The morbidity in adult scoliosis surgery is minimized with less invasive techniques. The rate of major complications in this study (12.1%) compares favorably to that reported from other studies of surgery for degenerative deformity.

SummaryObjective To assess (1) whether the Schwartz Center Rounds ("Rounds"), a multidisciplinary forum which brings together hospital staff to discuss the nonclinical, social and emotional aspects of caring for patients, could transfer from the US to a UK setting; and (2) whether UK Rounds would achieve a similar positive impact on individuals and teams, and hospital culture.Design The results reported are based on 41 qualitative interviews with context provided by additional quantitative research.Setting We introduced Rounds at two pilot sites, both NHS hospitals providing acute care.Participants Over the one-year, ten-Rounds pilot period, Rounds were attended by 1250 staff across the two sites. We conducted qualitative research into the experiences of staff involved in implementing Rounds at the outset and the end of the pilot.Main outcome measures Interviewees' assessment of the effects of Rounds on participants, their relationships with colleagues, and the wider hospital.Results The findings show that in the two pilot trusts, Rounds are perceived by participants as a source of support and that their benefit may translate into benefits for patients and team working; and that Rounds have the potential to effect change in the hospital culture.Conclusion Rounds appear to transfer successfully from the US to the UK, and there is some evidence that they are having a similarly positive impact, but more research is needed.

Background: Research shows that the way that healthcare staff experience their job impacts on their individual performance, patient experience and outcomes as well as on the performance of organisations. This article builds on this literature by investigating, with multi-disciplinary clinical teams as well as patients and relatives, what factors help or hinder changes designed to improve patient experience. Methods: Qualitative research looking at patient-and family-centred care (PFCC) on two care pathways (stroke and hip fracture) was conducted in England and Wales. A realist approach combined with participatory action research was used to account for the complexity of organisational context and power relations. Multiple methods were used, including documentary analysis, participatory steering groups with staff and patient representatives, observations of the care pathways (n = 7), staff and patient and relative focus groups (n = 8), and hospital staff, patient and PFCC staff interviews (n = 47). Results: Findings highlight multiple factors that support and hinder good patient experiences. Within individual care, paternalistic values and a lack of shared decision-making and patient-centred care still exist. Supportive interdisciplinary teamwork is needed to address issues of hierarchy, power and authority amongst staff and managers. At the organisational level, key issues of waiting times, patient flow, organisational resources and timely discharge affect staff's time and capacity to deliver care. In addition, macro contextual factors, such as finance, policy, targets and measures, set particular limits for improvement projects. Conclusions: Given this context, improving patient experience needs to go well beyond small-scale projects at the micro and meso level to incorporate a more critical understanding of systems, the wider organisational context and how power operates at multiple levels to enable and constrain action. In order to more meaningfully understand and address the factors that can help or hinder activities to improve patient experiences, PFCC frameworks and methods need to account for how power inequities operate and require the adoption of more participatory coproduced and empowering approaches to involve patients, relatives, carers and staff in improving complex healthcare environments.

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Although seasonal variations in births are observed in all human populations, the links between calendar events and sexual activity have received little attention in relation to health promotion and service provision. We have plotted various relevant data--routinely collected data for births within and outside of marriage, abortions, sexually transmitted infections, human immunodeficiency virus tests and condom sales figures--by calendar period. The trends point consistently to an increase in sexual activity and unsafe sex occurring at or around the Christmas period, and a longer but less pronounced subsidiary period of increased sexual activity and unsafe sex coinciding with the summer vacation. We conclude that seasonal patterns of sexual activity have implications for provision of sexual health services and for the timing and targeting of sexual health promotional interventions.

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ObjectiveTo evaluate the impact of Schwartz Center Rounds, a multi-disciplinary forum to reflect on the emotional consequences of working in healthcare, on the staff of a large acute general hospital over a three-year period.DesignEvaluation data following each Round were collected routinely from all staff attending over this period and analysed quantitatively and qualitatively.SettingAn integrated university teaching trust with both acute hospital and community services in the North East of England.ParticipantsOver the three-year period of the study, 795 participant evaluation forms were returned by staff attending the Rounds.Main outcome measuresA standard evaluation form completed at the end of each Round by those present, including ratings on a five-point scale against each of eight statements and an opportunity to offer additional free text comments.ResultsThe findings show a very positive response to all aspects of the Rounds by staff who attended. The most highly rated statement was: ‘I have gained insight into how others think/feel in caring for patients’. This was reinforced by the qualitative analysis in which the primary theme was found to be Insight. There were no significant differences between disciplines/staff groups, indicating that all staff whether clinical or non-clinical responded to the Rounds equally positively.ConclusionsSchwartz Rounds are highly valued by staff from all disciplines, and by managers and other non-clinicians as well as clinicians. They appear to have the potential to increase understanding between different staff, and so to reduce isolation and provide support.

Practitioners are under constant pressure to evaluate their work. In the current environment, health professionals frequently have limited time and financial resources, and opportunities for using existing data sets must be exploited. Routinely collected data provide a potentially useful resource for use in this context. The aim of this paper is to discuss the potential uses of routinely collected data in the evaluation of health promotion interventions. Opportunities for and limitations of routine data are discussed, drawing on examples primarily from the field of sexual health, to demonstrate principles which are also relevant in other areas of health care.