bluuebunny/crossref_metadata_2025 huggingface dataset:
Cluster randomised feasibility trial to test the routine use of the Needs Assessment Tool: Cancer (NAT:-C) in primary care to reduce unmet patient and carer needs and determine the feasibility of a definitive trial
Authors: Clark Joseph , Amoakwa Elvis , Blenkinsopp John , Currow David , Farrin Amanda , Foy Robbie , Macleod Una , Meads David , Wright-Hughes Alexandra , Johnson Miriam
Published: June 2019

Background

People with cancer commonly have unidentified palliative care needs. The NAT-C is a validated tool to identify and triage unmet needs.

Aim

To assess the feasibility and acceptability of a primary care cRCT of the NAT-C: 1) recruiting four GP-practices and 40–60 patients, 2) uptake of NAT-C, 3) questionnaire completion 4) acceptability of measures.

Method

A non-blinded cRCT with process evaluation. Patients with active cancer were identified through cancer registries or opportunistically. Carers were nominated by patient-participant. Participants completed measures at baseline, 1, 3, and 6 months. Patients booked a 20-minute GP-assessment post-baseline. Patients, carers, and GP practice staff participated in interviews and focus groups.

Results

Five GP practices were approached, four recruited and trained in the use of the NAT-C. Practices were randomised (1:1) to provide a consultation with a known NAT-C trained clinician, or a clinician as usual. Forty-seven patients and 17 carers were recruited. Process evaluation informed refinement of study invitations. Recruitment rate showed a trial was feasible. Forty-three (94%) patients received a study appointment, 42/43 (95%) attended and 32/43 (76%) a NAT-guided consultation. The proposed primary outcome measure (Supportive Care Needs Survey) was completed by 43 (91%) at 1 month and the proportion with ≥1 moderate–severe unmet need fell from 72% (baseline) to 45%. Fifteen patient interviews and four focus groups with GP practices were conducted. Participants supported the definitive trial and found measures acceptable.

Conclusion

A definitive cRCT is feasible based on the recruitment rate, intervention uptake, and data collection.
Active participation of ‘real-time’ patients in undergraduate medical education: a qualitative study
Authors: Alao Adedoyin , Burford Bryan , Hrisos Susan , Alberti Hugh , Kennedy David , Barton Roger , Vance Gillian
Published: June 2019

Background

The ‘patient’s voice’ is increasingly emphasised in educational strategies. However, much of this has focused on patients who have been recruited to have a primary educational role. Students also benefit from interaction with ‘real-time’ patients who attend the clinical settings with diverse health problems. The involvement of these patients does not usually extend to having an active part in the learning encounter, where the patient completes a potential triadic relationship with the clinical teacher and student.

Aim

To identify ways to enhance the active participation of ‘real-time’ patients in medical students’ training.

Method

Focus groups were conducted with patients, who were selected purposively from an earlier questionnaire survey. The discussions were audiorecorded, transcribed, and analysed using thematic analysis.

Results

A total of twenty-three participants attended four focus groups in general practices across the North East of England. Patient involvement in medical education may be described using Communities of Practice theory. Patients’ role within the educational Community of Practice is mainly peripheral. Factors affecting their active involvement may operate at the micro level (individual teaching consultation), organisational level, or within the NHS. Issues identified include patients’ awareness about medical education, ambiguity about their role, attitude of the doctor, and processes for consent and feedback.

Conclusion

This research has provided insights into patients’ perspectives towards their involvement in medical education. The data may provide evidence for a practical framework to encourage and prepare patients to play an active role in educational processes.
Routine health monitoring and preventative care for people with dementia in UK primary care
Authors: Bhanu Cini , Jones Mary Elizabeth , Walters Kate , Petersen Irene , Cooper Claudia
Published: June 2019

Background

UK National Dementia Strategies prioritise fair access to dementia treatment for all. It has been shown that people from black and minority ethnic (BME) groups are diagnosed later and those are less likely to receive anti-dementia medication.

Aim

It is hypothesised that access to primary care services post diagnosis is also reduced in ethnic minority groups.

Method

The Health Improvement Network (THIN) database of UK primary care records was analysed between 2015 and 2016, all patients with dementia were identified, and health service use was compared. Annual GP consultations, blood pressure (BP), weight/body mass index (BMI), Quality and Outcomes Framework (QOF) dementia review, and flu vaccination recordings were compared between ethnic groups.

Results

Over 20 000 individuals with a dementia diagnosis aged 50–105 years were included. There was no significant difference between white, black, and Asian groups across all outcomes. Overall 80% received an annual BP check, 86% received at least one annual GP consultation, 68% received an annual dementia review, and 48% had a weight/BMI recorded. People with dementia who did not have cardiovascular risk factors were less likely to have their BP checked (59%) and be seen by a GP.

Conclusion

There do not appear to be ethnic inequalities in primary care service use post-dementia diagnosis. The overall proportion receiving an annual dementia review and weight check was low, despite recommendations that a care plan should be reviewed annually (including nutrition as a key priority). Post-diagnosis support and preventative care should be prioritised in general practice for all people living with dementia.
Implementation of social prescribing to reduce frequent attender consultation rates in primary care
Authors: Jeyes Adam , Pugh Laura
Published: June 2019

Background

The impact of social determinants on health has been established. Evidence shows that addressing social needs through link workers can improve wellbeing and consultation rates. This is of importance since demand on primary care appointments is high and access to primary care is pivotal to the NHS as a whole.

Aim

To evaluate whether frequently-attending patients who might benefit from social prescribing, can be recognised through a computer search of risks for isolation, loneliness, or social pressures and whether a social intervention has an effect on wellbeing and consultation rate.

Method

Patients highlighted as frequent attenders (≥20 GP/nurse practitioner [NP] appointments in past 12 months) were screened for appropriateness of referral to link worker. A social risk tool was applied to select patients most at risk of social isolation. Patients who agreed had a pre- and post-intervention wellness score calculated. Number of appointments pre- and post-intervention were also recorded and matched by month. Post-intervention questionnaires allowed collation of qualitative data analysing patient opinions of the scheme.

Results

There was an average increase in wellbeing score post-intervention of 0.8/5. The average reduction in appointments for GPs and NPs combined was 5.1 appointment/patient (37% reduction) at 6 months and 12.9 appointments/patient at 1 year (53% reduction).

Conclusion

The numbers in this project are small, but it supports the growing evidence that social prescribing can improve patient well-being and sustained reduced demand for GP and NP appointments. It supports the suggestion that computer searches can delineate a high-risk population.
Variation in tests for people with type 2 diabetes, hypertension, or chronic kidney disease in UK primary care
Authors: Patel Rita , Elwenspoek Martha , Watson Jessica , Mann Ed , Alsop Katharine , Whiting Penny
Published: June 2019

Background

Rates of pathology testing are rising in the UK, with significant geographical variability. Around 50% of overall GP laboratory testing represents monitoring for chronic conditions such as high blood pressure, type 2 diabetes, and chronic kidney disease (CKD). Overuse of tests for monitoring chronic conditions may be a potential source of harm; causing patient anxiety, downstream tests/referrals, overdiagnosis, increase GP workload and increase health service costs. On the other hand, failure to test may lead to missed diagnoses, complications, patient harm and litigation.

Aim

This study aims to use an open cohort to examine current variation in the use of tests for individuals with type 2 diabetes, hypertension, and CKD>2 across the UK.

Method

Clinical Practice Research Datalink (CPRD) data will be used to consider what tests have been ordered for people with these conditions and look at variation over time, and by region, age, sex, ethnicity, and socioeconomic position using age–sex-standardised utilisation rates, descriptive statistics, and multilevel Poisson regression.

Results

An estimated 1.2 million patients within the CPRD database have previously been diagnosed with any of the chronic conditions with over 11 million tests. Some 1 029 496 patients have hypertension, 344 613 with diabetes, and 271 897 with CKD>2, with much overlap. The results from this study will help to find what tests are currently used among patients with these conditions and to quantify variation in testing.

Conclusion

This work will be used to inform the development of testing algorithms for patients with these conditions in primary care.
The incidence, prevalence, and management of plantar heel pain in Dutch general practice
Authors: Rasenberg Nadine , Bierma-Zeinstra Sita MA , Bindels Patrick , van der Lei Johan , Van Middelkoop Marienke
Published: June 2019

Background

Plantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.

Aim

The objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.

Method

A cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.

Results

The overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).

Conclusion

PHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.
A qualitative evaluation of a Clinical Effectiveness Scheme in London
Authors: Shefer Guy , Kordowicz Maria
Published: June 2019

Background

Clinical Effectiveness Southwark (CES) is a London-based primary care Quality Improvement (QI) scheme with the aim of improving clinical quality across local general practice. In order to improve patient outcomes in selected long-term conditions, a team of four GPs, working with other professionals, developed condition-based short guides, clinical templates, and other educational interventions.

Aim

A mixed methods evaluation of the processes and impact of CES in its implementation and operation phases.

Method

In the first year, qualitative methods were used which included 18 interviews, one focus group and observation of 53 meetings, educational events and teleconferences. The data were analysed thematically using NVivo software. The result of surveys with local clinicians about their use of CES guides are reported.

Results

In the first year since formation, CES produced seven clinical guides and three templates. Six months after the launch of the first three guides, 57% of the survey responders reported using at least one guide in their practice. Electronic templates took longer than expected to develop. The existence of other (typically online) guidelines and a wish for even shorter, more concise, guides were among the reasons reported by those who did not use the guides on a regular basis.

Conclusion

There is a demand from GPs and nurses for high quality, well-written, short, easy to use, local guides for various conditions.
Gout in primary care: can we improve patient outcomes?
Authors: Blakey Georgina , Callear Jacqueline
Published: June 2019

Background

Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common.

Aim

Improvement cycles aimed to educate patients, improve uric acid monitoring, and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance.

Method

A computer-based retrospective search at a large inner-city GP practice between January 2014–December 2014 identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels, and deficiencies in uric acid monitoring. All patients in the cohort received a telephone consultation regarding their gout followed by a diet, lifestyle, and advice sheet in the post. A new gout phlebotomy order set was devised to include full blood count, urea and electrolytes, cholesterol, urate, random blood sugar, and HbA1c. Letters were sent out to arrange for these blood tests in patients who had not received them during the previous 12 months.

Results

The improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (P = 0.14), 20% reduction in patients experiencing one or more gout flares, and 77% reduction in GP related consultations between March 2015 and March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (P = 0.0001).

Conclusion

The improvement and Plan, Do, Study, Act cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.
Potentially inappropriate medications in older patients based on Beers criteria at a large family medicine clinic in Saudi Arabia
Authors: Alturki Atheer
Published: June 2019

Background

The use of potentially inappropriate medications (PIMs) is an issue especially among older patients who have medical comorbidities. They are more at risk to drug adverse effects compared to younger patients.

Aim

To determine the prevalence of PIMs use according to Beers criteria among the older population in a large family medicine setting in Saudi Arabia and to identify the associated risk.

Method

This was a prospective cross-sectional study conducted from June 2017 to June 2018. All patients aged ≥65 years who were followed-up at the family medicine clinics were included. The American Geriatrics Society 2015 Updated Beers Criteria were used to determine the PIMs use.

Results

A total of 270 older patients aged 72.41 ± 6.23 years were included in the study. The prevalence of PIMs was 60.7%. Multivariate analyses identified three independent variables associated with PIMs: incremental age per 5 years (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.15 to 1.88; P = 0.002), female sex (OR 1.95; 95% CI = 1.10 to 3.42; P = 0.021), and polypharmacy (OR 8.21; 95% CI = 4.58 to 14.7; P<0.001). The most common PIMs used were 39.4% related to proton pump inhibitors (PPIs), 25.2% to diuretics (other than spironolactone), 10.6% to non-steroidal anti-inflammatory drugs (NSAIDs), and 8.7% to aspirin use.

Conclusion

This study showed high prevalence of PIMs. Increasing age, female sex, and polypharmacy were found to be significant risk factors for PIMs use. The present study reinforces the importance of comprehensive medication management and reviews. Future research should evaluate interventions aimed at improving primary care follow-up and reducing the prevalence of PIMs.
Trends in reported incidence of erectile dysfunction, hypogonadism, PDE5i prescriptions and TRT in patients with type 2 diabetes in primary care
Authors: Schartau Patricia , Horsfall Laura , Nazareth Irwin , Molokhia Mariam , Kirby Michael , Sharma Manuj
Published: June 2019

Background

Erectile dysfunction (ED) and testosterone deficiency (TD) are complications of type 2 diabetes mellitus (T2DM), and predictors of cardiovascular disease. Guidelines recommend that men with T2DM are assessed and treated for ED/TD, which was included into the Quality and Outcomes Framework (QOF) from 2013–2014 only.

Aim

Explore the effects of QOF on ED/TD diagnoses and management in T2DM patients.

Method

The study population included males (≥18 years) with T2DM and contributing to UK GP electronic health records from 1999–2016. Adjusted incidence rate ratios (IRRs) were estimated using multivariable Poisson regression.

Results

In total 135 342 adult males (mean age 60 years) with T2DM were included. During follow-up, 60 819 (45%) had a recorded ED assessment, 23 834 (18%) an ED diagnosis and of these 73% received a phosophodiesterase-5 inhibitor (PDE5i). ED assessments increased from 7.6 per 1000 PYAR in 2012 (95% confidence interval [CI] = 7.0 to 8.3) to 620 in 2013 (95% CI = 614 to 626) when included into QOF but dropped to 59.4 (95% CI = 56 to 63) in 2016. Compared with 2012, the adjusted incidence of recorded ED diagnoses and PDE5i prescriptions doubled in 2013 (incidence rate ratio [IRR] 2.0; 95% CI = 1.8 to 2.1) before falling to below pre-QOF levels in 2016 (IRR 0.89; 95% CI = 0.82 to 0.97). Of 1187 diabetic men diagnosed with ED or receiving a PDE5i in 2015, 213 (18%) had minimum one testosterone measurement, of which 45 (21%) met criteria for hypogonadism (testosterone ≤8nmol/l). Nine (20%) subsequently received testosterone replacement therapy (TRT).

Conclusion

To improve diagnosis and management of ED/TD in T2DM patients and thereby (cardiovascular) health and quality of life, incorporation of guidelines into a GP framework and/or financial incentives may be required alongside GP education.
Transforming community nursing services in the UK: lessons from a participatory evaluation of the implementation of a new model of community nursing in East London
Authors: Lalani Mirza , Fernandes Jane , Fradgley Richard , Ogunsola Caroline , Marshall Martin
Published: June 2019

Background

Buurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings.

Aim

This study aimed to examine the transferability of some of the principles of the Buurtzorg model to community nursing in the UK NHS.

Method

A community nursing model based on the Buurtzorg approach was piloted between June 2017 and August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London. The initiative was evaluated using a qualitative approach within the participatory Researcher-in-Residence model. Participant observation of meetings and semi-structured interviews with team members, patients/carers, and other local stakeholders were undertaken. A thematic framework analysis of the data was carried out.

Results

Patient experience of the service was positive, in particular because of the better access, improved continuity of care and longer appointment times in comparison with traditional district nursing provision. However, certain aspects of the Buurtzorg model were difficult to put into practice in the NHS because of significant cultural, human resource, and regulatory differences between The Netherlands and the UK.

Conclusion

While many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience, and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.
Routine consultations for dermatology problems in adults in general practice: cross-sectional study
Authors: Le Roux Emma , Edwards Peter , Sanderson Emily , Barnes Rebecca , Ridd Matthew
Published: June 2019

Background

Dermatological conditions present frequently in general practice, and treatment failure is common due to low adherence with treatments. There has been little research exploring GP consultations for skin problems.

Aim

To describe consultations for skin problems in adults including shared decision making (SDM) around treatment decisions, delivery of self-management advice, and follow-up.

Method

Data were extracted from the One in a Million Study, an archive of 327 videorecorded routine GP adult consultations and linked data. A coding instrument was developed and refined, which was applied to all consultations where a skin problem was identified as having been discussed. SDM was assessed using OPTION. Twenty per cent of the consultations were double coded and inter-rater reliability assessed. Data were analysed using Stata, with descriptive statistics reported.

Results

In total 45 consultations (13.8%) were examined, featuring a mean of 2.2 problems. Of the 100 problem types, 51 were dermatological. Mean time spent on skin problems was 4:16 minutes (29.6% of total duration of consultations with ≥2 problems). SDM for skin problems was low, with mean OPTION score of 10.7 (range 0–35). Self-management advice was given for 47.1% of skin problems (verbal only). Most skin problems (84.3%) were not referred to secondary care; 32.6% of skin problems not referred were seen again in primary care within 12 weeks of the index consultation, of which 35.6% were unplanned.

Conclusion

Skin problems commonly present alongside other complaints. SDM and self-management advice are uncommon. While most dermatological problems are not referred, patients often re-consult for the same problem.
Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: a qualitative study
Authors: Charman Sarah , Okwose Nduka , Maniatopoulos Gregory , Graziadio Sara , Vale Luke , Metzler Tamara , Seferovic Petar , Fuat Ahmet , Deaton Christi , Mant Jonathan , Hobbs FD Richard , Jakovljevic Djordje
Published: June 2019

Background

Primary care physicians lack access to an objective cardiac function test during diagnostic testing for suspected heart failure.

Aim

To determine the role of the novel Cardiac Output Response to Stress (CORS) test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.

Method

Qualitative study using semi-structured in-depth interviews which were audiorecorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. Fourteen healthcare professionals (six males, eight females) from primary (GPs, nurses, healthcare assistants, and practice managers) and secondary care (consultant cardiologists) participated.

Results

Four themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include establishment of clinical utility, suitability for immobile patients, and cost implication to GP practices.

Conclusion

The development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose however, factors such as cost-effectiveness, diagnostic accuracy, and seamless implementation in primary care have to be fully explored.
Evaluating health and well-being outcomes following the South Gloucestershire Pain Review pilot for patients on long-term opioids for chronic non-cancer pain
Authors: Kesten Jo , Scott Lauren , Bache Kevin , Closs Rosie , Redwood Sabi , Thomas Kyla
Published: June 2019

Background

The South Gloucestershire Pain Review pilot is an individually-tailored service to help primary care patients on long-term (>3 months) treatment with opioid painkillers for chronic non-cancer pain understand their relationship with opioids and support alternative non-drug-based pain management strategies. The pilot was based in two GP practices in South Gloucestershire.

Aim

To evaluate the health and well-being outcomes and perceived impact of the pilot service to inform future service development.

Method

Quantitative data were collected for all enrolled patients on demographics; opioid use, misuse and dose; and pre-post intervention changes in health, well-being, quality of life (QoL), pain intensity/relief, and interference with life measures. Twenty-five semi-structured interviews (18 service users, seven service providers) explored experiences of the pilot including perceived impacts.

Results

Fifty-nine patients were invited to use the service and 34 (58%) enrolled. The median prescribed opioid dose reduced from 90 mg (interquartile range [IQR] 60–240) at baseline to 72 mg (IQR 30–160) at follow-up (P<0.001). On average, service users showed improvement on all health, well-being, and QoL outcomes except pain relief. The service was received positively. Perceived benefits related to well-being and QoL, use of pain management strategies (for example pacing), changes in medication use and changes in primary care use.

Conclusion

The pilot has shown promising results. The service was viewed as acceptable and health and well-being outcomes suggest a benefit. Following further development of the service, a randomised controlled trial is needed to formally test the effects of this type of care pathway on pain management and reducing long-term opioid use.
Shared care pitfalls: high dose antipsychotic monitoring in the community
Authors: Shemtob Lara , Douglas Brian
Published: June 2019

Background

Shared care is an integral part of monitoring patients on high-dose antipsychotics (HDA). These off-label prescription medications used for treatment resistant schizophrenia carry significant risk of harm, including sudden death. The challenges of monitoring HDA prescriptions are complex in the community setting.

Aim

Identify pitfalls in community HDA prescribing and monitoring through an audit of a busy London adult psychosis service caseload.

Method

Two years on from an initial caseload audit and multidisciplinary team education programme, compliance on HDA monitoring forms was re-audited in greater depth. Correspondence between the community psychiatric team and each patient’s GP was reviewed, looking for evidence of shared care protocols. Results were combined with a literature search.

Results

None of monitoring tests were adequately recorded. In 100% of cases windows for repeat ECG and observation monitoring had been missed. In 100% of cases blood tests had been carried out by the GP but this information was not documented appropriately. 0% of case records showed clear documentation of the shared care protocol from psychiatric team to GP.

Conclusion

HDA psychotic monitoring policies has been poor when audited at inpatient centres, however, these audits have led to improvements in guideline compliance. In this case, MDT education failed to lead to improvement. The primary–secondary care interface leaves GPs lacking certainty in their roles monitoring HDAs. Patients in the community are not always stable enough to have the insight or motivation to consistently engage with services. New strategies with a focus on shared care have been implemented to drive quality improvement.
Innovating to build GP trainer capacity in London
Authors: Tate Andrew , Carter Nerys , Osborne Sarah
Published: June 2019

Background

A new GP trainer programme was developed by Health Education England (HEE) London in recognition of the need to expand GP trainer capacity across London, providing a flexible, non-accredited course within existing resources. An evaluation of its effectiveness was commissioned to assist the future development of primary care training courses.

Aim

The aim of the new GP trainer programme was to provide GP educators with access to authentic, practical, ‘real world’ experiences of GP training. It was also to build and connect the GP community; in particular, the GP training community. Indeed, the course aimed not only to encourage GPs to become trainers but in a very real sense ensure their preparation for practice.

Method

The programme consisted of five compulsory face-to-face taught days; self-directed learning via online modules, podcasts and reading; compulsory attendance at local GP trainer workshops; and an optional reflective portfolio.

Results

The rationale behind the development of the programme was that the appropriate education of primary healthcare practitioners is dependent on trainers having a sound understanding of key adult learning principles as well as the necessary practical and professional skills to facilitate effective teaching, learning, and assessment in practice. It purposefully lowered barriers to participation by emphasising and focusing on the practical application of relevant educational theory, and ensuring that assessments of GP trainer’s competence are appropriate and proportionate.

Conclusion

This presentation will discuss the processes and decisions involved in developing and designing this programme, as well as the implications of a recent evaluation of its impact.
The combined care clinic: a strategy in improving quality and efficiency related to essential patient reviews in the UK
Authors: Khoosal Nishaan , Swanson David , Purohit Girish , Morgan Cath , Bharkhada Amit
Published: June 2019

Background

Standardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.

Aim

To understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.

Method

The CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.

Results

QOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.

Conclusion

The CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.
Processos judiciais
Authors: Slemian Andréa , Feitler Bruno
Published: June 2019

Os processos judiciais tem sido uma fonte praticamente inesgotável para os historiadores desde há muito tempo. Ao menos desde que a história passou a ser contada não apenas com grandes personagens e heróis, com a definitiva entrada em cena de novos agentes cuja abrangência social impôs a necessidade de buscar suas pistas, trajetórias e formas de ação e pensamento em uma maior multiplicidade de resquícios do passado. [...].
El testimonio procesal y la administración de justicia penal en la periferia de la Monarquía Católica
Authors: Agüero Alejandro
Published: June 2019

A partir de la observación de los registros criminales de primera instancia de una justicia municipal de la remota periferia colonial (Córdoba del Tucumán, hoy una provincia de Argentina), procuraré analizar ciertos elementos discursivos que, aun formando parte de la tradición jurídica castellana, resultan difícilmente compatibles con la imagen todavía dominante del derecho penal de la Monarquía Absoluta. Intentaré mostrar además que, a pesar del carácter local y marginal del contexto, estos testimonios pueden servir de base para reflexionar sobre la lectura que hacemos de los cambios y persistencias en las formas de hacer justicia y resolver conflictos y, en particular, sobre el valor heurístico de algunos esquemas conceptuales, tales como justicia lega / justicia letrada; justicia / infrajusticia; community law / state law; justicia negociada / justicia hegemónica.
Da Rua do Ouvidor à Rua São Clemente
Authors: Franzini Fábio
Published: June 2019

O objetivo deste artigo é discorrer sobre as fontes que fundamentaram minha pesquisa de doutorado sobre a Coleção Documentos Brasileiros, realizada entre 2002 e 2006, para a partir daí discutir como elas me possibilitaram analisar esse projeto específi co da Livraria José Olympio Editora. Com isso, espera-se evidenciar como a relação entre a documentação encontrada e a não encontrada se mostrou decisiva para que o trabalho tomasse seu rumo e sua forma particulares e, por extensão, como os arquivos das casas editoriais podem ou não ser utilizados como fontes para o historiador.
As exéquias de D. João V e a aclamação de D. José I
Authors: Carrara Angelo Alves , Moreira Lucas Nascimento
Published: June 2019

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Sociedade dos Artistas Mecânicos e Liberais
Authors: Cord Marcelo Mac
Published: June 2019

O artigo que ofereço ao leitor tem por objetivo apresentar um conjunto documental bastante completo, complexo e denso, que foi produzido pela Sociedade dos Artistas Mecânicos e Liberais entre meados do século XIX e meados do século XX. Contudo, nesse texto, restringi minhas análises às fontes relativas ao período imperial – material que embasou minha tese de doutorado, defendida na Universidade Estadual de Campinas, em fevereiro 2009, sob o título “Andaimes, casacas, tijolos e livros: uma associação de artífices no Recife, 1836-1880”, e meu estágio pós-doutoral. Localizada na capital da província de Pernambuco, a referida entidade artística reuniu mestres de ofícios pretos e pardos, brasileiros, livres e libertos, que promoviam práticas de auxílio mútuo e aulas noturnas – inicialmente para os sócios e depois para o público em geral. Junto da análise e da descrição das referidas fontes, também indicarei meus caminhos na pesquisa empírica e minhas escolhas metodológicas.
Apresentação
Authors: Biondi Luigi
Published: June 2019

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Mão de obra na Fábrica de Ferro de São João de Ipanema
Authors: Santos Karina Oliveira Morais dos
Published: June 2019

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Tras las huellas de la Inquisición del Río de la Plata y el Tucumán por bibliotecas de y museos de Córdoba (Argentina)
Authors: Vassallo Jaqueline
Published: June 2019

El trabajar tomando como eje central las actuaciones de las comisarías que operaron en la periferia del imperio español, nos ha permitido evidenciar las marcas producidas en fuentes que no se hallan en los archivos que formó cada tribunal. Se hizo necesario ahondar en las redes que tejieron los comisarios con las autoridades locales o las obligaciones que debían cumplir siguiendo las órdenes de los superiores para poder hallar nuevas evidencias documentales en dos bibliotecas y un museo de la ciudad de Córdoba (Argentina).
Tras las huellas de un fantasma
Authors: Cisneros Gerardo Lara
Published: June 2019

La principal justificación jurídica, política y teológica de la colonización española de América, fue la “salvación” espiritual de los millones de almas de los indios a través del Evangelio. Esta tarea fue responsabilidad del rey quien para ello se auxilió de la Iglesia Católica, y en especial de sus obispos. En el caso particular del Arzobispado de México, los prelados se valieron de tribunales episcopales que les auxiliaron en sus funciones de gobierno y justicia. A dichos tribunales se les conoció como la Audiencia Episcopal o Provisorato Eclesiástico, mismo que, dado el perfil mayoritariamente indígena de la población novohispana, se dividió en dos: uno, el Provisorato del Arzobispado de México, que tuvo jurisdicción sobre la feligresía no india; el otro fue el Provisorato de Indios y Chinos, cuya vocación fue la vigilia de las costumbres de los indios (la mayor parte de la documentación es sobre asuntos matrimoniales), así como todo lo relacionado con las prácticas supersticiosas de los naturales. Este artículo se ocupa, específicamente de la historia de los archivos de esta Audiencia Eclesiástica para indios.
O anel de Sarah Hirsch
Authors: Zagni Rodrigo Medina
Published: June 2019

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A diplomacia brasileira e a Guerra Civil Espanhola
Authors: Souza Ismara Izepe de
Published: June 2019

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O genocídio em Ruanda e a inércia da comunidade internacional
Authors: Mendonça Marina Gusmão de
Published: June 2019

Entre abril e julho de 1994, o mundo assistiu impassível ao extermínio de mais de 800.000 pessoas em Ruanda. Tal morticínio é considerado o terceiro maior ocorrido desde 1950, comparável apenas àqueles verificados no Cambodja e em Bangladesh, na década de 1970. Entretanto, no caso de Ruanda, há um dado assustador: por ocasião da matança, a população do país era de aproximadamente 7.500.000 habitantes, sendo 6.300.000 hutus, 1.100.000 tutsis e 100.000 pigmeus. Isto significa que cerca de 11% dos ruandeses e ¾ da população tutsi foram eliminados em apenas um trimestre. A comunidade internacional nada fez para evitar a matança. Pelo contrário: além de não intervir diretamente, a Organização das Nações Unidas (ONU) reduziu drasticamente o contingente da força de paz que mantinha em Ruanda, a despeito das advertências do General Roméo Alain Dallaire, comandante das tropas da UNAMIR, de que a tragédia estava a caminho. Passado o estupor provocado pelo genocídio, restou o problema fundamental da reconstrução do país. A esse respeito, é preciso assinalar as precaríssimas condições econômicas da região, o que é agravado pelo estraçalhamento do tecido social durante a matança. Ademais, não podemos esquecer que, se em 1994, o mundo assistiu passivamente à dilaceração de Ruanda, agora poucos estão preocupados com as dificuldades de reconstrução de um lugar que não tem importância estratégica e não dispõe de grandes riquezas naturais.Os fatores que levaram ao genocídio em Ruanda e a inércia da comunidade internacional para impedir o massacre são os temas deste artigo.
ENTREVISTA COM JULIA GARCIA. MEMÓRIAS DA REPRESSÃO TRANSCRIÇÃO FINAL DA ENTREVISTA COM JULIA GARCIA REALIZADA POR ISMARA IZEPE DE SOUZA E RODRIGO RODRIGUES. SANTOS, 17 DE JANEIRO
Authors: Souza Ismara Izepe de
Published: June 2019

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LAVAGEM DE CAPITAIS E TERRORISMO NO BRASIL
Authors: PEREIRA FLÁVIO DE LEÃO BASTOS
Published: June 2019

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Adaptação curricular e o aluno com deficiência intelectual: relato de experiência de estágio curricular
Authors: Marques Aline Nathalia , Duarte Márcia
Published: June 2019

A inclusão escolar de alunos com necessidades educacionais especiais, dentre estes, os alunos com deficiência intelectual, demanda da escola e dos professores novas formas de trabalho para de fato incluí-los na aprendizagem dos conteúdos trabalhados. Dessa forma, o presente estudo tem por objetivo mostrar as adaptações curriculares realizadas pela aluna do curso de Licenciatura em Educação Especial da Universidade Federal de São Carlos durante o 1º semestre de 2012 na disciplina de Estágio Supervisionado III. O estágio ocorreu em uma escola de Ensino Fundamental, na cidade de São Carlos - SP. Participaram deste estudo uma professora do Ensino Regular, uma sala do 3º ano do Ensino Fundamental e um aluno com deficiência intelectual matriculado nesta sala. Os resultados apontaram a importância das adaptações curriculares para a aprendizagem do aluno com deficiência intelectual e mostraram que as diferentes oportunidades de apropriação dos conteúdos auxiliaram no processo de ensino e aprendizagem.   Palavras-Chave: Adaptação Curricular. Deficiência Intelectual. Estágio Supervisionado.
Entre disciplinas pedagógicas e disciplinas específicas: a formação de professores e a questão do estágio supervisionado em um curso de Licenciatura Integrada
Authors: Ramos Tacita Ansanello , Rosa Maria Inês Petrucci
Published: June 2019

As disciplinas pedagógicas e específicas, especialmente nos cursos de formação de professores, historicamente vêm sendo marcadas por disputas e relações de poder no que concerne à constituição dos currículos dos cursos de licenciatura. Nessa perspectiva, esse artigo pretende problematizar o aumento da carga horária dos estágios supervisionados, em decorrência das Diretrizes Curriculares Nacionais para a Formação de Professores da Educação Básica - DCNFP (PARECER CNE/CP 9/2001), e as possibilidades que esse aumento tem significado para o afastamento da antiga concepção de formação de professores, que ficou caracterizada como modelo 3+1, para a menor diferenciação entre disciplinas específicas e disciplinas pedagógicas, deixando de lado a antiga concepção da licenciatura como algo de responsabilidade exclusiva da Faculdade de Educação e para tentativas de construção de um currículo mais integrado.
Estágio curricular nas licenciaturas interculturais indígenas: um caso particular na área de linguagens
Authors: Gomes Antonio Almir Silva
Published: June 2019

Este artigo trata especificamente do estágio curricular das Licenciaturas Interculturais Indígenas desenvolvidas em universidades brasileiras como oportunidade para todos os envolvidos melhor conhecer a realidade da Educação Escolar Indígena, bem como pensar sobre ações que a potencialize. O artigo não trata, portanto, da relação da escola com o estagiário ou do professor com o estagiário, mas sobre o que deve ser o ato de estagiar; o que se pretende com essa ação, etc. Muito do que se discute ao longo do artigo, certamente não se constitui novo, mas inovador pelo fato de ser pensado para o contexto da escola indígena institucionalizada em sua natureza diferenciada sob a perspectiva da Legislação Federal Brasileira.
Análise da proposta de estágio na Licenciatura em Educação Física da Universidade de São Paulo
Authors: Ehrenberg Mônica Caldas , Neira Marcos Garcia
Published: June 2019

As mudanças atuais da Educação e da Educação Física buscam superar suas tradicionais práticas educativas para uma prática contextualizada, que amplie os significados dos alunos acerca da cultura corporal. O texto a seguir discute a experiência de estágio disciplinar do curso de Licenciatura em Educação Física da Universidade de São Paulo, cuja preocupação consiste no oferecimento de oportunidades para análise crítica de situações do contexto profissional docente na contemporaneidade. Evidencia-se a efetivação de uma política de estágio como processo significativo para formação de professores tendo em vista a parceria dos esforços de todas as partes envolvidas e, principalmente, situando o licenciando no interior de instituições que possibilitam o conhecimento aprofundado da realidade escolar e a experimentação prática em condições que estimulam a reflexão sobre a docência, além da visualização de alternativas para transformá-la.Palavras chave: Estágio; Educação Física; Licenciatura
Abordagens interdisciplinares nos estágios curriculares na formação de professores
Authors: Ayoub Eliana , Prado Guilherme do Val Toledo
Published: June 2019

Este artigo objetiva analisar os estágios curriculares na formação de professores, tendo em vista as relações entre a formação e a intervenção num percurso que se desenvolve por meio de uma parceria entre a Faculdade de Educação e as faculdades e institutos da Universidade Estadual de Campinas/UNICAMP que têm cursos de licenciatura. Para tal, focalizaremos o curso de Licenciatura em Educação Física, tomando como referência para a análise os materiais de estágio elaborados pelos graduandos, assim como o processo vivido desde 2008, ao longo do nosso trabalho com as turmas integradas de estágio supervisionado da Faculdade de Educação. Consideramos que as experiências formativas interdisciplinares proporcionadas nessas turmas de estágio têm contribuído significativamente para a formação de professores numa perspectiva ampla e complexa.
O estágio supervisionado e a constituição da profissionalidade docente
Authors: Garcia Maria de Fátima , Lustosa Francisca Geny
Published: June 2019

Este artigo discute o estágio supervisionado sob três aspectos interrelacionados: a pesquisa colaborativa entendida como uma metodologia problematizadora de atuação utilizada no desenvolvimento das práticas do referido estágio; a imersão do estudante em sua futura profissionalidade docente; e a escola, território de tensões e transformações, lugar de operacionalização dos estágios e das práticas profissionais. Os dados produzidos remetem-se ao segundo semestre/2010 tendo como empiria relatórios de estágio dos estudantes do curso de Pedagogia do Centro de Ensino Superior do Seridó/UFRN, Caicó/RN. Teorizações relacionadas à pesquisa colaborativa, estágio e profissionalização trazem, dentre outros, Garcia (2002); Pimenta e Lima (2002;2004);  Sacristán (1995); Lustosa (2010), os filósofos Deleuze; Guattari (1995;1996; 2008), intercessores do estudo. Ao final da investigação pode-se afirmar que a experiência do estágio, com base na problematização da escola, na ação-colaboração, e na multiplicidade de vivências, compõe a miríade rizomática traduzida na constituição da profissionalidade docente.
Estágio e formação de docentes de Educação Infantil em cursos de Pedagogia
Authors: Drumond Viviane
Published: June 2019

Resumo: Este artigo discute a formação inicial de professoras de Educação Infantil no Curso de Pedagogia. Aborda a questão do estágio supervisionado em creches e pré-escolas e problematiza as políticas e as pedagogias construídas para a formação de docentes da primeira etapa da Educação Básica. Analisa as mudanças introduzidas nos cursos de Pedagogia, com as novas Diretrizes Curriculares Nacionais, a partir do projeto pedagógico curricular desse curso, com ênfase nas disciplinas que tratam da Educação Infantil. O estudo destaca as contribuições das pesquisas na construção da Pedagogia da Educação Infantil, enquanto referência para a docência com crianças pequenas. Palavras-chave: Educação infantil, curso de pedagogia, estágio docente.
O estágio curricular nos anos iniciais do Ensino Fundamental - Apontamentos sobre o processo de inserção no campo de estágio.
Authors: Fontana Roseli
Published: June 2019

Este texto revisita a noção de “inserção”. Em interlocução com contribuições da antropologia sobre o trabalho de campo, com as discussões de Schwartz acerca dos processos de formação profissional, de Ezpeleta e Rockwell acerca das relações entre a “história documentada” e a “história não documentada”, de Bakhtin sobre a produção de sentidos e de Thompson a respeito da experiência, ele focaliza o processo de inserção do estagiário na escola, como um momento decisivo na constituição da profissionalidade docente, no qual os futuros professores cotejam suas compreensões da docência com as condições sociais cotidianas de sua produção e com as compreensões e sentidos que dela circulam no processo de formação. Palavras chave: formação inicial, prática docente, estágio.