Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator

Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care

Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

Photoacoustic detection of stimulated emission pumping in p-difluorobenzene

Photoacoustic detection has been used to monitor a stimulated emission pumping process in p‐difluorobenzene. Using the Ã^(1)B_(2u)5^1 state as an intermediate, several vibrational levels of the ground electronic state were populated. The photoacoustic method is an attractive alternative to other detection techniques because of its sensitivity, simplicity, and its ability to differentiate between stimulated emission pumping and excited state absorption. An example of excited state absorption in aniline is given

Systems development of a stall/spin research facility using remotely controlled/augmented aircraft models. Volume 1: Systems overview

A ground based, general purpose, real time, digital control system simulator (CSS) is specified, developed, and integrated with the existing instrumentation van of the testing facility. This CSS is built around a PDP-11/55, and its operational software was developed to meet the dual goal of providing the immediate capability to represent the F-18 drop model control laws and the flexibility for expansion to represent more complex control laws typical of control configured vehicles. Overviews of the two CSS's developed are reviewed as well as the overall system after their integration with the existing facility. Also the latest version of the F-18 drop model control laws (REV D) is described and the changes needed for its incorporation in the digital and analog CSS's are discussed

Technological development of cylindrical and flat shaped high energy density capacitors

Cylindrical wound metallized film capacitors rated 2 micron F 500 VDC that had an energy density greater than 0.3 J/g, and flat flexible metallized film capacitors rated at 2 micron F 500 VDC that had an energy density greater than 0.1 J/g were developed. Polysulfone, polycarbonate, and polyvinylidene fluoride (PVF2) were investigated as dielectrics for the cylindrical units. PVF2 in 6.0 micron m thickness was employed in the final components of both types. Capacitance and dissipation factor measurements were made over the range 25 C to 100 C, and 10 Hz to 10 kHz. No pre-life-test burning was performed, and six of ten cylindrical units survived a 2500 hour AC plus DC lift test. Three of the four failures were infant mortality. All but two of the flat components survived 400 hours. Finished energy densities were 0.104 J/g at 500 V and 0.200 J/g at 700 V, the energy density being limited by the availability of thin PVF2 films

Forest and range mapping in the Houston area with ERTS-1

ERTS-1 data acquired over the Houston area has been analyzed for applications to forest and range mapping. In the field of forestry the Sam Houston National Forest (Texas) was chosen as a test site, (Scene ID 1037-16244). Conventional imagery interpretation as well as computer processing methods were used to make classification maps of timber species, condition and land-use. The results were compared with timber stand maps which were obtained from aircraft imagery and checked in the field. The preliminary investigations show that conventional interpretation techniques indicated an accuracy in classification of 63 percent. The computer-aided interpretations made by a clustering technique gave 70 percent accuracy. Computer-aided and conventional multispectral analysis techniques were applied to range vegetation type mapping in the gulf coast marsh. Two species of salt marsh grasses were mapped

Study of fluid transients in closed conduits progress report no. 64-5, 1-30 nov. 1964

Fluid transients in closed conduit

Evaluation of CBS 600 carburized steel as a gear material

Gear endurance tests were conducted with one lot of consumable-electrode vacuum-melted (CVM) AISI 9310 gears and one lot of air-melt CBS 600 gears. The gears were 8 pitch with a pitch diameter of 8.89 centimeters (3.5 in.). Bench-type rolling-element fatigue tests were also conducted with one lot of CVM AISI 9310, three lots of CVM CBS 600, and one of air-melt CBS 600 material. The rolling-element bars were 0.952 centimeter (0.375 in.) in diameter. The CBS 600 material exhibited pitting fatigue lives in both rolling-element specimens and gears at least equivalent to that of CVM AISI 9310. Tooth fracture failure occurred with the CBS 600 gears after overrunning a fatigue spall, but it did not occur with the CVM AISI 9310 gears. Tooth fracture in the CBS 600 was attributed to excessive carbon content in the case, excessive case depth, and a higher than normal core hardness

Series-hybrid bearing - An approach to extending bearing fatigue life at high speeds

Fluid film bearing of hybrid device consists of orifice compensated annular thrust bearing and self-acting journal bearing. In series hybrid bearing, both ball bearing and annular thrust bearing carry full system thrust load, but two bearings share speed. Operation of system is stable and automatically fail-safe