bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skill mix in primary care: the scale and distribution of skill mix in GP practice across England
Authors: McDermott Imelda , Spooner Sharon , Gibson Jon , Sutton Matt , Hann Mark , Checkland Kath , Hodgson Damian , McBride Anne 
Published: June 2019

BackgroundDecades of under investment in primary care and inattention to suboptimal recruitment and retention of GPs and nurses have contributed to a workforce crisis. The General Practice Forward View sets out how the government is planning to achieve a strengthened model of general practice. A key element of this proposal is to expand the workforce by employing an increasingly diverse range of practitioners i.e. ‘skill mix’. The commitment to broadening skill mix in primary care is reiterated in the NHS Long Term Plan (LTP), with the announcement of a 5-year deal to boost investment in primary care. A significant proportion of this investment focuses on increasing the number of ‘new’ roles such as clinical pharmacists, physiotherapists, physician associates, and paramedics.AimThis presentation offers an early analysis of the scale and distribution of current skill mix in general practice across England. This is part of a wider study about how skill mix is affecting outcomes, costs, and experiences of healthcare in England.MethodDescriptive analysis of a longitudinal practice-level workforce data set using the practice-level workforce Minimum Data Set (wMDS).ResultsWe will present early findings about how staffing has changed and average changes within a region or a clinical commissioning group.ConclusionThese data will indicate the extent of progress towards achievement of the LTP vision of skill mix employment. Findings will inform our future analysis of the structures, contexts, and processes of these new ways of working and provide policymakers, commissioners, and practices with evidence about the wider effects of skill mix.
GPs’ views about their role when children and young people disclose a history of bullying in the community: a qualitative study
Authors: Prasad Vibhore , Condon Laura 
Published: June 2019

BackgroundBullying among children and young people (CYP) can lead to both physical and mental health consequences. CYP may disclose episodes of bullying and seek help from their GP. Therefore GPs have an important role in dealing with the mental and physical health consequences of bullying. However, there is currently little research on GPs’ views and perceptions on their role in dealing with bullying.AimTo explore GPs views about their role in dealing with disclosures of bullying by CYP.MethodSemi-structured interviews were conducted with GPs in England. Purposive sampling was used to achieve variation in GP demographics. Data were collected until thematic saturation was reached and analysed using the constant comparative method.ResultsData from 14 semi-structured interviews revealed three main themes: GP experience, bullying in schools and cyberbullying, and training needs. There was an encompassing feeling that dealing with disclosures of bullying came down to a GP’s clinical experience rather than guideline recommendations, which do not currently exist; and that bullying was a precipitating factor in presentations of CYP’s mental health issues. Continuing professional development opportunities are needed. Such opportunities should include both the nature and health consequences of bullying, including cyberbullying, for which GPs felt ill prepared but which was reported to affect their practice.ConclusionGPs feel they have a role to play in managing and supporting the health of CYP who disclose bullying. However, they feel ill equipped in dealing with these disclosures. There is a need for collaboration between GPs and education services to improve support.
An exploration of the views and training status of GPs in Ireland on termination of pregnancy following its legalisation
Authors: O’Connor Raymond , Spain Eimear , O’Doherty Jane , O’Mahony Michael 
Published: June 2019

BackgroundIn May 2018, abortion laws in Ireland were liberalised allowing medical abortion for the first time. It was envisaged that Irish GPs would provide this service.AimTo elicit the views and level of preparedness of Irish GPs to provide medical termination of pregnancy.MethodIn total 222 practising GPs were surveyed. Participants are affiliated with the Graduate Entry Medical School (GEMS) in the University of Limerick, as well as graduates of the University Specialist Training Programme in General Practice.ResultsThe response rate was 57% (127/222): 93.7% of GPs were willing to share abortion information with their patients; 48.0% would be willing to prescribe abortion pills before 12 weeks’ gestation, with 37.0% unwilling to do so. A further 40.9% of responders believed that such a service should not be part of general practice, with a further 17.3% indicating uncertainty. 72.4% believed that those who do not wish to be part of the process should be entitled to a conscientious objection (CO) but should also be obliged to refer a woman to a participating doctor. Over four-fifths (82.7%) of GPs had no training in this area of practice, with 3.2% indicating that they had sufficient training. The majority of responders feel that necessary support services such as counselling are not currently available.ConclusionExploring the views and experiences of GPs in Ireland on this topic reveals many issues which need to be resolved before the service can be rolled out in a safe manner. It will be vital for state and professional bodies to provide appropriate education and guidance.
Is it safe to leave my patient at home? Interprofessional community-based learning
Authors: Penrose Heidi , Ainsworth-Smith Mark , Wills Carmel , Scallan Samantha 
Published: June 2019

BackgroundJoint training of clinicians working in overlapping care areas can be a powerful way to help develop cross-professional insights and knowledge, and stimulate shared reflection and development. This poster describes a novel educational evening, which saw GP trainees and South Central Ambulance Service (SCAS) staff coming together to learn and reflect through case-based discussion.AimThe aim of the educational evening was to enable participants to engage in shared learning activities using facilitated case scenarios based on common cases. Evaluation of the session highlighted in particular different approaches to risk management and uncertainty.MethodForty-seven (25 SCAS staff/22 GPs) participants attended the evening and worked in mixed SCAS/GP groups, which were facilitated by educators drawn from general practice and paramedic education. All participants completed pre-session information sheets and post-session evaluations.ResultsParticipants valued the evening and reported broadened knowledge and insight about the clinical work of the other group, including the nature of work and differences in care management practice. Participants reported that the case-based scenarios were relevant.ConclusionThe event helped participants to better understand each other’s roles gain and to learn together. The educational evening demonstrated that shared leaning can be powerful and generate insights for trainees and SCAS clinicians. Participants also made suggestions as to how the event might be developed for the future.
Evaluating a large-scale roll out of blood pressure telemonitoring using routinely acquired data
Authors: McKinstry Brian , Hammersley Vicky , Parker Richard , Pinnock Hilary , Padfield Paul , Hanley Janet , Stoddart Andrew , Steventon Adam 
Published: June 2019

Background1.2 million appointments in Scottish primary care annually are used solely for checking blood pressure (BP). While evidence from randomised controlled trials (RCTs) shows that telemonitoring of BP produces significant reductions, it has not been mainstreamed because of difficulties in integrating telemonitoring with routine medical care. With NHS Lothian a system was developed which extracted data from a telemonitoring provider website, and delivered it as a routine DOCMAN report to GP practices without need for logons.AimTo determine the feasibility of implementing telemonitoring of high blood pressure (HBP) at scale in primary care and the potential of using routinely acquired data for exploring clinical and resource-use impacts.MethodPractice recorded BP, prescribing, and appointments data were transferred for all people with HBP to a safe-haven. We compared before and after BPs at 1 year from participants and non-participants. Patient and clinician interviews.ResultsOver 2400 people were recruited to telemonitoring overall. Over a year, BP control improved in both telemonitoring participants and non-participants. Mean systolic BP (SBP) fell by 6.6 mmHg in participants and 3.5 mmHg in non-participants. In uncontrolled participants (SBP >135 mmHg home-monitored) average fall was 15 mmHg. Proportion with very poor control BP (SBP >150 mmHg) fell from 13.6% to 3.4%. Appointment data were challenging to interpret, but there was little change from the previous year in face-to-face appointment time and total appointments. Patients and clinicians were positive about the implementationConclusionThe study demonstrated an improvement in BP control similar to effects in RCTs in routine general practice with little impact on workload using routinely acquired data providing strong support for mainstreaming low-cost telemonitoring for HBP.
eHub: Enhancing the emergence of the electronic consultation
Authors: Dyer-Smith Ross , Badial Gurbaksh 
Published: June 2019

BackgroundAlternatives to face-to-face consulting (F2F) with patients have been developed including telephone consulting and e-consulting. One area of concern about both alternatives is that they may act to increase total consultation time by generating additional F2F consultation activity.AimTo determine the proportion of clinical e-consults where a GP requested a follow-up F2F consultation and to determine whether e-consultation training reduced the proportion of GP requests for a follow-up F2F consultation.MethodA longitudinal study was conducted observing ‘remote closure’ rates (the proportion of clinical e-consults with no F2F follow-up appointment) before and after the launch of a dedicated at scale electronic consultation ‘eHub’ with a bespoke technical and clinical training programme. Remote closure rates were available for 42 months prior and 22 months following the intervention. A follow-up GP consultation was defined as the doctor requesting the patient to make a F2F appointment.ResultsThe remote closure rates were 63% (3019/4778) before and 87% (6957/7993) after the intervention. χ2 with Yates correction 1024.9; P<0.001.ConclusionThe consultation as a core competency of GP training requires specific skills for e-consulting. We have devised a training package for e-consultation training. Following implementation of a package of intensive e-consultation training, remote closure rates of 87% were obtained. Some of the observed increase in remote closure rates may have been attributable to increased familiarity of both GPs and patients with new models of consultation. We plan to test our e-consulting educational package in other settings with low e-consultation closure rates.
GP–consultant liaison Southampton 2018
Authors: Aggarwal Pritti , Ross Sally , Fraser Adam 
Published: June 2019

BackgroundCollaborative working across primary and secondary care is crucial to providing quality, safe care.AimImprove professional understanding, foster deeper partnership, ignite opportunities for innovation and quality improvement (QI) with co-owned local solutions.MethodFifty-nine consultants and GPs were strategically paired to enhance working relationships. Pairs hosted and visited each other’s workplace. Anonymous reflections were analysed for common themes and celebrated in an evening of shared learning where the focus was on compassionate leadership and next steps.ResultsFeedback from 71 (60%) participants was scaled from 1 (least likely) to 6 (most likely). Individuals supported a regular primary–secondary care forum; weighted average score of 5.25, found the scheme useful (4.59), likely to take part again (4.83), consider new ways of working (3.85). Production of leaflets on psychological support for patients in hospital consequent to insight obtained from primary care were produced, directories of primary care secretary’s were shared and outpatient clinic letters to state ‘For Information Only’ or ‘GP Action Required’ were restructured resulting in substantial time and cost savings. The liaison improved morale and insight and built better relationships. Common themes from reflections revolved around compassion, collaboration, complexity, efficiency, and education.ConclusionThis scheme was an easy and enjoyable way to reconnect individuals and allowed professionals to learn about challenges we face within the NHS. As QI activity, the scheme resulted in simple local solutions for patients. It is a low-cost intervention that can be replicated within any organisation in the NHS. It needs a motivated and persistent individual driving the project forward.
Державне управління у сфері цивільного захисту: грані міжнародного співробітництва в контексті євроінтеграції України
Authors: Бойко О. А. 
Published: June 2019

Проаналізовано стан міжнародного співробітництва України у сфері цивільного захисту. Основний акцент зроблено на співробітництві в рамках Європейського Союзу, Організації Північноатлантичного договору. Обґрунтовано та запропоновано шляхи подальшого поглиблення співробітництва в межах Механізму цивільного захисту Європейського Союзу, двостороннього співробітництва з країнами-членами Європейського Союзу.
Os processos da Igreja
Authors: Muniz Pollyanna Gouveia Mendonça 
Published: June 2019

Este artigo tem por objetivo apresentar o acervo do Tribunal Episcopal do bispado do Maranhão enquanto fonte para a pesquisa histórica. O estudo será dividido em duas partes, os processos cíveis e os processos crime. Em cada um desses itens, será explorada a potencialidade desses processos para a discussão de diferentes temáticas em História; tais como o uso dos documentos da Igreja para investigações em história econômica, para a averiguação de temas em história social, religião, cotidiano, dentre outros.
EDUCAÇÃO INCLUSIVA: O QUE DIZEM OS DOCUMENTOS?
Authors: Branco Maia Beatriz , Ávila de Lima e Dias Marian 
Published: June 2019

Resumo Dentre os textos do Ministério da Educação representativos da posição oficial sobre a educação inclusiva no Brasil, realizamos a análise de três documentos: as Diretrizes nacionais para a educação especial na educação básica (BRASIL, 2001); a Política nacional de educação especial na perspectiva da educação inclusiva (BRASIL, 2007); e Educação inclusiva: a fundamentação filosófica (ARANHA/SEESP, 2004). A análise evidencia que os textos apresentam categorias argumentativas de defesa da educação inclusiva principalmente a partir de valores morais e argumentos legalistas: para que a lei seja cumprida e para contribuir com uma sociedade justa, solidária e mais igual. Apesar de os documentos mencionarem a adaptação dos sistemas escolares, verificamos que estes pouco se detêm sobre o fazer pedagógico e as práticas inclusivas no ambiente escolar. O texto conclui que as contradições e inconsistências observadas na implementação da educação inclusiva também estão presentes nos próprios textos que buscam fornecer seus fundamentos. Palavras-chave: educação; educação inclusiva; fundamentos filosóficos.
BIBLIOTECA SÓLON BORGES DOS REIS: RELEVÂNCIA E POTENCIALIDADES DO ACERVO PARA A HISTÓRIA DA EDUCAÇÃO BRASILEIRA
Authors: De Souza Rosa Fátima 
Published: June 2019

Este texto apresenta uma reflexão sobre as peculiaridades da Biblioteca Sólon Borges dos Reis e sua relevância para a pesquisa No campo da História da Educação. Partindo de uma perspectiva autobiográfica, destaca a contribuição do acervo dessa instituição para a escrita da história do ensino primário, secundário e da educação rural no estado de São Paulo. O texto assinala a importância da preservação dessa biblioteca como instituição de memória da educação e aponta possibilidades de investigações inéditas com base no acervo.
La Ética Profesional Pedagógica y su Incidencia en la Evaluación del Desempeño Profesional del Docente
Authors: Lema Cachinell Alejandro Nicolas , Castro Durand Yaneiris , Zaldívar Almarales Daniel Austin 
Published: June 2019

La presente investigación hace levantar la mirada para realizar un examen crítico del quehacer profesional en términos de captar elementos del actuar del docente, donde se reflejan los modos de comprender y regular el comportamiento profesional favorablemente; pero, sin ser muy categóricos, se puede plantear que el abordaje científico del aspecto ético dentro de la evaluación del desempeño profesional del docente todavía no alcanza la jerarquía que este particular merece. Se analiza el comportamiento de la ética profesional pedagógica y su incidencia en la evaluación del desempeño profesional del docente.
Дослідження кутів прецесії та нутації куль стрілецької зброї після пробиття перешкод
Authors: Holub V. A. , Chepkov I. B. , Larin O. Yu. , Kuprinenko O. M. , Bisyk S. P. 
Published: June 2019

Наведено результати експериментальних досліджень впливу тонких сталевих перешкод на значення кутів нутації куль стрілецької зброї. Отримано залежності кутів прецесії і нутації від відстані після перешкод різної товщини. На основі отриманих результатів доведено перспективність використання в конструкції броньового захисту бойових колісних машин пристроїв, у яких реалізовано принцип попереднього впливу на кулі ще до початку їхньої взаємодії з броньовими деталями корпусу.
Методика оцінки стану живучості та вибухопожежобезпеки військових потенційно небезпечних об’єктів
Authors: Chernozubenko Oleksandr , Абрамсон А. Н. , Мошковський М. С. , Бабич А. М. 
Published: June 2019

Обгрунтовано визначення показників та критеріїв оцінки системи забезпечення живучості й вибухопожежобезпеки арсеналів, баз та складів, на яких зберігаються ракети, боєприпаси, вибухові речовини, компоненти ракетного палива та пально-мастильні матеріали. Запропоновано методику та програму оцінки стану живучості таких потенційно небезпечних об’єктів.
SÍNDROME DE SWEET ASOCIADO A LEUCEMIA MIELOIDE AGUDA: REPORTE DE UN CASO EN PERÚ
Authors: Quispe-Arango Ayde , Neyra-León Jesús Andreé , Franco-Soto Mario Luis , Antonio-Travezan Pedro Salvador 
Published: June 2019

Reporte de caso: Síndrome de Sweet asociado a Leucemia mieloide aguda Se presenta el caso de paciente mujer de 79 años que presenta fiebre, placas eritemato-violáceas y ampollas de contenido seroso, dolorosas en el antebrazo y dorso de la mano izquierda.
Los hemogramas seriados revelaron la presencia de anemia, leucocitosis marcada con neutrofilia, trombocitopenia y linfopenia. Se realiza lámina periférica donde se observa blastos (79%) y cuerpos de Auer. La biopsia de la lesión cutánea señala un infiltrado denso perivascular de neutrófilos maduros en la dermis superficial sin vasculitis asociada. Se diagnosticó Síndrome de Sweet asociado a Leucemia mieloide aguda, iniciando terapia de acuerdo a protocolo. El síndrome de Sweet es una afección cutánea poco frecuente de causa desconocida que se caracteriza por aparición brusca de fiebre, afectación del estado general y lesiones tipo placas o nódulos eritematosos muy dolorosos, con o sin pseudovesículas, de predominio en el hemicuerpo superior. Además, es frecuente leucocitosis, neutrofilia y PCR elevado.
Numénius a-t-il commenté le Parménide ?
Authors: Jourdan Fabienne 
Published: June 2019

Si Numénius, en platonicien de son temps, a utilisé le Timée et la République pour élaborer et étayer sa pensée métaphysique et cosmologique, il est devenu coutume de penser qu’il a également eu recours au Parménide dans sa description du premier principe. Il peut même paraître tentant d’identifier chez lui ce principe à l’Un. L’examen attentif de son œuvre ne fournit cependant que peu d’indices en ce sens et convainc même qu’elle ne permet pas une telle interprétation. Malgré ces conclusions, l’hypothèse persiste pour des raisons qui tiennent principalement à l’histoire de la philosophie et aux recherches qu’elle suscite. Elle est en effet souvent reprise pour trois raisons, présentées comme corollaires : le statut propre à Numénius de platonicien pythagorisant, prédécesseur de Plotin ; les affinités réelles entre sa pensée et celle du Commentaire anonyme au Parménide ; les parallèles également entrevus entre ses formules et celles de la source supposée commune au Zostrien et au Contre Arius de Marius Victorinus, conçue quant à elle comme fort proche du Commentaire anonyme . Autrement dit, sont invoquées trois raisons nées moins de l’étude de l’œuvre de Numénius elle-même que de la recherche des sources d’autres textes en mal d’auteur et d’origines bien définies, recherche se fondant en partie sur les prétendus liens entre Numérius et ses « pairs » en pythagorisme. L’étude proposée comporte trois parties indépendantes, examinant chacune de ces trois raisons avec les hypothèses qui lui sont associées. Après une esquisse des principaux tenants de la pensée de Numénius, cette première partie aborde les rapports parfois perçus et ceux encore perceptibles entre son œuvre et le Parménide . Elle montre que Numénius n’a visiblement pas utilisé le dialogue de Platon pour élaborer sa propre doctrine des deux premiers principes et a même pu adopter une relative distance à l’égard de l’Un de la première hypothèse, suivant en cela une injonction qu’il a pu penser percevoir chez Platon lui-même. Dès ce premier examen, il apparaît que l’œuvre parvenue de Numénius ne suggère pas de bouleverser la conception la plus courante de l’histoire du platonisme en faisant de Numénius le précurseur de Plotin dans l’interprétation métaphysique du Parménide . L’interrogation sur son rapport à ce dialogue fournit même a contrario les critères d’une interprétation réellement néoplatonicienne de la seconde partie de celui-ci. Un prolongement de cette étude montre toutefois que Numénius a pu inspirer Plotin dans son interprétation de certaines formules du Parménide historique lui-même.
L’entrée en pédagogie différente : « La part de l’enfant dans l’éducation du maître »
Authors: Gentès Deborah 
Published: June 2019

Cet article traite de « l’entrée en pédagogie différente » à partir d’une re-définition du statut de l’enfant et de celui de l’adulte dans la relation éducative, qui trouve son origine dans la pédagogie Freinet. En s’appuyant sur les différentes implications de l’auteur, en tant qu’enseignante, parent et chercheuse sur le terrain de l’éducation en anthropologie symétrique, nous verrons par quel biais, nous pouvons apprendre des enfants, et comment nous pouvons accéder au partage de leurs expériences.