Objectives: to elicit healthcare practitioners’ views on treatment following sport-related knee injury in young adults (18–35) and the potential for individuals to self-manage joint health. Design: Semi-structured interviews were audio-recorded, transcribed and analysed systematically using an inductive approach. Setting: South West UK. Participants: Twelve healthcare practitioners with experience of treating young adults. Main outcome measures: Understanding how healthcare practitioners treat young adults following knee injury and to what extent individuals may be able to self-manage knee health. Results: Participants’ perceptions were encapsulated in three consistent themes: [1] Treating patients; [2] Maintaining physical activity; and [3] Education and support. All participants described how staying physically active and maintaining a healthy weight were integral to conserving knee health, and that post-injury education was necessary to “empower” patients to self-manage knee health. A need for greater access to support, advice and guidance for patients was also articulated. Conclusions: Healthcare practitioners should tailor their treatment to young adults to account for individual characteristics, aspirations for sport and exercise participation, and their emotional wellbeing. Fulfilment of individuals’ educational and supportive needs is key to the establishment of self-management behaviours that may help to conserve knee health.

Background: Regular exercise is vital for overall health, and key to the maintenance of joint health. However, whilst people are encouraged to participate in sport and exercise, many are unaware that they could be at risk of developing post-traumatic osteoarthritis (PTOA) in the years following sport-related injury. Younger adults (< 40 years) with PTOA can experience declining quality of life, comorbid health conditions, and symptoms that place a chronic burden on health services. Conserving knee health through careful self-management in the latency period between injury and the onset of PTOA may help to delay disease progression. In this regard, the development of self-management interventions can be facilitated by understanding the post-injury experiences of young adults and their attitudes towards joint health. Methods: Semi-structured interviews were conducted with 13 young adults following a sport-related knee injury to explore their experiences of injury, and their attitudes and perceptions of self-managing knee health. The interviews were audio-recorded, transcribed and analysed systematically using an inductive approach. Results: Four themes pertaining to participants' experiences were identified: [1] perceptions of current care provision; [2] long-term impact of knee injury; [3] motivation to conserve knee health; and [4] opportunities for supplementary support. The expression "Nobody says to you 'come back in six months and we'll see how you're doing'"personifies the long-term impact of knee injury on young adults and a paucity of care provision. Conclusion: Participants did not perceive that they had adequate care in the aftermath of knee injury, leading to a sense of frustration and uncertainty. This had implications for continued participation in sport and exercise, negatively impacting their athletic identity and sense of wellbeing. Activity tracking, symptom monitoring, advice provision and peer support were identified as tools to enable individuals to self-manage knee health.

Background: the expansion of community pharmacy services is one solution to relieve pressure on general practice in the United Kingdom (UK). There is a paucity of research of general practitioners’ (GPs’) perspectives of quality of care in the community pharmacy sector. The purpose of this study was to explore GPs’:Conceptualisation of quality for community pharmacy services, including the management of acute (low acuity) conditions and defining indispensable aspects of the patient experience (‘always events’)Opinions regarding whether and how to measure quality in the community pharmacy sector Method: Semi-structured interviews were conducted with GPs in the UK. GPs were recruited using the snowballing technique and professional networks. Interviews were audio-recorded, transcribed and analysed using an interpretive approach. Results: Interviews were completed with 20 GPs from Scotland (n = 8) and England (n = 12). Multidimensional and inter-related concepts of quality were identified; most dimensions related to patient benefit, as well as impact on GP workload or other health service provision. Interviewees cautioned that “what counts can’t always be measured”. GPs’ expectations of quality often mirrored those of their own sector, but were ambivalent about the adoption of a quality outcome framework-type approach. Pharmacist involvement was expected to ensure quality in the management of ‘acute consultations’, however, GPs lacked awareness of community pharmacy personnel type, roles and training. Interviewees’ perceptions of quality varied by pharmacy type; independent pharmacies were sometimes associated with higher quality service delivery than larger chain organisations. Conclusions: Quality frameworks for community pharmacy services could be partly informed by GP experience and expectations, but need to be contextual to reflect differences between both settings. The importance of person-centred care, consistency and continuity was emphasised together with the need for competent personnel and privacy of interactions.

Objectives This study explored citizens' perspectives about the quality of community pharmacy services in the UK and whether and how the quality of community pharmacy services should be measured. Design Semistructured interviews and focus groups were conducted and were audio recorded, transcribed and analysed systematically using an interpretive approach. Participants Members of the public were approached via networks, such as Health and Social Care Alliance Scotland, as well as community groups and personal networks. Setting Scotland, England and Wales. Results Data were collected from 20 participants: 11 interviews and 2 focus groups (in community settings, with five and four participants). Quality was conceptualised as multidimensional with inter-related overarching themes of person-centredness, professionalism and privacy. The importance of relational aspects with pharmacy personnel was emphasised including the need for a 'friendly' caring service, continuity of care, being known to personnel, including their awareness of individual's health conditions: 'it's quite a personal service I would say. I think it means that they care about your welfare'. Participants discussed the importance of a professional approach to customer interactions including staff behaviour and appearance. Pharmacy design influenced perceptions of privacy, including having sufficient space or a separate consultation room to promote confidential consultations with a pharmacist. Participants suggested that quality assurance is needed to improve quality and to inspire confidence in the public 'it would drive up quality standards overall' but suggested that quality ratings were unlikely to influence their use of specific pharmacies. They emphasised the need for multidimensional quality ratings and for transparency with their derivation. Conclusions the public conceptualises quality of community pharmacy services as multidimensional and value relational aspects of care provided by personnel in this setting. While the development and application of quality indicators may drive improvement, it seems unlikely to influence the public's use of individual pharmacies.

Addressing problems associated with malnutrition in care home residents has been prioritized by researchers and decision-makers. This review aimed to better understand factors that may contribute to malnutrition by examining the attitudes, perceptions and experiences of mealtimes among care home residents and staff. Five databases were searched from inception to November 2015: Medline, Embase, PsychINFO, AMED, and the Cochrane Database. Forward and backward citation checking of included articles was conducted. Titles, abstracts, and full texts were screened independently by two reviewers and quality was assessed using the Wallace criteria. Thematic analysis of extracted data was undertaken. Fifteen studies were included in the review, encompassing the views and opinions of a total of 580 participants set in nine different countries. Four main themes were identified: (1) organizational and staff support, (2) resident agency, (3) mealtime culture, and (4) meal quality and enjoyment. Organizational and staff support was an over-arching theme, impacting all aspects of the mealtime experience. Mealtimes are a pivotal part of care home life, providing structure to the day and generating opportunities for conversation and companionship. Enhancing the mealtime experience for care home residents needs to take account of the complex needs of residents while also creating an environment in which individual care can be provided in a communal setting. PROSPERO Registration: CRD42015025890.

BACKGROUND: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents' health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents' experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents' enjoyment of meals, and resulting health and wellbeing. METHODS: Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. RESULTS: the dining experience was a focal point for participants' broader experiences of residing in a care home. Three themes pertaining to residents' experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. CONCLUSION: Mealtimes are a mainstay of life in a care home through which residents' experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.

BACKGROUND: Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to investigate the views of stakeholders on the key components of community-based interventions coordinating care in dementia. METHODS: We searched four databases from inception to June 2015; Medline, the Cochrane Library, EMBASE and PsycINFO, this was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted thematic synthesis on extracted data. RESULTS: a total of seven papers from five independent studies were included in the review, and encompassed the views of over 100 participants from three countries. Through thematic synthesis we identified 32 initial codes that were grouped into 5 second-order themes: (1) case manager had four associated codes and described preferences for the case manager personal and professional attributes, including a sound knowledge in dementia and availability of local services; (2) communication had five associated codes and emphasized the importance stakeholders placed on multichannel communication with service users, as well as between multidisciplinary teams and across organisations; (3) intervention had 11 associated codes which focused primarily on the practicalities of implementation such as the contact type and frequency between case managers and service users, and the importance of case manager training and service evaluation; (4) resources had five associated codes which outlined stakeholder views on the required resources for coordinating interventions and potential overlap with existing resources, as well as arising issues when available resources do not meet those required for successful implementation; and (5) support had seven associated codes that reflect the importance that was placed on the support network around the case manager and the investment of professionals involved directly in care as well as the wider professional network. CONCLUSION: the synthesis of relevant qualitative studies has shown how various stakeholder groups considered dementia care coordination interventions to be acceptable, useful and appropriate for dementia care, and have clear preferences for components, implementation methods and settings of these interventions. By incorporating stakeholders' perspectives and preferences when planning and developing coordinating interventions we may increase the likelihood of successful implementation and patient benefits.

BACKGROUND: Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. METHODS: We searched four databases from inception to April 2017: Medline, the Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. RESULTS: a total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = -9.5; 95% confidence interval (CI): -18.1 to -1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = -0.54; 95% CI: -1.01 to -0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p 

BACKGROUND: it is estimated that people with dementia are approximately three times more likely to fracture their hip than sex and age matched controls. A report by the Chartered Society of Physiotherapy found that this population have poor access to rehabilitation as inpatients and in the community. A recent scoping review found a paucity of research in this area, indeed there has been no qualitative research undertaken with physiotherapists. In order to address this evidence gap, the aim of this current study was to explore the experiences of physiotherapists treating this population. METHODS: Semi-structured interviews with physiotherapists were undertaken in order to gain an in-depth understanding of how they manage this population. Physiotherapists were recruited from all over the UK and a purposive sampling strategy was employed. Thematic analysis was utilised. RESULTS: a total of 12 physiotherapists were interviewed, at which stage data saturation was reached as no new themes were emerging. The participants had a broad range of experience both in physical and mental health settings. Analysis identified three separate themes: challenges, "thinking outside the box" and realising potential. Physiotherapists felt significant pressures and challenges regarding many aspects of the management of this population. Mainly this was the result of pressures placed on them by guidelines and targets that may not be achievable or appropriate for those with dementia. The challenges and importance of risk taking was also highlighted for this population with an appreciation that standard treatment techniques may need adapting. "Rehabilitation potential" was highlighted as an important consideration, but challenging to determine. CONCLUSION: Interventions for the management of people with dementia and hip fracture need to consider that a traditional biomedical physiotherapy approach may not be the most appropriate approach to use with this population. However physiotherapists reported feeling pressurised to conform to a biomedical approach.