Of the 400,000-500,000 permanent pacemaker leads implanted worldwide each year, around 10% may eventually fail or become infected, becoming potential candidates for removal. Intravascular techniques for removing problematic or infected leads evolved over a 5-year period (1989-1993). This article analyzes results from January 1994 through April 1996, a period during which techniques were fairly stable. Extraction of 3,540 leads from 2,338 patients was attempted at 226 centers. Indications were: infection (27%), nonfunctional or incompatible leads (25%), Accufix or Encore leads (46%), or other causes (2%). Patients were 64+/-17 years of age (range 5-96); 59% were men, 41% women. Leads were implanted 47+/-41 months (maximum 26 years), in the atrium (53%), ventricle (46%), or SVC (1%). Extraction was attempted via the implant vein using locking stylets and dilator sheaths, and/or transfemorally using snares, retrieval baskets, and sheaths. Complete removal was achieved for 93% of leads, partial for 5%, and 2% were not removed. Risk of incomplete or failed extraction increased with implant duration (P<0.0001), less experienced physicians (P<0.0001), ventricular leads (P<0.005), noninfected patients (P<0.0005), and younger patients (P<0.0001). Major complications were reported for 1.4% of patients (<1% at centers with >300 cases), minor for 1.7%. Risk of complications increased with number of leads removed (P<0.005) and with less experienced physicians (P<0.005); risk of major complications was higher for women (P<0.01). Given physician experience, appropriate precautions, and appropriate patient selection, contemporary lead removal techniques allow success with low complication rates.

The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from whom (i.e. which provider organization and which individual care worker). Drawing on interviews with 28 older service users, 20 informal carers and 22 care managers across four local authority areas in England, the paper goes on to describe the extent to which such choices - both at the strategic/macro and operation/micro level - have increased or decreased in practice. The evidence confirms that of other recent studies that the gap between the 'ideal' of user and carer involvement and the 'reality' of everyday practice is still considerable.

Purpose -To examine the introduction of role-redesign in the NHS and highlight implications for employment relations. Design/methodology/approach -A 12-month independent evaluation (2003)(2004) of a role redesign initiative in the NHS is reported. The study followed a developmental, case-study design and included secondary data analysis, semi-structured interviews and observations at five case-study sites.Findings -The role redesign process involved four types of change to job content: skill-mix changes; job widening; job deepening; and development of new roles. Each of these changes had implications for employment relations in terms of remuneration, management and accountability, and education and training.Research limitations/implications -The research involves one initiative in the NHS and was evaluating a developing programme. Whilst implications are suggested for efforts at role redesign generally the research specifically relates to NHS organisations. Practical implications -Three aspects of employment relations are identified as important when attempting role redesign: remuneration, management and accountability, and education and training. Originality/value -This paper offers the first account of this national NHS role redesign initiative.

The structuring of daytime activities for older people with intellectual disabilities (ID) is often at odds with the views or needs of the people involved with these activities. The aim of this study was to understand the perceptions of people with ID with respect to retirement—that is, the mandatory transition from attending day centers in two Scottish localities. Semi‐structured interviews were conducted with 16 older adults and the resultant transcripts subjected to interpretive phenomenological analysis. Five themes emerged from the analysis: the importance of activity, the day center as a social hub, confusion concerning retirement, desire for continuity, and the value of independence. The older adults placed great value on participation in daytime activity and on attendance at local authority‐run day centers. They wished to remain active well into old age and wished to contribute to their local communities. Disconcertingly, the participants highlighted the difficulties with their understanding of “retirement” and those who demonstrated a level of understanding felt that they had a disconnected role in the process. The study revealed some important implications for service provision and development. The authors suggest that the provision of daytime activity for older people with ID should be scrutinized closely with respect to what people do as retirees and how they prepare for a change in lifestyle.

The aim of this study was to explore United States (U.S.) seafood consumption patterns, food sourcing, expenditures, and geography of consumption. We analyzed seafood intake and food sourcing using the National Health and Nutrition Examination Survey (NHANES) cycles 2007–2008 to 2015–2016 for US adults ≥19 years old (n = 26,743 total respondents; n = 4957 respondents consumed seafood in the past 24 h). Seafood expenditures were extrapolated by combining NHANES with three other public datasets. U.S. adults consumed 63% of seafood (by weight) at home. The top sources of seafood (by weight) were food retail (56%), restaurants (31%), and caught by the respondent or someone they know (5%). Sixty-five percent of consumer expenditures for seafood were at restaurants and other “away from home” sources while 35% were at retail and other “at home” sources. Slightly less than half of overall U.S. food expenditures are “away from home,” which is much lower than for seafood, suggesting that consumers have very different spending habits for seafood than for an aggregate of all foods.

Previous research illustrates how managers use the ‘customer’ in the service sector to develop roles and determine requisite skill sets. This article uses the evaluation of a recent workforce modernisation initiative in the NHS to provide insights into the manner in which the patient has played an increasing role in the construction of skills in healthcare. It indicates how public‐funded healthcare in the NHS contains similar tensions and contradictions to service work in consumer capitalism. Although the patient is not in a position of authority, the desire of some workers to address fully the physical and psychological needs of the patient (or embodied customer) leads them to develop skills and roles that management may find hard to resource within current budgets.

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The main achievement of the intensive international recruitment period from a UK viewpoint was that such a major undertaking was seen through without major disruption to NHS services. The wider costs and challenges meant, however, that large-scale international recruitment was not sustainable as a solution to workforce shortages. Should such approaches be attempted in future, a clearer upfront appraisal of all the potential costs and implications will be vital.