Development of an information leaflet and diagnostic flow chart to improve the management of urinary tract infections in older adults: a qualitative study using the Theoretical Domains Framework.

BACKGROUND: Urinary tract infections (UTIs), older age, lack of access to health care, and recent antibiotic use are risk factors for Escherichia coli (E. coli) bloodstream infections. AIM: To explore the diagnosis and management of UTIs in primary care to inform the development of an information leaflet, a diagnostic flow chart, and recommendations for other resources. DESIGN & SETTING: The study had a qualitative design and was undertaken in primary care settings and care homes. METHOD: Interviews and focus groups were informed by the Theoretical Domains Framework (TDF) with 31 care home staff, three residents, six relatives, 57 GP staff, and 19 members of the public. An inductive thematic analysis was used and themes were placed in the Behaviour Change Wheel (BCW) to recommend interventions. RESULTS: Care home staff were pivotal for identifying suspected UTI, alerted clinicians to symptoms that influenced prescribing decisions, and reported confusion or behavioural changes as the most common diagnostic sign. Care home staff lacked knowledge about asymptomatic bacteriuria (ASB) and sepsis, and incorrectly diagnosed UTI using urine dipsticks. GP staff used urine dipsticks to rule out UTI and reported that stopping dipsticks would require a culture change, clear protocols, and education about ASB. Many prescribers believed that stopping urine dipstick use should help to reduce antibiotic use. CONCLUSION: A consistent message about ASB and UTI diagnosis and management in older adults should be communicated across the care pathway. Resource development should increase capability, motivation, and opportunity to improve management of suspected UTIs. An educational leaflet for older adults and a diagnostic flow chart for clinicians have been developed, and recommendations for interventions are discussed.

Exploring Perspectives on Antimicrobial Use in Livestock: A Mixed-Methods Study of UK Pig Farmers.

Increasing levels of antimicrobial resistance in human and veterinary medicine have raised concerns over the irresponsible use of antimicrobials. The role of administering antimicrobials in food producing animals most frequently falls to the farmer, therefore it is essential that their use of antimicrobials is both optimal and responsible. This study sought in-depth information on the drivers behind antimicrobial use behaviors and farmer attitudes to responsible use using a mixed-methodological approach. Initially, in-depth semi-structured interviews were conducted with a purposively selected sample of farmers (n = 22). A thematic analysis approach was taken to identify key themes from these qualitative data. The generalizability and variation of these themes was then tested on a larger randomly selected sample of pig farmers through a questionnaire study (n = 261). The influences behind antimicrobial use were complex with multiple drivers motivating decisions. There was no consensual opinion on what farming systems resulted in either a low or high antimicrobial requirement however, farmers reported that good management practices, low stocking densities, and a high health status were associated with low antimicrobial use. Farmers expressed desire to avoid the long-term use of in-feed antimicrobials, but identified barriers to discontinuing such behaviors, such as pig morbidity, mortality, and economic losses. The high cost of antimicrobials was described as a motivation toward seeking alternative methods of controlling disease to prophylactic use; however, this expense was balanced against the losses from an increased burden of disease. The high financial costs involved in pig production alongside the economic uncertainty of production and pressure from retailers, were identified as limiting the scope for improvements in pig accommodation and facilities which could reduce the antimicrobial requirements on farm. Long-term, sustainable and economically stable relationships between retailers and farmers may allow farmers to make necessary investments in improving management and housing in order to reduce antimicrobial use. Greater use and more widespread deployment of effective vaccinations were highlighted by farmers as being a feasible alternative to antimicrobial use in preventing disease.

Person-centred prophylaxis for venous thromboembolism.

All medical admissions should receive risk assessment for the value of prophylaxis against venous thromboembolism. Unfortunately, for such patients the risk of thromboembolism is closely balanced with the risk of haemorrhage exaggerated by chemical prophylaxis. The recent NICE guideline continues to recommend comprehensive risk assessment, and to use prophylaxis where the risk of thromboembolism exceeds the risk of bleeding. The widely used Department of Health Risk Assessment Tool does not rank the risks of thromboembolism and bleeding, but NICE was unable to mandate another assessment tool fit for the purpose in the UK. Validated risk scores are used elsewhere, and could enable safer and better targeted prophylaxis, pending further research in the UK.

Promoting safety voice with safety-specific transformational leadership: the mediating role of two dimensions of trust.

Although safety-specific transformational leadership is known to encourage employee safety voice behaviors, less is known about what makes this style of leadership effective. We tested a model that links safety-specific transformational leadership to safety voice through various dimensions of trust. Data from 150 supervisor-employee dyads from the United Kingdom oil industry supported our predictions that the effects of safety-specific transformational leadership are sequentially mediated by affect-based trust beliefs and disclosure trust intentions. Moreover, we found that reliance trust intentions moderated the effect of disclosure: employees' disclosure intentions mediated the effects of affect-based trust on safety voice behaviors only when employees' intention to rely on their leader was moderate to high. These findings suggest that leaders seeking to encourage safety voice behaviors should go beyond "good reason" arguments and develop affective bonds with their employees.

Trends in disability prevalence over 10 years in older people living in Gloucestershire.

INTRODUCTION: life expectancy in the UK appears to be growing faster than healthy life expectancy, which may imply that there are increasing years of disability. There are few sequential studies examining changes in disability amongst older people within a defined locality. METHODS: the population aged 75 and over of 10 general practices in Gloucestershire was surveyed using a validated postal questionnaire for disability called the Elderly At Risk Rating Scale. Surveys were carried out in 1998 and 2008. Age-adjusted disability prevalences were measured. Care home residents were under-represented in the 1998 survey, and missing data was supplied from a countywide census of care home residents in 2000. RESULTS: response rates of 81 and 74% were achieved. Reductions in disability prevalence were found for mobility, vision and self-care, but there was no significant change in a measure of self-rated health. Higher rates of independence were found in both genders and across the age range in 2008. The improvements suggested that the latter sample was equivalent to subjects being 3.8 years 'younger' than 10 years before and entering dependency on care 2.1 years later. DISCUSSION: the prevalence of disability affecting activities of daily living appears to have reduced over 10 years in older people in Gloucestershire. If generalisable, these results provide some optimism for current trends in ageing in England.

Housing and health care for older people.

There is an enormous impact of home conditions both on the health of an older person living with a long-term illness, and their ability to remain independent in the face of disability. Geriatricians are often called upon to give advice to older people with a new illness about where to live. It is important therefore that they should understand the relationship between housing and health, and how to signpost patients and their families to advice on housing options. Vulnerable older people are more likely to be living in non-decent homes, generally private rented or owner-occupied. A new UK government initiative, Lifetime Homes, Lifetime neighbourhoods, offers the prospect for improvements in Home Improvement Agencies, Lifetime Homes Standards, and Disabled Facilities Grants.

The moderating role of safety-specific trust on the relation between safety-specific leadership and safety citizenship behaviors.

The authors examined whether safety-specific trust moderates or mediates the relationship between safety-specific transformational leadership and subordinates' safety citizenship behavior. Data from 139 subordinate-supervisor dyads were collected from the United Kingdom construction industry and analyzed using hierarchical regression models. Results showed that safety-specific trust moderated rather than mediated the effects of safety-specific transformational leaders on subordinates' behavior. Specifically, in conditions of high and moderate safety-specific trust, leaders had a significant effect on subordinates' safety citizenship behavior. However, in conditions of low safety-specific trust, leaders did not significantly influence subordinates' safety citizenship behavior. The implications of these findings for general safety theory and practice are discussed.

Care home medicine in the UK--in from the cold.

The quality of care within care homes comes under frequent media scrutiny, and is underpinned by the medical support to the staff. In the UK, medical care to care homes is provided by general practitioners. A GP is likely to have patients in many homes, and each home relates to many GPs. The growing complexity of patients in care requires proactive models of care delivered by those with an understanding of care home medicine. A range of innovative models of medical care are emerging across the UK which have the potential to improve the standard of care in homes, and reduce inappropriate use of secondary care admissions. These models are described, and the need for them to be subjected to evaluation.

Testing the relationship between local cue-response patterns and the global structure of communication behaviour.

A central assumption of negotiation research is that organized sequences of cues and responses underlie the dimensions and constructs found to structure interaction. We empirically tested this assumption using a new 'proximity' coefficient, which measures the global interrelationships among behaviours based on their intrinsic local organization within an interaction sequence. An analysis of sequences from 21 hostage negotiations showed that local cue-response dependencies are organized in a way that corresponds with an established structural model of communication. Further analysis of case-specific coefficients showed that criminal, political and domestic incidents involve very different cue-response dynamics, with criminal incidents dividing into two distinct types of interaction. The importance of the proximity concept for unifying local and global accounts of negotiation behaviour, and the avenues of research made possible by the proximity coefficient, are discussed.

Trust: missing piece(s) in the safety puzzle.

While trust is increasingly recognized as a factor that impacts on safety behavior, the exact nature of trust and its role in shaping organizational safety is poorly understood. This special issue contains six articles that examine the relationship between trust and safety behavior in a range of high-risk work contexts. The issue begins with two articles that introduce the complex nature of trust and the positive and negative roles that trust can play in shaping an organization's safety culture. This background is then developed by two articles that explore the role of trust and distrust in safety performance, and uncover a range of significant but often counterintuitive relationships between forms of trust and safe behavior. Finally, the issue concludes with two articles that examine the role that leadership may play in developing trust. These articles examine the conditions important for the development of trust in leaders, and the trust-promoting actions that leaders can employ to influence employees' engagement in safety participation.

The role of distrust in offshore safety performance.

Trust is recognized as a potentially important factor in safety within high-risk industries. However, little detailed empirical research has explored how trust operates in these contexts to influence worker safety performance. The present study addresses this by (i) identifying the target (occupational group) in which trust is most important for good safety, and (ii) establishing the "type" of trust (trust or distrust) with the greatest impact on safety performance. A questionnaire survey of 203 UK offshore gas workers' attitudes of trust and distrust toward four occupational groups (workmates, supervisors, offshore managers, and contractors) and an operating company was conducted. Logistic regression analysis identified attitudes toward offshore management as the strongest predictor of safety performance at an industry level. At an installation level, safety performance was best predicted by attitudes toward contractors and workmates. Further analysis revealed attitudes of distrust as better predictors of safety performance compared to attitudes of trust. These findings suggest that safety professionals should pay more attention to the role of distrust in safety performance. They also suggest that safety initiatives should target attitudes toward specific groups for optimal effectiveness.