CDSS are likely to be more acceptable and effective if the prescribing support is provided much earlier in the process of generating a prescription.

BackgroundGetting lost outside is stressful for people with dementia and their caregivers and a leading cause of long-term institutionalisation. Although Global Positional Satellite (GPS) location has been promoted to facilitate safe walking, reduce caregivers’ anxiety and enable people with dementia to remain at home, there is little high quality evidence about its acceptability, effectiveness or cost-effectiveness. This observational study explored the feasibility of recruiting and retaining participants, and the acceptability of outcome measures, to inform decisions about the feasibility of a randomised controlled trial (RCT).MethodsPeople with dementia who had been provided with GPS devices by local social-care services and their caregivers were invited to participate in this study. We undertook interviews with people with dementia, caregivers and professionals to explore the perceived utility and challenges of GPS location, and assessed quality of life (QoL) and mental health. We piloted three methods of calculating resource use: caregiver diary; bi-monthly telephone questionnaires; and interrogation of health and social care records. We asked caregivers to estimate the time spent searching if participants became lost before and whilst using GPS.ResultsTwenty people were offered GPS locations services by social-care services during the 8-month recruitment period. Of these, 14 agreed to be referred to the research team, 12 of these participated and provided data. Eight people with dementia and 12 caregivers were interviewed. Most participants and professionals were very positive about using GPS. Only one person completed a diary. Resource use, anxiety and depression and QoL questionnaires were considered difficult and were therefore declined by some on follow-up. Social care records were time consuming to search and contained many omissions. Caregivers estimated that GPS reduced searching time although the accuracy of this was not objectively verified.ConclusionsOur data suggest that a RCT will face challenges not least that widespread enthusiasm for GPS among social-care staff may challenge recruitment and its ready availability may risk contamination of controls. Potential primary outcomes of a RCT should not rely on caregivers’ recall or questionnaire completion. Time spent searching (if this could be accurately captured) and days until long-term admission are potentially suitable outcomes.

High test retest reliability is essential in tests used for both scientific research and to monitor athletic performance. Thirty-nine (20 male and 19 female) well-trained university field hockey players volunteered to participate in the study. The reliability of the 9 in house designed 10 test was determined by repeating the test (3-14 days later) following full familiarisation. The validity was assessed by comparing coaches ranks of players with ranked performance on the skill test. 12The mean difference and confidence limits in overall skill test performance was 0.0 13 ± 1.0% and the standard error (confidence limits) was 2.1% (1.7 to 2.8%). The mean 14 15 difference and confidence limits for the 'decision making' time was 0.0 ± 1.0% and the 16 standard error (confidence limits) was 4.5% (3.6 to 6.2%). The validity correlation (Pearson) 17 was r = 0.83 and r= 0.73 for female players and r = 0.61 and r = 0.70 for male players for 18 19 20 21 overall time and 'decision making' time respectively. We conclude that the field hockey skill test is a reliable measure of skill performance and that it is valid as a predictor of coach assessed hockey performance, but the validity is greater for female players. To undertake research into field hockey in a controlled setting, it is necessary to employ a skill test that can be completed in the laboratory environment. However, there are only a limited number of field hockey skill tests and very little has been done scientifically to formulate tests that measure playing ability (14). Two decades later, further developments of hockey tests had not advanced. Reilly and Borrie (10) noted that it was surprising that even though field hockey had been part of the Physical Education curriculum in Europe and North America since the beginning of the 20 th Century, there had been little attention given to the design of field tests for the game.Thus, at present the number of published tests of field hockey skill is limited and no skill tests have been published during the last fifteen years. With the advent of synthetic sportsturfs as the major playing surface over that period, it is apparent that the skills have changed significantly and thus there is a need to develop a skill test that is appropriate to modern field hockey. Furthermore, the skill tests were designed to determine differences in skill performance between players, rather than to monitor improvements or changes for a particular player, and thus were not stringently tested for reliability.In the formulation of a skill test, it is important that technique is differentiated from skill.Technique is the production of some pattern of movements which are technically sound (7).The following definition of skill will be used for the purpose of the design of this study: "Skill is the learned ability to bring about predetermined results with the maximum certainty, often with the minimum outlay of energy, or of time and energy," (7). This encompasses the idea that a skilled athlete must take an action that is appropriate and theref...

BackgroundSharing the electronic health‐care record (EHR) during consultations has the potential to facilitate patient involvement in their health care, but research about this practice is limited.MethodsWe used multichannel video recordings to identify examples and examine the practice of screen‐sharing within 114 primary care consultations. A subset of 16 consultations was viewed by the general practitioner and/or patient in 26 reflexive interviews. Screen‐sharing emerged as a significant theme and was explored further in seven additional patient interviews. Final analysis involved refining themes from interviews and observation of videos to understand how screen‐sharing occurred, and its significance to patients and professionals.ResultsEighteen (16%) of 114 videoed consultations involved instances of screen‐sharing. Screen‐sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: ‘convincing’ the patient of a diagnosis or treatment; ‘translating’ between medical and lay understandings of disease/medication; and by patients ‘verifying’ the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient.ConclusionsScreen‐sharing can facilitate patient involvement in the consultation, depending on the way in which sharing comes about, but the perception that the record belongs to the doctor is a barrier. To exploit the potential of sharing the screen to promote patient involvement, there is a need to reconceptualise and redesign the EHR.

Desert theories of distributive justice have been attacked on the grounds that they attempt to found large inequalities on morally arbitrary features of individuals: desert is usually classijied as a meritocratic principle in contrast to the egalitarian principle that goods should be discributed according to need. I argue that there is an egalitarian version of desert theory, which focuses on eflort rather than success, and which aims at equal levels of well-being; I call it a 'well-being desert' theory. It is argued that this egalitarian conception of desert is preferable to a meritocratic conception, and that its adoption would encourage greater clarity in arguments over wage differentials and in debates about m'teria for job and educational competitions.