The role of primary care in adult weight management: qualitative interviews with key stakeholders in weight management services

Background: Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Methods: Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach. Results: A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance). Conclusions: Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

Objective: To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). Design: Cross-sectional study. Setting: Regional specialist WMS located in the West of Scotland. Participants: 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. Primary and secondary outcome measures: Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. Analysis: Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. Results: Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. Conclusions: There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation

Rapid surfactant-free synthesis of Mg(OH)2 nanoplates and pseudomorphic dehydration to MgO

Magnesium hydroxide nanoplates ca. 50 nm in thickness can be prepared over minute timescales via hydrothermal synthesis in a multimode cavity (MMC) microwave reactor. This approach allows ca. 1 g of single-phase Mg(OH)2 to be synthesised in under 3 minutes without the requirement of surfactants or non-aqueous solvents. The hydroxide nanomaterial dehydrates at temperatures >200 K below that of the equivalent bulk material and can be utilised as a precursor for the pseudomorphic synthesis of nanoplates of MgO as investigated by TG-DTA-MS, XRD and SEM measurements. Equally, the pseudomorphic synthesis can be performed by irradiating the Mg(OH)2 nanomaterial with microwaves for 6 minutes to produce single phase MgO

Pupil mobility, attainment and progress in secondary school

This paper is the second of two articles arising from a study of the association between pupil mobility and attainment in national tests and examinations in an inner London borough. The first article (Strand & Demie, 2006) examined the association of pupil mobility with attainment and progress during primary school. It concluded that pupil mobility had little impact on performance in national tests at age 11, once pupils’ prior attainment at age 7 and other pupil background factors such as age, sex, special educational needs, stage of fluency in English and socio-economic disadvantage were taken into account. The present article reports the results for secondary schools (age 11-16). The results indicate that pupil mobility continues to have a significant negative association with performance in public examinations at age 16, even after including statistical controls for prior attainment at age 11 and other pupil background factors. Possible reasons for the contrasting results across school phases are explored. The implications for policy and further research are discussed

Teacher induction: personal intelligence and the mentoring relationship

This article is aimed at probationer teachers in Scotland, their induction supporters, and all those with a responsibility for their support and professional development. It argues that the induction process is not merely a mechanistic one, supported only by systems in schools, local authorities and the General Teaching Council for Scotland (GTCS), but a more complex process where the relationship between the new teacher and the supporter is central to its success. In particular, the characteristics and skills of the induction supporter in relation to giving feedback are influential. This applies to feedback in all its forms – formative and summative, formal and informal. The ability of the probationer to handle that feedback and to be proactive in the process is also important

Longitudinal genomic surveillance of MRSA in the UK reveals transmission patterns in hospitals and the community.

Genome sequencing has provided snapshots of the transmission of methicillin-resistant Staphylococcus aureus (MRSA) during suspected outbreaks in isolated hospital wards. Scale-up to populations is now required to establish the full potential of this technology for surveillance. We prospectively identified all individuals over a 12-month period who had at least one MRSA-positive sample processed by a routine diagnostic microbiology laboratory in the East of England, which received samples from three hospitals and 75 general practitioner (GP) practices. We sequenced at least 1 MRSA isolate from 1465 individuals (2282 MRSA isolates) and recorded epidemiological data. An integrated epidemiological and phylogenetic analysis revealed 173 transmission clusters containing between 2 and 44 cases and involving 598 people (40.8%). Of these, 118 clusters (371 people) involved hospital contacts alone, 27 clusters (72 people) involved community contacts alone, and 28 clusters (157 people) had both types of contact. Community- and hospital-associated MRSA lineages were equally capable of transmission in the community, with instances of spread in households, long-term care facilities, and GP practices. Our study provides a comprehensive picture of MRSA transmission in a sampled population of 1465 people and suggests the need to review existing infection control policy and practice

Research findings from the Memories of Nursing oral history project.

Capturing the stories of nurses who practised in the past offers the opportunity to reflect on the changes in practice over time to determine lessons for the future. This article shares some of the memories of a group of 16 nurses who were interviewed in Bournemouth, UK, between 2009 and 2016. Thematic analysis of the interview transcripts identified a number of themes, three of which are presented: defining moments, hygiene and hierarchy. The similarities and differences between their experiences and contemporary nursing practice are discussed to highlight how it may be timely to think back in order to take practice forward positively in the future