2010-09-07

    ... Docket No. CP2010-71 serve as the baseline contract for future functional equivalence analyses of the... Classification Schedule language for GEPS. The Postal Service identifies customer-specific information and... Service asserts that ``[b]ecause the agreements incorporate the same cost attributes and methodology, the...

  15. 75 FR 52786 - New Postal Product

    Science.gov (United States)

    2010-08-27

    ...: 1. Attachment 1--proposed Mail Classification Schedule (MCS) language for Inbound Market Dominant... fit within the proposed MCS language, are with foreign postal operators, conform to a common..., 2010. The public portions of these filings can be accessed via the Commission's website ( http://www...

  16. 77 FR 24996 - New Postal Product

    Science.gov (United States)

    2012-04-26

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a... product list. This notice addresses procedural steps associated with the filing. DATES: Comments are due... supporting information to add First-Class Package Service Contract 1 to the Competitive Product List.\\1\\ The...

  17. 75 FR 44138 - New Postal Products

    Science.gov (United States)

    2010-07-28

    ... Service International Business Reply Mail Service Money Orders Post Office Box Service Negotiated Service... International Reply Coupon Service International Business Reply Mail Service Money Orders Post Office Box... Entry Contracts with Foreign Postal Administrations 1 (MC2008-6 and CP2009-62) International Business...

  18. Osteogenesis imperfecta: profiles of motor development as assessed by a postal questionnaire

    NARCIS (Netherlands)

    Engelbert, R. H.; Uiterwaal, C. S.; Gulmans, V. A.; Pruijs, H. E.; Helders, P. J.

    2000-01-01

    This study was performed to achieve more detailed information regarding the age and sequence in the development of motor milestones in the different types of osteogenesis imperfecta (OI). The parents of 98 patients with a diagnosis of OI were sent a questionnaire regarding the age at which patients

  19. Osteogenesis imperfecta : profiles of motor development as assessed by a postal questionnaire

    NARCIS (Netherlands)

    Engelbert, RHH; Uiterwaal, CSPM; Gulmans, VAM; Pruijs, HEH; Helders, PJM

    This study was performed to achieve more detailed information regarding the age and sequence in the development of motor milestones in the different types of osteogenesis imperfecta (OI). The parents of 98 patients with a diagnosis of OI were sent a questionnaire regarding the age at which patients

  20. Efficient postal service and respectful with the environment

    Energy Technology Data Exchange (ETDEWEB)

    Vera Lopez, J.A.

    2016-07-01

    The postal service is suffering an adaptation to the new markets opened by the users. The traditional post, letters and postcards, is being used less and is substituted by mail and packaging. To adequate to this new market it's important for the postal sector companies. In Spain, the operator of the Universal Postal Service has taken example from other companies of the sector, national and international, implanting electrical bicycle mail and packaging service in the centre of big cities. This is due to the fact that there are more the cities that are forbidding vehicle access to it's historical centres and the volume of packaging to deliver is greater. But, is it viable to deliver using hybrid and electrical vehicles in cities? This study intends to improve the distribution in cities with the implantation of these vehicles. It takes into account the characteristics of populations between 50.000 and 100.000 inhabitants, in which it will be analysed the advantages and inconvenience, doing special emphasis in the economic cost, conducting studies of the costs of implantation and amortization time. (Author)

  1. Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks.

    Science.gov (United States)

    Cook, Erica J; Sharp, Chloe; Randhawa, Gurch; Guppy, Andy; Gangotra, Raj; Cox, Jonathon

    2016-01-20

    NHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual's ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme. NHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis. The overall uptake rate for Luton was 44 %, markedly lower that the set target of 50-75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with 'White British' 'Black Caribbean' and 'Indian' patients most likely to take up a NHS Health Check. However, patients from 'Any Other White Background' and 'Black African' were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method. The findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.

  2. Application of EPC Standards and Mobile Networks Services to Enhance the Quality of Postal Service

    Directory of Open Access Journals (Sweden)

    Vaculik Juraj

    2015-02-01

    Full Text Available This article deals with new technologies and methods to optimize the transport and delivery of postal mails. Introduction of this article defines the technologies and procedures that postal operators have started to use. The main part of the article describes specific implemented solutions of several postal operators and their benefits. The last part shows using of EPC standards in a processes chain. The conclusion of the article is devoted to the evaluation of these technologies and their potential in the area of postal sector.

  3. 75 FR 65676 - New Postal Product

    Science.gov (United States)

    2010-10-26

    ... contract for future functional equivalence analyses of the GEPS 3 product. \\1\\ Notice of United States... Schedule language for the GEPS 3 product. The Postal Service identifies customer-specific information and... Service asserts that ``[b]ecause the agreements incorporate the same cost attributes and methodology, the...

  4. 76 FR 49798 - New Postal Product

    Science.gov (United States)

    2011-08-11

    ... Docket No. CP2010-36 serve as the baseline contract for future functional equivalence analyses of the... Classification Schedule language for GREP Contracts 1. The Postal Service states that the instant contract... agreement incorporates the same cost attributes and methodology, the relevant characteristics of this GREP...

  5. 75 FR 72845 - New Postal Product

    Science.gov (United States)

    2010-11-26

    ... contract for future functional equivalence analyses of the GEPS 3 product. \\1\\ Notice of United States... Classification Schedule language for the GEPS 3 product. The Postal Service identifies customer-specific... methodology, the relevant characteristics of these five GEPS contracts are similar, if not the same, as the...

  6. 75 FR 61785 - New Postal Product

    Science.gov (United States)

    2010-10-06

    ... have the contract in Docket No. CP2010-71 serve as the baseline contract for future functional... GEPS 3 contracts fit within the Mail Classification Schedule language for GEPS. The Postal Service... same cost attributes and methodology, the relevant characteristics of these seven GEPS contracts are...

  7. 75 FR 57303 - New Postal Product

    Science.gov (United States)

    2010-09-20

    ... Docket No. CP2010-71 serve as the baseline contract for future functional equivalence analyses of the... fit within the Mail Classification Schedule language for GEPS. The Postal Service identifies customer... attributes and methodology, the relevant characteristics of these 11 GEPS contracts are similar, if not the...

  8. 78 FR 65015 - New Postal Product

    Science.gov (United States)

    2013-10-30

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing recent... product list. This notice informs the public of the filings, invites public comment, and takes other... Service Contract 5 to the competitive product list.\\1\\ It is the successor agreement to the contract...

  9. 78 FR 79025 - New Postal Product

    Science.gov (United States)

    2013-12-27

    ... Product AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is noticing a recent... product list. This notice informs the public of the filing, invites public comment, and takes other... associated supporting information to add Priority Mail Express Contract 17 to the competitive product list.\\1...

  10. 78 FR 77508 - New Postal Product

    Science.gov (United States)

    2013-12-23

    ... Counsel, at 202-789-6820. SUPPLEMENTARY INFORMATION: Table of Contents I. Introduction II. Contents of Filing III. Commission Action IV. Ordering Paragraphs I. Introduction Notice of filing. On December 16...' Decision, the new rates and related financial information. Id. at 3. The Postal Service filed redacted...

  11. 76 FR 80985 - New Postal Product

    Science.gov (United States)

    2011-12-27

    ... calendar year 2011. Id. at 3. Both notices expressed the Postal Service's view that the contingency pricing....gov/prc-pages/filing-online/login.aspx . Commenters who cannot submit their views electronically..., pursuant to 39 CFR 3015.5, of contingency prices under an outstanding International Business Reply Service...

  12. The benefits and costs of a master's programme in primary health care: a cross-sectional postal survey.

    Science.gov (United States)

    Tsimtsiou, Zoi; Sidhu, Kalwant; Jones, Roger

    2010-11-01

    Master's programmes can provide continuing professional development, equipping GPs to teach, research, and lead general practice. A previous evaluation of the MSc in primary health care found that graduates were contributing significantly to the discipline of general practice. Given the changes in general practice over the last 10 years, it was considered useful to investigate longer-term outcomes. To assess the benefits GPs have derived from the MSc in terms of the intended learning outcomes and their own plans for involvement in research and teaching. A cross-sectional survey using a postal questionnaire. Department of Primary Care and Public Health Sciences, King's College London. A postal questionnaire was sent to the graduates of MSc in primary health care from 1997 until 2008. A total of 50 completed questionnaires were returned (response rate 76%). After graduation, 22 GPs had completed another degree or diploma and 21 had work accepted for publication, resulting in 74 papers. Nine held academic posts at lecturer or senior lecturer level, 21 were GP trainers, and 21 undergraduate teachers. Twenty-five GPs held more than one teaching-related post. The majority of the graduates confirmed the attainment of the MSc's intended outcomes. Positive influences of the MSc were identified, including career development, personal development, and job satisfaction. Graduates reported a number of benefits to themselves, their practices, and their patients. As the requirements for continuing professional development of GPs become more stringent, and with the advent of revalidation, the current ad hoc approach to career development in general practice is becoming unsustainable. To enhance its credibility as an academic discipline, general practice must continue to develop its capacity for research and scholarship. Master's programmes are likely to have an important role in supporting professional development in general practice in the future.

  13. Work aggravated asthma in Great Britain: a cross-sectional postal survey.

    Science.gov (United States)

    Bradshaw, Lisa; Sumner, Jade; Delic, Julian; Henneberger, Paul; Fishwick, David

    2018-04-12

    Work aggravated asthma (WAA), asthma made worse by but not caused by workplace exposures, can have a negative impact on personal, social, financial and societal costs. There is limited data on prevalence levels of WAA in Great Britain (GB). The objective of this study was to estimate the prevalence of WAA in GB, and to assess its potential causes.Materials and methodsA cross-sectional postal questionnaire study was carried out. A total of 1620 questionnaires were sent to three populations of adults with asthma. The questionnaire recorded; demographic details, current job, self-reported health status, presence of asthma and respiratory symptoms, duration and severity of symptoms and medication requirements. Questions relating to work environment and employers' actions were included, and each participant completed an assessment of health-related quality of life using the EuroQol Research Foundation EQ-5D. There were 207 completed questionnaires; response rates were 6% primary care, 45% secondary care and 71% Asthma UK. This represented a 13% overall response rate. Self-reported prevalence of WAA was 33% (95% CI 24.4-41.6%). In all, 19% of workers had changed their job because of breathing problems. Workers with WAA reported higher levels of work-related stress. Quality of life using the EQ-5D utility index was lower in those with WAA. WAA is a common problem in asthmatics in GB. This result is in keeping with international prevalence rates. Further research could assist the understanding of the most significant aggravants to asthma at work and help define appropriate interventions by workplaces.

  14. 39 CFR 762.27 - Processing of disbursement postal money orders by Federal Reserve Banks.

    Science.gov (United States)

    2010-07-01

    ..., and its other depositors which guarantee all prior endorsements thereon; (2) Give immediate credit... DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS DISBURSEMENT POSTAL MONEY ORDERS Endorsements...

  15. 75 FR 80859 - New Postal Product

    Science.gov (United States)

    2010-12-23

    ... consideration of the Request pertaining to the proposed Priority Mail Contract 32 product and the related... recently-filed Postal Service request to add Priority Mail Contract 32 to the competitive product list... Service filed a formal request and associated supporting information to add Priority Mail Contract 32 to...

  16. 75 FR 80857 - New Postal Product

    Science.gov (United States)

    2010-12-23

    ... CP2011-46 for consideration of the Request pertaining to the proposed Priority Mail Contract 31 product... recently-filed Postal Service request to add Priority Mail Contract 31 to the competitive product list... Service filed a formal request and associated supporting information to add Priority Mail Contract 31 to...

  17. 75 FR 67147 - New Postal Product

    Science.gov (United States)

    2010-11-01

    ... requested to have the contract in Docket No. CP2010-36 serve as the baseline contract for future functional... GREP contract fits within the Mail Classification Schedule language for GREP Contracts 1. The Postal... incorporates the same cost attributes and methodology, the relevant characteristics of this GREP contract are...

  18. 75 FR 23824 - New Postal Products

    Science.gov (United States)

    2010-05-04

    ... of Classification Change to Add Existing Shipping Charges to the Mail Classification Schedule for... Form 3202-X, October 2009). Id., Attachment A. The Postal Service states further its belief that the... MCS.\\2\\ Attachment B to the Notice shows the proposed changes to the Stamped Envelope MCS language in...

  19. Conceptual foresight of the volumes of postal money orders in the Republic of Komi

    Directory of Open Access Journals (Sweden)

    Lyubov' Aleksandrovna Kuratova

    2012-03-01

    Full Text Available This paper describes a methodology elaborated for forecasting the volume of postal services on the basis of statistical methods of regression analysis on the example of the Republic of Komi. The influence of internal and external factors on the market of postal money orders of the Republic is constructed and investigated using the statistical regression model of the market of postal money orders of the Komi Republic in the period of 2005–2010. The conceptual foresight of development of the regional market of postal money orders for 2011–2012 is presented. Regression models were analyzed not only for the dynamic sequence of data, but also for sequences of data on territories, which revealed independent correlated factors which are weakly changing and evolving over time. The presented results have important practical and methodological significance for predicting both the volume of postal money orders as well as other types of services.

  20. 39 CFR Appendix A to Part 3002 - Postal Regulatory Commission, Mission Statement of the Office of the Consumer Advocate

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Postal Regulatory Commission, Mission Statement of the Office of the Consumer Advocate A Appendix A to Part 3002 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL ORGANIZATION Pt. 3002, App. A Appendix A to Part 3002—Postal Regulatory Commission, Mission Statement of the Office of the Consumer...

  1. Sun safety knowledge and practice in UK postal delivery workers

    OpenAIRE

    Houdmont, J.; Davis, S.; Griffiths, A.

    2015-01-01

    Background: Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk for skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK.\\ud Aims: To describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential str...

  2. 78 FR 37246 - New Postal Product

    Science.gov (United States)

    2013-06-20

    ... statement, and supporting financial workpapers. Id. The Postal Service filed redacted versions of the... extension was based on the understanding a successor agreement would be filed. See Docket No. CP2012-30...--a redacted copy of the certified statement required by 39 CFR 3015.5(c)(2); Attachment 3--a redacted...

  3. 75 FR 7951 - New Postal Product

    Science.gov (United States)

    2010-02-23

    ... is adding Express Mail Contract 8 to the Competitive Product List. This action is consistent with a postal reform law. Republication of the Product Lists is also consistent with a statutory provision... seeks to add a new product identified as Express Mail Contract 8 to the Competitive Product List. For...

  4. Approaches to leadership and managing change in the NHS.

    Science.gov (United States)

    Lumbers, Melanie

    2018-05-24

    The NHS is continually changing as research evidence leads to new practices and technology transforms the workplace. Resistance to some changes may occur because of staff fears about adapting to and coping with new methods. This is where change models and leadership are important. This article discusses changes taking place in the NHS, and some theoretical models of change. Leadership styles are also discussed, including those most useful for the nurse to use when leading a team and implementing change.

  5. 75 FR 42171 - New Postal Product

    Science.gov (United States)

    2010-07-20

    ... establishes Docket No. CP2010-66 for consideration of matters related to the contract identified in the Postal... Service request to add a Global Expedited Package Services 2 (GEPS 2) contract to the existing GEPS 2... announcing that it has entered into an additional Global Expedited Package Services 2 (GEPS 2) contract.\\1...

  6. 78 FR 33451 - New Postal Product

    Science.gov (United States)

    2013-06-04

    .... Introduction II. Contents of Filing III. Commission Action IV. Ordering Paragraphs I. Introduction On May 24... and supporting financial information required by 39 CFR 3015.5(c).\\2\\ For purposes of 39 CFR 3015.5(a...' Decision No. 11-6 authorizes Postal Service management to prepare and present to the Commission product...

  7. International patients within the NHS: a case of public sector entrepreneurialism.

    Science.gov (United States)

    Lunt, Neil; Exworthy, Mark; Hanefeld, Johanna; Smith, Richard D

    2015-01-01

    Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional income. This is especially the case where public sector hospitals have a reputation as global centres of excellence. Yet, this requires public sector entrepreneurship which, given the unique features of the public sector, means a change to professional culture. This paper examines how and under what conditions public sector entrepreneurship develops, drawing on the example of international patients in the UK NHS. It reports on a subset of data from a wider study of UK medical tourism, and explores inward flows and NHS responses through the lens of public entrepreneurship. Interviews in the English NHS were conducted with managers of Foundation Trusts with interest in international patient work. Data is from seven Foundation Trusts, based on indepth, semi-structured interviews with a range of NHS managers, and three other key stakeholders (n = 16). Interviews were analysed using a framework on entrepreneurship developed from academic literature. Empirical findings showed that Trust managers were actively pursuing a strategy of expanding international patient activity. Respondents emphasised that this was in the context of the current financial climate for the NHS. International patients were seen as a possible route to ameliorating pressure on stretched NHS resources. The analysis of interviews revealed that public entrepreneurial behaviour requires an organisational managerial or political context in order to develop, such as currently in the UK. Public sector workers engaged in this process develop entrepreneurship - melding political, commercial and stakeholder insights - as a coping mechanism to health system constraints

  8. Xcat, a novel mouse model for Nance-Horan syndrome inhibits expression of the cytoplasmic-targeted Nhs1 isoform.

    Science.gov (United States)

    Huang, Kristen M; Wu, Junhua; Duncan, Melinda K; Moy, Chris; Dutra, Amalia; Favor, Jack; Da, Tong; Stambolian, Dwight

    2006-01-15

    Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features and mental retardation. A recent report suggests that the novel gene NHS1 is involved in this disorder due to the presence of point mutations in NHS patients. A possible mouse model for NHS, Xcat, was mapped to a 2.11 Mb interval on the X-chromosome. Sequence and FISH analysis of the X-chromosome region containing the Xcat mutation reveal a large insertion between exons 1 and 2 of the mouse Nhs1 gene. The insertion inhibits the expression of the Nhs1 isoform containing exon 1 and results in exclusive expression of the alternative isoform containing exon 1A. Quantitative RT-PCR of Xcat cDNA shows reduced levels of Nhs1 transcripts. The Nhs1 protein is strongly expressed within the cytoplasm of elongating lens fiber cells from wild-type neonate lens, but is significantly reduced within the Xcat lens. Transient transfection studies of CHO cells with Nhs1-GFP fusion proteins were done to determine whether the amino acids encoded by exon 1 were critical for protein localization. We found the presence of Nhs1 exon 1 critical for localization of the fusion protein to the cytoplasm, whereas fusion proteins lacking Nhs1 exon 1 are predominantly nuclear. These results indicate that the first exon of Nhs1 contains crucial information required for the proper expression and localization of Nhs1 protein. Inhibition of expression of the exon 1 containing isoform results in the abnormal phenotype of Xcat.

  9. The fallacy of choice in the common law and NHS policy.

    Science.gov (United States)

    Whiteman, Ingrid

    2013-06-01

    Neither the English courts nor the National Health Service (NHS) have been immune to the modern mantra of patient choice. This article examines whether beneath the rhetoric any form of real choice is endorsed either in law or in NHS policy. I explore the case law on 'consent', look at choice within the NHS and highlight the dilemmas that a mismatch of language and practice poses for clinicians. Given the variance in interpretation and lack of consistency for the individual patient I argue for a semantic change that obviates the use of 'choice', focussing instead on the options for treatment that are available and accessible, with due acknowledgement of individual patient preferences, without raising unfettered and false expectations.

  10. Conceptual foresight of the volumes of postal money orders in the Republic of Komi

    OpenAIRE

    Lyubov Kuratova

    2012-01-01

    This paper describes a methodology elaborated for forecasting the volume of postal services on the basis of statistical methods of regression analysis on the example of the Republic of Komi. The influence of internal and external factors on the market of postal money orders of the Republic is constructed and investigated using the statistical regression model of the market of postal money orders of the Komi Republic in the period of 2005–2010. The conceptual foresight of development of the ...

  11. Electronic mail was not better than postal mail for surveying residents and faculty.

    Science.gov (United States)

    Akl, Elie A; Maroun, Nancy; Klocke, Robert A; Montori, Victor; Schünemann, Holger J

    2005-04-01

    To compare response rate, time to response, and data quality of electronic and postal surveys in the setting of postgraduate medical education. A randomized controlled trial in a university-based internal medicine residency program. We randomized 119 residents and 83 faculty to an electronic versus a postal survey with up to two reminders and measured response rate, time to response, and data quality. For residents, the e-survey resulted in a lower response rate than the postal survey (63.3% versus 79.7%; difference -16.3%, 95% confidence interval (95% CI) -32.3% to -0.4%%; P=.049), but a shorter mean response time, by 3.8 days (95% CI 0.2-7.4; P=.042). For faculty, the e-survey did not result in a significantly lower response rate than the postal survey (85.4% vs. 81.0%; difference 4.4%, 95% CI -11.7 to 20.5%; P=.591), but resulted in a shorter average response time, by 8.4 days (95% CI 4.4 to 12.4; P < 0.001). There were no differences in the quality of data or responses to the survey between the two methods. E-surveys were not superior to postal surveys in terms of response rate, but resulted in shorter time to response and equivalent data quality.

  12. 76 FR 13242 - Change in Postal Prices

    Science.gov (United States)

    2011-03-10

    [email protected] (electronic filing assistance). SUPPLEMENTARY INFORMATION: Table of Contents I. Introduction II. Notice of Filings III. Ordering Paragraphs I. Introduction On March 1, 2011, the Commission... Postal Service-branded parcel box designed to contain product samples and other advertising material from...

  13. 77 FR 54937 - International Mail Postal Contract

    Science.gov (United States)

    2012-09-06

    ... recently-filed Postal Service filing addressing a new International Business Reply Service Contract 3. It... contract within the International Business Reply Service (IBRS) Competitive Contract 3 grouping.\\1\\ The... Service Filing of a Functionally Equivalent International Business Reply Service Competitive Contract 3...

  14. 75 FR 69143 - Postal Rate and Classification Changes

    Science.gov (United States)

    2010-11-10

    ..., Pricing Strategy, as the official available to provide prompt responses to requests for clarification from..., at 30. II. Postal Service Filing Reply Rides Free. This pricing initiative is available for mailers...

  15. Barriers to healthy eating by National Health Service (NHS hospital doctors in the hospital setting: results of a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Wilson Sue

    2008-08-01

    Full Text Available Abstract Background With high levels of obesity and related illness, improving the health of the nation is a major public health concern. This study aimed to identify factors that prevent healthy eating among doctors, and that are associated with satisfaction with catering services. Findings Methods: Cross-sectional survey of 328 NHS doctors working in two NHS Trusts with on-site hospital canteen. Questionnaire to establish perceived barriers to healthy eating, weekly use and satisfaction with the hospital canteen, lifestyle and dietary habits, gender, age, height, weight, job details, and affect. Results: 70% of doctors reported using their hospital canteen each week, with 2 visits per week on average. Canteen opening times, lack of selection and lack of breaks were the most commonly perceived barriers to healthy eating. Availability of healthy options caused the most dissatisfaction. Only 12% felt the NHS was supportive of healthy eating. 74% did not feel their canteen advocated healthy eating. Canteen use is associated with younger age (r = -0.254, p Conclusion Interventions to encourage regular meal breaks, eating breakfast and drinking more water each day need developing. Improved canteen accessibility and availability of healthy options at evenings and weekends may be beneficial.

  16. Self-rostering can improve work-life balance and staff retention in the NHS.

    Science.gov (United States)

    Barrett, Renee; Holme, Annie

    2018-03-08

    Renee Barrett, Staff Nurse, ITU, Great Ormond Street Hospital NHS Trust, renee.barrett@gosh.nhs.uk , and Annie Holme, Lecturer, King's College London, look at how e-rostering can benefit health organisations and staff.

  17. Clinical psychologists' experiences of NHS organisational change

    OpenAIRE

    Colley, Rich; Eccles, Fiona; Hutton, Cheryl

    2015-01-01

    Organisational-change experiences of eight clinical psychologists working in the NHS were captured. Three themes revealed the challenges they experienced and how their knowledge and skills have helped them understand, cope with, and respond to change.

  18. 76 FR 29013 - Change in Postal Prices

    Science.gov (United States)

    2011-05-19

    ... Contents I. Introduction II. Notice of Filing III. Ordering Paragraphs I. Introduction On May 11, 2011, the... Service Contract 2 accompanies the Notice. Additionally, the Postal Service states that the financial... methodology is still pending, the notice also provides a financial analysis based upon the current methodology...

  19. Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform

    OpenAIRE

    Sharma, Shiwani; Burdon, Kathryn P.; Dave, Alpana; Jamieson, Robyn V.; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E.

    2008-01-01

    Purpose Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junction...

  20. The oral health of people with learning disabilities - a user-friendly questionnaire survey.

    Science.gov (United States)

    Owens, J; Jones, K; Marshman, Z

    2017-03-01

    To conduct a user-friendly questionnaire survey of the oral health and service needs of adults with learning disabilities. Researchers collaborated with local self-advocacy services to develop a questionnaire adapted from one used in a regional postal survey. The questionnaire, which covered dental status, oral health and dental services use, was sent to a random sample of people from the learning disability case register. Of 2,000 questionnaires mailed, 117 were returned undelivered and 625 were completed (response rate 31.3%). The self-reported dental status of people with learning disabilities appeared similar to that of the 2008 postal survey of the general population in Sheffield. The major difference in dental status was 11.5% of people with learning disabilities wore upper dentures and 7.2% wore lower dentures, compared to 21.2% and 12.1% of the general population in Sheffield. Using the case register as a recruitment instrument may have excluded people with learning disabilities not registered. Time and finances only permitted one mailing. Analysis on the basis of deprivation could not be conducted. Contrary to current practice, it is possible to include people with learning disabilities in oral health surveys. A multidisciplinary team was essential for enabling the progression and implementation of inclusive research and for people with learning disabilities and their supporters to engage meaningfully. This level of collaboration appears necessary if we are committed to ensuring that people with learning disabilities and their supporters are made visible to policy and decision-makers. Copyright© 2017 Dennis Barber Ltd

  1. Team performance in the Italian NHS: the role of reflexivity.

    Science.gov (United States)

    Urbini, Flavio; Callea, Antonino; Chirumbolo, Antonio; Talamo, Alessandra; Ingusci, Emanuela; Ciavolino, Enrico

    2018-04-09

    Purpose The purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output. Design/methodology/approach The Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping. Findings Underpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance. Practical implications The results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance. Originality/value This study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

  2. The NHS and market forces in healthcare: the need for organisational ethics.

    Science.gov (United States)

    Frith, Lucy

    2013-01-01

    The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

  3. A GIS Application to Explore Postal Retail Outlet Locations

    Directory of Open Access Journals (Sweden)

    Nikola Trubint

    2012-03-01

    Full Text Available The use of GIS in solving a wide variety of problems in postal operations is expanding. This approach provides the development and usage of new methods in spatial data analysis, as support in achieving a better quality of the decision-making process. The use of location analysis model based on GIS software is implemented in solving the Belgrade postal retail outlet problem. One of the most important experiences of model implementation is that the local environmental conditions have a significant impact on strategic as well as operational approach. A portion of the material included in the paper has resulted from the Serbian PTT and CPC (Canada Post Corporation joint project Location Analysis.

  4. A postal survey of data in general practice on the prevalence of Acquired Brain Injury (ABI) in patients aged 18-65 in one county in the west of Ireland.

    LENUS (Irish Health Repository)

    Finnerty, Fionnuala

    2009-01-01

    BACKGROUND: Very little is known about the prevalence of acquired brain injury (ABI) in Ireland. ABI prevalence has previously been obtained from Belgian general practitioners using a postal survey. We attempted to ascertain the prevalence of ABI in County Mayo through a postal survey of all general practitioners in the county.The specific objectives of this project were to:1. identify whether general practitioners are a. aware of patients with ABI aged 18-65 in their practices b. able to provide prevalence data on ABI in patients aged 18-65 c. able to provide data on age, gender and patient diagnosis 2. analyse prevalence of ABI from any available data from general practitioners. METHODS: A pilot postal survey was performed initially in order to assess the feasibility of the study. It was established that general practitioners did have the necessary information required to complete the questionnaire. A main postal survey was then undertaken. A postal questionnaire was administered to all general practices in County Mayo in the west of Ireland (n = 59). The response rate was 32.2% (n = 19). RESULTS: General practitioners who replied on behalf of their practice could provide data on patient age, gender and diagnosis. In the nineteen practices, there were 57 patients with ABI. The age-specific prevalence of ABI in the area surveyed was estimated at 183.7 per 100,000. The mean patient population per practice was 2,833 (SD = 950). There were found to be significantly more patients with ABI in rural areas than urban areas (p = 0.006). There were also significant differences in the ages of patients in the different ABI categories. Patients whose ABI was of traumatic origin were significantly younger than those patients with ABI of haemorrhagic origin (p = 0.002). CONCLUSION: Although this is a small-scale study, we have ascertained that general practitioners do have data on patients with ABI. Also, some prevalence data now exist where none was available before. These can

  5. Running an NHS community homeopathy clinic - 10-year anniversary 2001-2011.

    Science.gov (United States)

    Bawden, Stella

    2012-01-01

    An outcome series was conducted over a five-year period of patients attending a community NHS homeopathy clinic in Dorchester, Dorset. 273 new patients were seen. 183 (67%) questionnaires were completed at six months after initial consultation. 44% of patients had been unwell for more than five years; 19% of all patients for more than 15 years. A wide variety of conditions were seen, the largest group with depression, anxiety or grief. For follow-up patients 75-81% indicated an improvement in their symptoms and activity while 58% recorded an improvement in their overall wellbeing. Six months after the initiation of treatment 155 (84.7%) felt an improvement in their condition with 148 (81%) attributing this to homeopathy. Nobody reported deterioration due to homeopathic treatment; conventional drug use was reduced in 46 patients (25%). Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  6. Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the ?NHS Services, Seven Days a Week? project 2013?2016

    OpenAIRE

    Gan, Hoong-Wei; Wong, Danny Jon Nian; Dean, Benjamin John Floyd; Hall, Alistair Scott

    2017-01-01

    Background The cause of adverse weekend clinical outcomes remains unknown. In 2013, the ?NHS Services, Seven Days a Week? project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained from national...

  7. Do expanded seven-day NHS services improve clinical outcomes? Analysis of comparative institutional performance from the "NHS Services, Seven Days a Week" project 2013-2016

    OpenAIRE

    Gan, H-W; Wong, D. J. N.; Dean, B. J. F.; Hall, A. S.

    2017-01-01

    Background: The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods: Aggregated trust-level data on crude mortality rates, Summary Hospital-Level Mortality Indicator (SHMI), mean length of stay (LOS), A&E admission and four-hour breach rates were obtained f...

  8. African Postal Heritage : Tanzania 1885-1920s : part I : German East Africa, 1885-1914

    NARCIS (Netherlands)

    Dietz, A.J.

    2016-01-01

    An earlier version of this African Postal Heritage Paper was published as African Studies Centre Leiden Working Paper 119 / 2015: "A postal history of the First World War in Africa and its aftermath - German colonies; III Deutsch Ostafrika / German East Africa", written by Ton Dietz.

  9. Career destinations, views and future plans of the UK medical qualifiers of 1988.

    Science.gov (United States)

    Taylor, Kathryn; Lambert, Trevor; Goldacre, Michael

    2010-01-01

    To report the career destinations, views and future plans of a cohort of senior doctors who qualified in the 1980s. Postal questionnaire survey of all doctors who qualified from all UK medical schools in 1988. The response rate was 69%. We estimated that 81% of the total cohort was working in the NHS, 16 years after qualification; and that at least 94% of graduates who, when students, were from UK homes, were working in medicine. Of NHS doctors, 30% worked part-time. NHS doctors rated their job satisfaction highly (median score 19.9, scale 5-25) but were less satisfied with the amount of leisure time available to them (median score 5.4, scale 1-10). NHS doctors were very positive about their careers, but were less positive about working hours and some other aspects of the NHS. Women were more positive than men about working conditions; general practitioners were more positive than hospital doctors. Twenty-five percent reported unmet needs for further training or career-related advice, particularly about career development. Twenty-nine percent intended to reduce their hours in future, while 6%, mainly part-time women, planned to increase their hours. Overall, 10% of NHS doctors planned to do more service work in future and 24% planned to do less; among part-time women, 18% planned to do more and only 14% less. These NHS doctors, now in their 40s, had a high level of satisfaction with their jobs and their careers but were less satisfied with some other aspects of their working environment. A substantial percentage had expectations about future career development and change.

  10. Information related to postal flows and big data analysis potential. The case of Spain

    Energy Technology Data Exchange (ETDEWEB)

    Martinez Alvaro, O.; Nuñez Gonzalez, A.

    2016-07-01

    National Post Offices manage huge volumes of letters and parcels. Data associated to these flows are growing fast, with a great variety related to the diversity of postal products. The research described in this paper has classified all information flows of Correos, the Spanish National Post Office. In spite of the complexity of the current postal service portfolio, only four categories of matrices allow the classification of all postal information flows. Thanks to the migration towards new products, analyses with simple techniques will provide more and better information in the future, due to the structured nature of existing databases. (Author)

  11. 75 FR 78915 - Conduct on Postal Property

    Science.gov (United States)

    2010-12-17

    ... lottery ticket sales contains an exception for Randolph-Sheppard vendors. This exception is amended to... tickets ``for any lottery authorized by State law and conducted by an agency of a State''. This amendment... lottery or pool, or the selling or purchasing of lottery tickets, is prohibited on postal premises. In...

  12. 28 CFR 540.22 - Special postal services.

    Science.gov (United States)

    2010-07-01

    ... 540.22 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT...) In the event of loss or damage, any claim relative to this matter is made to the U.S. Postal Service... example, hobbycraft articles mailed out of the institution). Official mail is not insured. If such an item...

  13. Provider diversity in the English NHS: a study of recent developments in four local health economies.

    Science.gov (United States)

    Allen, Pauline; Turner, Simon; Bartlett, Will; Perotin, Virginie; Matchaya, Greenwell; Zamora, Bernarda

    2012-01-01

    To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies. There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

  14. Differential biotin labelling of the cell envelope proteins in lipopolysaccharidic diderm bacteria: Exploring the proteosurfaceome of Escherichia coli using sulfo-NHS-SS-biotin and sulfo-NHS-PEG4-bismannose-SS-biotin.

    Science.gov (United States)

    Monteiro, Ricardo; Chafsey, Ingrid; Leroy, Sabine; Chambon, Christophe; Hébraud, Michel; Livrelli, Valérie; Pizza, Mariagrazia; Pezzicoli, Alfredo; Desvaux, Mickaël

    2018-06-15

    Surface proteins are the major factor for the interaction between bacteria and its environment, playing an important role in infection, colonisation, virulence and adaptation. However, the study of surface proteins has proven difficult mainly due to their hydrophobicity and/or relatively low abundance compared with cytoplasmic proteins. To overcome these issues new proteomic strategies have been developed, such as cell-surface protein labelling using biotinylation reagents. Sulfo-NHS-SS-biotin is the most commonly used reagent to investigate the proteins expressed at the cell surface of various organisms but its use in lipopolysaccharidic diderm bacteria (archetypical Gram-negative bacteria) remains limited to a handful of species. While generally pass over in silence, some periplasmic proteins, but also some inner membrane lipoproteins, integral membrane proteins and cytoplasmic proteins (cytoproteins) are systematically identified following this approach. To limit cell lysis and diffusion of the sulfo-NHS-SS-biotin through the outer membrane, biotin labelling was tested over short incubation times and proved to be as efficient for 1 min at room temperature. To further limit labelling of protein located below the outer membrane, the use of high-molecular weight sulfo-NHS-PEG4-bismannose-SS-biotin appeared to recover differentially cell-envelope proteins compared to low-molecular weight sulfo-NHS-SS-biotin. Actually, the sulfo-NHS-SS-biotin recovers at a higher extent the proteins completely or partly exposed in the periplasm than sulfo-NHS-PEG4-bismannose-SS-biotin, namely periplasmic and integral membrane proteins as well as inner membrane and outer membrane lipoproteins. These results highlight that protein labelling using biotinylation reagents of different sizes provides a sophisticated and accurate way to differentially explore the cell envelope proteome of lipopolysaccharidic diderm bacteria. While generally pass over in silence, some periplasmic proteins

  15. Market--what market? A review of Health Authority purchasing in the NHS internal market.

    Science.gov (United States)

    West, P A

    1998-05-01

    This paper argues that the British NHS Reforms (the 'Reforms') set out in Working for Patients [1] largely failed to create a market, to achieve the changes that market forces might have been expected to achieve or to meet the objectives set for the NHS in Working for Patients. It draws on the available literature and the author's experience of work with the NHS during the 6 years after Working for Patients. It is hampered, as are all such reviews of the UK Reforms, by the lack of a detailed and systematic research appraisal of the internal market. Many small changes, resulting from market mechanisms, may have occurred throughout the NHS without being publicized or well documented. But overall, there is little convincing evidence that the Reforms have achieved their goals or met the objectives of the politicians who initiated them. The argument here is necessarily limited by the space available (but see [2] for a detailed analysis of the NHS Reforms). The initial sections of the paper examine the characteristics of markets and market power and the extent to which the NHS Reforms created a market, with health authorities and fund-holders as its buyers. The paper concentrates in particular on health authorities. Later sections then examine the extent to which the Reforms met the objectives set out in Working for Patients.

  16. 78 FR 12108 - New Postal Product; Negotiated Service Agreement

    Science.gov (United States)

    2013-02-21

    .... Introduction II. Contents of Filing III. Ordering Paragraphs I. Introduction On February 13, 2013, the Postal... unredacted amendment under seal. It asserts that the ``supporting financial documentation and financial...

  17. 78 FR 22490 - Administrative Practice and Procedure; Postal Service; Review of Price Cap Rules

    Science.gov (United States)

    2013-04-16

    ...] Administrative Practice and Procedure; Postal Service; Review of Price Cap Rules AGENCY: Postal Regulatory Commission. ACTION: Proposed rule. SUMMARY: The Commission is initiating a review of its Price Cap Rules. The... implemented without a price cap calculation. Docket No. R2011-5, Order Approving Market Dominant Price...

  18. Do NHS walk-in centres in England provide a model of integrated care?

    Directory of Open Access Journals (Sweden)

    C. Salisbury

    2003-08-01

    Full Text Available Purpose: To undertake a comprehensive evaluation of NHS walk-in centres against criteria of improved access, quality, user satisfaction and efficiency. Context: Forty NHS walk-in centres have been opened in England, as part of the UK governments agenda to modernise the NHS. They are intended to improve access to primary care, provide high quality treatment at convenient times, and reduce inappropriate demand on other NHS providers. Care is provided by nurses rather than doctors, using computerised algorithms, and nurses use protocols to supply treatments previously only available from doctors. Data sources: Several linked studies were conducted using different sources of data and methodologies. These included routinely collected data, site visits, patient interviews, a survey of users of walk-in centres, a study using simulated patients to assess quality of care, analysis of consultation rates in NHS services near to walk-in centres, and audit of compliance with protocols. Conclusion & discussion: The findings illustrate many of the issues described in a recent WHO reflective paper on Integrated Care, including tensions between professional judgement and use of protocols, problems with incompatible IT systems, balancing users' demands and needs, the importance of understanding health professionals' roles and issues of technical versus allocative efficiency.

  19. Reducing questionnaire length did not improve physician response rate: a randomized trial.

    Science.gov (United States)

    Bolt, Eva E; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D

    2014-04-01

    To examine the effect of reducing questionnaire length on the response rate in a physician survey. A postal four double-page questionnaire on end-of-life decision making was sent to a random sample of 1,100 general practitioners, 400 elderly care physicians, and 500 medical specialists. Another random sample of 500 medical specialists received a shorter questionnaire of two double pages. After 3 months and one reminder, all nonresponding physicians received an even shorter questionnaire of one double page. Total response was 64% (1,456 of 2,269 eligible respondents). Response rate of medical specialists for the four double-page questionnaire was equal to that of the two double-page questionnaire (190 and 191 questionnaires were returned, respectively). The total response rate increased from 53% to 64% after sending a short one double-page questionnaire (1,203-1,456 respondents). The results of our study suggest that reducing the length of a long questionnaire in a physician survey does not necessarily improve response rate. To improve response rate and gather more information, researchers could decide to send a drastically shortened version of the questionnaire to nonresponders. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. NHS constitution values for values-based recruitment: a virtue ethics perspective.

    Science.gov (United States)

    Groothuizen, Johanna Elise; Callwood, Alison; Gallagher, Ann

    2018-05-17

    Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that 'integrity' and 'practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating 'integrity' and 'practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Employee engagement within the NHS: a cross-sectional study.

    Science.gov (United States)

    Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

    2015-02-01

    Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. We found that the score for vigor and dedication is significantly lower than comparison group (Pengagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one's effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

  2. The early NHS and the crisis of public health nursing.

    Science.gov (United States)

    Webster, C

    2000-01-01

    Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office

  3. One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process.

    Science.gov (United States)

    Thompson, Andrew G H; France, Emma F

    2010-05-13

    Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland), which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for gaining research governance approval need improvement. Attention is

  4. Violence and stress at work in the postal sector

    OpenAIRE

    Giga, Sabir I; Hoel, Helge; Cooper, Cary L

    2003-01-01

    Reviews literature on the prevalence, causes and consequences of violence and stress within the postal sector and presents examples of good practice and relevant sources of information to guide practitioners and researchers.

  5. Fluorescence studies on the aggregation behaviors of collagen modified with NHS-activated poly(γ-glutamic acid).

    Science.gov (United States)

    Zhang, Min; Yang, Junhui; Yang, Qili; Huang, Liulian; Wu, Hui; Chen, Lihui; Ding, Cuicui

    2018-06-01

    The poly(γ-glutamic acid)-NHS (γ-PGA-NHS) esters were used to endow collagen with both of excellent water-solubility and thermal stability via cross-linking reaction between γ-PGA-NHS and collagen. In the present work, the effect of γ-PGA-NHS on the aggregation of collagen molecules was studied by fluorescence techniques. The fluorescence emission spectra of pyrene in collagen solutions and the intrinsic fluorescence emission spectra of collagen suggested different effects of γ-PGA-NHS on collagen molecules: inhibiting aggregation below critical aggregation concentration (CAC) and promoting aggregation above CAC. The two-dimensional (2D) fluorescence correlation spectra indicated that the intermolecular hydrogen bonding and cross-linking between γ-PGA-NHS and collagen would influence the aggregation of collagen molecules. By the ultra-sensitive differential scanning calorimeter (VP-DSC), it was found that the main denaturational transition temperature (T m2 ) of modified collagen increased, while its calorimetric enthalpy changes (ΔH 2 ) decreased compared to those of native collagen, further indicating that the modification of γ-PGA-NHS influenced the aggregation of collagen molecules. The study provide useful information for the utilizing and or the processing of water-soluble collagen in aqueous solution in the fields such as cosmetics, health care products, tissue engineering and biomedical materials, etc. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. 39 CFR 222.1 - Authority to administer postal affairs.

    Science.gov (United States)

    2010-07-01

    ..., or in any other Postal Service employee. (b) Corporate officers. Corporate officers are authorized to... matters within their areas of responsibility, except as limited by law or by the specific terms of their...

  7. The anthrax vaccine and research: reactions from postal workers and public health professionals.

    Science.gov (United States)

    Quinn, Sandra Crouse; Thomas, Tammy; Kumar, Supriya

    2008-12-01

    During the 2001 anthrax attacks, public health agencies faced operational and communication decisions about the use of antibiotic prophylaxis and the anthrax vaccine with affected groups, including postal workers. This communication occurred within an evolving situation with incomplete and uncertain data. Guidelines for prophylactic antibiotics changed several times, contributing to confusion and mistrust. At the end of 60 days of taking antibiotics, people were offered an additional 40 days' supply of antibiotics, with or without the anthrax vaccine, the former constituting an investigational new drug protocol. Using data from interviews and focus groups with 65 postal workers in 3 sites and structured interviews with 16 public health professionals, this article examines the challenges for public health professionals who were responsible for communication with postal workers about the vaccine. Multiple factors affected the response, including a lack of trust, risk perception, disagreement about the recommendation, and the controversy over the military's use of the vaccine. Some postal workers reacted with suspicion to the vaccine offer, believing that they were the subjects of research, and some African American workers specifically drew an analogy to the Tuskegee syphilis study. The consent forms required for the protocol heightened mistrust. Postal workers also had complex and ambivalent responses to additional research on their health. The anthrax attacks present us with an opportunity to understand the challenges of communication in the context of uncertain science and suggest key strategies that may improve communications about vaccines and other drugs authorized for experimental use in future public health emergencies.

  8. A Proven Method for Meeting Export Control Objectives in Postal and Shipping Sectors

    Science.gov (United States)

    2015-02-01

    A Proven Method for Meeting Export Control Objectives in Postal and Shipping Sectors Gregory Crabb, U.S. Postal Inspection Service Julia H...mail fraud, mail theft, identity theft, child exploitation, and prohibited mailings such as bombs and biological and chemical threats...April 2012. http://resources.sei.cmu.edu/library/asset-view.cfm?assetid=10085 [Allen 2014a] Allen, Julia H., Crabb, Gregory; Curtis, Pamela D

  9. 77 FR 64148 - Postal Rate and Classification Changes

    Science.gov (United States)

    2012-10-18

    .... Priority Mail International. Overall, Priority Mail International (PMI) prices increase by 15.1 percent. The existing price structure of PMI Flat Rate, Retail, Commercial Base, and Commercial Plus price.... Additionally, the Postal Service may offer a promotional discount or rebate on certain PMI items. International...

  10. Can Six Sigma be the "cure" for our "ailing" NHS?

    Science.gov (United States)

    Antony, Jiju; Downey-Ennis, Kay; Antony, Frenie; Seow, Chris

    2007-01-01

    The purpose of this research is to analyse whether Six Sigma business strategy can be used to improve the financial and operational performance of the NHS. The paper will also look at some of the major challenges and barriers in the implementation of this powerful process improvement strategy within the healthcare sector. This paper discusses whether Six Sigma DMAIC methodology can be a useful and disciplined approach to tackle process- and quality-related problems in the NHS. The paper presents some key findings from other researchers in the field, followed by some comments on whether Six Sigma is a useful approach to be considered by the NHS for cost reduction and defect reduction strategies. The paper illustrates the point that Six Sigma is not confined just to manufacturing industry, rather it is equally applicable to service industry, especially the healthcare and financial sectors. The application of Six Sigma in the UK health sector is relatively new and the purpose of the paper is to increase the awareness of this powerful business strategy in healthcare discipline.

  11. Novel causative mutations in patients with Nance-Horan syndrome and altered localization of the mutant NHS-A protein isoform.

    Science.gov (United States)

    Sharma, Shiwani; Burdon, Kathryn P; Dave, Alpana; Jamieson, Robyn V; Yaron, Yuval; Billson, Frank; Van Maldergem, Lionel; Lorenz, Birgit; Gécz, Jozef; Craig, Jamie E

    2008-01-01

    Nance-Horan syndrome is typically characterized by severe bilateral congenital cataracts and dental abnormalities. Truncating mutations in the Nance-Horan syndrome (NHS) gene cause this X-linked genetic disorder. NHS encodes two isoforms, NHS-A and NHS-1A. The ocular lens expresses NHS-A, the epithelial and neuronal cell specific isoform. The NHS-A protein localizes in the lens epithelium at the cellular periphery. The data to date suggest a role for this isoform at cell-cell junctions in epithelial cells. This study aimed to identify the causative mutations in new patients diagnosed with Nance-Horan syndrome and to investigate the effect of mutations on subcellular localization of the NHS-A protein. All coding exons of NHS were screened for mutations by polymerase chain reaction (PCR) and sequencing. PCR-based mutagenesis was performed to introduce three independent mutations in the NHS-A cDNA. Expression and localization of the mutant proteins was determined in mammalian epithelial cells. Truncating mutations were found in 6 out of 10 unrelated patients from four countries. Each of four patients carried a novel mutation (R248X, P264fs, K1198fs, and I1302fs), and each of the two other patients carried two previously reported mutations (R373X and R879X). No mutation was found in the gene in four patients. Two disease-causing mutations (R134fs and R901X) and an artificial mutation (T1357fs) resulted in premature truncation of the NHS-A protein. All three mutant proteins failed to localize to the cellular periphery in epithelial cells and instead were found in the cytoplasm. This study brings the total number of mutations identified in NHS to 18. The mislocalization of the mutant NHS-A protein, revealed by mutation analysis, is expected to adversely affect cell-cell junctions in epithelial cells such as the lens epithelium, which may explain cataractogenesis in Nance-Horan syndrome patients. Mutation analysis also shed light on the significance of NHS-A regions for

  12. Local Purchasing of Journals is Required in Addition to a Nationally Purchased Collection to Meet the Information Needs of NHS Staff. A review of: Glover, Steven William, John Addison, Colette Gleghorn, and John Bramwell. “Journal Usage in NHS Hospitals: A Comparison Report of Total Usage at an Acute NHS Trust and a Specialist NHS Trust in the North West of England.” Health Information and Libraries Journal 24.3 (2007: 193‐9.

    Directory of Open Access Journals (Sweden)

    Jennie Kelson

    2008-03-01

    Full Text Available Objective ‐ To compare journal usage between an acute National Health Service (NHS Trust and a specialist NHS Trust located in North West England to provide some evidence as to how well the National Core Content Collection (provided by ProQuest meets the needs of staff in these settings.Design ‐ Comparative studySetting ‐ An acute NHS Trust, comprising four hospital sites, and a cancer specialist NHS Trust based on a single site. Both Trusts are located in North West England. The cancer specialist NHS Trust is a teaching hospital with undergraduate nurses, medical students, and student radiographers. This Trust is also closely associated with an adjoining cancer research institute. The acute NHS Trust has a large number of healthcare staff in training and was not described as a teaching hospital.Subjects ‐ Staff of the respective NHS Trusts. The staff numbers for each organisation were not provided.Methods ‐ COUNTER usage statistics of online journals, obtained from publisher administration tools, were collected for one year covering the period 1 December 2005 to 30 November 2006. Where available, the number of photocopies made from print journals during the same period by library users for their own use was also included. All full‐text downloads of journal articles were counted as part of this study, hence the possibility of double counting if a single article was requested in both HTML and PDF versions. Details of free or open access articles accessed without the need for a username and password were not included in the study. To encourage use of the electronic journals, library services at both Trusts implemented a number of initiatives to maximize publicity. These included direct e‐mails to staff, posters, and presentations to staff. Athens registration, required for access to the electronic journal collections, was promoted as part of the induction process for new library users. Staff members were encouraged to apply for the

  13. Provision of NHS generalist and specialist services to care homes in England: review of surveys.

    Science.gov (United States)

    Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

    2016-03-01

    The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population

  14. Volunteering and overseas placements in the NHS: a survey of current activity.

    Science.gov (United States)

    Chatwin, John; Ackers, Louise

    2016-10-19

    The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Cross-sectional survey. Descriptive statistics. 4 main regional hospitals in the North West of England, and additional NHS staff training events. Convenience sample of NHS staff (n=911). 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating 'below 25' to '41-50' (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain momentum. Published by the BMJ Publishing Group Limited. For permission to use

  15. The National Health Service (NHS) at 70: some comparative reflections.

    Science.gov (United States)

    Tuohy, Carolyn H

    2018-03-16

    As the National Health Service (NHS) turns 70, it bears comparison with another universal system celebrating an anniversary this year: Canada's 50-year-old medicare model. Each system is iconically popular, and each revolves around a profession-state accommodation. Both the popularity and the central axis of each system have been tested by external shocks in the form of periodic fiscal cycles of investment and austerity, and internal stresses generating organizational cycles of centralization and decentralization. In addition, the English NHS has undergone periodic bursts of major policy change, which have arguably moved the system closer to the Canadian single-payer model.

  16. Managing clinical negligence litigation and costs in the NHS.

    Science.gov (United States)

    Tingle, John

    2016-11-24

    John Tingle, Reader in Health Law, Nottingham Trent University, discusses recent Government proposals to improve NHS maternity services and make changes to litigation and patient safety investigation procedures.

  17. Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

    Science.gov (United States)

    Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

    2017-04-01

    2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health

  18. A postal history of the First World War in Africa and its aftermath - German colonies : III Deutsch-Sdwestafrika (SWA)

    NARCIS (Netherlands)

    Dietz, A.J.

    2015-01-01

    The 'Great War' had a major impact on Africa and that is visible in the post stamps used in the various postal territories in Africa. This paper discusses the postal offices, postal services, and stamps used in the German colony Deutsch-Sdwestafrika (SWA) during the early twentieth century. For the

  19. 'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry.

    Science.gov (United States)

    Gorsky, Martin

    2013-01-01

    This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of 'general management' in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths' key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

  20. The impact of integrated team care taught using a live NHS contract on the educational experience of final year dental students.

    Science.gov (United States)

    Radford, D R; Holmes, S; Woolford, M J; Dunne, S M

    2014-11-01

    To investigate the responses of the dental student body in the first three years of outreach education (2010-13) at the University of Portsmouth Dental Academy in the areas of integrated team work and use of a current NHS contact. Use of a questionnaire to allow both quantitative and qualitative data to be obtained, administered to the three cohorts of students at the end of their longitudinal attendance at the Academy in their final year of education at King's College London Dental Institute. Data were obtained from 227 students which represented a 95% return rate. Sixty-four percent of students strongly agreed with both statements: 'I am confident with working with a dental nurse' and 'I now understand properly the scope of practice of dental hygiene-therapists'. Sixty-seven percent strongly agreed with the statement 'I have had useful experience of working in NHS primary care during the final year'. Eighty percent either strongly agreed or agreed with the statement 'My experience of real Units of Dental Activity and Key Performance Indicators has encouraged me to positively consider NHS high street dentistry as a career option'. Within the limitations of this study the dental students reported having gained useful experience of working in integrated team care dentistry. They expressed strong support for the education that is being delivered in an outreach environment and, most importantly, the student body was looking forward to entering general dental practice in the UK.

  1. Does a modified mindfulness-based cognitive therapy (MBCT) course have the potential to reduce stress and burnout in NHS GPs? Feasibility study.

    Science.gov (United States)

    Hamilton-West, Kate; Pellatt-Higgins, Tracy; Pillai, Neil

    2018-04-19

    AimTo explore, for the first time, whether a modified mindfulness-based cognitive therapy (MBCT) course has the potential to reduce stress and burnout among National Health Service (NHS) General Practitioners. There is a crisis of low morale among NHS GPs, with most describing their workload as 'unmanageable'. MBCT has been demonstrated to improve stress and burnout in other populations, but has not yet been evaluated in a cohort of NHS GPs. NHS GPs in South East England (n=22) attended a modified version of the MBCT course approved by National Institute for Health and Care Excellence for prevention of depressive relapse. This comprised eight weekly 2-h sessions with homework (mindfulness practice) between sessions. Participants completed the Maslach Burnout Inventory (MBI) and Perceived Stress Scale (PSS) before (baseline) and then again one month (T2) and three months (T3) after attending the course. We also obtained qualitative data on participants' experiences of the course.FindingsCompliance with the intervention was very high. All GPs attended at least six sessions and all completed baseline questionnaires. At T2, data were obtained from 21 participants (95%); PSS scores were significantly lower than at baseline (P<0.001), as were MBI emotional exhaustion (P<0.001) and depersonalization scores (P=0.0421). At T3 we obtained data for 13 participants (59%); PSS scores and MBI emotional exhaustion scores were significantly lower (P<0.001; P=0.0024, respectively) and personal accomplishment scores were significantly higher (P<0.001) than at baseline. Participants reported that the course helped them to manage work pressures, feel more relaxed, enjoy their work and experience greater empathy and compassion (for self, colleagues and patients). Findings of this preliminary evaluation are promising. Further research is needed to evaluate this approach within a larger randomized-controlled trial.

  2. Plus ça change, plus c'est la même chose: senior NHS managers' narratives of restructuring.

    Science.gov (United States)

    Macfarlane, Fraser; Exworthy, Mark; Wilmott, Micky; Greenhalgh, Trish

    2011-09-01

    The UK National Health Service (NHS) is regularly restructured. Its smooth operation and organisational memory depends on the insights and capability of managers, especially those with experience of previous transitions. Narrative methods can illuminate complex change from the perspective of key actors. We used an adaptation of Wengraf's biographical narrative life interview method to explore how 20 senior NHS managers (chief executives, directors and assistant directors) had perceived and responded to major transitions since 1974. Data were analysed thematically using insights from phenomenology, neo-institutional theory and critical management studies. Findings were contextualised within a literature review of NHS policy and management 1974-2009. Managers described how experience in different NHS organisations helped build resilience and tacit knowledge, and how a strong commitment to the 'NHS brand' allowed them to weather a succession of policy changes and implement and embed such changes locally. By synthesising these personal and situated micro-narratives, we built a wider picture of macro-level institutional change in the NHS, in which the various visible restructurings in recent years appear to have masked a deeper continuity in terms of enduring values, norms and ways of working. We consider the implications of these findings for the future NHS. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  3. The costs to the NHS of multiple births after IVF treatment in the UK.

    Science.gov (United States)

    Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

    2006-01-01

    To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

  4. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    DEFF Research Database (Denmark)

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... and gynecologists would personally prefer vaginal delivery in uncomplicated pregnancies, but nearly 40% agree with the woman's right to request a cesarean section....

  5. Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

    Science.gov (United States)

    Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

    2016-01-01

    Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

  6. Employee Engagement within the NHS: A Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Yadava Bapurao Jeve

    2015-02-01

    Full Text Available Background Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES at a teaching hospital. Methods We have conducted a cross-sectional study within the National Health Service (NHS Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption and total score compared with control score from test manual. Results We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both. The score for absorption was significantly higher than comparison group (P< 0.0001. However, total score is not significantly different. Conclusion The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.

  7. Next Generation Hemostatic Materials Based on NHS-Ester Functionalized Poly(2-oxazoline)s.

    Science.gov (United States)

    Boerman, Marcel A; Roozen, Edwin; Sánchez-Fernández, María José; Keereweer, Abraham R; Félix Lanao, Rosa P; Bender, Johan C M E; Hoogenboom, Richard; Leeuwenburgh, Sander C; Jansen, John A; Van Goor, Harry; Van Hest, Jan C M

    2017-08-14

    In order to prevent hemorrhage during surgical procedures, a wide range of hemostatic agents have been developed. However, their efficacy is variable; hemostatic devices that use bioactive components to accelerate coagulation are dependent on natural sources, which limits reproducibility. Hybrid devices in which chain-end reactive poly(ethylene glycol) is employed as active component sometimes suffer from irregular cross-linking and dissolution of the polar PEG when blood flow is substantial. Herein, we describe a synthetic, nonbioactive hemostatic product by coating N-hydroxysuccinimide ester (NHS)-functional poly(2-oxazoline)s (POx-NHS) onto gelatin patches, which acts by formation of covalent cross-links between polymer, host blood proteins, gelatin and tissue to seal the wound site and prevent hemorrhage during surgery. We studied different process parameters (including polymer, carrier, and coating technique) in direct comparison with clinical products (Hemopatch and Tachosil) to obtain deeper understanding of this class of hemostatic products. In this work, we successfully prove the hemostatic efficacy of POx-NHS as polymer powders and coated patches both in vitro and in vivo against Hemopatch and Tachosil, demonstrating that POx-NHS are excellent candidate polymers for the development of next generation hemostatic patches.

  8. Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

    Science.gov (United States)

    Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

    2008-09-01

    Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

  9. Evaluating construct validity of the second version of the Copenhagen Psychosocial Questionnaire through analysis of differential item functioning and differential item effect

    DEFF Research Database (Denmark)

    Bjorner, Jakob Bue; Pejtersen, Jan Hyld

    2010-01-01

    AIMS: To evaluate the construct validity of the Copenhagen Psychosocial Questionnaire II (COPSOQ II) by means of tests for differential item functioning (DIF) and differential item effect (DIE). METHODS: We used a Danish general population postal survey (n = 4,732 with 3,517 wage earners) with a ...

  10. NHS should provide nurses with decent catering facilities.

    Science.gov (United States)

    Whelan, Adrian

    2016-11-16

    How about the NHS gives us access to decent catering facilities or even tables and chairs that aren't a 10 to 15-minute walk away from the ward or unit - which must be taken out of the already paltry half-hour meal break?

  11. 10 x 15. Las tarjetas postales como huellas de las prácticas de los turistas

    Directory of Open Access Journals (Sweden)

    Carla Lois

    2017-01-01

    Full Text Available Las postales han sido objeto de análisis que han puesto el acento en diferentes cuestiones. De manera destacada puede reconocerse una tradición que ha analizado las imágenes que componen las postales para conocer cómo se retratan los destinos turísticos. Otros abordajes han complementado estos análisis señalando la condición de objeto complejo: un objeto que se elige, se adquiere, se escribe, se envía (e incluso se conserva como parte de la experiencia turística. Se ha sugerido que la postal presenta una imagen estandarizada (la que se encuentra en el verso y un espacio para la escritura del turista (en el reverso marcada por la subjetividad. Este artículo busca cuestionar esa supuesta dicotomía entre imagen estereotipada y anónima versus texto subjetivo y personal a partir de una revisión histórica de la postal como objeto (sus modos de uso, sus formatos, sus usuarios y proponer un análisis cualitativo de las postales que entrelace el verso y el reverso como fuente para indagar sobre las prácticas turísticas desde el punto de vista desde el propio turista.

  12. Measuring and modelling occupancy time in NHS continuing healthcare

    Directory of Open Access Journals (Sweden)

    Millard Peter H

    2011-06-01

    Full Text Available Abstract Background Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31 London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly. Results We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days, some others staying for few months and the third category of patients staying for a long period of time (years. Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards

  13. Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey

    NARCIS (Netherlands)

    de Bie, J.; Cuperus-Bosma, J.M.; van der Jagt, M.A.; Gevers, J.K.M.; van der Wal, G.

    2005-01-01

    Occurrence of problems with, refusals of orders and contemplated refusals of orders for risky procedures by nurses in Dutch hospitals and views on the safety of performance was studied using postal questionnaires (600 physicians and 3200 nurses, response 60-71%). Of the respondents, 11-30%

  14. One stop or full stop? The continuing challenges for researchers despite the new streamlined NHS research governance process

    Directory of Open Access Journals (Sweden)

    France Emma F

    2010-05-01

    Full Text Available Abstract Background Obtaining the necessary approvals and permission for clinical research requires successful negotiation of the ethical and R&D layers of the NHS. Differences in structure and governance frameworks feature between the constituent nations of the UK (England, Scotland, Wales and Northern Ireland, which adds complexity to cross-national studies. Difficulties in carrying out research in the NHS in the UK due to bureaucratic and time-consuming governance processes have led to the development of a new system of application and co-ordination from 2009. This paper illustrates how this new system fails to be consistent and streamlined and is unlikely to become so unless changes are made to the implementation and management of the governance processes. Methods We present a case study of the research governance process at the survey stage of an investigation into the use, preferences and need for information by people making choices or decisions about health care. The method involved home-based, face-to-face interviewing in a questionnaire survey in relation to decisions about lymphoma treatment, Down's syndrome screening in pregnancy, and caring for people with dementia. Results Our experience of the ethics stage was very positive, noting an efficient process of application and a speedy decision, both in relation to the initial application and to subsequent substantial amendments. By contrast, the R&D stages were very slow, most with unexplained delays, but some offering contradictory advice and exhibiting a lack of clear guidance and training for NHS staff. The R&D arrangements in Scotland were far quicker and more likely to be successful than in England. Overall, the delays were so severe that substantial parts of the research could not be delivered as planned within the funding timescale. Conclusions If high-quality research in the NHS, particularly in England, is to be delivered in a timely and cost-effective way, R&D processes for

  15. Enhancing nurse satisfaction: an exploration of specialty nurse shortage in a region of NHS England.

    Science.gov (United States)

    Gray, Keith; Wilde, Rebecca; Shutes, Karl

    2018-03-22

    This article offers nurse managers guidance on analysing, managing and addressing a potentially dissatisfied nursing workforce, focusing on three priority shortage specialties: emergency care, paediatrics and cardiology. The aim of the study was to explore to what extent registered nurses and healthcare assistants, referred to collectively here as 'nursing staff', are satisfied with teamworking opportunities, continuing professional development (CPD) opportunities and workplace autonomy. A survey questionnaire was developed to evaluate three derived determinants of nurse satisfaction: team working, CPD and autonomy. The NHS West Midlands region was the focus given that it is among the poorest performing regions outside London in filling nursing posts. Overall, nursing staff respondents were satisfied with teamworking, CPD and autonomy, which challenges the perception that nurses in NHS England are dissatisfied with these satisfaction determinants. The findings give a complex picture of nurse satisfaction; for example a large minority of respondents were dissatisfied with their ability to carry out duties as they see fit. When developing management systems to investigate, manage and enhance nurse satisfaction, nurse managers must recognise the complexity and subtleties of determining factors. This will increase as nursing becomes more specialised. Subsequently, nurse managers need to work closely with staff at higher education institutions and other professional agencies to commission appropriate professional development. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  16. Leadership in the NHS: does the Emperor have any clothes?

    Science.gov (United States)

    Checkland, Kath

    2014-10-01

    In this essay, I explore the rise of the concept of 'leadership' in the English NHS, highlighting the similarity with a previous shift from (bad, old) 'administration' to (good, new) 'management'. I take a critical look at this discursive shift and highlight some of the overblown claims made for the value of 'clinical leadership'. I argue that, rather than turning all NHS staff into leaders, we should perhaps tone down the level of our rhetoric and instead emphasize the need for a service full of good followers who will maintain a relentless focus on care, quality and efficiency. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

    Science.gov (United States)

    Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

    2013-01-01

    Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

  18. A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.

    LENUS (Irish Health Repository)

    Naughton, Corina

    2009-10-01

    The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.

  19. A clean bill of health? The efficacy of an NHS commissioned outsourced police custody healthcare service.

    Science.gov (United States)

    de Viggiani, Nick

    2013-08-01

    Police custody healthcare services for detainees in the UK are most commonly outsourced to independent healthcare providers who employ custody nurses and forensic physicians to deliver forensic healthcare services. A pilot was introduced in 2008 by the Department of Health to explore the efficacy of commissioning custody healthcare via the NHS, in the wake of the 2005-2006 shift of prison healthcare to the NHS. The objective was to improve quality and accountability through NHS commissioning and the introduction of NHS governance to the management and delivery of custody healthcare. This article discusses key themes that arose from the project evaluation, which focused on the commissioning relationship between the police, the NHS commissioner and the private healthcare provider. The evaluation observed an evolving relationship between the police, the local NHS and the front-line nurses, which was complicated by the quite distinctive professional values and ideologies operating, with their contrasting organisational imperatives and discordant values and principles. A key challenge for commissioners is to develop synergy between operational and strategically located stakeholders so that they can work effectively towards common goals. Government policy appears to remain focused on creating safe, supportive and humane custody environments that balance criminal justice and health imperatives and support the rights and needs of detainees, victims, professionals and the public. This remains an ambitious agenda and presents a major challenge for new criminal justice health partnerships. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  20. La imagen postal de Guayaquil. De las imágenes regeneradas a las microintenciones de control estético

    Directory of Open Access Journals (Sweden)

    Zerega , Tina

    2007-01-01

    Full Text Available Los estudios de la visualidad han analizado las series de postales en forma individual y en su conjunto, ya que sintetizan intenciones e idealizaciones que pueden considerarse como actos antropológicos. Este artículo presenta un estudio sobre postales de Guayaquil producidas entre 1970 y 2004 y da cuenta del impacto de la regeneración urbana en el imaginario visual urbano actual. Un análisis de contenido y textual de estas postales, así como entrevistas a los fotógrafos que las producen, permitieron descubrir discursividades visuales generadas alrededor de la ciudad de Guayaquil. Las postales y fotógrafos evidencian cómo la mirada se centra en espacios regenerados que materializan intenciones de control social e idealizaciones urbanas y raciales, así como un rechazo hacia lo popular. Asimismo, también se analizan postales que presentan otras miradas-intenciones alternativas a los discursos hegemónicos visuales.

  1. Market-driven production of biospecimens and the role of NHS hospital-led biobanks.

    Science.gov (United States)

    Timmons, Stephen; Vezyridis, Paraskevas

    2017-09-01

    Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare. © 2017 Foundation for the Sociology of Health & Illness.

  2. 77 FR 20656 - Postal Service Classification and Price Adjustments

    Science.gov (United States)

    2012-04-05

    ... and Price Adjustments AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is... implement Picture Permit Imprint Indicia as price categories for First-Class Mail and Standard Mail letters and cards pursuant to 39 U.S.C. 3622 and 39 CFR 3010.\\1\\ The classification and price adjustment will...

  3. Mutations in a novel gene, NHS, cause the pleiotropic effects of Nance-Horan syndrome, including severe congenital cataract, dental anomalies, and mental retardation.

    Science.gov (United States)

    Burdon, Kathryn P; McKay, James D; Sale, Michèle M; Russell-Eggitt, Isabelle M; Mackey, David A; Wirth, M Gabriela; Elder, James E; Nicoll, Alan; Clarke, Michael P; FitzGerald, Liesel M; Stankovich, James M; Shaw, Marie A; Sharma, Shiwani; Gajovic, Srecko; Gruss, Peter; Ross, Shelley; Thomas, Paul; Voss, Anne K; Thomas, Tim; Gécz, Jozef; Craig, Jamie E

    2003-11-01

    Nance-Horan syndrome (NHS) is an X-linked disorder characterized by congenital cataracts, dental anomalies, dysmorphic features, and, in some cases, mental retardation. NHS has been mapped to a 1.3-Mb interval on Xp22.13. We have confirmed the same localization in the original, extended Australian family with NHS and have identified protein-truncating mutations in a novel gene, which we have called "NHS," in five families. The NHS gene encompasses approximately 650 kb of genomic DNA, coding for a 1,630-amino acid putative nuclear protein. NHS orthologs were found in other vertebrates, but no sequence similarity to known genes was identified. The murine developmental expression profile of the NHS gene was studied using in situ hybridization and a mouse line containing a lacZ reporter-gene insertion in the Nhs locus. We found a complex pattern of temporally and spatially regulated expression, which, together with the pleiotropic features of NHS, suggests that this gene has key functions in the regulation of eye, tooth, brain, and craniofacial development.

  4. An evaluation of Knowledge and Understanding Framework personality disorder awareness training: can a co-production model be effective in a local NHS mental health Trust?

    Science.gov (United States)

    Davies, Julie; Sampson, Mark; Beesley, Frank; Smith, Debra; Baldwin, Victoria

    2014-05-01

    5 Boroughs Partnership NHS Foundation Trust, in the Northwest of England, has trained over 500 staff in the Knowledge and Understanding Framework, level 1 personality disorder awareness training. This is a 3-day nationally devised training programme delivered via an innovative co-production model (i.e. co-delivery and partnership working with service users who have lived experience). This paper provides quantitative and qualitative information on the effectiveness of training delivery and also serves to provide some insight into the impact of service-user involvement via such a co-production model. Information on 162 participants using the Knowledge and Understanding Framework bespoke questionnaire (Personality Disorder Knowledge, Attitudes and Skills Questionnaire) suggests that the training can be effectively delivered by and within a local NHS Mental Health Trust. Results immediately post-training suggest an improvement in levels of understanding and capability efficacy and a reduction in negative emotional reactions. Indications from a 3-month follow-up suggest that while understanding and emotional reaction remain improved, capability efficacy regresses back to pre-training levels, suggesting the need for ongoing supervision and/or support to consolidate skills. Discussion includes guidelines for the implementation of a truly integrated co-production model of training provision, as well as advice relating to the maximization of long-term benefits. Copyright © 2014 John Wiley & Sons, Ltd.

  5. The National Health Service (NHS) at 70: Bevan's double-edged legacy.

    Science.gov (United States)

    Klein, Rudolf

    2018-01-08

    The paper analyses the achievements and problems stemming from Nye Bevan's model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan's vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle - to combine the strengths of Bevan's model and those of a less hierarchic system - but have so far failed to deliver and can be expected to continue.

  6. A proposed instrument for the assessment of job satisfaction in Greek mental NHS hospitals.

    Science.gov (United States)

    Labiris, Georgios; Gitona, Kleoniki; Drosou, Vasiliki; Niakas, Dimitrios

    2008-08-01

    Since its introduction in 1983, the Greek NHS is under an almost constant reform, aiming improvement on the efficiency and the quality of provided services. The national program of psychiatric reform "Psychargos" introduced new models of therapeutic approach to the care of the mentally ill, that required expansion of the existing roles and development of new roles of the healthcare staff. Consequently, the efficient management of the healthcare workforce in Greek mental facilities was identified as a primary determinant of the successful implementation of the program. Primary objective of this study was the development of a research framework for the assessment of job satisfaction in Greek Mental Health Hospitals. Among the objectives was the evaluation of the capacity of the underlying motivators and hygiene factors and the identification of potential correlations of the global job satisfaction and the motivation and retention factors with the demographic, social and occupational characteristics of the employees. A custom questionnaire was developed, based on Herzberg two-factor theory, after a systematic review of the relevant literature. The instrument was constructed by two parts and 37 items. Ten items addressed the sociodemographic characteristics of the subjects, while the remaining 27 items were distributed in 11 subscales which addressed the global satisfaction index and the "retention" and the "motivation" variables. The instrument was validated by means of the Cronbach alpha for each subscale and by confirmatory factor analysis. The study was conducted at the Public Mental Hospital of Chania (PMHC). From the 300 employees of the PMHC, 133 subjects successfully responded to the questionnaire (response rate, 44.3%). In accordance to former surveys, subjects presented average scores in the global satisfaction index (GSI). The professional category of the employee was identified as the primary determinant of the GSI. Nurses presented statistically

  7. Caseload of NHS plastic surgeons in Scotland, 2005-2006: analysis of Scottish hospital activity data.

    Science.gov (United States)

    Brewster, Colin T; Shoaib, Taimur

    2009-04-01

    To assess the contemporary caseload of NHS plastic surgeons. Descriptive study. Scotland. Analysis of routinely collected NHS hospital activity data relating to the financial year 2005-2006. Number of inpatient/day-case episodes and bed-days by principal diagnosis and main operative procedure. During the study period, 12,844 inpatient and 9439 day-case episodes were recorded in 19,166 patients, accounting for 36,300 bed-days. There were more female patients, especially among middle-age groups. Socioeconomic deprivation was more common than expected (P accounted for a higher proportion of bed-days (37.3%) than neoplasms (23.8%). Only approximately half of all surgical procedures were assigned to the skin chapter of the OPCS-4 classification. Despite some limitations, this study provides an insight into the current caseload of NHS plastic surgeons working in Scotland. The data suggest that cosmetic surgery for purely aesthetic reasons represents a relatively small part of NHS plastic surgery activity in Scotland, and that the majority of caseload is in reconstructive plastic surgery.

  8. First evaluation of the NHS direct online clinical enquiry service: A nurse-led web chat triage service for the public

    NARCIS (Netherlands)

    Eminovic, Nina; Wyatt, Jeremy C.; Tarpey, Aideen M.; Murray, Gerard; Ingrams, Grant J.

    2004-01-01

    Background: NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their

  9. 39 CFR 111.1 - Mailing Standards of the United States Postal Service, Domestic Mail Manual; incorporated by...

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Mailing Standards of the United States Postal Service, Domestic Mail Manual; incorporated by reference of regulations governing domestic mail services... the approval of the Director of the Federal Register.” In conformity with that provision, and with 39...

  10. POLLUTION PREVENTION OPPORTUNITY ASSESSMENT - U.S. POSTAL INSPECTION SERVICE FORENSIC & TECHNICAL SERVICES DIVISION - NATIONAL FORENSIC LABORATORY, DULLES, VIRGINIA

    Science.gov (United States)

    The United States Postal Service (USPS) in cooperation with EPA's National Risk Management Research Laboratory (NRMRL) is engaged in an effort to integrate waste prevention and recycling activities into the waste management programs at Postal facilities. This report describes the...

  11. The development of a postal method to assess X-ray beam parameters and image quality in dental radiology

    International Nuclear Information System (INIS)

    Fenton, D.M.

    1994-10-01

    Intraoral radiographs are an extremely valuable diagnostic tool in dentistry. Radiography permits the early detection and diagnosis of dental disease and consequently is used extensively. However, public concern about radiation exposure has increased in recent times. This concern is reflected in national and international law, to the extent that, the basic principles of radiological protection, that is, justification, optimisation and dose limitation are written into law. Furthermore, in Ireland, the regulations, as outlined in the Code of Practice for Radiological Protection in Dentistry, require intraoral dental X-ray machines to perform to certain standards. A report of a direct survey of 164 intraoral dental X-ray machines is given in this study. The survey covered mechanical, electrical as well as radiation safety. Inadequacies with respect to focus to skin distance and timer accuracy were found in 45% and 42% of the machines surveyed. Ninety eight machines were assessed for electrical safety in which 48% were found to be unsafe. The results indicate that a complete assessment of the performance of dental X-ray units in Ireland is required. However, as there are in excess of 800 dental X-ray machines located throughout the country, such an assessment would be very costly for the regulatory authority. The development of a postal method for the assessment of the performance of dental X-ray machines is described in this study. This postal method provides information on the kV, total filtration, beam width and timer linearity and is undertaken by means of a penetrameter and film envelopes for exposure to the X-ray set under examination, together with a questionnaire that requests information on environment in which the machine is located. Using this method an accuracy of +-5% of the actual value was achieved in the measurement of kVp. The penetrameter was also used to assess whether or not the filtration of a particular machine complies with the regulations. This

  12. Centralised 3D printing in the NHS: a radiological review.

    Science.gov (United States)

    Eley, K A

    2017-04-01

    In recent years, three-dimensional (3D) printing has seen an explosion of interest fuelled by improvements in technology and associated reduction in costs. The literature is replete with novel medical applications of custom anatomical models, prostheses, and surgical guides. Although the fundamental core of 3D printing lies in image manipulation, the driving force in many National Health Service (NHS) trusts has come from individual surgical specialties with 3D printers independently run and confined to respective departments. In this review of 3D printing, experience of establishing a new centralised 3D-printing service within an NHS hospital trust is reported, focusing on the requirements and challenges of such an endeavour. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  13. Morocco : Spanish postal administration after 1912 and Morocco during the Spanish Civil War and the Second World War

    NARCIS (Netherlands)

    Dietz, A.J.

    2017-01-01

    An earlier version of (parts of) APH 5 was published as African Studies Centre Leiden Working Paper 125 / 2016: "A postal history of the First World War in Africa and its aftermath - German colonies/postal areas : V Morocco", written by Ton Dietz.

  14. Radical 10-point plan to refocus NHS estate.

    Science.gov (United States)

    Ellis, Conor; Baldwin, Ed; Dick, Rachel

    2010-11-01

    Conor Ellis, head of health, Ed Baldwin, partner, and Rachel Dick, consultant, at international built asset consultancy EC Harris, present a "10-step guide" to help the NHS achieve radical efficiency savings, optimise the use of its estate, maximise the value of under-utilised land, buildings, and other assets, and harness better value from its existing FM operations.

  15. Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS.

    Science.gov (United States)

    Hamarneh, Ashraf

    2015-01-01

    International Medical Graduates (IMGs) form a coherent part of the National Health Service (NHS). Nearly 25% of the doctors working in the NHS are IMGs who obtained their primary medical degree from outside the EU. Moving to a different country that holds a different set of values and belief systems can be very challenging for IMGs, which in turn could have a significant effect on the service provided to NHS patients. This article will address the issue of effective communication skills within the IMG population and will explore the underlying issues behind this problem.

  16. 78 FR 51678 - Market Tests of Experimental Postal Products

    Science.gov (United States)

    2013-08-21

    ... Gift Cards market test on April 28, 2011.\\11\\ The market test enabled customers to purchase a gift card... United States Postal Service for Temporary Extension of Gift Cards Market Test, June 18, 2013; Docket No... authorized the market test to proceed subject to the condition that the sale of gift cards be limited to...

  17. Moral Legitimacy: The Struggle Of Homeopathy in the NHS.

    Science.gov (United States)

    Crawford, Louise

    2016-02-01

    This article deploys a well-established theoretical model from the accountability literature to the domain of bioethics. Specifically, homeopathy is identified as a controversial industry and the strategic action of advocates to secure moral legitimacy and attract public funding is explored. The Glasgow Homeopathic Hospital (GHH) is used as the location to examine legitimizing strategies, from gaining legitimacy as a National Health Service (NHS) hospital in 1948, followed by maintaining and repairing legitimacy in response to government enquires in 2000 and 2010. An analysis of legitimizing strategies leads to the conclusion that advocates have been unsuccessful in maintaining and repairing moral legitimacy for homeopathy, thus threatening continued public funding for this unscientific medical modality. This is an encouraging development towards open and transparent NHS accountability for targeting limited public resources in pursuit of maximizing society's health and well-being. Policy implications and areas for future research are suggested. © 2016 John Wiley & Sons Ltd.

  18. Respiratory health as a predictor of questionnaire return in a sample of United States underground coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Trent, R B; Ames, R G

    1987-06-01

    A logistic model was used to analyse questionnaire return in a postal survey of 311 coalminers, who had left their place of employment between 1977 and 1982. Three measures of respiratory health, obstruction, restriction, and presence of chronic bronchitis symptoms, were included in the model as predictors together with the possibly confounding factors of age, education and marital and smoking status. Age was positively associated with questionnaire return (p<0.001). Speed of return, and whether the return was in response to a prompt, were not predicted by either the respiratory health measures or any of the other possibly confounding variables. 47 refs., 2 tabs.

  19. Can conditional health policies be justified? A policy analysis of the new NHS dental contract reforms.

    Science.gov (United States)

    Laverty, Louise; Harris, Rebecca

    2018-06-01

    Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects. Contractualist, paternalistic and mutualist arguments that reflect notions of responsibility and obligation are used as justification within policy. Underlying these arguments is an emphasis on preserving the finite resources of a strained NHS. We argue that the proposed conditional component may differentially affect disadvantaged patients, who do not necessarily have access to the resources needed to meet the behavioural requirements. As such, the conditional component of the NHS dental contract reform has the potential to exacerbate oral health inequalities. Conditional health policies may challenge core NHS principles and, as is the case with any conditional policy, should be carefully considered to ensure they do not exacerbate health inequities. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Effect of Some Synthetic Parameters on Size and Polydispersity Index of Gelatin Nanoparticles Cross-Linked by CDI/NHS System

    Directory of Open Access Journals (Sweden)

    S. Zinatloo-Ajabshir

    2015-04-01

    Full Text Available In our previous work, the effect of use of a water soluble CDI/NHS system as nontoxic cross-linking agent on fabrication of gelatin nanoparticles was investigated. In this research, the effect of variation in some synthetic parameters of gelatin nanoparticles cross-linked by CDI/NHS system such as type of gelatin and formulation of cross- linking agent on their size and distribution was examined. The conventional two step desolvation method was used for preparation of gelatin nanoparticles. The morphology, mean size and size distribution of the formed nanoparticles were evaluated and compared with each other. In addition, intrinsic viscosities of all the nanoparticles were measured and compared under different conditions. The results showed that the presence of more NHS and absence of NHS catalyst in CDI/NHS system lead to the large particle size and broad size distribution of nanoparticles that were attributed to the fast and slow cross-linking rate, respectively.

  1. NHS Trusts' clinical research activity and overall CQC performance - Is there a correlation?

    Science.gov (United States)

    Jonker, L; Fisher, S J

    2015-11-01

    Since the late 2000's, the creation of the National Institute for Health Research (NIHR) has transformed clinical research activity in the United Kingdom. This study sought to establish if there is a link between clinical research activity and overall NHS Trust performance. Retrospective cohort study. Data for NHS Trust performance were obtained from public databases, namely the Care Quality Commission (CQC) 2013 risk rating for overall performance, and 2012-13 NIHR records for clinical research activity. Applying Spearman's rank analysis, none of the Trust categories showed a correlation with CQC risk rating: small hospitals, r = -0.062 (P = 0.76; n = 27); medium, r = -0.224 (P = 0.13; n = 47); large, r = -0.008 (P = 0.96; n = 57); academic, r = -0.18 (P = 0.41; n = 24). Similar results were observed when CQC risk rating was compared with the number of different clinical research studies conducted per Trust. The degree of NIHR National Portfolio clinical research activity is not significantly related to CQC risk rating, used as an indicator of overall NHS Trust performance. Other studies have previously shown that increased research activity correlates with improved mortality rates, one component of CQC risk rating scores. Alternative tools may have to be explored to evaluate the impact of clinical research on NHS Trusts and its patients. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  2. Pain in patients with myotonic dystrophy type 2: a postal survey in Finland.

    Science.gov (United States)

    Suokas, Kimmo I; Haanpää, Maija; Kautiainen, Hannu; Udd, Bjarne; Hietaharju, Aki J

    2012-01-01

    Widespread musculoskeletal pain is a well-known symptom of myotonic dystrophy type 2 (DM2), but so far it has been addressed in only a few studies. A postal survey for all traceable DM2 patients (n = 132) was conducted. A specific questionnaire, and severity and interference subscales of the Brief Pain Inventory, quality of life (RAND-36), and modified Beck Depression Inventory were completed. The response rate was 70%. The mean age of respondents was 53 years, 59% of whom were women. Current pain was reported by 54%. Lifetime prevalence of pain was 76%. The mean intensity of pain at its highest in the last week was 5.9, and 2.3 at its lowest (on a numerical rating scale of 0-10). Quality of life was lower in DM2 patients who reported pain. In 18%, the depression score was noticeably different. Pain of moderate severity and unpleasant muscular symptoms are common in DM2. DM2 should be taken into consideration in the differential diagnosis of musculoskeletal pain. Copyright © 2011 Wiley Periodicals, Inc.

  3. Capitalising on leadership fellowships for clinicians in the NHS.

    Science.gov (United States)

    Nicol, Edward D

    2011-04-01

    Clinical leadership has become a primary focus of the NHS with many leadership programmes, particularly those aimed at junior clinicians, being developed. This article illustrates the potential of these programmes but also urges caution when assessing the success of these schemes both from an individual and organisational perspective.

  4. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    DEFF Research Database (Denmark)

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... indication. Obstetricians and gynecologists who had experienced a noninstrumental vaginal delivery themselves or practiced as a private gynecologist only, were less likely to agree with the woman's right to elective cesarean section on maternal request. CONCLUSION: The vast majority of Danish obstetricians...

  5. Hypnobirth within the NHS: time to ditch the parent craft?

    Science.gov (United States)

    Gavin-Jones, Teri

    2016-05-01

    Antenatal education within the National Health Service (NHS) is a service in decline within some hospital trusts. Classes on offer are being moved into online formats or discontinued completely. Whilst research into antenatal education remains limited, what is known is that good birth preparation is of value. "Participative preparation for childbirth can enhance women's overall satisfaction with the childbirth experience" (Schrader McMillan et al 2009: 49). There are pockets of excellent antenatal education within the NHS, but no system for regulating the quality and content. Traditional 'parent craft' classes can be oversubscribed, turning what should be a participative group into an audience. Offering good quality antenatal education has the potential to increase normality, improve the birth outcome and the experience of both woman and her birth partner. Is it time to ditch the parent craft and implement dynamic woman-focused education?

  6. Improving access for patients – a practice manager questionnaire

    Directory of Open Access Journals (Sweden)

    Brown James S

    2006-06-01

    Full Text Available Abstract Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256 had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006, urban practices (p Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study.

  7. Barriers and facilitators to using NHS Direct: a qualitative study of 'users' and 'non-users'.

    Science.gov (United States)

    Cook, Erica J; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M; Ali, Nasreen

    2014-10-25

    NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK's diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both 'users' and 'non- users'. Focus groups were held with NHS Direct 'users' (N = 2) from Bedfordshire alongside 'non-users' from Manchester (N = 3) and Mendip, Somerset (N = 4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants' permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. 'Non-users' were unaware of the range of services that NHS Direct provided. Furthermore, 'non-users' highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a '0845' number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by 'non-users' from deprived communities. NHS Direct 'users' identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through

  8. Refinement of the NHS locus on chromosome Xp22.13 and analysis of five candidate genes.

    Science.gov (United States)

    Toutain, Annick; Dessay, Benoît; Ronce, Nathalie; Ferrante, Maria-Immacolata; Tranchemontagne, Julie; Newbury-Ecob, Ruth; Wallgren-Pettersson, Carina; Burn, John; Kaplan, Josseline; Rossi, Annick; Russo, Silvia; Walpole, Ian; Hartsfield, James K; Oyen, Nina; Nemeth, Andrea; Bitoun, Pierre; Trump, Dorothy; Moraine, Claude; Franco, Brunella

    2002-09-01

    Nance-Horan syndrome (NHS) is an X-linked condition characterised by congenital cataracts, dental abnormalities, dysmorphic features, and mental retardation in some cases. Previous studies have mapped the disease gene to a 2 cM interval on Xp22.2 between DXS43 and DXS999. We report additional linkage data resulting from the analysis of eleven independent NHS families. A maximum lod score of 9.94 (theta=0.00) was obtained at the RS1 locus and a recombination with locus DXS1195 on the telomeric side was observed in two families, thus refining the location of the gene to an interval of around 1 Mb on Xp22.13. Direct sequencing or SSCP analysis of the coding exons of five genes (SCML1, SCML2, STK9, RS1 and PPEF1), considered as candidate genes on the basis of their location in the critical interval, failed to detect any mutation in 12 unrelated NHS patients, thus making it highly unlikely that these genes are implicated in NHS.

  9. Addressing current and future challenges for the NHS: the role of good leadership.

    Science.gov (United States)

    Elton, Lotte

    2016-10-03

    Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

  10. Obtaining corporate information from NHS foundation trusts.

    Science.gov (United States)

    Woodward, Valerie; Endacott, Ruth; Sheaff, Rod; Jones, Ray

    Foundation trusts have boards of directors that are responsible for the day-to-day running of the organisation, planning services and developing strategy. Unlike non-foundation trusts and primary care trusts (PCTs), foundation trusts are not obliged to hold directors' board meetings in public. This article describes the online availability and accessibility of the minutes of such meetings in a number of foundation trusts, non-foundation trusts and PCTs. The implications for transparency in the NHS are also discussed.

  11. Evaluation of international recruitment of health professionals in England.

    Science.gov (United States)

    Young, Ruth; Noble, Jenny; Mahon, Ann; Maxted, Mairead; Grant, Janet; Sibbald, Bonnie

    2010-10-01

    To explore whether a period of intensive international recruitment by the English National Health Service (NHS) achieved its objectives of boosting workforce numbers and to set this against the wider costs, longer-term challenges and questions arising. A postal survey of all pre-2006 NHS providers, Strategic Health Authorities and Deans of Postgraduate Medical Education obtained information on 284 (45%) organizations (142 completed questionnaires). Eight subsequent case studies (74 interviews) covered medical consultant, general practitioner, nurse, midwife and allied health professional recruitment. Most respondents had undertaken or facilitated international recruitment between 2001 and 2006 and believed that it had enabled them to address immediate staff shortages. Views on longer-term implications, such as recruit retention, were more equivocal. Most organizations had made only a limited value-for-money assessment, balancing direct expenditure on overseas recruitment against savings on temporary staff. Other short and long-term transaction and opportunity costs arose from pressures on existing staff, time spent on induction/pastoral support, and human resource management and workforce planning challenges. Though recognized, these extensive 'hidden costs' for NHS organizations were harder to assess as were the implications for source countries and migrant staff. The main achievement of the intensive international recruitment period from a UK viewpoint was that such a major undertaking was seen through without major disruption to NHS services. The wider costs and challenges meant, however, that large-scale international recruitment was not sustainable as a solution to workforce shortages. Should such approaches be attempted in future, a clearer upfront appraisal of all the potential costs and implications will be vital.

  12. The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

    Science.gov (United States)

    Croker, Richard; Smyth, Darren; Walker, Alex J; Goldacre, Ben

    2018-06-07

    Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. English primary care. English general practices. Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million. © Article author(s) (or their employer(s) unless

  13. NHS-Esters As Versatile Reactivity-Based Probes for Mapping Proteome-Wide Ligandable Hotspots.

    Science.gov (United States)

    Ward, Carl C; Kleinman, Jordan I; Nomura, Daniel K

    2017-06-16

    Most of the proteome is considered undruggable, oftentimes hindering translational efforts for drug discovery. Identifying previously unknown druggable hotspots in proteins would enable strategies for pharmacologically interrogating these sites with small molecules. Activity-based protein profiling (ABPP) has arisen as a powerful chemoproteomic strategy that uses reactivity-based chemical probes to map reactive, functional, and ligandable hotspots in complex proteomes, which has enabled inhibitor discovery against various therapeutic protein targets. Here, we report an alkyne-functionalized N-hydroxysuccinimide-ester (NHS-ester) as a versatile reactivity-based probe for mapping the reactivity of a wide range of nucleophilic ligandable hotspots, including lysines, serines, threonines, and tyrosines, encompassing active sites, allosteric sites, post-translational modification sites, protein interaction sites, and previously uncharacterized potential binding sites. Surprisingly, we also show that fragment-based NHS-ester ligands can be made to confer selectivity for specific lysine hotspots on specific targets including Dpyd, Aldh2, and Gstt1. We thus put forth NHS-esters as promising reactivity-based probes and chemical scaffolds for covalent ligand discovery.

  14. Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

    Science.gov (United States)

    Harries, U; Elliott, H; Higgins, A

    1999-03-01

    The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

  15. ANALYSIS AND PERSPECTIVES OF PRIVATE POSTAL AND COURIER SERVICES IN ROMANIA DURING 2009-2015

    Directory of Open Access Journals (Sweden)

    Silviu Dorin GEORGESCU

    2013-11-01

    Full Text Available Services occupy an important role in a country’s economic development. At present, services sector is under a continuous change and diversification, for this reason theoretical and practical approaches are both difficult and controversial. Services have complex forms of manifestation, being involved in all compartments of economic and social life; have a heterogeneous character (Criveanu, 2009, p.13. The evaluation and measurement of postal services sector through some indicators, such as: the population occupied in this sector and its change in time; internal and international traffic of mail; degree of employees’ burden. The development of postal and courier sector during the period preceding 2009 was influenced by external factors such as the growth of the GDP, the development of niche segments, the ascending trend being a normal consequence of the evolution of the entire national economy. Although the field of postal services has felt the evolution of national economy and the effects of the economic crisis, the strategies adopted by private companies in this sector have demonstrated the necessity of knowing the market, its evolutions and perspectives. The present paper aims at analyzing the evolution of postal and courier services in Romania during 2009-2012, a period marked by the profound economic crisis which affected Romania and the European Union, as well as the perspectives regarding the number of employees in this sector within private companies in Romania during 2013-2015 using statistical methods to forecast the employed population in private companies in this sector.

  16. Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

    Science.gov (United States)

    Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

    2013-01-01

    Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

  17. Correistas, estafetas y líneas postales en Antioquia entre 1859 y 1919

    Directory of Open Access Journals (Sweden)

    Gustavo Adolfo Hernandez Rojas

    2016-06-01

    Full Text Available El presente artículo es uno de los resultados del proceso de investigación que se llevó a cabo en la tesis de Maestría en Historia: “El sistema de correos en Antioquia 1859-1919”. Este producto, titulado “Correistas, estafetas y líneas postales en Antioquia entre 1859 y 1919”, es una reconstrucción de carácter histórico, donde se plasmó la estructura de la institución y el funcionamiento del ramo postal de la época en el territorio antioqueño. En él, se aborda la dinámica institucional, su distribución y cobertura a través de las líneas  establecidas y las demás técnicas administrativas de control que se implementaron para su operatividad en Antioquia. El presente artículo títulado “Correistas, estafetas y líneas postales en Antioquia entre 1859 y 1919”, es una reconstrucción de carácter histórico, que trata sobre el funcionamiento y la estructura del Ramo Postal de la época, en el territorio antioqueño. En él, se aborda la dinámica institucional, su distribución y cobertura a través de las líneas establecidas y las técnicas administrativas de control que se implementaron para su operatividad. Así, las estafetas, los empleados, las líneas, los tipos de correos y los itinerarios de circulación, sonelementos que evidencian el accionar del correo como institución y servicio.

  18. Assessing obstetric patient experience: a SERVQUAL questionnaire.

    Science.gov (United States)

    Garrard, Francesca; Narayan, Harini

    2013-01-01

    Across health services, there is a drive to respond to patient feedback and to incorporate their views into service improvement. The SERVQUAL method has been used in several clinical settings to quantify whether services meet patient expectations. However, work has been limited in the obstetric population. This paper seeks to address these issues. This study used an adapted SERVQUAL questionnaire to assess a reconfigured antenatal clinic service. The most important care aspects, as rated by patients, were used to construct the SERVQUAL questions. The questionnaire was administered to eligible women in two parts. The first was completed before their first hospital antenatal appointment and the second either at home (a postal-chasing exercise) or while waiting for their next appointment. Only fully completed questionnaires (both parts) were analysed. Service strengths included staff politeness, patient respect and privacy. Areas for improvement included hand cleanliness, women's involvement in decision making and communicating risk. However, the low variability in patient responses makes concrete conclusions difficult and methodological issues complicate evaluating hand cleanliness. The new antenatal clinic service received low negative weighted and un-weighted overall scores. The SERVQUAL measure was developed from patient feedback and used to further improve services. The SERVQUAL-based measure allowed an internal evaluation of patient experience and highlighted areas for improvement. However, without validation, the questionnaire cannot be used as an outcome measure and variation between published SERVQUAL questionnaires makes comparisons difficult. This highlights an important balance in patient evaluation measures--between locally responsive and externally comparable. The SERVQUAL approach allows healthcare teams to evaluate patient experience, while accounting for variation in their expectations and priorities. The study highlights several areas that are

  19. Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

    International Nuclear Information System (INIS)

    Jonker, Leon; Cox, Diane; Marshall, Gill

    2011-01-01

    Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

  20. Considerations, clues and challenges: Gaining Ethical and Trust research approval when using the NHS as a research setting

    Energy Technology Data Exchange (ETDEWEB)

    Jonker, Leon, E-mail: leon.jonker@cumbria.ac.uk [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom); Research and Development Department, North Cumbria University Hospitals NHS Trust, Carlisle CA2 7HY (United Kingdom); Cox, Diane; Marshall, Gill [Faculty of Health and Wellbeing, University of Cumbria, Lancaster LA1 3JD (United Kingdom)

    2011-08-15

    Substantial changes have been made in recent years to the process of obtaining ethical and research governance approval for research projects in the NHS. The advent of the Integrated Research Application System (IRAS) has streamlined the process, providing a single point of entry. Ethical approval gained in one part of the country is now valid throughout the UK. The previous process of gaining research governance approval in NHS Trusts was maligned and it has been overhauled with the introduction of the National Institute of Health Research (NIHR) Coordinated System for gaining NHS Permission. In addition to updating the reader about the new processes around gaining ethical and Trust approval for research within an NHS setting, essential research project documentation needed for submission are discussed. The aspects of a proposal that Ethics Committees and Trust R and D Departments consider when reviewing applications are highlighted. The implemented changes to the research approval processes will mostly benefit large multi-centre studies; small scale unfunded studies and student projects are potentially at risk of being marginalised in the quest for a streamlined ethics and NHS Trust research governance approval process. However, researchers' familiarity with the approval system should minimise rejection rates and delays.

  1. Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts.

    Science.gov (United States)

    Thompson, Charles Dr; Mahay, Arun; Stuckler, David; Steele, Sarah

    2017-09-01

    We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Freedom of Information requests were sent to the 105 England's NHS Trusts delivering acute care in England. NHS Trusts providing secondary care in England. English NHS Trusts. We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation.

  2. Do clinicians receive adequate training to identify trafficked persons? A scoping review of NHS Foundation Trusts

    Science.gov (United States)

    Mahay, Arun; Stuckler, David; Steele, Sarah

    2017-01-01

    Objective We investigate whether physicians in secondary care in the English NHS receive adequate training to recognise and appropriately refer for services those persons suspected to be victims of human trafficking. Design Freedom of Information requests were sent to the 105 England’s NHS Trusts delivering acute care in England. Setting NHS Trusts providing secondary care in England. Participants English NHS Trusts. Main outcome measures We requested data about the training provided on human trafficking to clinicians, including the nature, delivery, and format of any education, and any planned training. Results A total of 89.5% of the 105 Trusts responded. Of these Trusts, 69% provide education to physicians on human trafficking, and a further 6% provide training but did not specify who received it. The majority of Trusts providing training did so within wider safeguarding provision (91%). Only one trust reported that it provides stand-alone training on trafficking to all its staff, including physicians. Within training offered by Trusts, 54% observed best practice providing training on the clinical indicators of trafficking, while 16% referenced the National Referral Mechanism. Amongst those not providing training, 39% of Trusts report provision is in development. Conclusions Our results find that 25% of NHS Foundation Trusts appear to lack training for physicians around human trafficking. It is also of concern that of the Trusts who currently do not provide training, only 39% are developing training or planning to do so. There is an urgent need to review and update the scope of available training and bring it into alignment with current legislation. PMID:28904806

  3. Exploring HRD in two Welsh NHS Trusts: analysing the discursive resources used by senior managers.

    Science.gov (United States)

    Sambrook, Sally

    2007-01-01

    The purpose of this paper is to examine human resource development (HRD) in the UK National Health Service (NHS), and particularly in two Welsh NHS Trusts, to help illuminate the various ways in which learning, training and development are talked about. The NHS is a complex organisation, not least with its recent devolution and separation into the four distinct countries of the UK. Within this, there are multiple and often conflicting approaches to human resource development associated with the various forms of employee, professional (nursing, medical etc.), managerial and organisational development. How people are developed is crucial to developing a modern health service, and yet, with the diverse range of health workers, HRD is a complex process, and one which receives little attention. Managers have a key role and their perceptions of HRD can be analysed through the discursive resources they employ. From an interpretivist stance, the paper employs semi-structured interviews with seven Directorate-General Managers, and adopts discourse analysis to explore how HRD is talked about in two Welsh NHS Trusts. The paper finds some of the different discourses used by different managers, including those with a nursing background and those without. It examines how they talk about HRD, and also explores their own (management) development and the impact this has had on their sense of identity. The paper highlights some of the tensions associated with HRD in the NHS, including ambiguities between professional and managerial development, the functional and physical fragmentation of HRD, conflict between a focus on performance/service delivery and the need to learn, discursive dissonance between the use of the terms training and learning, a delicate balance between "going on courses" and informal, work-related learning, inequities regarding "protected time" and discourses shifting between competition and cooperation. These tensions are exposed to help develop a shared

  4. Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS

    Directory of Open Access Journals (Sweden)

    Aston Louise M

    2011-06-01

    Full Text Available Abstract Background The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW by the NHS. Method Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years; median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2. Participants received vouchers (funded by the PCT following referral by a healthcare professional to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.

  5. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Sharp Debbie

    2006-06-01

    Full Text Available Abstract Background Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. Methods Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent, recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. Results A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors" and attractive aspects of complementary therapies ("pull factors". While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. Conclusion Complementary therapy

  6. Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

    Science.gov (United States)

    Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

    2015-04-01

    To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing

  7. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

    Directory of Open Access Journals (Sweden)

    Cochrane Thomas

    2012-11-01

    Full Text Available Abstract Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p Conclusions The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

  8. Corneal Stromal Cell Growth on Gelatin/Chondroitin Sulfate Scaffolds Modified at Different NHS/EDC Molar Ratios

    Directory of Open Access Journals (Sweden)

    Jui-Yang Lai

    2013-01-01

    Full Text Available A nanoscale modification strategy that can incorporate chondroitin sulfate (CS into the cross-linked porous gelatin materials has previously been proposed to give superior performance for designed corneal keratocyte scaffolds. The purpose of this work was to further investigate the influence of carbodiimide chemistry on the characteristics and biofunctionalities of gelatin/CS scaffolds treated with varying N-hydroxysuccinimide (NHS/1-ethyl-3-(3-dimethyl aminopropyl carbodiimide hydrochloride (EDC molar ratios (0-1 at a constant EDC concentration of 10 mM. Results of Fourier transform infrared spectroscopy and dimethylmethylene blue assays consistently indicated that when the NHS to EDC molar ratio exceeds a critical level (i.e., 0.5, the efficiency of carbodiimide-mediated biomaterial modification is significantly reduced. With the optimum NHS/EDC molar ratio of 0.5, chemical treatment could achieve relatively high CS content in the gelatin scaffolds, thereby enhancing the water content, glucose permeation, and fibronectin adsorption. Live/Dead assays and interleukin-6 mRNA expression analyses demonstrated that all the test samples have good cytocompatibility without causing toxicity and inflammation. In the molar ratio range of NHS to EDC from 0 to 0.5, the cell adhesion ratio and proliferation activity on the chemically modified samples significantly increased, which is attributed to the increasing CS content. Additionally, the materials with highest CS content (0.143 ± 0.007 nmol/10 mg scaffold showed the greatest stimulatory effect on the biosynthetic activity of cultivated keratocytes. These findings suggest that a positive correlation is noticed between the NHS to EDC molar ratio and the CS content in the biopolymer matrices, thereby greatly affecting the corneal stromal cell growth.

  9. The NHS could learn from inspiring leaders like Barack Obama.

    Science.gov (United States)

    Coghill, Yvonne

    2017-02-01

    I remember November 2008 like it was yesterday. I was the lead for the NHS Leadership Academy's national Breaking Through programme for black and minority ethnic staff, and recall being at our annual conference bursting with pride at the news that Barack Obama had been elected president of the United States.

  10. Liberlizacija poštnih storitev ter njihovo financiranje v prihodnosti = Liberalisation of Postal Services and Their Financing in the Future

    Directory of Open Access Journals (Sweden)

    Matjaz Andric

    2007-12-01

    Full Text Available This article analyses the issues in the process of the EU postal services market liberalisation, which is in the final stage of its legal basis drafting process. The acceptance of the legal basis by competent EU institutions will largely define the postal services market liberalisation method, which is to be carried out by all EU Member States in a given period of time. For the final step of the liberalisation the authors (eu expert bodies of the legal basis draft proposal have managed to maintain a relatively high standard of universal postal services (delivery every working day and at least five days a week for EU addresses, and short delivery times and in addition to these also foreseen various financing methods. The latter are based on solutions taken from other sectors where the liberalisation process has been recently concluded and where a sector is also subject to the universal service obligation. Even though those financing models are more or less effective in other sectors, they have been subject to many concerns in a public debate on changes in postal sector. The key concerns relate to the foreseen mechanisms of universal service financing, the regulation of access to the public postal network, and the financing of the public postal network maintenance as well as development. The best way to overcome partially unproductive public debates on the issue is to start making factual and precise estimates of the effect of changes presented in this article by applying simplified financing mechanisms of the universal service. These mechanisms will need the input of specific data which will take into the account all relevant traits of every single EU Member State.

  11. Employee engagement within the NHS: a cross-sectional study

    Science.gov (United States)

    Jeve, Yadava Bapurao; Oppenheimer, Christina; Konje, Justin

    2015-01-01

    Background: Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. Methods: We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. Results: We found that the score for vigor and dedication is significantly lower than comparison group (Pemployees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience PMID:25674571

  12. The disposal of redundant teletherapy units from NHS hospitals

    International Nuclear Information System (INIS)

    Gaffka, A.P.; Ord, M.A.

    1994-01-01

    The removal/disposal of redundant teletherapy units from NHS hospitals is described, detailing the operational procedures and the transport package background. The Harwell section of the Transport Technology Department has been carrying out these operations since 1991, where initially the service was just offered to the NHS; however, today their specialist transport service has significantly widened and is now offered to other business sectors. Due to the level of radioactivity found in each teletherapy unit, it was necessary to design a special transport packaging to meet the requirements for shipment of these units. Approval was sought from the Department of Transport to adapt a standard Type B package as no other packaging could be found to comply with the necessary requirements. All work undertaken on the removal and disposal of these units complied with an approved scheme of work and was carried out in accordance with a Quality Assurance workplan. However, to keep abreast of modern standards in a manner which is cost effective to customers and acceptable to the general public, the full development of a new Type B packaging is taking place, which is specifically designed to undertake these removal/disposal duties. (author)

  13. The Effects of Immigration on NHS Waiting Times

    OpenAIRE

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2015-01-01

    This paper analyses the effects of immigration on waiting times in the National Health Service (NHS) in England. Linking administrative records from the Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in Accident and Emergency (A&E) and elective care. These results are explained by the fact that immigration increases...

  14. Morocco : postes chérifiennes of the Sultan of Morocco, 1892-1911 and Moroccan private and consular postal services, 1892-1901

    NARCIS (Netherlands)

    Dietz, A.J.

    2017-01-01

    An earlier version of (parts of) APH 5 was published as African Studies Centre Leiden Working Paper 125 / 2016: "A postal history of the First World War in Africa and its aftermath - German colonies/postal areas : V Morocco", written by Ton Dietz.

  15. NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

    Science.gov (United States)

    Shoshany, Nadav; Avni, Isaac; Morad, Yair; Weiner, Chen; Einan-Lifshitz, Adi; Pras, Eran

    2017-09-01

    To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

  16. Tracing experiences of NHS change in England: a process philosophy perspective.

    Science.gov (United States)

    McMurray, Robert

    2010-01-01

    For over three decades public services have been the subject of unprecedented change. Nowhere has this been more evident than in the English National Health Service (NHS) where despite the effort expended on change there is growing evidence that such restructuring is largely ineffective. Drawing on a study of culture modification in the English NHS, this paper utilizes Chia's (1999) account of the metaphysics of processual change to consider why attempts to restructure public services are not always successful. The paper contributes to our understanding of public management reform by considering how an ontology of becoming, and a loosening of control, might alter how we approach reforming. Further, the paper offers a theoretical justification for the use of standard research methods for novel processual ends. The paper concludes with a reflection on the implications of a processual perspective for the future management, organization and study of change in public administration.

  17. From NHS Choices to the integrated customer service platform.

    Science.gov (United States)

    Gann, Bob; Grant, Maria J

    2013-03-01

    In 2013 the NHS Commissioning Board launches its new integrated customer service platform. The new service utilises the full range of channels (web, telephone, apps etc) to provide access to information to support transparency, participation and transactions. Digital health services have proven benefits in informed choice, shared decision making and patient participation. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

  18. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    DEFF Research Database (Denmark)

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... pregnancies at term. RESULTS: Of Danish specialists in obstetrics and gynecology, 1.1% would prefer an elective cesarean section in an uncomplicated pregnancy at 37 weeks of gestation with fetal weight estimation of 3.0 kg. This rose to 22.5% when the fetal weight estimation was 4.5 kg at 37 weeks. The main...

  19. 78 FR 52694 - Price Cap Rules for Certain Postal Rate Adjustments

    Science.gov (United States)

    2013-08-26

    ... Service outlined the basic concept that eventually formed the basis of Sec. 3010.23(d).\\20\\ The Postal... Establishing a System of Ratemaking, January 30, 2007 (Order No. 2). \\20\\ Docket No. RM2007-1, Reply Comments.... RM2007-1, Second Advance Notice of Proposed Rulemaking on Regulations Establishing a System of Ratemaking...

  20. Communication, perception and behaviour during a natural disaster involving a 'Do Not Drink' and a subsequent 'Boil Water' notice: a postal questionnaire study.

    Science.gov (United States)

    Rundblad, Gabriella; Knapton, Olivia; Hunter, Paul R

    2010-10-25

    During times of public health emergencies, effective communication between the emergency response agencies and the affected public is important to ensure that people protect themselves from injury or disease. In order to investigate compliance with public health advice during natural disasters, we examined consumer behaviour during two water notices that were issued as a result of serious flooding. During the summer of 2007, 140,000 homes in Gloucestershire, United Kingdom, that are supplied water from Mythe treatment works, lost their drinking water for up to 17 days. Consumers were issued a 'Do Not Drink' notice when the water was restored, which was subsequently replaced with a 'Boil Water' notice. The rare occurrence of two water notices provided a unique opportunity to compare compliance with public health advice. Information source use and other factors that may affect consumer perception and behaviour were also explored. A postal questionnaire was sent to 1,000 randomly selected households. Chi-square, ANOVA, MANOVA and generalised estimating equation (with and without prior factor analysis) were used for quantitative analysis. In terms of information sources, we found high use of and clear preference for the local radio throughout the incident, but family/friends/neighbours also proved crucial at the onset. Local newspapers and the water company were associated with clarity of advice and feeling informed, respectively. Older consumers and those in paid employment were particularly unlikely to read the official information leaflets. We also found a high degree of confusion regarding which notice was in place at which time, with correct recall varying between 23.2%-26.7%, and a great number of consumers believed two notices were in place simultaneously. In terms of behaviour, overall non-compliance levels were significantly higher for the 'Do Not Drink' notice (62.9%) compared to the 'Boil Water' notice (48.3%); consumers in paid employment were not likely to

  1. Communication, perception and behaviour during a natural disaster involving a 'Do Not Drink' and a subsequent 'Boil Water' notice: a postal questionnaire study

    Directory of Open Access Journals (Sweden)

    Knapton Olivia

    2010-10-01

    Full Text Available Abstract Background During times of public health emergencies, effective communication between the emergency response agencies and the affected public is important to ensure that people protect themselves from injury or disease. In order to investigate compliance with public health advice during natural disasters, we examined consumer behaviour during two water notices that were issued as a result of serious flooding. During the summer of 2007, 140,000 homes in Gloucestershire, United Kingdom, that are supplied water from Mythe treatment works, lost their drinking water for up to 17 days. Consumers were issued a 'Do Not Drink' notice when the water was restored, which was subsequently replaced with a 'Boil Water' notice. The rare occurrence of two water notices provided a unique opportunity to compare compliance with public health advice. Information source use and other factors that may affect consumer perception and behaviour were also explored. Method A postal questionnaire was sent to 1,000 randomly selected households. Chi-square, ANOVA, MANOVA and generalised estimating equation (with and without prior factor analysis were used for quantitative analysis. Results In terms of information sources, we found high use of and clear preference for the local radio throughout the incident, but family/friends/neighbours also proved crucial at the onset. Local newspapers and the water company were associated with clarity of advice and feeling informed, respectively. Older consumers and those in paid employment were particularly unlikely to read the official information leaflets. We also found a high degree of confusion regarding which notice was in place at which time, with correct recall varying between 23.2%-26.7%, and a great number of consumers believed two notices were in place simultaneously. In terms of behaviour, overall non-compliance levels were significantly higher for the 'Do Not Drink' notice (62.9% compared to the 'Boil Water' notice (48

  2. Comparison of response rates and cost-effectiveness for a community-based survey: postal, internet and telephone modes with generic or personalised recruitment approaches

    Science.gov (United States)

    2012-01-01

    Background Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches. The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling. There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology. Methods We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use. Potential respondents were contacted only once, with no follow up of non-responders. Results The telephone survey produced the highest adjusted response rate (30.2%), followed by the personalised postal survey (10.5%), generic postal survey (7.5%) and then the internet survey (4.7% for the personalised approach and 2.2% for the generic approach). There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches. These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users. The generic postal survey had the lowest costs per valid survey received (Australian $22.93), followed by the personalised postal survey ($24.75). Conclusions Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches. Internet surveys may be effective for specialised groups where email

  3. The NHS as a learning organization: aspirations beyond the rainbow?

    Science.gov (United States)

    Timpson, J

    1998-09-01

    It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.

  4. Duncan Tanner Essay Prize Winner 2014. Against the 'Sacred Cow': NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72.

    Science.gov (United States)

    Seaton, Andrew

    2015-01-01

    This essay recovers organized opposition to the National Health Service (NHS) by considering the Fellowship for Freedom in Medicine (FFM), a conservative organization of doctors who challenged the 'Sacred Cow' of nationalized healthcare in the 1950s and 1960s. While there has been little interest in anti-NHS politics because of shortcomings in the institution's historiography, this study suggests ways a new history of the service can be written. Central to that project is taking the broader ideological and emotive quality of the NHS seriously, and appreciating the way, for all sides of the political spectrum, as well as the general public, the service has always been a contested symbol of post-war British identity. This essay argues that two NHS 'crises'--panics over costs, and disillusionment within general practice--were not merely disagreements over budgets and pay-packets but politically charged moments infused with conservative anxieties over Britain's post-war trajectory. The FFM imagined the NHS as an economically dangerous bureaucratic machine that crushed medical independence and risked pushing the country towards dictatorship. Allies within the Conservative Party, private health insurance industry, and free-market 'think-tanks' worked with the FFM to challenge defences of both the service's operation and meaning. To appreciate why the NHS remains 'the closest thing the English have to a religion', one must consider the apostates as well as the faithful.

  5. Radiographer-performed stereotactic needle core biopsy: Making a difference

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Anne-Marie [School of Health Studies, University of Bradford, Unity Building, 25 Trinity Road, Bradford BD5 0BB (United Kingdom)], E-mail: a.m.dixon@leeds.ac.uk; Dearnley, Christine [School of Health Studies, University of Bradford, Unity Building, 25 Trinity Road, Bradford BD5 0BB (United Kingdom)

    2008-12-15

    This case study describes a qualitative investigation of the experiences of 14 experienced mammography radiographers who successfully undertook a formal programme of education and training in stereotactic needle core biopsy (SNCB) of the breast. They now routinely perform SNCB within symptomatic and screening breast services in a variety of NHS hospitals across the country. All 14 radiographers completed a semi-structured postal questionnaire approximately six months after the end of the course. A tentative theory derived from the data suggests that the professional challenge associated with radiographer-performed SNCB builds personal confidence and effects positive change. Three main categories emerging from the data - challenge, confidence and change are underpinned by two main themes - educational, professional and service drivers that promote the realisation of goals and vision; and personal, peer and external motivation sustained by respect, recognition and reward. SNCB role extension as explored in this study is having a positive and transformational impact on patient users of breast diagnostic clinical services and on the professional health carers providing them. The key drivers for this as identified in the study are a formal educational experience, professional role extension opportunities and the NHS modernisation process. The participants experienced positive change as individuals and as professional breast cancer multidisciplinary team members. Academic and financial rewards, respect and recognition from colleagues across professional disciplines and from patients, were key motivators that sustained the process. This study indicates that radiographer-performed SNCB can help deliver the NHS Plan and the NHS Cancer Plan and in doing so has the potential to improve the working lives of health care professionals and ultimately to improve the quality of care for patients.

  6. Radiographer-performed stereotactic needle core biopsy: Making a difference

    International Nuclear Information System (INIS)

    Dixon, Anne-Marie; Dearnley, Christine

    2008-01-01

    This case study describes a qualitative investigation of the experiences of 14 experienced mammography radiographers who successfully undertook a formal programme of education and training in stereotactic needle core biopsy (SNCB) of the breast. They now routinely perform SNCB within symptomatic and screening breast services in a variety of NHS hospitals across the country. All 14 radiographers completed a semi-structured postal questionnaire approximately six months after the end of the course. A tentative theory derived from the data suggests that the professional challenge associated with radiographer-performed SNCB builds personal confidence and effects positive change. Three main categories emerging from the data - challenge, confidence and change are underpinned by two main themes - educational, professional and service drivers that promote the realisation of goals and vision; and personal, peer and external motivation sustained by respect, recognition and reward. SNCB role extension as explored in this study is having a positive and transformational impact on patient users of breast diagnostic clinical services and on the professional health carers providing them. The key drivers for this as identified in the study are a formal educational experience, professional role extension opportunities and the NHS modernisation process. The participants experienced positive change as individuals and as professional breast cancer multidisciplinary team members. Academic and financial rewards, respect and recognition from colleagues across professional disciplines and from patients, were key motivators that sustained the process. This study indicates that radiographer-performed SNCB can help deliver the NHS Plan and the NHS Cancer Plan and in doing so has the potential to improve the working lives of health care professionals and ultimately to improve the quality of care for patients

  7. Assessing the impact of a new health sector pay system upon NHS staff in England

    Directory of Open Access Journals (Sweden)

    Buchan James

    2008-06-01

    Full Text Available Abstract Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions, and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact

  8. Use of programme budgeting and marginal analysis to set priorities for local NHS dental services: learning from the north east of England.

    Science.gov (United States)

    Holmes, R D; Steele, J G; Exley, C; Vernazza, C R; Donaldson, C

    2018-05-03

    Priority setting is necessary where competing demands exceed the finite resources available. The aim of the study was to develop and test a prioritization framework based upon programme budgeting and marginal analysis (PBMA) as a tool to assist National Health Service (NHS) commissioners in their management of resources for local NHS dental services. Twenty-seven stakeholders (5 dentists, 8 commissioners and 14 patients) participated in a case-study based in a former NHS commissioning organization in the north of England. Stakeholders modified local decision-making criteria and applied them to a number of different scenarios. The majority of financial resources for NHS dental services in the commissioning organization studied were allocated to primary care dental practitioners' contracts in perpetuity, potentially constraining commissioners' abilities to shift resources. Compiling the programme budget was successful, but organizational flux and difficulties engaging local NHS commissioners significantly impacted upon the marginal analysis phase. NHS dental practitioners' contracts resemble budget-silos which do not facilitate local resource reallocation. 'Context-specific' factors significantly challenged the successful implementation and impact of PBMA. A local PBMA champion embedded within commissioning organizations should be considered. Participants found visual depiction of the cost-value ratio helpful during their initial priority setting deliberations.

  9. 39 CFR 3050.21 - Content of the Postal Service's section 3652 report.

    Science.gov (United States)

    2010-07-01

    ... competitive advantage for the Postal Service or any mailer. (i) For each nonpostal service, estimate its costs... unreasonable. (g) For each competitive negotiated service agreement: (1) Identify its rates and service... and by competitive product group; (2) Estimate the quality of service of each individual experimental...

  10. Supplying commercial biomedical companies from a human tissue bank in an NHS hospital--a view from personal experience.

    Science.gov (United States)

    Gray, N; Womack, C; Jack, S J

    1999-04-01

    NHS histopathology laboratories are well placed to develop banks of surgically removed surplus human tissues to meet the increasing demands of commercial biomedical companies. The ultimate aim could be national network of non-profit making NHS tissue banks conforming to national minimum ethical, legal, and quality standards which could be monitored by local research ethics committees. The Nuffield report on bioethics provides ethical and legal guidance but we believe that the patient should be fully informed and the consent given explicit. Setting up a tissue bank requires enthusiasm, hard work, and determination as well as coordination between professionals in the NHS trust and in the commercial sector. The rewards are exiting new collaborations with commercial biomedical companies which could help secure our future.

  11. Lean and Six Sigma Methodologies in NHS Scotland: An Empirical Study and Directions for Future Research

    Directory of Open Access Journals (Sweden)

    Jiju Antony

    2012-12-01

    Full Text Available In recent years, the healthcare industry is constantly concerned to provide better quality of patient care with less waste of resources through application of continuous improvement (CI initiatives such as Lean and Six Sigma. The purpose of this paper is to evaluate the status of Lean and Six Sigma methodologies in the National Health Service (NHS Scotland. Data was collected using survey instrument to determine the status of these strategies within the NHS. Although the personnel of NHS do seem to have the basic skills to successfully implement Lean Six Sigma, there appears to be a failure on the part of senior management to successfully communicate the desires and needs of these powerful CI initiatives with personnel. Moreover, a lack of encouragement and motivation, resistance to change and blame culture are quite prevalent across the sector which prevents Lean and Six Sigma strategies from being utilized in a systematic manner.

  12. Can NHS politics, power and conflict ever be a good thing for nurses?

    Science.gov (United States)

    Lees, Carolyn

    2016-07-14

    This article explores how organisational politics, power and conflict have a positive role to play for nurses in NHS organisational change and improvement, rather than always leading to disagreement and dispute.

  13. Using stakeholder perspectives to develop an ePrescribing toolkit for NHS Hospitals: a questionnaire study.

    Science.gov (United States)

    Lee, Lisa; Cresswell, Kathrin; Slee, Ann; Slight, Sarah P; Coleman, Jamie; Sheikh, Aziz

    2014-10-01

    To evaluate how an online toolkit may support ePrescribing deployments in National Health Service hospitals, by assessing the type of knowledge-based resources currently sought by key stakeholders. Questionnaire-based survey of attendees at a national ePrescribing symposium. 2013 National ePrescribing Symposium in London, UK. Eighty-four delegates were eligible for inclusion in the survey, of whom 70 completed and returned the questionnaire. Estimate of the usefulness and type of content to be included in an ePrescribing toolkit. Interest in a toolkit designed to support the implementation and use of ePrescribing systems was high (n = 64; 91.4%). As could be expected given the current dearth of such a resource, few respondents (n = 2; 2.9%) had access or used an ePrescribing toolkit at the time of the survey. Anticipated users for the toolkit included implementation (n = 62; 88.6%) and information technology (n = 61; 87.1%) teams, pharmacists (n = 61; 87.1%), doctors (n = 58; 82.9%) and nurses (n = 56; 80.0%). Summary guidance for every stage of the implementation (n = 48; 68.6%), planning and monitoring tools (n = 47; 67.1%) and case studies of hospitals' experiences (n = 45; 64.3%) were considered the most useful types of content. There is a clear need for reliable and up-to-date knowledge to support ePrescribing system deployments and longer term use. The findings highlight how a toolkit may become a useful instrument for the management of knowledge in the field, not least by allowing the exchange of ideas and shared learning.

  14. An investigation into the move towards electronic journals: a case study of NHS libraries in Kent, Surrey and Sussex.

    Science.gov (United States)

    England, Rebecca

    2013-09-01

    Electronic journals are so embedded into practice in academic libraries that it is easy to forget that this is not the case everywhere. In NHS libraries, for example, the staff face a particular set of issues. This article is based on Rebecca England's dissertation on this topic, completed as part of the MSc Econ course in Information and Library studies at Aberystwyth University. Rebecca is E-resources Librarian at the Maidstone and Tunbridge Wells NHS Trust. She investigated the momentum towards electronic journals in NHS libraries in the Kent, Surrey and Sussex region and the potential for a regional purchasing consortium. © 2013 The author. Health Information and Libraries Journal © 2013 Health Libraries Group.

  15. Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers.

    Science.gov (United States)

    Browne, John; Jamieson, Liz; Lewsey, Jim; van der Meulen, Jan; Copley, Lynn; Black, Nick

    2008-04-09

    There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs) introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres) in England during 2006-07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction) or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D) instrument) was assessed either 3-months (day surgery) or 6-months (hip/knee) after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression) for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity). Post-operative response rates varied by procedure (73%-88%) and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other procedures. Patients treated in ISTCs were less likely to

  16. Medical Tourism: A Cost or Benefit to the NHS?

    OpenAIRE

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policym...

  17. Challenges of commissioning and contracting for integrated care in the National Health Service (NHS) in England.

    Science.gov (United States)

    Addicott, Rachael

    2016-01-01

    For many years there has been a separation between purchasing and provision of services in the English National Health Service (NHS). Many studies report that this commissioning function has been weak: purchasers have had little impact or power in negotiations with large acute providers, and have had limited strategic control over the delivery of care. Nevertheless, commissioning has become increasingly embedded in the NHS structure since the arrival of Clinical Commissioning Groups (CCGs) in 2012. Recently, some of these CCGs have focused on how they can contract and commission in different ways to stimulate greater collaboration across providers. This paper examines experiences of commissioning and contracting for integrated care in the English NHS, based on a series of national-level interviews and case studies of five health economies that are implementing novel contracting models. The cases illustrated here demonstrate early experiments to drive innovation through contracting in the NHS that have largely relied on the vision of individual teams or leaders, in combination with external legal, procurement and actuarial support. It is unlikely that this approach will be sustainable or replicable across the country or internationally, despite the best intentions of commissioners. Designing and operating novel contractual approaches will require considerable determination, alongside advanced skills in procurement, contract management and commissioning. The cost of developing new contractual approaches is high, and as the process is difficult and resource-intensive, it is likely that dedicated teams or programs will be required to drive significant improvement.

  18. Implementation of Itella mail Logistics System in Ghana Postal Services

    OpenAIRE

    Tetteh, Richard

    2012-01-01

    Information technology is one of the major drivers of innovation, economic growth and social change. The emergence of Information and Communication Technology (ICT) has led to a paradigm shift in the Postal Services industry, where innovation has become a competitive tool in the logistics chain process. Unlike the traditional way of receiving, sorting and delivering letters by human, the modern real-time based practical approach brings the public faster and more reliable services. To resp...

  19. Measuring the experiences of health care for patients with musculoskeletal disorders (MSD): development of the Picker MSD questionnaire.

    Science.gov (United States)

    Jenkinson, Crispin; Coulter, Angela; Gyll, Robert; Lindström, Pål; Avner, Linda; Höglund, Elisabeth

    2002-09-01

    Analysis of data from a survey of patients with musculoskeletal problems (mainly back and neck pain) to develop a core measure of patients' experiences of health care. A secondary purpose was to determine whether a single summary index figure could be generated from the instrument. The data reported here comes from a postal survey of patients attending a spine clinic in Stockholm, Sweden. After attending the clinic patients were mailed a questionnaire. Up to two reminders were sent to nonresponders. Questionnaires were sent to 342 patients. Totally 173 (51%) questionnaires were returned, of which 38.1% respondents were male and 61.2% female. The mean age of patients was 54 years (SD 13.84), ranging from 16 to 88. Sixteen items on the questionnaire were found to constitute a reliable index of patient experience and which seem to be tapping the most important aspects of patient experience. The index score was found to have high construct validity. The instrument provides a core set of issues that should be covered when assessing the quality of care patients attending clinics for musculoskeletal disorders.

  20. Carbon reduction in the NHS : a role for finance

    OpenAIRE

    Brown, Steve

    2009-01-01

    HFMA briefing sponsored by ACCA NHS bodies’ performance on carbon reduction is increasingly having an impact on annual audit assessments, and a new energy efficiency scheme, involving the purchase and trading of carbon emissions allowances, will provide real financial consequences for under or over consumption of carbon. But perhaps the biggest driver for the finance community is the fact that carbon reduction should in fact help them meet their key challenge – the need for efficienc...

  1. Career Education Program: Geneva Area City Schools. [Grade 2 Units: Postal Services, Our Homes, Clothing, Community Helpers, and Custodians In Our Lives].

    Science.gov (United States)

    Geneva Area City Schools, OH.

    Five curriculum units for the second grade level focus on: (1) clothing producers and suppliers, and the clothing industry; (2) postal service workers and the postal system; (3) janitorial workers; (4) workers who build, furnish, and maintain homes and the housing industry; and (5) various community workers. Behavioral unit objectives emphasize…

  2. The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

    Science.gov (United States)

    Almeida, Álvaro S

    2017-06-01

    The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Combination Therapy with NHS-muIL12 and Avelumab (anti-PD-L1) Enhances Antitumor Efficacy in Preclinical Cancer Models.

    Science.gov (United States)

    Xu, Chunxiao; Zhang, Yanping; Rolfe, P Alexander; Hernández, Vivian M; Guzman, Wilson; Kradjian, Giorgio; Marelli, Bo; Qin, Guozhong; Qi, Jin; Wang, Hong; Yu, Huakui; Tighe, Robert; Lo, Kin-Ming; English, Jessie M; Radvanyi, Laszlo; Lan, Yan

    2017-10-01

    Purpose: To determine whether combination therapy with NHS-muIL12 and the anti-programmed death ligand 1 (PD-L1) antibody avelumab can enhance antitumor efficacy in preclinical models relative to monotherapies. Experimental Design: BALB/c mice bearing orthotopic EMT-6 mammary tumors and μMt - mice bearing subcutaneous MC38 tumors were treated with NHS-muIL12, avelumab, or combination therapy; tumor growth and survival were assessed. Tumor recurrence following remission and rechallenge was evaluated in EMT-6 tumor-bearing mice. Immune cell populations within spleen and tumors were evaluated by FACS and IHC. Immune gene expression in tumor tissue was profiled by NanoString® assay and plasma cytokine levels were determined by multiplex cytokine assay. The frequency of tumor antigen-reactive IFNγ-producing CD8 + T cells was evaluated by ELISpot assay. Results: NHS-muIL12 and avelumab combination therapy enhanced antitumor efficacy relative to either monotherapy in both tumor models. Most EMT-6 tumor-bearing mice treated with combination therapy had complete tumor regression. Combination therapy also induced the generation of tumor-specific immune memory, as demonstrated by protection against tumor rechallenge and induction of effector and memory T cells. Combination therapy enhanced cytotoxic NK and CD8 + T-cell proliferation and T-bet expression, whereas NHS-muIL12 monotherapy induced CD8 + T-cell infiltration into the tumor. Combination therapy also enhanced plasma cytokine levels and stimulated expression of a greater number of innate and adaptive immune genes compared with either monotherapy. Conclusions: These data indicate that combination therapy with NHS-muIL12 and avelumab increased antitumor efficacy in preclinical models, and suggest that combining NHS-IL12 and avelumab may be a promising approach to treating patients with solid tumors. Clin Cancer Res; 23(19); 5869-80. ©2017 AACR . ©2017 American Association for Cancer Research.

  4. NHS trust chief executives as heroes?

    Science.gov (United States)

    Learmonth, M

    2001-01-01

    This paper presents a reading of the transcripts of interviews with NHS Trust Chief Executives. Using a poststructuralist understanding of the interviews, it privileges a reading that (ironically) represents these Chief Executives as heroes. Following the classic hero story line, they leave the civilized order of home and journey into a threatening wilderness where they encounter dangerous and magical things but overcome them all because of their masculine characteristics such as rationality, strength and resourcefulness. One way in which these stories can be understood to have significance is that they (misleadingly but powerfully) portray management as obvious and necessary by evocatively drawing on a myth of ancient origin. The piece concludes with some reflections on the ontological implications of the analysis and reflexive comments on the production of truth as a problem.

  5. A comparison of the efficacy of three intervention trial types: postal, group, and one-to-one facilitation, prior management and the impact of message framing and repeat messages on the flock prevalence of lameness in sheep.

    Science.gov (United States)

    Grant, Claire; Kaler, Jasmeet; Ferguson, Eamonn; O'Kane, Holly; Green, Laura Elizabeth

    2018-01-01

    The aim of this study was to evaluate the effectiveness of three knowledge-transfer intervention trial types (postal, group, one-to-one) to promote best practice to treat sheep with footrot. Further aims were to investigate whether farmer behaviour (i.e. management of lameness) before the trial was associated with uptake of best practice and whether the benefits of best practice framed positively or negatively influenced change in behaviour. The intervention was a message developed from evidence and expert opinion. It was entitled "Six steps to sound sheep" and promoted (1) catch sheep within three days of becoming lame, (2) inspect feet without foot trimming, (3) correctly diagnose the cause, (4) treat sheep lame with footrot or interdigital dermatitis with antibiotic injection and spray without foot trimming, (5) record the identity of treated sheep, (6) cull repeatedly lame sheep. In 2013, 4000 randomly-selected English sheep farmers were sent a questionnaire, those who responded were recruited to the postal (1081 farmers) or one-to-one intervention (32 farmers) trials. A random sample of 400 farmers were invited to join the group trial; 78 farmers participated. A follow-up questionnaire was sent to all participants in summer 2014. There were 72%, 65% and 91% useable responses for the postal, group and one-to-one trials respectively. In both 2013 and 2014, the prevalence of lameness was lower in flocks managed by LC1 farmers than LC2 and LC3 farmers. Between 2013 and 2014, the reduction in geometric mean (95% CI) period prevalence of lameness, proportional between flock reduction in lameness and within flock reduction in lameness was greatest in the one-to-one (7.6% (7.1-8.2%) to 4.3% (3.6-5.0%), 35%, 72%) followed by the group (4.5% (3.9-5.0%) to 3.1% (2.4-3.7%), 27%, 55%) and then the postal trial (from 3.5% (3.3-3.7%) to 3.2% (3.1-3.4%), 21%, 43%). There was a marginally greater reduction in lameness in farmers using most of Six steps but slow to treat lame

  6. Occupational burnout and work engagement: a national survey of dentists in the United Kingdom.

    Science.gov (United States)

    Denton, D A; Newton, J T; Bower, E J

    2008-10-11

    To determine the levels of burnout and work engagement among dentists in the United Kingdom.Study design Postal survey of 500 dentists selected at random from the General Dental Council register. Respondents completed a questionnaire pack comprising the Utrecht Work Engagement Scale (UWES-17) and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), together with questions on demographic characteristics. Approximately 8% of respondents had scores suggestive of burnout on all three scales of the MBI-HSS and a further 18.5% had high scores in two of the domains. Eighty-three percent of respondents had work engagement scores suggestive of moderate or high work engagement. Dentists with postgraduate qualifications and those who work in larger teams had lower burnout scores and more positive work engagement scores. Dentists who spend a greater proportion of their time in NHS practice showed lower work engagement and higher levels of burnout. Burnout affects a small but significant proportion of dental practitioners in the United Kingdom. A larger proportion of practitioners show low work engagement, suggesting a negative attitude to their work. Higher burnout scores and lower work engagement scores were found in dentists without postgraduate qualifications, those in small teams and in those who spend a greater proportion of their time in NHS practice.

  7. Assessing organisational culture for quality and safety improvement: a national survey of tools and tool use.

    Science.gov (United States)

    Mannion, R; Konteh, F H; Davies, H T O

    2009-04-01

    There is growing international interest in managing organisational culture as a lever for healthcare improvement. This has prompted a practical need to understand what instruments and tools exist for assessing cultures in healthcare contexts. The present study was undertaken to determine the culture assessment tools being used in the English NHS and assess their fitness for purpose. Postal questionnaire survey of clinical governance leads in 275 English NHS organisations, with a response rate of 77%. A third of the organisations were currently using a culture assessment instrument to support their clinical governance activity. Although we found a high degree of satisfaction with existing instruments, in terms of ease of use and relevance, there is an immediate practical need to develop new and better bespoke culture assessment tools to bridge the gap between the cultural domains covered by extant instruments and the broader range of concerns of clinical governance managers. There is growing interest in understanding and shaping local cultures in healthcare, which is not yet matched by widespread use of available instruments. Even though extant tools cover many of the most important cultural attributes identified by clinical governance managers, the over-riding focus of tools in use is on safety rather than a holistic assessment of the dimensions of healthcare quality and performance.

  8. Adding Postal Follow-Up to a Web-Based Survey of Primary Care and Gastroenterology Clinic Physician Chiefs Improved Response Rates but not Response Quality or Representativeness.

    Science.gov (United States)

    Partin, Melissa R; Powell, Adam A; Burgess, Diana J; Haggstrom, David A; Gravely, Amy A; Halek, Krysten; Bangerter, Ann; Shaukat, Aasma; Nelson, David B

    2015-09-01

    This study assessed whether postal follow-up to a web-based physician survey improves response rates, response quality, and representativeness. We recruited primary care and gastroenterology chiefs at 125 Veterans Affairs medical facilities to complete a 10-min web-based survey on colorectal cancer screening and diagnostic practices in 2010. We compared response rates, response errors, and representativeness in the primary care and gastroenterology samples before and after adding postal follow-up. Adding postal follow-up increased response rates by 20-25 percentage points; markedly greater increases than predicted from a third e-mail reminder. In the gastroenterology sample, the mean number of response errors made by web responders (0.25) was significantly smaller than the mean number made by postal responders (2.18), and web responders provided significantly longer responses to open-ended questions. There were no significant differences in these outcomes in the primary care sample. Adequate representativeness was achieved before postal follow-up in both samples, as indicated by the lack of significant differences between web responders and the recruitment population on facility characteristics. We conclude adding postal follow-up to this web-based physician leader survey improved response rates but not response quality or representativeness. © The Author(s) 2013.

  9. 37 CFR 201.8 - Disruption of postal or other transportation or communication services.

    Science.gov (United States)

    2010-07-01

    ... transportation or communication services. 201.8 Section 201.8 Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF CONGRESS COPYRIGHT OFFICE AND PROCEDURES GENERAL PROVISIONS § 201.8 Disruption of postal or other transportation or communication services. (a) For purposes of 17 U.S.C. 709, when the...

  10. Determination of risk identification process employed by NHS for a PFI hospital project in the UK

    Directory of Open Access Journals (Sweden)

    F. E. Mohamed Ghazali

    2009-12-01

    Full Text Available Long-term concession contracts associated with Private Finance Initiative (PFI projects, such as National Health Service (NHS hospitals, are subject to substantial risks, which may not only emerge from project activities such as design and construction, but also from global issues beyond the control of project parties, such as commercial, legal and political risks. Therefore, the principal parties involved must manage risks effectively and efficiently, as early as the project initiation stage, in order to ensure a successful delivery. The aim of this paper is to examine the risk identification process of the NHS PFI hospital in the UK, as a case study, in order to determine the techniques used in risk identification, and their significance, based on estimated probabilities of occurrence. These objectives were achieved through interviews with key personnel within the NHS Trust involved. Results found the sole technique used in risk identification to be brainstorming, through which more than thirty risks were identified and classified under six risk categories: planning, pre-commissioning, design, land purchasing, construction and operation. Thirteen risks were identified as significant based on their estimated probability of occurrence had the project been developed via public procurement. The results of this research will enable public sector clients like the NHS Trust to not only identify the significant risks, which will allow them to focus more attention on developing appropriate mitigation strategies and contingency plans, but also to improve its risk identification process through the use of other techniques in order to support findings from the brainstorming process.

  11. Healthcare reform. Is the NHS ready for US business guru's strategy?

    Science.gov (United States)

    Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

    2006-12-07

    The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

  12. Organisational innovation in health services: lessons from the NHS treatment centres

    National Research Council Canada - National Science Library

    Gabbay, J

    2011-01-01

    ... design and methods References Index 103 133 147 149 155 165 v List of abbreviationsOrganisational innovation in health services List of abbreviations A&E ACAD DH DTC GP G-Supp NHS NIHR PCT PFI SDO SHA TC accident and emergency (department) Ambulatory Care and Diagnostic Centre Department of Health ('the Department') diagnosis and treatment centr...

  13. Case-mix & patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers

    Directory of Open Access Journals (Sweden)

    van der Meulen Jan

    2008-04-01

    Full Text Available Abstract Background There has been considerable concern expressed about the outcomes achieved in Independent Sector Treatment Centres (ISTCs introduced in England since 2003. Our aim was to compare the case-mix and patients' reported outcomes of surgery in ISTCs and in NHS providers. Methods Prospective cohort study of 769 patients treated in six ISTCs and 1895 treated in 20 NHS providers (acute hospitals and treatment centres in England during 2006–07. Participants underwent one of three day surgery procedures (inguinal hernia repair, varicose vein surgery, cataract extraction or hip or knee replacement. Change in patient-reported health status and health related quality of life (measured using a disease-specific and a generic (EQ-5D instrument was assessed either 3-months (day surgery or 6-months (hip/knee after surgery. In addition patient-reported post-operative complications and an overall assessment of success of surgery were collected. Outcome measures were adjusted (using multivariable regression for patient characteristics (disease severity, duration of symptoms, age, sex, socioeconomic status, general health, previous similar surgery, comorbidity. Results Post-operative response rates varied by procedure (73%–88% and were similar for those treated in ISTCs and NHS facilities. Patients treated in ISTCs were healthier, were less likely to have any comorbidity and, for those undergoing cataract surgery or joint replacement, their primary condition was less severe. Those undergoing hernia repair or joint replacement were less likely to have had similar surgery before. When adjustment was made for pre-operative characteristics, patients undergoing cataract surgery or hip replacement in ISTCs achieved a slightly greater improvement in functional status and quality of life than those treated in NHS facilities, while the opposite was true of patients undergoing hernia repair. No significant differences were found for the two other

  14. A novel small deletion in the NHS gene associated with Nance-Horan syndrome.

    Science.gov (United States)

    Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

    2018-02-05

    Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), and 2 female carriers were heterozygous for the same variant. All 3 affected males presented with typical Nance-Horan syndrome features. One female carrier displayed lens opacities centered on the posterior Y-suture in both eyes, as well as mild dental abnormalities. We recorded the clinical features of a Chinese Nance-Horan syndrome family and broadened the spectrum of mutations in the NHS gene.

  15. The effectiveness of computer reminders versus postal reminders for improving quality assessment for point-of-care testing in primary care

    DEFF Research Database (Denmark)

    Siersma, Volkert; Kousgaard, Marius Brostrøm; Reventlow, Susanne

    2015-01-01

    Rationale, aims and objectives: This study aimed to evaluate the relative effectiveness of electronic and postal reminders for increasing adherence to the quality assurance programme for the international normalized ratio (INR) point-of-care testing (POCT) device inprimary care. Methods: All 213...... family practices that use the Elective Laboratory of the Capital Region, Denmark, and regularly conduct INR POCT were randomly allocated into two similarly sized groups. During the 4-month intervention, these practices were sent either computer reminders (ComRem) or computer generated postal reminders...... (Postal) if they did not perform a split test to check the quality of their INR POCT for each calendar month. The adherence of the practices was tracked during the subsequent 8 months subdivided into two 4-month periods both without intervention. Outcomes were measures of split test procedure adherence...

  16. The challenges in monitoring and preventing patient safety incidents for people with intellectual disabilities in NHS acute hospitals: evidence from a mixed-methods study.

    Science.gov (United States)

    Tuffrey-Wijne, Irene; Goulding, Lucy; Gordon, Vanessa; Abraham, Elisabeth; Giatras, Nikoletta; Edwards, Christine; Gillard, Steve; Hollins, Sheila

    2014-09-24

    There has been evidence in recent years that people with intellectual disabilities in acute hospitals are at risk of preventable deterioration due to failures of the healthcare services to implement the reasonable adjustments they need. The aim of this paper is to explore the challenges in monitoring and preventing patient safety incidents involving people with intellectual disabilities, to describe patient safety issues faced by patients with intellectual disabilities in NHS acute hospitals, and investigate underlying contributory factors. This was a 21-month mixed-method study involving interviews, questionnaires, observation and monitoring of incident reports to assess the implementation of recommendations designed to improve care provided for patients with intellectual disabilities and explore the factors that compromise or promote patient safety. Six acute NHS Trusts in England took part. Data collection included: questionnaires to clinical hospital staff (n = 990); questionnaires to carers (n = 88); interviews with: hospital staff including senior managers, nurses and doctors (n = 68) and carers (n = 37); observation of in-patients with intellectual disabilities (n = 8); monitoring of incident reports (n = 272) and complaints involving people with intellectual disabilities. Staff did not always readily identify patient safety issues or report them. Incident reports focused mostly around events causing immediate or potential physical harm, such as falls. Hospitals lacked effective systems for identifying patients with intellectual disabilities within their service, making monitoring safety incidents for this group difficult.The safety issues described by the participants were mostly related to delays and omissions of care, in particular: inadequate provision of basic nursing care, misdiagnosis, delayed investigations and treatment, and non-treatment decisions and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. The events leading to avoidable harm

  17. Interventions for information systems introduction in the NHS.

    Science.gov (United States)

    Maguire, Stuart; Ojiako, Udechukwu

    2007-12-01

    This article provides a historical review of five long-term interventions which were undertaken within the NHS. The objective of the exercise was to examine how information systems (IS) were introduced into operational environments. The length of the interventions ranged from 9 months to almost 3 years. The five sites were all at different stages of system development and the research was carried out using a combination of participant observation and action research. The research question asks, 'How can organizations think about and hence go about their information provision in such a way that successful IS are introduced?'

  18. Immobilization of heparin to EDC/NHS-crosslinked collagen. Characterization and in vitro evaluation

    NARCIS (Netherlands)

    Wissink, M.J.B.; Beernink, R.; Pieper, J.S.; Poot, Andreas A.; Engbers, G.H.M.; Beugeling, T.; Beugeling, T.; van Aken, W.G.; Feijen, Jan

    2001-01-01

    In the present study, heparin immobilization to a non-cytotoxic crosslinked collagen substrate for endothelial cell seeding was investigated. Crosslinking of collagen using N-(3-dimethylaminopropyl)-N′-ethylcarbodiimide (EDC) and N-hydroxysuccinimide (NHS) resulted in a material containing 14 free

  19. Refinement of the X-linked cataract locus (CXN) and gene analysis for CXN and Nance-Horan syndrome (NHS).

    Science.gov (United States)

    Brooks, Simon; Ebenezer, Neil; Poopalasundaram, Subathra; Maher, Eamonn; Francis, Peter; Moore, Anthony; Hardcastle, Alison

    2004-06-01

    The X-linked congenital cataract (CXN) locus has been mapped to a 3-cM (approximately 3.5 Mb) interval on chromosome Xp22.13, which is syntenic to the mouse cataract disease locus Xcat and encompasses the recently refined Nance-Horan syndrome (NHS) locus. A positional cloning strategy has been adopted to identify the causative gene. In an attempt to refine the CXN locus, seven microsatellites were analysed within 21 individuals of a CXN family. Haplotypes were reconstructed confirming disease segregation with markers on Xp22.13. In addition, a proximal cross-over was observed between markers S3 and S4, thereby refining the CXN disease interval by approximately 400 Kb to 3.2 Mb, flanked by markers DXS9902 and S4. Two known genes (RAI2 and RBBP7) and a novel gene (TL1) were screened for mutations within an affected male from the CXN family and an NHS family by direct sequencing of coding exons and intron- exon splice sites. No mutations or polymorphisms were identified, therefore excluding them as disease-causative in CXN and NHS. In conclusion, the CXN locus has been successfully refined and excludes PPEF1 as a candidate gene. A further three candidates were excluded based on sequence analysis. Future positional cloning efforts will focus on the region of overlap between CXN, Xcat, and NHS.

  20. An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable?

    Science.gov (United States)

    Duane, B; Lee, M Berners; White, S; Stancliffe, R; Steinbach, I

    2017-10-27

    Introduction National Health Service (NHS) England dental teams need to consider from a professional perspective how they can, along with their NHS colleagues, play their part in reducing their carbon emissions and improve the sustainability of the care they deliver. In order to help understand carbon emissions from dental services, Public Health England (PHE) commissioned a calculation and analysis of the carbon footprint of key dental procedures.Methods Secondary data analysis from Business Services Authority (BSA), Health and Social Care Information Centre (HSCIC) (now called NHS Digital, Information Services Division [ISD]), National Association of Specialist Dental Accountants (NASDA) and recent Scottish papers was undertaken using a process-based and environmental input-output analysis using industry established conversion factors.Results The carbon footprint of the NHS dental service is 675 kilotonnes carbon dioxide equivalents (CO2e). Examinations contributed the highest proportion to this footprint (27.1%) followed by scale and polish (13.4%) and amalgam/composite restorations (19.3%). From an emissions perspective, nearly 2/3 (64.5%) of emissions related to travel (staff and patient travel), 19% procurement (the products and services dental clinics buy) and 15.3% related to energy use.Discussion The results are estimates of carbon emissions based on a number of broad assumptions. More research, education and awareness is needed to help dentistry develop low carbon patient pathways.

  1. Dosimetric study for characterization of a postal system of quality control in brachytherapy; Estudo dosimetrico para caracterizacao de um sistema postal de controle de qualidade em braquiterapia

    Energy Technology Data Exchange (ETDEWEB)

    Alves, Victor Gabriel Leandro, E-mail: vgalves@inca.gov.b [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil); Queiroz Filho, Pedro Pacheco de; Santos, Denison de Souza, E-mail: queiroz@ird.gov.b, E-mail: santosd@ird.gov.b [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Begalli, Marcia, E-mail: begalli@uerj.b [Universidade do Estado do Rio de Janeiro (IF/UERJ), RJ (Brazil). Inst. de Fisica

    2009-07-01

    This work presents a dosimetric study of a postal system, to be developed for measurements of brachytherapy. It was projected a PMMA phantom with orifices for insertion of the high dose {sup 192}Ir source and the T L dosemeters. The system was characterized with using of Monte Carlo simulations, using the dosimetric magnitudes defined at the T G-43 of AAPM, as function of radial dose g(f)

  2. Electronic prompts significantly increase response rates to postal questionnaires: a randomized trial within a randomized trial and meta-analysis.

    Science.gov (United States)

    Clark, Laura; Ronaldson, Sarah; Dyson, Lisa; Hewitt, Catherine; Torgerson, David; Adamson, Joy

    2015-12-01

    To assess the effectiveness of sending electronic prompts to randomized controlled trial participants to return study questionnaires. A "trial within a trial" embedded within a study determining the effectiveness of chronic obstructive pulmonary disease (DOC) screening on smoking cessation. Those participants taking part in DOC who provided a mobile phone number and/or an electronic mail address were randomized to either receive an electronic prompt or no electronic prompt to return a study questionnaire. The results were combined with two previous studies in a meta-analysis. A total of 437 participants were randomized: 226 to the electronic prompt group and 211 to the control group. A total of 285 (65.2%) participants returned the follow-up questionnaire: 157 (69.5%) in the electronic prompt group and 128 (60.7%) in the control group [difference 8.8%; 95% confidence interval (CI): -0.11%, 17.7%; P = 0.05]. The mean time to response was 23 days in the electronic prompt group and 33 days in the control group (hazard ratio = 1.27; 95% CI: 1.105, 1.47). The meta-analysis of all three studies showed an increase in response rate of 7.1% (95% CI: 0.8%, 13.3%). The use of electronic prompts increased response rates and reduces the time to response. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Success factors for implementation of the balanced scorecard in a NHS multi-agency setting.

    Science.gov (United States)

    Radnor, Zoe; Lovell, Bill

    2003-01-01

    Even though the balanced scorecard (BSC) has become a highly popular performance management tool, usage in local public sector National Health Service (NHS) organisations is still rare. This paper conditionally outlines some grounds in supporting such usage. In particular underlying conceptual concerns with the BSC system and its implementation pitfalls require full consideration. This paper then outlines some factors to be taken into account for "successful" BSC implementation in a NHS multi-agency setting. These findings emerged from a series of focus groups that took place with contributors drawn from all the key organisations within the Bradford Health Action Zone. Finally, this paper argues that if key criteria are met, successful implementation of the BSC may then proceed. However, "blind" BSC implementation without consideration of these factors may result in potential "failure".

  4. Serving the Customer – Do Patient Feedback and Questionnaires Improve Quality?

    Science.gov (United States)

    Keshtgar, Asma; D’Cruz, Len

    2017-01-01

    This review article aims to analyse whether patient feedback and questionnaires improve quality of care. It is recognized that patients cannot assess the medical competence of the clinician, yet patient experience provides an insight into the process of care through the patients’ eyes. Patient experience measures are more reliable for use to assess quality than patient satisfaction surveys. It is inappropriate to use patient satisfaction surveys as a basis for remuneration of dentists within the NHS. Patient Reported Outcome Measures (PROMs) have been a successful measure of patient experience in medicine and their introduction to dentistry needs to be considered. Clinical relevance: This article will enable clinicians to understand the importance of patient experience measures as a more reliable way of improving the quality of clinical care than patient satisfaction surveys.

  5. La memoria de Vejer en sus primeras tarjetas postales

    OpenAIRE

    Gámiz-Gordo, Antonio

    2013-01-01

    Se acaba de imprimir este libro sobre imágenes del pasado del gaditano pueblo de Vejer de la Frontera, donde el profesor Gámiz reúne un novedoso plano de la ciudad de 1907 y 40 tarjetas postales fechadas entre 1904 y 1930 (muchas de ellas con puntos de toma localizables en el plano citado, al ser callejero de la época), además de comentarios y reflexiones que el autor realiza sobre las imágenes gráficas, contexto e historia. Así, se abordan temas como memoria e imagen, sus relaciones e int...

  6. Quality of travel health advice in higher-education establishments in the United Kingdom and its relationship to the demographic background of the provider.

    Science.gov (United States)

    Porter, J F Hugh; Knill-Jones, Robin P

    2004-01-01

    The number of international trips undertaken by residents of the United Kingdom has risen dramatically over the past 50 years. Likewise, the numbers studying in higher education have also shown a huge increase. This study aimed to assess the appropriateness of advice given to traveling students by higher education-based health services and to relate this to the demography and experience of the professionals involved. A postal questionnaire describing three hypothetical groups of students traveling to different parts of the world was sent to 335 doctors and nurses. These clinicians belonged to the British Association of Health Services in Higher Education. They worked in 105 practices that serve higher-educational establishments in the United Kingdom. Main outcome measures included whether appropriate immunizations were advised and given correctly through the National Health Service (NHS) or privately, and whether appropriate advice was given regarding malaria, human immunodeficiency virus (HIV), and miscellaneous risks. The sources of information used to advise travelers were also asked, and the effect of demographic characteristics of the respondents on the quality of advice was investigated. Two hundred fifteen (64%) questionnaires were returned. The mean score for whether the correct immunizations were advised was 77%, and for whether these were given correctly through the NHS or privately was 79.6%. For malaria, HIV, and miscellaneous risks, the scores were lower at 65%, 38%, and 32%, respectively. The score for correct immunizations was significantly affected by sex, with females respondents scoring higher (p = .036). Previous training in travel medicine improved scores for immunizations (p = .034) and for the correct choice being given through the NHS or privately (p = .006). Age, hours worked, role, and size of practice had no influence on scores. Charts in the general practice free newspapers were the most popular source of information. Practices serving

  7. NHS England Patient Online - Patient Access to their Medical Record in General Practice

    Directory of Open Access Journals (Sweden)

    Jana Dale

    2015-10-01

    Patient Online can be promoted quickly and successfully when the clear evidence demonstrates it reduces workload. Its implementation will then result in the improved patient care and changes in behaviour necessary for the NHS National Information Board “Personalised Health and Care 2020” Implementation.

  8. Investigating the governance of autonomous public hospitals in England: multi-site case study of NHS foundation trusts.

    Science.gov (United States)

    Allen, Pauline; Keen, Justin; Wright, John; Dempster, Paul; Townsend, Jean; Hutchings, Andrew; Street, Andrew; Verzulli, Rossella

    2012-04-01

    To investigate the external and internal governance of NHS foundation trusts (FTs), which have increased autonomy, and local members and governors unlike other NHS trusts. In depth, three-year case studies of four FTs; and analysis of national quantitative data on all FT hospitals and NHS Trust hospitals to give national context. Data included 111 interviews with managers, clinicians, governors and members, and local purchasers; observation of meetings; and analysis of FTs' documents. The four case study FTs were similar to other FTs. They had used their increased autonomy to develop more business-like practices. The FT regulator, Monitor, intervened only when there were reported problems in FT performance. National targets applying to the NHS also had a large effect on FT behaviour. FTs saw themselves as part of the local health economy and tried to maintain good relationships with local organisations. Relationships between governors and the FTs' executives were still developing, and not all governors felt able to hold their FT to account. The skills and experience of staff members and governors were under-used in the new governance structures. It is easier to increase autonomy for public hospitals than to increase local accountability. Hospital managers are likely to be interested in making decisions with less central government control, whilst mechanisms for local accountability are notoriously difficult to design and operate. Further consideration of internal governance of FTs is needed. In a deteriorating financial climate, FTs should be better placed to make savings, due to their more business-like practices.

  9. Efficiency in pathology laboratories: a survey of operations management in NHS bacteriology.

    Science.gov (United States)

    Szczepura, A K

    1991-01-01

    In recent years pathology laboratory services in the U.K. have experienced large increases in demand. But the extent to which U.K. laboratories have introduced controls to limit unnecessary procedures within the laboratory was previously unclear. This paper presents the results of a survey of all 343 NHS bacteriology laboratories which records the extent to which such operations management controls are now in place. The survey shows large differences between laboratories. Quality controls over inputs, the use of screening tests as a culture substitute, the use of direct susceptibility testing, controls over routine antibiotic susceptibility testing, and controls over reporting of results all vary widely. The survey also records the prevalence of hospital antibiotic policies, the extent to which laboratories produce antibiograms for user clinicians, the degree of computerisation in data handling, and the degree of automation in processing specimens. Finally, the survey uncovers a large variation between NHS labs in the percentage of bacteriology samples which prove positive and lead to antibiotic susceptibility tests being carried out.

  10. Private patients in NHS hospitals: comparison of two sources of information.

    Science.gov (United States)

    Williams, B T; Pearson, J

    1999-03-01

    The use of National Health Service (NHS) hospitals to treat private patients is debatable on the grounds of equity of access. Hospital Episodes Statistics (HES) annual reports are the only routine source of information on the scale of this activity. The accuracy of the information is doubted. This enquiry tested the completeness of HES data against information obtained directly from private patient unit managers. Managers of the 71 pay bed units in NHS hospitals in England were asked to supply from local registers and accounts the numbers of in-patients and day cases admitted in 1995-1996. Their reports were matched with the numbers of first consultant episodes for private in-patients and day cases shown for those hospitals in the HES data file for that year. Of the 71 units 62 responded; 53 of these gave usable data. The 53 included, and 18 excluded from the comparison, matched on median and range of bed numbers. Managers identified 16 per cent more total admissions than did HES, 62,572 against 54,131; 13 per cent more in-patient admissions, 39,776 against 35,319; and 21 per cent more day cases, 22,796 against 18,812. More total admissions were reported by managers of 38 pay bed units than were recorded in HES, fewer by 12, and equal numbers by three. Similar sized discrepancies were noted for in-patient admissions and day cases. Reasons for the under-reporting of private patients in HES included the use of separate patient administration systems for private patients with a failure to feed data to HES, and the omission of some provider units altogether by a minority of trusts from the returns made to the Department of Health. Overall, HES underestimates the amount of private patient activity reported directly by NHS hospitals. No method of validating private patient data is currently available. An amendment to an existing statistical return would provide a check on numbers. Central guidance on the inclusion of private patient activity in data transmitted by

  11. Impact of postal invitations and user fee on influenza vaccination rates among the elderly. A randomized controlled trial in general practice

    DEFF Research Database (Denmark)

    Nexøe, J; Kragstrup, J; Rønne, T

    1997-01-01

    , compared with 49% (42-56%) in the group who received a postal reminder and paid the usual fee, and 72% (65-78%) in the group invited to be vaccinated free of charge. CONCLUSION: It is suggested that GPs send postal invitations to their elderly patients in the risk groups urgently recommending influenza...... vaccination. Attention should also be given to offering free influenza vaccination to elderly patients who have recognized indications for vaccination. Udgivelsesdato: 1997-Jun...

  12. Dentists with enhanced skills (Special Interest) in Endodontics: gatekeepers views in London.

    Science.gov (United States)

    Ghotane, Swapnil G; Al-Haboubi, Mustafa; Kendall, Nick; Robertson, Claire; Gallagher, Jennifer E

    2015-09-21

    Dentists with a special interest hold enhanced skills enabling them to treat cases of intermediate complexity. The aim of this study was to explore primary dental care practitioners' views of dentists with a special interest (DwSIs) in Endodontics in London, with reference to an educational and service initiative established by (the former) London Deanery in conjunction with the NHS. A cross-sectional postal survey of primary care dentists working across different models of care within London was conducted, with a target to achieve views of at least 5 % of London's dentists. The questionnaire instrument was informed by qualitative research and the dental literature and piloted prior to distribution; data were analysed using SPSS v19 and STATA v12.0. Six per cent of London's primary care dentists (n = 243) responded to the survey; 53 % were male. Just over one third (37 %; n = 90) were aware of the DwSI service being provided. Most practitioners reported that having access to a DwSI in Endodontics would support the care of their patients (89 %; n = 215), would carry out more endodontic treatment in the NHS primary dental care if adequately reimbursed (93 %; n = 220), and had more time (76 %; n = 180). Female respondents appeared to be less confident in doing endodontic treatment (p = 0.001). More recently qualified respondents reported greater need for training/support for performing more endodontic treatment in the NHS primary dental care (p = 0.001), were more dissatisfied with access to endodontic service in the NHS primary dental care (p = 0.007) and more interested to train as a DwSI in endodontics (p = 0.001) compared with respondents having a greater number of years of clinical experience since qualification. The findings lend support to the concept of developing dentists with enhanced skills as well as ensuring additional funding, time and support to facilitate more routine endodontics through the NHS primary care to meet

  13. Paternity leave experiences of NHS doctors.

    Science.gov (United States)

    Gordon, Hannah; Szram, Joanna

    2013-10-01

    This study assesses NHS doctors' experiences of paternity leave and evaluates whether practices have changed since the introduction of additional paternity leave (APL) in April 2011. An anonymised online survey designed to discover experiences and uptake of APL and ordinary paternity leave (OPL) was distributed to all members of the London Deanery Synapse® network. In total, 364 fathers responded. Their seniority ranged from foundation trainees to consultants. Following the formal introduction of OPL in 2003, the number of fathers taking any paternity leave increased (from 50% to 95.6%). The majority of respondents (76.7%) felt well supported by their employer. Since the introduction of APL, 3% of respondents took additional leave. Reasons for the low uptake of APL included the impracticalities of the law, poor awareness and perceived attitudes and implications for training. Problems with OPL included the inadequate provision of cover and difficulties in timing the leave appropriately.

  14. Developing leadership interventions for black and minority ethnic staff: A case study of the National Health Service (NHS) in the U.K.

    Science.gov (United States)

    Kalra, V S; Abel, P; Esmail, A

    2009-01-01

    The National Health Service (NHS) is the largest employer in the U.K. but, despite decades of equal opportunities legislation, its senior management workforce does not reflect the diversity of either the wider NHS workforce or the U.K. population. The aim of the paper is to consider the range of management interventions available to organisations like the NHS to deliver change in the area of promotion of Black and minority ethnic staff. Intervention programmes in a range of public and private organisations are reviewed and the nature of barriers to promotion and the range of interventions to overcome these are explored. The paper uses the paradigm of institutional racism to examine the ways in which the NHS discriminates against certain sections of its workforce. The methods used include a literature review combined with key stakeholder interviews. A comparative dimension which involved a review of research on leadership initiatives in the U.S.A. was also undertaken. The literature review found that there were a range of initiatives which could be implemented by public organisations such as the NHS to increase the presence of Black and Minority Ethnic (BME) staff in senior management positions. Most of these interventions were largely focused on the individual. Much more progress on institutional or organisational change needed to be made before the NHS could be perceived as a model employer in this area. The literature review also indicated that there is little published research on such initiatives within other European Union countries. The paper is targeted at both policy makers and human resource officers responsible for equality and diversity issues within large organisations, who have a remit to improve the career pathways of staff. The analysis provided offers a set of critical tools and interventions that have not hitherto been well examined in the U.K. context.

  15. Mortality in NHS Greater Glasgow and Clyde employees: 2007-2009.

    Science.gov (United States)

    Freer, K; Waclawski, E

    2013-09-01

    Just over a fifth of all deaths in Scotland occur in those under the age of 65. This study examined deaths in service in employees of the National Health Service Greater Glasgow and Clyde (NHS GG&C) Health Board over a 3-year period. To assess crude death rates by occupational group, the main causes of death and evidence of causes that could have been prevented or modified by lifestyle changes. Demographic details, occupational grouping and death certificate data were obtained for all NHS GG&C employees who died in service between 2007 and 2009. A total of 138 employees died in this period. The occupational groups in which most deaths occurred were support services (porters, domestic and catering staff; 35%) and nurses (34%). The commonest causes of death were lung cancer (15%), ischaemic heart disease (9%) and suicide (9%). The overall crude death rate was 1.2/1000 persons/year (females 1.0 and males 1.7) and was highest among support services employees (2.4) and lowest among medical staff (0.5). The relative risk of death in support services was significantly greater than the majority of occupational groups. These findings suggest health inequality within this workforce. The main causes of death identified in the support services group could potentially be modified through workplace risk factor screening and health promotion.

  16. FLUXUS E ARTE POSTAL COMO ARTE RELACIONAL: BREVE ESTUDO

    OpenAIRE

    Amizo, Isadora Banducci

    2014-01-01

    Este artigo tem como objetivo a análise das questões que envolvem a produção da Arte postal ou Mail art, e do grupo Fluxus, difundidas ao redor do mundo a partir da década de 1960. Procura-se investigar sua aproximação com o conceito de arte relacional, exposto pelo crítico e filósofo francês Nicolas Bourriaud no livro “Estética relacional”. Para isso, são revisadas algumas das temáticas que envolvem as duas expressões artísticas destacando–se a produção de alguns de seus principais expoentes...

  17. Facing the future: the effects of the impending financial drought on NHS finances and how UK radiology services can contribute to expected efficiency savings

    Science.gov (United States)

    Grant, L; Appleby, J; Griffin, N; Adam, A; Gishen, P

    2012-01-01

    The recent turmoil within the banking sector has led to the development of the most significant recession since the “great depression” of the 1930s. Although the coalition government has promised to “guarantee that health spending increases in real terms in each year of Parliament”, this may still not be enough to meet future needs over the coming years due to increasing demand and cost pressures. The expected mismatch between actual National Health Service (NHS) funding post-2011 and that required to satisfy increasing demand has been estimated by the Department of Health to require efficiency savings representing up to one-fifth of the overall NHS budget. This paper explains the reasons behind the anticipated slowdown in the growth of real NHS funding, and how, as a discipline, radiology can increase the efficiency of the services it provides in anticipation of future financial austerity within the NHS. PMID:22167516

  18. 39 CFR 447.52 - Holding of State or local office by Postal Service employees.

    Science.gov (United States)

    2010-07-01

    ... ascertaining: (1) Whether the office is “nonpartisan” within the definition in § 447.62(a). (2) Whether State... encouraged to seek advice from his Associate Ethical Conduct Counselor prior to taking any action to seek... that the employee's postal responsibilities are being conducted in a satisfactory manner and that the...

  19. Liberating the NHS; commissioning, outsourcing and a new politics debate.

    Science.gov (United States)

    Regan, Paul; Ball, Elaine

    2010-10-01

    In the short months following the result of the UK 2010 General election, a new Government White Paper has been released entitled: Equity and Excellence: Liberating the NHS (Department of Health (DH), 2010a). It strives to distance itself from previous health-care proposals (DH, 2009), yet if the initiatives of this latest paper are combined against previous initiatives, also using high impact declarative terms, such as competition and choice, it is clear that little has changed and more important principles than saving money are at risk.

  20. Recruitment barriers in a randomized controlled trial from the physicians' perspective – A postal survey

    Directory of Open Access Journals (Sweden)

    Karrer Werner

    2009-03-01

    Full Text Available Abstract Background The feasibility of randomized trials often depends on successful patient recruitment. Although numerous recruitment barriers have been identified it is unclear which of them complicate recruitment most. Also, most surveys have focused on the patients' perspective of recruitment barriers whereas the perspective of recruiting physicians has received less attention. Therefore, our aim was to conduct a postal survey among recruiting physicians of a multi-center trial to weigh barriers according to their impact on recruitment. Methods We identified any potential recruitment barriers from the literature and from our own experience with a multi-center trial of respiratory rehabilitation in patients with chronic obstructive pulmonary disease. We developed and pilot-tested a self-administered questionnaire where recruiting physicians were asked to express their agreement with statements about recruitment barriers on a Likert-type scale from 1 (full agreement with statement = very substantial recruitment barrier to 7 (no agreement with statement = no recruitment barrier. Results 38 of 55 recruiting physicians returned questionnaires (69% response rate, of which 35 could be analyzed (64% useable response rate. Recruiting physicians reported that "time constraints" (median agreement of 3, interquartile range 2–5 had the most negative impact on recruitment followed by "difficulties including identified eligible patients" (median agreement of 5, IQR 3–6. Other barriers such as "trial design barriers", "lack of access to treatment", "individual barriers of recruiting physicians" or "insufficient training of recruiting physicians" were perceived to have little or no impact on patient recruitment. Conclusion Physicians perceived time constraints as the most relevant recruitment barrier in a randomized trial. To overcome recruitment barriers interventions, that are affordable for both industry- and investigator-driven trials, need to be

  1. Feasibility study of radiophotoluminescent glass rod dosimeter postal dose intercomparison for high energy photon beam

    International Nuclear Information System (INIS)

    Rah, Jeong-Eun; Kim, Siyong; Cheong, Kwang-Ho; Lee, Jeong-Woo; Chung, Jin-Beom; Shin, Dong-Oh; Suh, Tae-Suk

    2009-01-01

    A radiophotoluminescent glass rod dosimeter (GRD) system has recently become commercially available. In this study we evaluated whether the GRD would be suitable for external dosimetric audit program in radiotherapy. For this purpose, we introduced a methodology of the absorbed dose determination with the GRD by establishing calibration coefficient and various correction factors (non-linearity dose response, fading, energy dependence and angular dependence). A feasibility test of the GRD postal dose intercomparison was also performed for eight high photon beams by considering four radiotherapy centers in Korea. In the accuracy evaluation of the GRD dosimetry established in this study, we obtained within 1.5% agreements with the ionization chamber dosimetry for the 60 Co beam. It was also observed that, in the feasibility study, all the relative deviations were smaller than 3%. Based on these results, we believe that the new GRD system has considerable potential to be used for a postal dose audit program

  2. Validating dose rate calibration of radiotherapy photon beams through IAEA/WHO postal audit dosimetry service

    International Nuclear Information System (INIS)

    Jangda, A.Q.; Hussein, S.

    2012-01-01

    In external beam radiation therapy (EBRT), the quality assurance (QA) of the radiation beam is crucial to the accurate delivery of the prescribed dose to the patient. One of the dosimetric parameters that require monitoring is the beam output, specified as the dose rate on the central axis under reference conditions. The aim of this project was to validate dose rate calibration of megavoltage photon beams using the International Atomic Energy Agency (IAEA)/World Health Organisation (WHO) postal audit dosimetry service. Three photon beams were audited: a 6 MV beam from the low-energy linac and 6 and 18 MV beams from a dual high-energy linac. The agreement between our stated doses and the IAEA results was within 1% for the two 6 MV beams and within 2% for the 18 MV beam. The IAEA/WHO postal audit dosimetry service provides an independent verification of dose rate calibration protocol by an international facility. (author)

  3. Validating dose rate calibration of radiotherapy photon beams through IAEA/WHO postal audit dosimetry service.

    Science.gov (United States)

    Jangda, Abdul Qadir; Hussein, Sherali

    2012-05-01

    In external beam radiation therapy (EBRT), the quality assurance (QA) of the radiation beam is crucial to the accurate delivery of the prescribed dose to the patient. One of the dosimetric parameters that require monitoring is the beam output, specified as the dose rate on the central axis under reference conditions. The aim of this project was to validate dose rate calibration of megavoltage photon beams using the International Atomic Energy Agency (IAEA)/World Health Organisation (WHO) postal audit dosimetry service. Three photon beams were audited: a 6 MV beam from the low-energy linac and 6 and 18 MV beams from a dual high-energy linac. The agreement between our stated doses and the IAEA results was within 1% for the two 6 MV beams and within 2% for the 18 MV beam. The IAEA/WHO postal audit dosimetry service provides an independent verification of dose rate calibration protocol by an international facility.

  4. Truncating mutation in the NHS gene: phenotypic heterogeneity of Nance-Horan syndrome in an asian Indian family.

    Science.gov (United States)

    Ramprasad, Vedam Lakshmi; Thool, Alka; Murugan, Sakthivel; Nancarrow, Derek; Vyas, Prateep; Rao, Srinivas Kamalakar; Vidhya, Authiappan; Ravishankar, Krishnamoorthy; Kumaramanickavel, Govindasamy

    2005-01-01

    A four-generation family containing eight affected males who inherited X-linked developmental lens opacity and microcornea was studied. Some members in the family had mild to moderate nonocular clinical features suggestive of Nance-Horan syndrome. The purpose of the study was to map genetically the gene in the large 57-live-member Asian-Indian pedigree. PCR-based genotyping was performed on the X-chromosome, by using fluorescent microsatellite markers (10-cM intervals). Parametric linkage analysis was performed by using two disease models, assuming either recessive or dominant X-linked transmission by the MLINK/ILINK and FASTLINK (version 4.1P) programs (http:www.hgmp.mrc.ac.uk/; provided in the public domain by the Human Genome Mapping Project Resources Centre, Cambridge, UK). The NHS gene at the linked region was screened for mutation. By fine mapping, the disease gene was localized to Xp22.13. Multipoint analysis placed the peak LOD of 4.46 at DSX987. The NHS gene mapped to this region. Mutational screening in all the affected males and carrier females (heterozygous form) revealed a truncating mutation 115C-->T in exon 1, resulting in conversion of glutamine to stop codon (Q39X), but was not observed in unaffected individuals and control subjects. conclusions. A family with X-linked Nance-Horan syndrome had severe ocular, but mild to moderate nonocular, features. The clinical phenotype of the truncating mutation (Q39X) in the NHS gene suggests allelic heterogeneity at the NHS locus or the presence of modifier genes. X-linked families with cataract should be carefully examined for both ocular and nonocular features, to exclude Nance-Horan syndrome. RT-PCR analysis did not suggest nonsense-mediated mRNA decay as the possible mechanism for clinical heterogeneity.

  5. The NHS: assessing new technologies, NICE and value for money.

    Science.gov (United States)

    Stevens, A; Chalkidou, K; Littlejohns, P

    2011-06-01

    The healthcare system in the UK, essentially the NHS, is an open economic system subject to the same pressures as any other economic system. The pressures concern limited resources coupled with powerful drivers for increasing spending: invention, demography and inflation. There have only ever been three types of economic system: steady state (everything, as in a feudal system, stays as it was the year before), market capitalism (supply and demand are allowed to find their own equilibrium) and some version of central planning. In healthcare, most advanced countries favour the last of the three. This is for three reasons: distribution (not only are the poor less able to pay for sickness, but sickness exacerbates poverty), information (markets operate poorly when providers can easily outsmart customers) and externalities (it is in the interest of everyone that infectious diseases and the other knock-on consequences of ill health are ameliorated). So in the UK, the state, with a good deal of cross-party consensus, directs most of health service supply. This system has become more complex over the decades since the formation of the NHS in 1948. A notable element of the complexity is the regulation of the introduction of new technologies. A key element of the regulatory system has been the National Institute for Health and Clinical Excellence (NICE), and a key aspect of NICE's decisions has been not just value, but also value for money. This has not been without controversy.

  6. Transforming dementia care in an NHS trust.

    Science.gov (United States)

    Robinson, Jennifer; Longden, Jane; Murphy, Jayne

    2015-02-01

    Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

  7. Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

    OpenAIRE

    Osaro, Erhabor; Chima, Njemanze

    2014-01-01

    The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern...

  8. Identification of a novel NHS mutation in a Chinese family with Nance-Horan syndrome.

    Science.gov (United States)

    Li, Aijun; Li, Bingzhen; Wu, Lemeng; Yang, Liping; Chen, Ningning; Ma, Zhizhong

    2015-04-01

    To identiy the disease causing mutation in a Chinese family presenting with early-onset cataract and dental anomalies. A specific Hereditary Eye Disease Enrichment Panel (HEDEP) (personalized customization by MyGenostics, Baltimore, MD) based on targeted exome capture technology was used to collect the protein coding regions of 30 early-onset cataract associated genes, and high throughput sequencing was done with Illumina HiSeq 2000 platform. The identified variant was confirmed with Sanger sequencing. A novel deletion in exon 4 (c.852delG) of NHS gene was identified; the identified 1 bp deletion altered the reading frame and was predicted to result in a premature stop codon after the addition of twelve novel amino acid (p.S285PfsX13). This mutation co-segregated in affected males and obligate female carriers, but was absent in 100 matched controls. Our findings broaden the spectrum of NHS mutations causing Nance-Horan syndrome and phenotypic spectrum of the disease in Chinese patients.

  9. [Connecting the Baltic area : the Swedish postal System in the seventeenth century] / Kaarel Vanamölder

    Index Scriptorium Estoniae

    Vanamölder, Kaarel, 1981-

    2011-01-01

    Arvustus: Connecting the Baltic area : the Swedish postal System in the seventeenth century. Ed. by Heiko Droste. Södertörn Studies in History, 9, Södertörn Academic Studies, 42 (Huddinge: Södertörns högskola, 2011)

  10. The Oxford Participation and Activities Questionnaire: study protocol

    Directory of Open Access Journals (Sweden)

    Morley D

    2013-12-01

    Full Text Available David Morley, Sarah Dummett, Laura Kelly, Jill Dawson, Ray Fitzpatrick, Crispin JenkinsonNuffield Department of Population Health, University of Oxford, Oxford, UKBackground: With an ageing population and increasing demands on health and social care services, there is growing importance attached to the management of long-term conditions, including maximizing the cost-effectiveness of treatments. In line with this, there is increasing emphasis on the need to keep people both active and participating in daily life. Consequently, it is essential that well developed and validated instruments that can meaningfully assess levels of participation and activity are widely available. Current measures, however, are largely focused on disability and rehabilitation, and there is no measure of activity or participation for generic use that fully meets the standards set by regulatory bodies such as the US Food and Drug Administration. Here we detail a protocol for the development and validation of a new patient-reported outcome measure (PROM for assessment of participation and activity in people experiencing a variety of health conditions, ie, the Oxford Participation and Activities Questionnaire (Ox-PAQ. The stages incorporated in its development are entirely in line with current regulations and represent best practice in the development of PROMs.Methods: Development of the Ox-PAQ is theoretically grounded in the World Health Organization International Classification of Functioning, Disability, and Health. The project incorporates a new strategy of engaging with stakeholders from the outset in an attempt to identify those characteristics of PROMs considered most important to a range of potential users. Items will be generated through interviews with patients from a range of conditions. Pretesting of the instrument will be via cognitive interviews and focus groups. A postal survey will be conducted, with data subject to factor and Rasch analysis in order to

  11. The mutuality metaphor: understanding healthcare provision in NHS Scotland.

    Science.gov (United States)

    Howieson, Brian

    2016-06-20

    Purpose - Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated. Design/methodology/approach - The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered. Findings - It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland. Research limitations/implications - The existence of paradox and ambiguity does not, however, negate the usefulness of the term "mutuality". Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated. Practical implications - There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help. Originality/value - Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.

  12. Dental radiography ten years ago and now: overview of results of postal TLD audit

    International Nuclear Information System (INIS)

    Vtelenska, M.; Novak, L.

    2014-01-01

    Since 2002, regular postal audit in dental radiography organized by NRPI Prague belongs to basic radiography QA/QC tools in the Czech Republic. The measured parameters are incident air kerma, field size, and exposure reproducibility. The overall quality of the dental radiograph is also assessed. Ten-year summary of the audit results is presented here. (authors)

  13. Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review.

    Science.gov (United States)

    Mills, Katie; Harte, Emma; Martin, Adam; MacLure, Calum; Griffin, Simon J; Mant, Jonathan; Meads, Catherine; Saunders, Catherine L; Walter, Fiona M; Usher-Smith, Juliet A

    2017-11-15

    To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice. A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data. An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers. Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice. Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues. The success of the NHS Health Check Programme relies on engagement by those responsible for its

  14. Increasing organ donation via anticipated regret (INORDAR: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    O'Carroll Ronan E

    2012-03-01

    Full Text Available Abstract Background Throughout the world there is an insufficient supply of donor organs to meet the demand for organ transplantations. This paper presents a protocol for a randomised controlled trial, testing whether a simple, theory-based anticipated regret manipulation leads to a significant increase in posthumous organ donor registrations. Methods We will use a between-groups, prospective randomised controlled design. A random sample of 14,520 members of the adult Scottish general public will be contacted via post. These participants will be randomly allocated into 1 of the 4 conditions. The no questionnaire control (NQC group will simply receive a letter and donor registration form. The questionnaire control (QC arm will receive a questionnaire measuring their emotions and non-cognitive affective attitudes towards organ donation. The theory of planned behavior (TPB group will complete the emotions and affective attitudes questionnaire plus additional items assessing their cognitive attitudes towards organ donation, perceived control over registration and how they think significant others view this action. Finally, the anticipated regret (AR group will complete the same indices as the TPB group, plus two additional anticipated regret items. These items will assess the extent to which the participant anticipates regret for not registering as an organ donor in the near future. The outcome variable will be NHS Blood and Transplant verified registrations as an organ donor within 6 months of receiving our postal intervention. Discussion This study will assess whether simply asking people to reflect on the extent to which they may anticipate regret for not registering as an organ donor increases organ donor registration 6 months later. If successful, this simple and easy to administer theory-based intervention has the potential to save lives and money for the NHS by reducing the number of people receiving treatments such as dialysis. This

  15. Creating an impersonal NHS? Personalization, choice and the erosion of intimacy.

    Science.gov (United States)

    Owens, John

    2015-02-01

    Personalization - most often understood in terms of granting patients greater opportunity to participate in, and make choices about, the services they receive - has become a key principle guiding reform of the English NHS. This study sets out to explore the relationship between two senses of the term 'personal' within the context of personalization. Firstly, much of the policy literature equates a 'personal' service with one that is responsive to the choices of individual patients. Secondly, the term 'personal' can be thought to refer to the intimate relationships between patients and medical professionals that have typified traditional models of good practice. I combine a review of the relevant academic and policy literature on personalization with a process of conceptual analysis to uncover three arguments, which suggest that personalization based on choice may adversely affect standards of care by eroding the qualities of intimacy at the heart of the care process. Thus, an unintended consequence of the drive for personalization may be the creation of an NHS that is, in an important sense, less personal than it once was. Whilst personalization may deliver many potential benefits, the tension between promoting patient choice and retaining intimate professional-patient relationships ought to be taken seriously. Thus, the task of promoting choice whilst retaining intimacy represents a key policy challenge for advocates of personalization. © 2012 John Wiley & Sons Ltd.

  16. Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

    Science.gov (United States)

    Wilkinson, G

    1986-01-01

    I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

  17. Responsibility for managing musculoskeletal disorders--a cross-sectional postal survey of attitudes.

    Science.gov (United States)

    Larsson, Maria E H; Nordholm, Lena A

    2008-08-05

    Musculoskeletal disorders are a major burden on individuals, health systems and social care systems and rehabilitation efforts in these disorders are considerable. Self-care is often considered a cost effective treatment alternative owing to limited health care resources. But what are the expectations and attitudes in this question in the general population? The purpose of this study was to describe general attitudes to responsibility for the management of musculoskeletal disorders and to explore associations between attitudes and background variables. A cross-sectional, postal questionnaire survey was carried out with a random sample of a general adult Swedish population of 1770 persons. Sixty-one percent (n = 1082) responded to the questionnaire and was included for the description of general attitudes towards responsibility for the management of musculoskeletal disorders. For the further analyses of associations to background variables 683-693 individuals could be included. Attitudes were measured by the "Attitudes regarding Responsibility for Musculoskeletal disorders" (ARM) instrument, where responsibility is attributed on four dimensions; to myself, as being out of my hands, to employers or to (medical) professionals. Multiple logistic regression was used to explore associations between attitudes to musculoskeletal disorders and the background variables age, sex, education, physical activity, presence of musculoskeletal disorders, sick leave and whether the person had visited a care provider. A majority of participants had internal views, i.e. showed an attitude of taking personal responsibility for musculoskeletal disorders, and did not place responsibility for the management out of their own hands or to employers. However, attributing shared responsibility between self and medical professionals was also found. The main associations found between attitude towards responsibility for musculoskeletal disorders and investigated background variables were that

  18. Dosimetric study for characterization of a postal system of quality control in brachytherapy

    International Nuclear Information System (INIS)

    Alves, Victor Gabriel Leandro; Queiroz Filho, Pedro Pacheco de; Santos, Denison de Souza; Begalli, Marcia

    2009-01-01

    This work presents a dosimetric study of a postal system, to be developed for measurements of brachytherapy. It was projected a PMMA phantom with orifices for insertion of the high dose 192 Ir source and the T L dosemeters. The system was characterized with using of Monte Carlo simulations, using the dosimetric magnitudes defined at the T G-43 of AAPM, as function of radial dose g(f)

  19. Doctors' views about training and future careers expressed one year after graduation by UK-trained doctors: questionnaire surveys undertaken in 2009 and 2010.

    Science.gov (United States)

    Maisonneuve, Jenny J; Lambert, Trevor W; Goldacre, Michael J

    2014-12-21

    The UK medical graduates of 2008 and 2009 were among the first to experience a fully implemented, new, UK training programme, called the Foundation Training Programme, for junior doctors. We report doctors' views of the first Foundation year, based on comments made as part of a questionnaire survey covering career choices, plans, and experiences. Postal and email based questionnaires about career intentions, destinations and views were sent in 2009 and 2010 to all UK medical graduates of 2008 and 2009. This paper is a qualitative study of 'free-text' comments made by first-year doctors when invited to comment, if they wished, on any aspect of their work, education, training, and future. The response rate to the surveys was 48% (6220/12952); and 1616 doctors volunteered comments. Of these, 61% wrote about their first year of training, 35% about the working conditions they had experienced, 33% about how well their medical school had prepared them for work, 29% about their future career, 25% about support from peers and colleagues, 22% about working in medicine, and 15% about lifestyle issues. When concerns were expressed, they were commonly about the balance between service provision, administrative work, and training and education, with the latter often suffering when it conflicted with the needs of medical service provision. They also wrote that the quality of a training post often depended on the commitment of an individual senior doctor. Service support from seniors was variable and some respondents complained of a lack of team work and team ethic. Excessive hours and the lack of time for reflection and career planning before choices about the future had to be made were also mentioned. Some doctors wrote that their views were not sought by their hospital and that NHS management structures did not lend themselves to efficiency. UK graduates from non-UK homes felt insecure about their future career prospects in the UK. There were positive comments about

  20. A case study into labour turnover within an NHS Trust.

    Science.gov (United States)

    Bamford, David; Hall, Catherine

    2007-02-01

    This paper investigates turnover in a British NHS Trust, to find out why staff left and whether factors identified in the literature with regards to improving turnover were pertinent to the organization. The research also investigated staff groups with high turnover--staff with less than 12 months service, and the unqualified nursing staff group--to ascertain whether there were any reasons for leaving or areas of dissatisfaction particular to these groups. The outcomes of the research complied with much of the published research with some interesting differences. The main reasons for leaving were identified as moving house, promotion or career development and taking up education and training opportunities elsewhere. There was no evidence of 'level of pay', commonly given as a significant influence behind turnover, as a reason for leaving. It was also found that the retention strategies identified in the published research were mainly applicable to the research, with evidence to support the improvement of line management skills, training and development, career development, appraisal, communications and induction in order to reduce turnover. There was less evidence for introducing work-life balance policies, improving communications, pay and working relationships as retention strategies. Recommendations for future management of labour turnover within the NHS Trust and elsewhere are made, with observations about the validity of some existing models. The core contribution of this research is in adding to the body of knowledge about labour turnover issues. This is of value to those working in the UK health-care and wider public sector. Specific recommendations for future research are made.

  1. Monopolization versus sustainable growth – the case of postal services market in Poland

    Directory of Open Access Journals (Sweden)

    Tomasz Bernat

    2013-11-01

    Full Text Available Economies of the European Union are evolving towards the competitive development along with sustainable development. For many years, these have been the key elements of the unions strategic goals. This indicates, actions in order to achieve them on particular markets, especially on monopolized markets. These includes the postal services market. This raises the question, whether the monopolization of the area-at least a certain segment, has an impact on the biggest player on the market when taking or not taking action regarding the sustainable growth? Three hypotheses and their verification give the answer to this question. The hipotheses are as follow: the Poczta Polska SA is operator which ratify the Universal Postal Convention, therefore, pro-environmental and pro-social goals should be part of their actions; Operators involved in environmental and social activities take official strategy CSR (Corporate Social Responsibility and officially announce it publicly, for instance, on their own websites; actions speak for themselves - the entity involved in the particular area will be actively participate in it, so that its operation will be known to the public. As a research method, have been used case study and analysis of the literature. The paper highlights both academic as well as managerial implications.

  2. A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

    Science.gov (United States)

    Feldman, Harriet Ruth; DeVito, Nicholas J; Mendel, Jonathan; Carroll, David E; Goldacre, Ben

    2018-03-05

    We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. NHS Trusts (secondary/tertiary care organisations) in England. 236 Trusts were contacted, of which 217 responded. We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and

  3. Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

    Science.gov (United States)

    Pinder, Richard J; Greaves, Felix E; Aylin, Paul P; Jarman, Brian; Bottle, Alex

    2013-07-01

    There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups. Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = -0.22, psatisfaction with the quality of care delivered by oneself and institutional HSMR. In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

  4. 75 FR 16837 - Public Review of Draft United States Thoroughfare, Landmark, and Postal Address Data Standard

    Science.gov (United States)

    2010-04-02

    ... comments shall be sent to Julie Binder Maitra, of the FGDC Secretariat via electronic mail, [email protected] electronic addresses such as e-mail addresses. It recognizes that some organizations are prohibited by..., participants will receive written notification of how their comments were addressed by electronic or postal...

  5. General Practitioners' views on the provision of nicotine replacement therapy and bupropion

    Directory of Open Access Journals (Sweden)

    West Robert

    2001-10-01

    Full Text Available Abstract Background Nicotine replacement therapies (NRT and a new drug, bupropion, are licensed in several countries as aids to smoking cessation. General practitioners (GPs play a crucial role in recommending or prescribing these medications. In the UK there has been discussion about whether the medications should be reimbursable by the National Health Service (NHS. This study assessed English GPs' attitudes towards reimbursement of NRT and bupropion. Methods Postal survey of a randomly selected national sample of GPs; 376 GPs completed the questionnaire after one reminder; effective response rate: 53%. There was no difference between the responses of GPs who responded to the initial request and those who responded only after a reminder suggesting minimal bias due to non-response. Results Attitudes of GPs were remarkably divided on most issues relating to the medications. Forty-three percent thought that bupropion should not be on NHS prescription while 42% thought that it should be (15% did not know; Fifty percent thought that NRT should not be on NHS prescription while 42% thought it should be (8% did not know. Requiring that smokers attend behavioural support programmes to be eligible to receive the medications on NHS prescription made no appreciable difference to the GPs' views. GPs were similarly divided on whether having the medications reimbursable would add unacceptably to their workload or offer a welcome opportunity to discuss smoking with their patients. A principal components analysis of responses to the individual questions on NRT and bupropion revealed that GPs' attitudes could be understood in terms of a single 'pro-con' dimension accounting for 53% of the total variance which made no distinction between the two medications. Conclusions GPs in England appear to be divided in their attitudes to medications to aid smoking cessation and appear not to discriminate in their views between different types of medication or different

  6. Postal dosimetry audit test for small photon beams

    International Nuclear Information System (INIS)

    Espinosa, María del Mar; Núñez, Luis; Muñiz, José Luis; Lagares, Juan Ignacio; Embid, Miguel; Gómez-Ros, José María

    2012-01-01

    Background and purpose: Small radiation beams ( 3 ) of TLD-100 inserted at 5 and 10 cm of depth in a cylindrical PMMA phantom designed for this purpose. This experimental system is mailed to the audited centres to be irradiated with beams of 1 and 3 cm of side or diameter. The prescribeddose is 1.5 Gy at 10 cm. The properties of this system were studied experimentally and by Monte Carlo (MC) simulation, before the external test. Results: Deviations between the prescribed and measured absorbed doses are below 5% for 69% (1 × 1 cm 2 beam) and 64% (3 × 3 cm 2 beam) of the audited centres. When deviations are above 5%, their causes have been investigated and led to corrections. Conclusion: The developed postal audit is suitable to verify the absorbed doses in small photon beams with an accuracy of 2.9% (1s).

  7. Evaluation of the uncertainties in the TLD radiosurgery postal dose system

    International Nuclear Information System (INIS)

    Campos, Luciana Tourinho; Leite, Sandro Passos; Almeida, Carlos Eduardo Veloso de; Magalhães, Luís Alexandre Gonçalves

    2017-01-01

    Radiosurgery is a single-fraction radiation therapy procedure for treating intracranial lesions using a stereotactic apparatus and multiple narrow beams delivered through noncoplanar isocentric arcs. The Radiological Science Laboratory (LCR/UERJ) operates a postal audit programme in SRT and SRS. The purpose of the programme is to verify the target localization accuracy and the dosimetric conditions of the TPS. The programme works in such a way those TLDs are sent to the centre where they are to be irradiated to a certain dose. The aim of the present work is estimate the uncertainties in the process of dose determination, using experimental data. (author)

  8. Evaluation of the uncertainties in the TLD radiosurgery postal dose system

    Energy Technology Data Exchange (ETDEWEB)

    Campos, Luciana Tourinho; Leite, Sandro Passos; Almeida, Carlos Eduardo Veloso de; Magalhães, Luís Alexandre Gonçalves, E-mail: tc_luciana@yahoo.com.br [Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ (Brazil)

    2017-07-01

    Radiosurgery is a single-fraction radiation therapy procedure for treating intracranial lesions using a stereotactic apparatus and multiple narrow beams delivered through noncoplanar isocentric arcs. The Radiological Science Laboratory (LCR/UERJ) operates a postal audit programme in SRT and SRS. The purpose of the programme is to verify the target localization accuracy and the dosimetric conditions of the TPS. The programme works in such a way those TLDs are sent to the centre where they are to be irradiated to a certain dose. The aim of the present work is estimate the uncertainties in the process of dose determination, using experimental data. (author)

  9. "Bird in the hand" cash was more effective than prize draws in increasing physician questionnaire response.

    Science.gov (United States)

    Drummond, Frances J; O'Leary, Eamonn; O'Neill, Ciaran; Burns, Richeal; Sharp, Linda

    2014-02-01

    To investigate the effects of two monetary incentives on response rates to postal questionnaires from primary care physicians (PCPs). The PCPs were randomized into three arms (n=550 per arm), namely (1) €5 sent with the questionnaire (cash); (2) entry into a draw on return of completed questionnaire (prize); or (3) no incentive. Effects of incentives on response rates and item nonresponse were examined, as was cost-effectiveness. Response rates were significantly higher in the cash (66.1%; 95% confidence interval [CI]: 61.9, 70.4%) and prize arms (44.8%; 95% CI: 40.1, 49.3%) compared with the no-incentive arm (39.9%; 95% CI: 35.4, 44.3%). Adjusted relative risk of response was 1.17 (95% CI: 1.02, 1.35) and 1.68 (95% CI: 1.48, 1.91) in the prize and cash arms, respectively, compared with the no-incentive group. Costs per completed questionnaire were €9.85, €11.15, and €6.31 for the cash, prize, and no-incentive arms, respectively. Compared with the no-incentive arm, costs per additional questionnaire returned in the cash and prize arms were €14.72 and €37.20, respectively. Both a modest cash incentive and entry into a prize draw were effective in increasing response rates. The cash incentive was most effective and the most cost-effective. Where it is important to maximize response, a modest cash incentive may be cost-effective. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. 39 CFR 265.13 - Compliance with subpoenas, summonses, and court orders by postal employees within the Inspection...

    Science.gov (United States)

    2010-07-01

    ... assigned to the Postal Inspection Service, student interns, contractors and employees of contractors who... or testimony fails to cooperate in good faith, preventing Inspection Service legal counsel from... disruptive methods to the employee's official duties. Testimony may, for example, be provided by affidavits...

  11. Master of science in medical leadership and management and its role in the current NHS.

    Science.gov (United States)

    Barratt, Shaney; Bateman, Kathryn; Harvey, John

    2010-10-01

    Traditionally there has been little formal leadership and management education in the core medical curriculum. The Department of Health has recently emphasised the development of clinical leadership within the NHS. In this article, trainees share their experience of the Master of Science in medical leadership and management postgraduate qualification.

  12. Introduction into the NHS of magnetic sphincter augmentation: an innovative surgical therapy for reflux - results and challenges.

    Science.gov (United States)

    Prakash, D; Campbell, B; Wajed, S

    2018-04-01

    Introduction Gastro-oesophageal reflux disease (GORD) is a common, chronic debilitating condition. Surgical management traditionally involves fundoplication. Magnetic sphincter augmentation (MSA) is a new definitive treatment. We describe our experience of introducing this innovative therapy into NHS practice and report the early clinical outcomes. Methods MSA was introduced into NHS practice following successful acceptance of a cost-effective business plan and close observation of National Institute for Health and Care Excellence (NICE) recommendations for new procedures, including a carefully planned prospective data collection over a two-year follow-up period. Results Forty-seven patients underwent MSA over the 40-month period. Reflux health-related quality of life (GERD-HRQL) was significantly improved after the procedure and maintained at one- and two-year (P business plan and compliance with NICE recommendations.

  13. How does the outcome of research training fellowships funded via the NHS compare with that from competitively funded fellowships from the MRC and other charities: a cross-sectional retrospective survey of trainees undertaking research training in the West Midlands.

    Science.gov (United States)

    Maybury, Charlotte; Morgan, Matthew David; Smith, Russell; Harper, Lorraine

    2018-01-23

    This study aimed to investigate the impact of research training funded via the National Health Service (NHS) on medical trainees compared with traditional clinical research training fellowships (CRTFs). Online survey of 221 clinical trainees who had completed a period of research during their clinical training between 2009 and 2015 in the West Midlands. Research outcomes. Overall response rate was 59%, of whom 72 participants were funded by CRTFs and 51 funded by the NHS. Although participants with CRTFs were more likely to be awarded a higher degree compared with those on NHS-administered funding (66/72 CRTFs and 37/51 NHS, P=0.005), similar proportions of NHS-funded and CRTF-funded participants entered clinical lecturer posts on completing initial research training (8/51 NHS and 16/72 CRTF, P=0.37). 77% of participants had three or more publications (CRTF 57 and NHS 39, P=0.72). 57 participants had completed clinical training; similar proportions of CRTF-funded and NHS-funded trainees had research included in their consultant contract (12/22 NHS and 14/26 CRTF, P=0.96) or were appointed to academic posts (3 of 25 NHS funded and 6 of 32 CRTF, P>0.05). 95% of participants would recommend to colleagues and 82% of participants felt the research experience improved their provision of clinical care with no difference between CRTF-funded and NHS-funded participants (P=0.49). Continuing to participate in clinical work during the research reduced reports of trainee difficulty on returning to clinical work (23/108 continued clinical work vs 12/22 no clinical work, P=0.001). Research training funded by the NHS provides a quality experience and contributes to the clinical academic capacity within the UK. More needs to be done to support NHS participants to successfully achieve a higher degree. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly

  14. Healthcare scandals in the NHS: crime and punishment.

    Science.gov (United States)

    Alghrani, Amel; Brazier, Margaret; Farrell, Anne-Maree; Griffiths, Danielle; Allen, Neil

    2011-04-01

    The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of 'shocking' systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare.

  15. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs.

    Science.gov (United States)

    Scarborough, Peter; Bhatnagar, Prachi; Wickramasinghe, Kremlin K; Allender, Steve; Foster, Charlie; Rayner, Mike

    2011-12-01

    Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992-93. Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006-07. In 2006-07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion. The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

  16. Validation of the Oxford Participation and Activities Questionnaire

    Directory of Open Access Journals (Sweden)

    Morley D

    2016-06-01

    Full Text Available David Morley, Sarah Dummett, Laura Kelly, Jill Dawson, Ray Fitzpatrick, Crispin Jenkinson Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK Purpose: There is growing interest in the management of long-term conditions and in keeping people active and participating in the community. Testing the effectiveness of interventions that aim to affect activities and participation can be challenging without a well-developed, valid, and reliable instrument. This study therefore aims to develop a patient-reported outcome measure, the Oxford Participation and Activities Questionnaire (Ox-PAQ, which is theoretically grounded in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF and fully compliant with current best practice guidelines. Methods: Questionnaire items generated from patient interviews and based on the nine chapters of the ICF were administered by postal survey to 386 people with three neurological conditions: motor neuron disease, multiple sclerosis, and Parkinson's disease. Participants also completed the Medical Outcomes Study (MOS 36-Item Short Form Health Survey (SF-36 and EQ-5D-5L. Results: Thus, 334 participants completed the survey, a response rate of 86.5%. Factor analysis techniques identified three Ox-PAQ domains, consisting of 23 items, accounting for 72.8% of variance. Internal reliability for the three domains was high (Cronbach's α: 0.81–0.96, as was test–retest reliability (intraclass correlation: 0.83–0.92. Concurrent validity was demonstrated through highly significant relationships with relevant domains of the MOS SF-36 and the EQ-5D-5L. Assessment of known-groups validity identified significant differences in Ox-PAQ scores among the three conditions included in the survey. Conclusion: Results suggest that the Ox-PAQ is a valid and reliable measure of participation and activity. The measure will now be validated in

  17. Doing transformational change in the English NHS in the context of "big bang" redisorganisation.

    Science.gov (United States)

    Hunter, David J; Erskine, Jonathan; Small, Adrian; McGovern, Tom; Hicks, Chris; Whitty, Paula; Lugsden, Edward

    2015-01-01

    The purpose of this paper is to examine a bold and ambitious scheme known as the North East transformation system (NETS). The principal aim of the NETS is the achievement of a step-change in the quality of health services delivered to people living in the North East region of England. The paper charts the origins of the NETS and its early journey before describing what happened to it when the UK coalition government published its proposals for unexpected major structural change in the NHS. This had a profound impact on the leadership and direction of the NETS and resulted in it taking a different direction from that intended. The research design took the form of a mixed methods, longitudinal 3.5-year study aimed at exploring transformational change in terms of content, context, process and outcomes. The sample of study sites comprised 14 NHS trusts in the North East region chosen to provide geographical coverage of the area and to reflect the scale, scope and variety of the bodies that formed part of the NETS programme. The qualitative component of the research, which the paper draws upon, included 68 semi-structured interviews, observational studies and focus groups. Data analysis made use of both deductive and inductive frameworks. The deductive framework adopted was Pettigrew et al.'s "receptive contexts for change" and four of the eight factors stood out as especially important and form the basis of the paper. The fate of the NETS was shaped and influenced by the eight factors comprising the Pettigrew et al. receptive contexts for change framework but four factors in particular stood out as being especially significant: environmental pressure, quality and coherence of policy, key people leading change, supportive organisational culture. Perhaps the most significant lesson from the NETS is that achieving whole systems change is particularly vulnerable to the vicissitudes of politics especially where that system, like the UK NHS, is itself subject to those very

  18. La prestación del servicio postal universal ¿conlleva un riesgo inexorable de quiebra?

    Directory of Open Access Journals (Sweden)

    A. Javier Prado-Domínguez

    2012-01-01

    Full Text Available Este artículo profundiza en la problemática planteada por el precio uniforme y el descremado del mercado en un contexto de regulación asimétrica del operador dominante en precios y productos, que puede conducir a un proceso inexorable de quiebra. De suceder esto, quedaría limitada notablemente la implementación de políticas públicas sectoriales capaces de constituirse en alternativas a la privatización, la cual se pretende consagrar, actualmente, como la única vía posible para gestionar servicios esenciales, como el postal. Señalamos que factores tales como la lealtad a la marca y la adopción de políticas que fomenten la competencia a largo plazo, frente a un enfoque a corto, pueden contribuir a mitigar problemas de financiación del servicio postal universal (SPU, y subrayamos la importancia de la eficiencia en costes como respuesta al descremado del mercado. Nuestra principal conclusión es que, tras quince años de liberalización del sector, no existe evidencia concluyente de riesgo de quiebra de operadores actuales en la Unión Europea.

  19. Artificial Intelligence Techniques to Optimize the EDC/NHS-Mediated Immobilization of Cellulase on Eudragit L-100

    Directory of Open Access Journals (Sweden)

    Min-Chao He

    2012-06-01

    Full Text Available Two artificial intelligence techniques, namely artificial neural network (ANN and genetic algorithm (GA were combined to be used as a tool for optimizing the covalent immobilization of cellulase on a smart polymer, Eudragit L-100. 1-Ethyl-3-(3-dimethyllaminopropyl carbodiimide (EDC concentration, N-hydroxysuccinimide (NHS concentration and coupling time were taken as independent variables, and immobilization efficiency was taken as the response. The data of the central composite design were used to train ANN by back-propagation algorithm, and the result showed that the trained ANN fitted the data accurately (correlation coefficient R2 = 0.99. Then a maximum immobilization efficiency of 88.76% was searched by genetic algorithm at a EDC concentration of 0.44%, NHS concentration of 0.37% and a coupling time of 2.22 h, where the experimental value was 87.97 ± 6.45%. The application of ANN based optimization by GA is quite successful.

  20. Experiences on the implementation of a postal auditing service to know teletherapy doses using Cobalt 60 attained by the Secondary laboratory for dosimetric calibration from CPHR

    International Nuclear Information System (INIS)

    Campa, R.; Morales, J.A.; Molina, D.; Dominguez, L.

    1998-01-01

    This paper analyzes experiences gained by LSCD from CPHR on the implementation and validation of a postal auditing system. The system checks doses absorbed by water for teletherapy equipment using Cobalt 60. The verification was made with Chinese DTL type JR 1152F (microbars) introduced in capsules developed and employed by IAEA in the postal auditing service for doses IAEA/WHO. The analysis includes the creation of groups of detectors based on their individual sensibility. They have a dispersion range that was almost 2%. Here irradiation was applied to a water dummy. Other tests employed were that for thermal treatment and calibration. Besides one auditing the effectiveness of the postal technique in two facilities using Cobalt 60. The methodology implemented helps to determine doses absorbed in reference conditions with a lower global uncertainty (k=2) (3.2%)

  1. Towards Religious/Spiritual Competence for Applied Psychologists in NHS Settings in the UK

    OpenAIRE

    Koce, Precious

    2013-01-01

    The profession of psychology in the UK is gradually showing signs of renewed interest in the area of religion/spirituality (e.g., Collicut, 2011). The present study aimed to (i) explore applied psychologists‟ accounts of their practice in the NHS, UK, with clients with religious/spiritual issues; and (ii) from these accounts identify participants‟ indications of religious/spiritual competencies. Thematic analysis as outlined by Braun and Clarke (2006) was employed and subscribed to a critical...

  2. Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers.

    Science.gov (United States)

    Harcombe, Helen; McBride, David; Derrett, Sarah; Gray, Andrew

    2010-04-01

    To investigate the association of physical and psychosocial risk factors with musculoskeletal disorders (MSDs) in New Zealand nurses, postal workers and office workers. A cross-sectional postal survey asking about demographic, physical and psychosocial factors and MSDs. A total of 911 participants was randomly selected; nurses from the Nursing Council of New Zealand database (n=280), postal workers from their employer's database (n=280) and office workers from the 2005 electoral roll (n=351). Self-reported pain in the low back, neck, shoulder, elbow, wrist/hand or knee lasting more than 1 day in the month before the survey. The response rate was 58%, 443 from 770 potential participants. 70% (n=310) reported at least one MSDs. Physical work tasks were associated with low back (odds ratio (OR) 1.35, 95% CI 1.14 to 1.6), shoulder (OR 1.41, 95% CI 1.17 to 1.69), elbow (OR 1.14, 95% CI 1.13 to 1.83) and wrist/hand pain (OR 1.39, 95% CI 1.15 to 1.69). Job strain had the strongest association with neck pain (OR 3.46, 95% CI 1.30 to 9.21) and wrist/hand pain. Somatisation was weakly associated with MSDs at most sites. Better general and mental health status were weakly associated with lower odds of MSDs. In injury prevention and rehabilitation the physical nature of the work needs to be addressed for most MSDs, with modest decreases in risk seemingly possible. Addressing job strain could provide significant benefit for those with neck and wrist/hand pain, while the effects of somatisation and the promotion of good mental health may provide smaller but global benefits.

  3. Do hairdressers in Denmark have their hand eczema reported as an occupational disease? Results from a register-based questionnaire study

    DEFF Research Database (Denmark)

    Lysdal, Susan H; Søsted, Heidi; Johansen, Jeanne D

    2012-01-01

    Background. Occupational hand eczema is common in hairdressers, owing to wet work and chemicals. Objectives. To estimate whether hairdressers in Denmark have their hand eczema reported as an occupational disease and to clarify the reasons for not reporting. Methods. A register-based study...... was performed, comprising trained hairdressers (n = 7840), using a self-administered postal questionnaire including questions on hand eczema and it being reported as an occupational disease. A response rate of 67.9% (n = 5324) was obtained. Results. Overall, 2186 respondents ever had hand eczema; 71.3% were......-reported as an occupational disease; the perception of hand eczema among hairdressers and the lack of reporting from doctors are the main reasons for this....

  4. Chest radiography practice in critically ill patients: a postal survey in the Netherlands

    International Nuclear Information System (INIS)

    Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J

    2006-01-01

    To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a 'daily-routine chest radiography' ICU. From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

  5. Reliability and validity of the Attributional Style Questionnaire- Survey in people with multiple sclerosis

    Science.gov (United States)

    Kneebone, Ian I.; Dewar, Sophie J.

    2016-01-01

    Background: The current study aimed to examine the psychometric properties of an attributional style measure that can be administered remotely, to people who have multiple sclerosis (MS). Methods: A total of 495 participants with MS were recruited. Participants completed the Attributional Style Questionnaire-Survey (ASQ-S) and two comparison measures of cognitive variables via postal survey on three occasions, each 12 months apart. Internal reliability, test-retest reliability and congruent validity were considered. Results: The internal reliability of the ASQ-S was good (α > 0.7). The test-retest correlations were significant, but failed to reach the 0.7 set. The congruent validity of the ASQ-S was established relative to the comparisons. Conclusions: The psychometric properties of the ASQ-S indicate that it shows promise as a tool for researchers investigating depression in people with MS and is likely sound to use clinically in this population. PMID:28450893

  6. Gender differences in exerted forces and physiological load during pushing and pulling of wheeled cages by postal workers

    NARCIS (Netherlands)

    Van Der Beek, Allard J.; Kluver, B.D.R.; Frings-Dresen, M. H. W.; Hoozemans, M. J M

    The aim was to determine gender differences regarding exerted forces and physiological load during push/pull tasks simulating the daily working practice of postal workers. Eight female and four male workers handled four-wheeled cages under eight conditions corresponding to the cage weight (130, 250,

  7. Protein quantitation using Ru-NHS ester tagging and isotope dilution high-pressure liquid chromatography-inductively coupled plasma mass spectrometry determination.

    Science.gov (United States)

    Liu, Rui; Lv, Yi; Hou, Xiandeng; Yang, Lu; Mester, Zoltan

    2012-03-20

    An accurate, simple, and sensitive method for the direct determination of proteins by nonspecies specific isotope dilution and external calibration high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICPMS) is described. The labeling of myoglobin (17 kDa), transferrin (77 kDa), and thyroglobulin (670 kDa) proteins was accomplished in a single-step reaction with a commercially available bis(2,2'-bipyridine)-4'-methyl-4-carboxybipyridine-ruthenium N-succinimidyl ester-bis(hexafluorophosphate) (Ru-NHS ester). Using excess amounts of Ru-NHS ester compared to the protein concentration at optimized labeling conditions, constant ratios for Ru to proteins were obtained. Bioconjugate solutions containing both labeled and unlabeled proteins as well as excess Ru-NHS ester reagent were injected onto a size exclusion HPLC column for separation and ICPMS detection without any further treatment. A (99)Ru enriched spike was used for nonspecies specific ID calibration. The accuracy of the method was confirmed at various concentration levels. An average recovery of 100% ± 3% (1 standard deviation (SD), n = 9) was obtained with a typical precision of better than 5% RSD at 100 μg mL(-1) for nonspecies specific ID. Detection limits (3SD) of 1.6, 3.2, and 7.0 fmol estimated from three procedure blanks were obtained for myoglobin, transferrin, and thyroglobulin, respectively. These detection limits are suitable for the direct determination of intact proteins at trace levels. For simplicity, external calibration was also tested. Good linear correlation coefficients, 0.9901, 0.9921, and 0.9980 for myoglobin, transferrin, and thyroglobulin, respectively, were obtained. The measured concentrations of proteins in a solution were in good agreement with their volumetrically prepared values. To the best of our knowledge, this is the first application of nonspecies specific ID for the accurate and direct determination of proteins using a Ru-NHS ester

  8. A novel small deletion in the NHS gene associated with Nance-Horan syndrome

    OpenAIRE

    Li, Huajin; Yang, Lizhu; Sun, Zixi; Yuan, Zhisheng; Wu, Shijing; Sui, Ruifang

    2018-01-01

    Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), a...

  9. Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

    Science.gov (United States)

    Osaro, Erhabor; Chima, Njemanze

    2014-06-01

    The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

  10. Views of senior UK doctors about working in medicine: questionnaire survey.

    Science.gov (United States)

    Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

    2014-11-01

    We surveyed the UK medical qualifiers of 1993. We asked closed questions about their careers; and invited them to give us comments, if they wished, about any aspect of their work. Our aim in this paper is to report on the topics that this senior cohort of UK-trained doctors who work in UK medicine raised with us. Questionnaire survey. 3479 contactable UK-trained medical graduates of 1993. UK. Comments made by doctors about their work, and their views about medical careers and training in the UK. Postal and email questionnaires. Response rate was 72% (2507); 2252 were working in UK medicine, 816 (36%) of whom provided comments. Positive comments outweighed negative in the areas of their own job satisfaction and satisfaction with their training. However, 23% of doctors who commented expressed dissatisfaction with aspects of junior doctors' training, the impact of working time regulations, and with the requirement for doctors to make earlier career decisions than in the past about their choice of specialty. Some doctors were concerned about government health service policy; others were dissatisfied with the availability of family-friendly/part-time work, and we are concerned about attitudes to gender and work-life balance. Though satisfied with their own training and their current position, many senior doctors felt that changes to working hours and postgraduate training had reduced the level of experience gained by newer graduates. They were also concerned about government policy interventions.

  11. Options for change in the NHS consultant contract.

    Science.gov (United States)

    Clarke, R W; Gray, C

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

  12. The effects of immigration on NHS waiting times.

    Science.gov (United States)

    Giuntella, Osea; Nicodemo, Catia; Vargas-Silva, Carlos

    2018-03-01

    This paper analyzes the effects of immigration on waiting times for the National Health Service (NHS) in England. Linking administrative records from Hospital Episode Statistics (2003-2012) with immigration data drawn from the UK Labour Force Survey, we find that immigration reduced waiting times for outpatient referrals and did not have significant effects on waiting times in accident and emergency departments (A&E) and elective care. The reduction in outpatient waiting times can be explained by the fact that immigration increases natives' internal mobility and that immigrants tend to be healthier than natives who move to different areas. Finally, we find evidence that immigration increased waiting times for outpatient referrals in more deprived areas outside of London. The increase in average waiting times in more deprived areas is concentrated in the years immediately following the 2004 EU enlargement and disappears in the medium term (e.g., 3-4 years). Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  13. SU-E-T-425: Feasibility of Establishing a National Postal Dosimetry System Using EBT3 Gafchromic Film

    International Nuclear Information System (INIS)

    Abdel-Rahman, W; Mohammed, I; Bamajboor, S

    2015-01-01

    Purpose: To evaluate the performance of a postal dosimeter consisting of EBT3 films and a miniature Lucite phantom to be used for photon beams output audits for mega-voltage photon beams across the Saudi Arabia. Methods: Two batches of EBT3 films were calibrated in 5 mega-voltage photon beams with energies ranging between 6 MV and 18 MV in the dose range between 0 to 4 Gy. A 4×4×20 cm 3 lucite phantom was constructed to be used as an irradiation phantom. The lucite irradiation phantom consists of two parts and allows for embedding a 2.5×2.0 cm 2 EBT3 film at 8.9 cm depth. Factors that convert the dose measured in the lucite irradiation phantom at 8.9 cm depth to the dose at 10 cm depth in water for 10×10 cm 2 field for different photon energies were calculated using the dosxyznrc/EGSnrcMP user code. The performance of the proposed postal dosimeter was tested in 17 different photon beams across 4 radiotherapy centres in Saudi Arabia. The outputs of the 17 beams are monitored by either the International Atomic Energy Agency or by the Radiological Physics Centre. Results: For the 17 photon beams, the average of the ratios of measured to stated outputs was 1.01 ± 0.02 and with a maximum ratio of 1.05. Conclusion: The results of our work indicate that the proposed postal dosimetry system can be used for national auditing of outputs for mega-voltage photon beams. The service can be offered to other national radiotherapy centres or to a be used for credentialing of centres participating in national trials

  14. SU-E-T-425: Feasibility of Establishing a National Postal Dosimetry System Using EBT3 Gafchromic Film

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Rahman, W [KING FAHAD SPECIALIST HOSPITAL, Dammam, Eastern Province (Saudi Arabia); Mohammed, I [King Fahd University of Petroleum & Minerals, Dhahran, Eastern Province (Saudi Arabia); Bamajboor, S [Prince Sultan Military Medical City, Riyadh, Riyadh (Saudi Arabia)

    2015-06-15

    Purpose: To evaluate the performance of a postal dosimeter consisting of EBT3 films and a miniature Lucite phantom to be used for photon beams output audits for mega-voltage photon beams across the Saudi Arabia. Methods: Two batches of EBT3 films were calibrated in 5 mega-voltage photon beams with energies ranging between 6 MV and 18 MV in the dose range between 0 to 4 Gy. A 4×4×20 cm{sup 3} lucite phantom was constructed to be used as an irradiation phantom. The lucite irradiation phantom consists of two parts and allows for embedding a 2.5×2.0 cm{sup 2} EBT3 film at 8.9 cm depth. Factors that convert the dose measured in the lucite irradiation phantom at 8.9 cm depth to the dose at 10 cm depth in water for 10×10 cm{sup 2} field for different photon energies were calculated using the dosxyznrc/EGSnrcMP user code. The performance of the proposed postal dosimeter was tested in 17 different photon beams across 4 radiotherapy centres in Saudi Arabia. The outputs of the 17 beams are monitored by either the International Atomic Energy Agency or by the Radiological Physics Centre. Results: For the 17 photon beams, the average of the ratios of measured to stated outputs was 1.01 ± 0.02 and with a maximum ratio of 1.05. Conclusion: The results of our work indicate that the proposed postal dosimetry system can be used for national auditing of outputs for mega-voltage photon beams. The service can be offered to other national radiotherapy centres or to a be used for credentialing of centres participating in national trials.

  15. Centro de clasificación postal en la estación de Chamartin Madrid - España

    Directory of Open Access Journals (Sweden)

    González Cruz, Luis

    1980-10-01

    Full Text Available This mail sorting center in the Chamartin Railroad Station is made up by three clearly differentiated buildings: — Mail station, located between the railroad tracks in order to facilitate the loading and unloading of mail trains. — Mail sorting building located between the railroad tracks and the parking area for vehicles. — Administrative offices and social services, to the South-East of the complex. The structure consists of: main portals in reinforced concrete for large spans; floor structures capable of supporting loads of 1,000 kg/m2, and rolled steel shapes supported on the portal frames. Throughout the construction an effort has been made to achieve maximum use of gravity for the functions of moving the objects to be sorted.

    Este centro de clasificación postal, realizado en la Estación de Chamartin, está formado por tres edificios claramente diferenciados: — Estación postal, situada sobre las vías de ferrocarril, para facilitar la carga y descarga de trenes postales. — Edificio de clasificación de correspondencia con un emplazamiento entre las vías de ferrocarril y la explanada para vehículos automóviles. — Oficinas administrativas y servicios sociales, situados al S.E. del conjunto. La estructura de la obra se compone de: pórticos principales de hormigón armado para grandes luces; forjados aptos para cargas de 1.000 kg/m2 y perfiles laminados de acero apoyados en los pórticos. En todo el conjunto se ha procurado, lo más posible, la utilización de la gravedad para las funciones de movimiento de los objetos a clasificar.

  16. A Method of Postal Audit in Dental Radiodiagnostics

    International Nuclear Information System (INIS)

    Kroutilikova, D.; Novak, L.

    2001-01-01

    Full text: The National Radiation Protection Institute (NRPI) develops a new method for independent control of radiodiagnostic dental intraoral units for purposes of state supervision. The method is aimed to check not only basic dosimetric characteristics of the unit, but also conditions of developing process used by dentists. It is considered as a postal audit. The dosimetric part of the method includes irradiation of a radiographic film along with an attached TLD in order to check Ka output, field size and exposition reproducibility. The developing process is checked by means of dental films and a standardised dental phantom. The dentist is asked to develop a dental film irradiated under reference conditions by NRPI, and on the other hand to irradiate his own dental film using the phantom, that will be developed later by NRPI. Comparison of both the dental films provides information about developing process quality. It also indicates a relation between applied Ka and developing process at the place. The method is supposed to simplify the state supervision operation in the field of dental radiodiagnostics. (author)

  17. Engaging dental professionals in NHS leadership - the challenges, the opportunities and the risks.

    Science.gov (United States)

    Ford, J

    2014-09-01

    Leadership training in dentistry and the wider NHS is often overlooked or seen as an unnecessary distraction from front line duties. Dentists themselves are often reluctant to adopt formal leadership learning due to the way work is structured and rewarded. So, what is it like for a dentist to undertake leadership training and how can the gap be bridged between the need for highly trained leaders in dentistry and the reticence of front line professionals to take time away from practice?

  18. What motivates doctors to leave the UK NHS for a "life in the sun" in New Zealand; and, once there, why don't they stay?

    Science.gov (United States)

    Gauld, Robin; Horsburgh, Simon

    2015-09-08

    At 44%, New Zealand has the highest proportion of international medical graduates (IMGs) in its workforce amongst OECD member countries. Around half of New Zealand's IMGs come from the UK NHS, yet only around 50% stay longer than 1 year post-registration with significant costs to the New Zealand health care system. Why these doctors go to New Zealand and do not stay for long is an important question. UK-trained doctors who had gained registration with the Medical Council of New Zealand and currently practising in New Zealand were surveyed (n = 1357) on the motivation for their move to New Zealand, experiences once there and what was prompting any intentions to move away from New Zealand. Multivariate proportional odds models (POM) were used to quantify various associations. The survey had a 47% response (n = 632). Quality of life considerations motivated 96% of respondents to move to New Zealand, although 65% indicated they were pushed by a desire to leave the NHS. POM analyses revealed older respondents were significantly less likely than younger respondents to be motivated by quality of life considerations. Younger doctors were significantly more likely to be seeking to leave the NHS. Seventy-six per cent of respondents signalling an intention to leave New Zealand indicated that the desire to return to the UK was the primary reason for this. There is a long history of medical migration from the UK to New Zealand. However, the 65% of respondents in this study seeking to leave the NHS was much higher than found elsewhere, perhaps reflecting increasing workplace and funding pressures in recent years. Of concern to policy makers were the higher odds of seeking to leave the NHS motivating younger doctors. Various changes "down under", in New Zealand as well as Australia, mean their IMG markets may well be tightening up.

  19. Validation of the Oxford Participation and Activities Questionnaire.

    Science.gov (United States)

    Morley, David; Dummett, Sarah; Kelly, Laura; Dawson, Jill; Fitzpatrick, Ray; Jenkinson, Crispin

    2016-01-01

    There is growing interest in the management of long-term conditions and in keeping people active and participating in the community. Testing the effectiveness of interventions that aim to affect activities and participation can be challenging without a well-developed, valid, and reliable instrument. This study therefore aims to develop a patient-reported outcome measure, the Oxford Participation and Activities Questionnaire (Ox-PAQ), which is theoretically grounded in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) and fully compliant with current best practice guidelines. Questionnaire items generated from patient interviews and based on the nine chapters of the ICF were administered by postal survey to 386 people with three neurological conditions: motor neuron disease, multiple sclerosis, and Parkinson's disease. Participants also completed the Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) and EQ-5D-5L. Thus, 334 participants completed the survey, a response rate of 86.5%. Factor analysis techniques identified three Ox-PAQ domains, consisting of 23 items, accounting for 72.8% of variance. Internal reliability for the three domains was high (Cronbach's α: 0.81-0.96), as was test-retest reliability (intraclass correlation: 0.83-0.92). Concurrent validity was demonstrated through highly significant relationships with relevant domains of the MOS SF-36 and the EQ- 5D-5L. Assessment of known-groups validity identified significant differences in Ox-PAQ scores among the three conditions included in the survey. Results suggest that the Ox-PAQ is a valid and reliable measure of participation and activity. The measure will now be validated in a range of further conditions, and additional properties, such as responsiveness, will also be assessed in the next phase of the instrument's development.

  20. Consumerism 2: preregistration nursing and midwifery curricula.

    Science.gov (United States)

    Fox, Jane

    This article, the second of two parts, presents findings from a four-stage study exploring the extent to which consumerism and its related aspects have been incorporated into the preregistration nursing and midwifery curriculum. The study was undertaken in recognition that NHS policy (as considered in the first article: Vol 12(5): 321-6) increasingly gave emphasis to the development of a health service that was more consumer and user focused. The study involved use of a Delphi panel, postal questionnaire, review of curriculum documentation, and timetables, together with a small focused group discussion. Findings indicate some aspects relevant to consumerism in health care, e.g. communication and ethical principles were included in the curriculum. Other aspects, such as advocacy, quality assurance, and lay health beliefs, were viewed logically from the perspective of the professional role. In essence, no curriculum transparently addressed consumerism in a central and focused way, although midwifery--and to some extent mental health, learning disabilities, and child branches--gave more overt attention to consumerism than adult branches.

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