Stemless reverse humeral component neck-shaft angle has an influence on initial fixation.

BACKGROUND: Stemless anatomic humeral components are commonly used and are an accepted alternative to traditional stemmed implants in patients with good bone quality. Presently, little literature exists on the design and implantation parameters that influence primary time-zero fixation of stemless reverse humeral implants. Accordingly, this finite element analysis study assessed the surgical implantation variable of neck-shaft angle, and its effect on the primary time-zero fixation of reversed stemless humeral implants. METHODS: Eight computed tomography-derived humeral finite element models were used to examine a generic stemless humeral implant at varying neck-shaft angles of 130°, 135°, 140°, 145°, and 150°. Four loading scenarios (30° shoulder abduction with neutral forearm rotation, 30° shoulder abduction with forearm supination, a head-height lifting motion, and a single-handed steering motion) were employed. Implantation inclinations were compared based on the maximum bone-implant interface distraction detected after loading. RESULTS: The implant-bone distraction was greatest in the 130° neck-shaft angle implantation cases. All implant loading scenarios elicited significantly lower micromotion magnitudes when neck-shaft angle was increased (P = .0001). With every 5° increase in neck-shaft angle, there was an average 17% reduction in bone-implant distraction. CONCLUSIONS: The neck-shaft angle of implantation for a stemless reverse humeral component is a modifiable parameter that appears to influence time-zero implant stability. Lower, more varus, neck-shaft angles increase bone-implant distractions with simulated activities of daily living. It is therefore suggested that humeral head osteotomies at a higher neck-shaft angle may be beneficial to maximize stemless humeral component stability.

First contact physiotherapists' perceptions and experiences of practice-based small group learning in NHS Scotland: a qualitative study.

Practice-Based Small Group Learning (PBSGL) is a continuing professional development programme use by various professions in primary healthcare teams in NHS Scotland. Primary healthcare teams have enlarged with the addition of new professions including First Contact Physiotherapists (FCP) who provide services to patients without the need for referral. In 2020 a pilot of FCPs groups using PBSGL was undertaken.The pilot involved volunteers from a FCP team in one large NHS board in Scotland. It lasted for 12 months and groups met in-person, switching to video-conferencing (VC) as a consequence of the pandemic. A grounded theory approach was adopted for the evaluation. Research participants took part in individual interviews held using VC. Interviews were recorded and transcribed. Data was analysed using grounded theory methods with codes and themes being constructed.Two PBSGL groups were formed from 10 participants and 2 facilitators. Ten took part in one-to-one research interviews. Seven main themes were constructed from the data. There was recognition that FCPs had a new role and work context. There was a sense of volunteerism in the pilot and that participants met in their own time. FCPs appreciated the PBSGL learning methods and their meetings fostered peer support and improved professional socialisation. There was a preference for in-person meetings rather than using VC and some participants wanted to join inter-professional groups in the future.

The future of CPD for general practitioners, registered pharmacy staff and general practice nurses in Scotland - qualitative responses from a national survey.

In the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: 'Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.' Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare.

Practice-Based Small Group Learning (PBSGL) in Scotland: the past, the present and the future.

Practice-based Small Group Learning (PBSGL) originated in Canada and transferred to Scotland in 2003 with a successful pilot involving 45 general practitioners (GPs). The Scottish programme has grown considerably since then and now has 3,400 members drawn from GPs, GP nurses, pharmacists and other professions. Members get together in small groups and discuss case presentations written by authors who have drawn on their own experiences with real patients. The group review a distillation of the current evidence base included in the module and propose changes to their own practice. Members make a commitment to change and log these changes in a shared document.In Scotland, 34% of groups are inter-professional, reflecting the dynamic changes to the primary health care team as it meets the health care needs of the Scottish population. Professional (and inter-professional) socialisation is a key feature of many PBSGL groups. Some groups have peer support as a central function to their meetings.The programme has recruited a small team of module writers and authors and most modules are now produced in Scotland by primary health care members. In addition, over 1,000 members have been trained up to be peer facilitators for their small group. The PBSGL programme in Scotland has ensured that continuing professional development of the primary health care team is available to teams across Scotland and that PBSGL groups can control the content and logistics of their own meetings.

General practice recruitment - a survey of awareness and influence of the Scottish Targeted Enhanced Recruitment Scheme (TERS).

The World Health Organisation reported that health-care systems worldwide have problems with the recruitment and retention of general practitioners (GPs) into clinical practice, particularly to rural and under-served areas. A recent survey of United Kingdom (UK) trainees found that they valued posts with good training conditions, were in desirable locations and gave opportunities for their partner. The Scottish Government has set a target to increase the number of GPs in Scotland by 800 in the next 10 years. In recent years, GP speciality training recruitment has been challenging with significant vacancies in some training programmes, primarily in rural areas, or urban areas with a history of poorer recruitment. Recruitment incentive schemes are in operation in different countries in the UK. The Scottish Government introduced a Targeted Enhanced Recruitment Scheme (TERS), offering a £20,000 payment to GPST trainees accepting a targeted post. This study aimed to evaluate awareness and influence of the TERS initiative on programme choice in Scotland in August 2017. A survey was developed and sent to GP trainees taking up a GPST post in August 2017. Ninety-five out of 245 doctors responded (response rate of 39%). Almost two-thirds (65.3%) were aware of TERS at the time of application and this was via word of mouth and from the National Recruitment Office website. Only 21% of GPSTs aware of TERS were influenced by it in their choice of training location. The locations of family, spouse or partner, and of pre-existing geographical preferences were more influential than TERS.

CPD preferences and activities of general practitioners, registered pharmacy staff and general practice nurses in NHS Scotland - a questionnaire survey.

In the United Kingdom, taking part in continuing professional development (CPD) is required for revalidation for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. The literature has many research studies which describe one profession's activities, or a specific learning method or topic. Few studies compared the CPD preferences across these four professional groups or compared their CPD activity. A survey was designed by the authors with assistance from colleagues within NHS Education for Scotland (NES). It was sent to the four professions and 2,813 clinicians responded. More than 75% of all respondents spent between 0 and 10 h per month on CPD activities. Participation in formal Protected Learning Time (PLT) varied across different NHS boards in NHS Scotland and ranged from 23.9% of respondents in the board with the lowest participation, to 68.6% in the board with the highest participation. All professions indicated a greatest preference to learn with other members of their profession. The preferred time for learning during the day varied amongst professions. The CPD activity of greatest preference for all professions was discussion with peers. There were some minor differences in learning preferences and activities from professionals working in remote and rural areas and in areas of socio-economic deprivation in Scotland.

Practice-Based Small Group Learning (PBSGL) in Scotland - a survey of registered pharmacy staff and general practice nurses.

INTRODUCTION: Practice-based small group learning (PBSGL) has grown in primary healthcare in Scotland, and is used regularly by 2244 GPs and GP specialist trainees. The programme has been available to general practice nurses (GPNs) and pharmacy staff since uni-professional and inter-professional pilot studies were considered successful. Growth has been slower compared to GPs uptake but has now reached significant levels. It seemed timely to evaluate the use of the programme by these professions. METHOD: A questionnaire previously used by GPs was adapted. It consisted of 16 questions and two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to maintain membership. The questionnaire was converted into an electronic format and emailed to pharmacy and GPNs in Scotland who were PBSGL members. RESULTS: A range of pharmacy staff and GPNs were involved in PBSGL and the mean number of modules studied by pharmacy staff was 3.93 and 4.48 by GPNs in the last year. A high percentage were likely or very likely to continue with membership (pharmacy staff - 95.6%, GPNs - 90.1%). The dominant reasons to join and stay in the programme related to learning issues: meeting learning needs, learning from peers and professional socialisation.

The recruitment of new members to existing PBSGL small groups: a qualitative study.

Introduction Practice-Based Small Group Learning (PBSGL) is a learning programme widely adopted by primary healthcare professions (general practitioners, general practice nurses and pharmacists) in Scotland and other countries in the UK. PBSGL groups recruit members and decide on meeting dates and venues. Study aims To determine how groups recruit new members and discern what are the important attributes of the new members. Method A grounded theory approach was used with purposive sampling to recruit PBSGL groups to the study. Focus groups drawn from established PBSGL groups were conducted by two researchers following an iterative process, with interviews audio-recorded and transcribed, and codes and themes constructed. Data saturation was achieved. Results and conclusions Four themes were identified that affected group recruitment: group formation and purpose; group culture and ethos; experience and seniority range of group members; professional socialisation and cross-fertilisation. Groups whose main purpose was learning encouraged diverse membership, while groups that were stricter with recruitment often prioritised friendship, group safety, trust and peer support over learning. The variation in group's openness to recruitment may make it difficult for potential members to find a group and this may affect the development and expansion of the PBSGL programme.

NHS Scotland's community GP fellowship - a qualitative study of the first year.

NHS Scotland faces the challenges of an ageing population and a GP recruitment problem. Research has shown that hospital admissions can be reduced if community services can offer enhanced support, in keeping with the Scottish Government's 2020 Vision for healthcare. This study presents the findings of an evaluation of the first year of a three-year community GP fellowship which included working in primary care and secondary care and an educational programme. A grounded theory approach was adopted with data collected from GP fellows and key stakeholders using focus groups and individual interviews. A total of 12 fellows were interviewed at various times in the first year and 22 key stakeholders were interviewed once. The main themes were: aspirations for the fellowship, career choices of recently-qualified GPs, perceptions of primary care and secondary care components, planning and preparation of educational events, the creation of community hubs and identity and status of fellows. The fellowship showed potential for a change in practice and was a good foundation for further collaboration between health care sectors. Physical hubs need to be constructed and resourced to allow fellows to demonstrate a reduction in hospital admissions. More research is needed throughout the lifetime of the fellowship.

Ten years of practice-based small group learning (PBSGL) in Scotland - a survey of general practitioners.

INTRODUCTION: Practice-based small group learning (PBSGL) has grown in Scotland since its pilot in 2004. There are now over 2,100 clinicians in 370 groups across the UK. The programme is used by all 14 territorial health boards in NHS Scotland. It seemed timely to undertake an evaluation of the programme. METHOD: A questionnaire was developed and piloted. It consisted of 16 questions with two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to stay. The questionnaire was converted into an electronic format and emailed to all qualified general practitioners (GPs) in Scotland. RESULTS: A wide range of GPs were involved in PBSGL and the mean number of modules studied per year was 6.8. The vast majority (589 (88.2%)) of respondents met in their own home or practice and were either very likely (549 (82.2%)) or likely (93 (13.9%)) to continue with the programme. The dominant reasons to join and stay with the programme related to learning issues: meeting learning needs, learning from peers and issues of peer support. CONCLUSION: PBSGL has become an established continuous professional development resource for many GPs in Scotland. It is well-received and likely to continue.

GP and pharmacist inter-professional learning - a grounded theory study.

BACKGROUND: Practice Based Small Group Learning (PBSGL) is an established learning resource for primary care clinicians in Scotland and is used by one-third of general practitioners (GPs). Scottish Government and UK professional bodies have called for GPs and pharmacists to work more closely together to improve care. AIM: To gain GPs' and pharmacists' perceptions and experiences of learning together in an inter-professional PBSGL pilot. DESIGN AND SETTING: Qualitative research methods involving established GP PBSGL groups in NHS Scotland recruiting one or two pharmacists to join them. METHOD: A grounded theory method was used. GPs were interviewed in focus groups by a fellow GP, and pharmacists were interviewed individually by two researchers, neither being a GP or a pharmacist. Interviews were audio-recorded, transcribed and analysed using grounded theory methods. Data saturation was achieved and confirmed. RESULTS AND CONCLUSION: Three themes were identified: GPs' and pharmacists' perceptions and experiences of inter-professional learning; Inter-professional relationships and team-working; Group identity and purpose of existing GP groups. Pharmacists were welcomed into GP groups and both professions valued inter-professional PBSGL learning. Participants learned from each other and both professions gained a wider perspective of the NHS and of each others' roles in the organisation. Inter-professional relationships, communication and team-working were strengthened and professionals regarded each other as peers and friends.

Learning needs, preferred learning methods and learning challenges of first five general practitioners in NHS Scotland: a qualitative study.

OBJECTIVES: To identify the learning needs and preferred learning methods of First5 general practitioners (GPs) in National Health Service (NHS) Scotland. DESIGN: Qualitative research study using grounded theory methods. First5 GPs were interviewed in small focus groups or individual interviews in-person, or over the telephone depending on their preference. SETTING: General practice in NHS Scotland. PARTICIPANTS: GPs, within the first 5 years of completion of GP training, who were working in NHS Scotland. RESULTS: Thirty-eight First5s were recruited to the study. Participants recognised that gaps in their GP training became apparent in independent practice. Some of this related to NHS appraisal and revalidation, and with the business of general practice. They were interested in learning from an older generation of GPs but perceived that preferred learning methods differed. First5 GPs were less reliant on reading journals to change their practice, preferring to find learning resources that allowed them to gain new knowledge quickly and easily. There were considerations about resilience and of the challenges of learning in remote and rural areas of NHS Scotland. This related to travel costs and time, and to accessibility of learning courses. Participants appreciated collective learning and commented about the logistics and costs of learning. CONCLUSIONS: Preferred learning methods and learning resources differ with First5 GPs compared with those who have been in practice for some years. Learning providers need to recognise this and take these differences into account when planning and preparing learning in the future.

Community nursing managers' perceptions and experiences of protected learning time: a qualitative study.

BACKGROUND: Protected learning time (PLT) is used to allow primary healthcare teams time to learn, protected from service delivery. Different occupational groups have different perceptions and experiences of PLT. Research has shown that community nurses have low rates of attendance at practice-based PLT (PB-PLT) in one area in Scotland. Nursing managers have considerable influence with PLT, as leaders of community nursing teams and as members of PLT steering committees. AIMS: To understand the community nursing managers' perceptions and experiences of PLT, and to explore their perceptions of the low rate of attendance by community nurses at PB-PLT. METHODS: Qualitative study involving two focus groups (six nursing managers) and one interview (director of nursing), in three community health partnerships in one NHS health board in Scotland. Focus group interviews and one in-depth interview were conducted, audio-recorded and then transcribed. Transcriptions were analysed using a grounded theory approach to data analysis. RESULTS: Participants recognised the potential benefits of PLT for community nursing and primary healthcare teams. They perceived low rates of attendance were because learning at PB-PLT was considered irrelevant by community nurses. They felt community nurses were not involved in planning and preparing PB-PLT, and that their learning needs were not incorporated into PB-PLT. Participants felt there were organisational differences between practices and the community nursing team, which acted as a barrier to learning. Participants had concerns about the learning arranged for practice nurses at PB-PLT. They considered that the new general medical services contract had been an initial barrier to learning. CONCLUSION: Nursing managers had perceptions of PLT that contrasted with those of their community nurses. There were similarities also. Primary healthcare teams need to improve mutual understanding, and need to work together to improve the quality of learning at PB-PLT.

Community nurses' perceptions and experiences of protected learning time: a focus group study.

BACKGROUND: Protected learning time (PLT) has spread quickly to primary healthcare teams in Scotland. Previous research has shown that PLT is generally well received, but that different professional and occupational groups have differing perceptions and experiences of PLT. Community nurses have low rates of attendance at practice-based PLT in NHS Ayrshire and Arran. It is not known why. AIMS: To explore and understand the community nurses' perceptions and experiences of PLT, and to discover the barriers to their attendance at practice-based PLT. DESIGN: Qualitative study involving four focus groups of 37 community nurses. SETTING: Three community health partnerships in one NHS health board area in Scotland. METHODS: Focus group interviews were conducted, audio-recorded and then transcribed. Transcriptions were analysed using a grounded theory approach to data analysis. RESULTS: Community nurses often had separate learning events at PLT, and were not involved in the processes of learning with the general medical practice. Chosen topics were often irrelevant to them and their attendance was low. Learning was often uniprofessional. Community nurses perceived they did not have adequate protection from service delivery during PLT. They felt that practice managers had a key role in the delivery of PLT, and that team working and team learning were important, and useful if done well. They considered that the new contract had had a negative impact on PLT. DISCUSSION: Community nurses need to be involved more in the learning process, if PLT is to be relevant and useful to them and the practice. Nursing managers may need to increase the service protection for community nurses in order to allow them to learn with the rest of the primary healthcare team. Those who organise PLT at primary care organisation level may have to consider using independent facilitators to effect changes.

Scottish pharmacists' perceptions and experiences of a practice-based small group learning pilot: a qualitative study.

INTRODUCTION: CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. METHODS: A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. RESULTS: Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. CONCLUSION: Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups.

General practice training in Scotland: the views of GP trainers and educators.

INTRODUCTION: There are a number of recommendations for changes to GP training to meet the future needs of patients but the views of those who deliver GP training in Scotland are not known. METHODS: A qualitative research approach was used to gain the views of GP trainers and educators. Focus group interviews and telephone interviews were audio-recorded and transcribed. Transcripts were coded and themes developed. RESULTS: Participants considered GP training had changed with more emphasis on assessment than training and mentoring. They perceived that GP training was relatively inflexible and earlier learning experiences should be valued. Participants contrasted learning in general practice compared to hospital posts, and considered the influence of the training practice and trainer on the trainee. Training needed to be longer for GPs to gain sufficient knowledge and skills to cope with future work, and participants reflected on how GP's careers had changed. DISCUSSION: This research complements the findings from studies of GP trainees and from The Shape of Training Review. GP training needs to be longer and situated in a range of practices so that newly qualified GPs feel prepared for their future career.