Annual Review Research Articles

Effectiveness of a digital health and financial incentive intervention to promote physical activity in patients with type 2 diabetes: study protocol for a randomised controlled trial with a nested qualitative study-ACTIVATE trial.

The prevention of type 2 diabetes (T2DM) is recognised as a health care priority in the UK. In people living with T2DM, lifestyle changes (e.g. increasing physical activity) have been shown to slow disease progression and protect from the development of associated comorbidities. The use of digital health technologies provides a strategy to increase physical activity in patients with chronic disease. Furthermore, behaviour economics suggests that financial incentives may be a useful strategy for increasing the maintenance and effectiveness of behaviour change intervention, including physical activity intervention using digital health technologies. The Milton Keynes Activity Rewards Programme (MKARP) is a 24-month intervention which combines the use of a mobile health app, smartwatch (Fitbit or Apple watch) and financial incentives to encourage people living with T2DM to increase physical activity to improve health. Therefore, this randomised controlled trial aims to examine the long-term acceptability, health effects and cost-effectiveness of the MKARP on HbA1c in patients living with T2DM versus a waitlist usual care comparator. A two-arm, single-centre, randomised controlled trial aiming to recruit 1018 participants with follow-up at 12 and 24months. The primary outcome is the change in HbA1c at 12months. Secondary outcomes included changes in markers of metabolic, cardiovascular, anthropometric, and psychological health along with cost-effectiveness. Recruitment will be via annual diabetes review in general practices, retinal screening services and social media. Participants aged 18 or over, with a diagnosis of type 2 diabetes and a valid HbA1c measurement in the last 2months are invited to take part in the trial. Participants will be individually randomised (1:1 ratio) to receive either the Milton Keynes Activity Rewards Programme or usual care. The intervention will last for 24months with assessment for outcomes at baseline, 12 and 24months. This study will provide new evidence of the long-term effectiveness of an activity rewards scheme focused on increasing physical activity conducted within routine care in patients living with type 2 diabetes in Milton Keynes, UK. It will also investigate the cost-effectiveness of the intervention. ISRCTN 14925701. Registered on 30 October 2023.

Effect of the National Enhanced Service for weight management on the content of annual review consultations for patients living with obesity and hypertension and/or diabetes.

Guidelines specify that clinicians should support patients living with obesity by referring to weight management programmes (WMPs), but clinicians do so infrequently. To provide additional support to patients living with obesity and weight-related conditions, the UK government instated the National Enhanced Service (NES) for weight management in England, including a reimbursement to general practices for referring eligible patients to WMPs. To assess the impact of the NES on conversations regarding weight and relevant behavioural risk factors in primary care consultations we recruited 11 medical practices in England where the NES was operating and six comparator practices from Scotland and Wales where the NES was not implemented. Clinicians audio-recorded annual review appointments of patients living with obesity and hypertension and/or diabetes. The content of these consultations was synthesised using quantitative content analysis. Consultations with 92 patients were analysed: 58 in England and 34 in Scotland and Wales. No difference was found between the NES sites (England) and non-NES sites (Scotland and Wales) in the proportion of referrals made to WMPs. Clinicians in England weighed patients and took other body measurements more often, mentioned body mass index more often, and had more detailed discussions about patients' diets, but there was no evidence that they differed in their discussion of WMPs or other modifiable risk factors. We found no strong evidence that the NES affected how clinicians addressed weight management or related behavioural risk factors within annual review consultations for patients living with obesity and hypertension and/or diabetes.

A quality improvement model to identify undiagnosed heart failure at chronic obstructive pulmonary disease annual reviews

Abstract Introduction Heart failure (HF) is a common comorbidity in people with chronic obstructive pulmonary disease (COPD). The estimated prevalence of HF comorbidity in patients with COPD is up to 40%1. COPD and HF have overlapping symptoms which could delay the diagnosis of HF. Studies have shown that in UK primary care, HF treatment for COPD patients is delayed by almost twelve months compared to patients without COPD2. Early diagnosis and management of HF for COPD patients in primary care could reduce risk of recurrent exacerbation and subsequent hospitalisation. HF screen is not currently emphasised in the primary care COPD annual reviews. NICE guidance for COPD diagnosis mentions the use of serum natriuretic peptides to aid differential diagnosis of HF3. Pharmacists in general practice are the patients’ first point of contact, they are able to take leading roles in the holistic management of long-term conditions such as HF and COPD. Aim Reduce HF related complication including exacerbations and subsequent hospital admissions for COPD patients through early HF identification programme at COPD annual review. Methods Electronic Emis search was conducted on the practice database to identify patients on the COPD register. Patients with existing diagnosis of HF or NT-ProBNP in the last 12 month were excluded. Patients were invited for COPD annual review and screened for HF symptoms (breathlessness, fluid retention, fatigue, lightheadness) as per NICE guidance for HF identification. NT-ProBNP test was added to routine annual blood test for patients experiencing any of the HF symptoms. Patients with elevated NT-ProBNP >400ng/L were referred for further assessment for suspected HF. The project was a small scale service improvement project, it did not require ethical approval, this was confirmed with the Broad Street Health Centre clinical lead. Results Twenty six patients were screened out of 48 (54 %). Six patients (23%) had NT-pro BNP results over 400ng/L and were referred for further investigation for suspected HF. Diagnosis was confirmed for three patients 11%. Two of the newly diagnosed patients had an MRC score of 3, while one had and MRC score of 2. No patients with MRC score 1, 4 or 5 where among the newly diagnosed group. Discussion Results analysis correlates with published data regarding the prevalence of HF in COPD patients. Screening for HF in primary care might be most beneficial for patients with MRC of 2 or 3. Patients with score of 1 might have milder symptoms however annual screening will allow early detection of future deterioration. There were no newly diagnosed patients from the MRC score of 4 and 5 groups as they might have already been diagnosed if their symptoms were related to underlying HF. The three patients diagnosed with HF were treated for HF as per NICE guidance. Patients’ spontaneous feedback was positive regarding the new management approach. Conclusion Pharmacists in general practice can play a dynamic role in early identification of existing co-morbidities while conducting annual long-term conditions reviews. This in return facilitates vital early interventions to improve prognosis and reduce further complications along the way.

Exploring the Essential Higher Order Cognitive Skills (HOCS) for the Employability of Engineering Graduates in Bangladesh

Employability of engineering graduates is largely impacted by their higher order cognitive skills. In addition to their academic knowledge and technical capabilities, graduates need HOCS. Employers give a larger value on HOCS than on technical abilities. For career-long employment sustainability, these skills are essential success factors. Employability is significantly correlated with HOCS. To succeed in the job, engineers require HOCS. Technical skills are valued by employers throughout the hiring process, but as engineering careers progress, employers give more emphasis on HOCS. However, not every level of a person's career requires the same set of HOCS. At a certain point in a career, employers look for different HOCS. Starting with early career, moving through mid-career, and ending with advanced career, this research attempts to uncover those HOCS accountable for workplace success meeting employer’s expectations. Both graduates with a diploma and a bachelor's degree in engineering have been covered by this study. The majority of engineers share the same Intelligent Quotient (IQ) on an average. Technical skill gaps are easily bridged with quick trainings. The only things that set engineers apart from the masses are HOCS, which are primarily higher order brain-based executive functions. Employability is influenced by numerous factors. Only the employability's absolute dimension is the subject of the inquiry. Absolute dimension is contingent upon the candidate’s skill sets. It is true that having technical abilities is a requirement for employment. But in addition to technical skills, modern employers now prioritize HOCS. It is an indisputable fact that engineer’s HOCS play a major role in their Annual Compensation Review (ACR). The study identifies 14 distinct HOCS that engineers need. Since not all skills are equally valuable at every point of a career, they are grouped according to career stage.

Investigating the Essential Soft Skills (SS) that Engineering Graduates Need to Enhance their Employability in Bangladesh

Soft skills (SS) significantly influence engineering graduate’s employability. In addition to their academic knowledge and technical capabilities, graduates need soft skills. Employers give a greater value on soft skills than on technical abilities. For career-long employment sustainability, these skills are essential success factors. Employability is significantly correlated with soft skills. To succeed in the job, engineers require soft skills. Technical skills are valued by employers throughout the hiring process, but as engineering careers progress, employers give more emphasis on soft skills. However, not every level of a person's career requires the same set of soft skills. At a certain point in a career, employers look for different soft skills. Starting with early career, moving through mid-career, and ending with advanced career, this research attempts to uncover those soft skills accountable for workplace success meeting employer’s expectations. Both graduates with a diploma and a bachelor's degree in engineering have been covered by this study. The majority of engineers share the same Intelligent Quotient (IQ) on an average. Technical skill gaps are easily bridged with quick trainings. The only things that set engineers apart from the masses are soft skills, which are primarily characterized by personality traits and Emotional Intelligence (EQ). Employability is influenced by numerous factors. Only the employability's absolute dimension is the subject of the inquiry. Absolute dimension is contingent upon the candidate’s skill sets. It is true that having technical abilities is a requirement for employment. But in addition to technical skills, modern employers now prioritize soft skills. Of course, an engineer continues to be measured by his/her soft skills in mapping their Annual Compensation Review (ACR). The study identifies 46 distinct soft skills that engineers need. Since not all skills are equally valuable at every level of a career, they are grouped according to career stage.

Finding Fulfillment: Leveraging Meaningful Feedback to Boost Worker Engagement

This article explores how organizations can design more meaningful feedback practices to boost employee engagement. Drawing on academic literature linking feedback and engagement, key drivers of the connection are identified, such as fulfilling psychological needs for competence and purpose. The brief then advocates shifting feedback focus from retrospective evaluations to forward-looking development centered on learning, growth opportunities, and stronger role alignment. Practical application examples across industries including healthcare, education, technology, and manufacturing demonstrate embedding feedback within organizational purpose and contextual priorities. Additional implementation strategies are offered, such as framing managers as coaches, emphasizing continual check-ins over annual reviews, rewarding continuous learning, and soliciting worker feedback. The conclusion asserts that by reframing routine feedback interactions to stimulate motivation, skills, and purpose-driven work, companies can transform this tool into a key lever for fostering enduring employee commitment, dedication, and fulfillment.

Factors Considered for the Assessment of Risk in Administrative Review Boards of Canada: A Scoping Review

Background: This scoping review examines the risk factors considered in assessing the dangerousness of individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) in Canadian administrative courts. This review aims to identify the factors used by mental health review boards during annual case reviews to guide decisions on detention or release. Methods: Using a scoping review approach following PRISMA guidelines, this study analyzed research across multiple databases to identify relevant studies focusing on risk assessment for NCRMD cases. Results: The findings indicate that five primary categories of risk factors—historical, clinical, behavioral, legal, and miscellaneous—are influential in the decision-making process. Historical factors, such as past violence and early psychiatric contacts, are critical in predicting future risk. Clinical factors, including psychiatric diagnosis and treatment adherence, are key to evaluating current and potential future risks. This study reveals variability in the application of standardized risk assessment tools, highlighting a need for more consistent practices across Canadian jurisdictions. Conclusion: This review concludes that, while a multifaceted approach to risk assessment is essential for balancing public safety with individual rehabilitation, further research is needed to refine these processes and establish more uniform standards for managing NCRMD cases in forensic psychiatry.

Enhancing cardiology trainee competence through simulation-based pericardiocentesis training: a pilot programme evaluation

Abstract Introduction Cardiology training requires trainees to manage clinical duties whilst developing practical skills. Changes to the UK curriculum have resulted in reduced time available for procedural teaching. Pericardiocentesis is one of many required competencies. The Joint Royal College of Physicians Training Board cardiology curriculum cites the importance of simulation-based education to teach procedures. Procedural training encompasses the development of clinical reasoning alongside motor skills. Gange (1962) and Carless (2010) emphasized the importance of expert-guided practice, interactive teaching, and instant feedback in motor skills teaching to maximize the educational experience. Aim Develop a simulation teaching programme to enhance trainees' confidence and competency in pericardiocentesis. Procedures form part of a summative Direct Observation of Procedural Skills, enabling trainees to learn in a safe environment and use as evidence at their Annual Review of Competence Progression (ARCP). Method We developed a pilot programme for pericardiocentesis facilitated through high-fidelity equipment between February 2023 and February 2024. Participants were recruited through medical education departments. The sessions were delivered on a one-to-one basis by a cardiology consultant to facilitate discussion and interactivity. The teaching involved a core knowledge presentation, discussion of trainee experiences, case studies as examples, including review of echocardiography features. This was followed by clinical skills teaching of pericardiocentesis, utilizing a model, and transthoracic echocardiography. Trainees were sent anonymous feedback forms after the session. Results 46 cardiology registrars participated; 48% were within their first few years of training. 87% reported difficulty in practicing this skill in clinical practice due to: lack of exposure, other clinical responsibilities taking priority, and the need for consultant-delivered care on patients requiring an urgent or emergency procedure. Mean trainee confidence before teaching was 3.24 out of 5 (SD = 1.14), with a significant improvement to 4.48 (SD = 0.59 p<0.001). 52% improved in confidence by 1 unit and, 31% improved in confidence by 2 or more units. Trainees reported the following themes regarding the session: knowledgeable trainer, high fidelity equipment, instant feedback to predict, prevent, and overcome challenges, and a multi-modal approach to teaching, incorporating presentation and discussion on pericardial effusion, tamponade, and drainage. Conclusion Our programme offers a unique multi-modal teaching approach, with dedicated time with an expert. We supported the progress of 46 trainees and enhanced their training competencies. We aim to expand the programme to incorporate more procedures in line with growing curriculum requirements. Tracking trainee progress until ARCP outcomes will reveal the impact of simulation teaching on their experience and professional development.

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans

BackgroundAdvance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.MethodsWe conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.ResultsAnalysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.ConclusionGreater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates.

Incidence of hip problems in developmental central hypotonia: A scoping review.

To describe what is known about hip problems in individuals with developmental central hypotonia. Searches were conducted in five databases to October 2023. Down syndrome was excluded from this analysis of less well-known genetic diagnoses. At least two reviewers independently screened titles, abstracts, read full-text articles, and extracted data. Of 89 full-text articles, 79 met inclusion criteria. Studies included 544 individuals aged 1 month to 63 years with Kabuki, 49, XXXXY, Prader-Willi, PURA, Koolen de Vries, Emanuel, TRPM3, Wolf-Hirschhorn, and other rare syndromes. Most diagnoses may be associated with a combination of differences in hip structure or stability that are evident at birth, or develop in early infancy, with increasing hip dysplasia and subluxation over time. Joint or ligamentous laxity was most reported along with hypotonia and hypermobility as risk factors. Limited data were identified about conservative or surgical intervention and outcomes in these populations. Children with significant hypotonia, with or without a confirmed genetic diagnosis, are at increased risk of hip problems that may be missed with standard neonatal screening. Ultrasound is recommended between 6 weeks and 6 months, and annual orthopaedic review with regular radiographs for older children and adults with significant and persistent hypotonia.

Perceptions of Annual Research Evaluations as Preparation for Future and Early Career Faculty

Thousands of university faculty complete annual evaluations to determine their yearly productivity. These assessments often determine the ability of a faculty member to continue in their current position (Zahneis, 2024). Evaluations play a crucial role in shaping the careers of early career tenure track professors. Given the importance of annual reviews, this poster presents the preliminary results of a study designed to examine how departments assess faculty research productivity and to understand their perceptions of the processes used to evaluate them. Providing these results to doctoral students and new faculty can help prepare them for the annual review process. Concerns emerged among the participants regarding the evaluation process. For instance, some participants noted that the quantity of publications was valued more than the quality, and there were no clear research quality standards. Another stated that some colleagues do little research and still receive positive evaluations. Faculty members were more satisfied with reviews when policies clearly outlined expectations. They liked it when alternative publication methods were valued. Participants believed research with students should be equally important to solo or collaborative projects with other faculty. Additionally, the participants appreciated it when their deans and chairs understood and celebrated their research. Participants shared factors that affect their research productivity. Time to complete research was a frequent response. Answers further indicated that support from research and teaching assistants saved them time. Funding to complete studies and research space was instrumental in their success.

Best clinical practice experience at University of Gondar Comprehensive specialized Hospital Emergency and critical care Medicine department, A Case Study Under a resource limited set up

Abstract Background The emergency department (ED) is unique unstable environment where someone faces unscheduled and undifferentiated diseased patients, stressed families, unsettled staffs and unequitable resources.UoGCSH is the oldest in the Ethiopia and the only referral hospital for more than 13 million people from the five-zone north-west Ethiopia with 950 beds capacity. During the 2020 G.C a proposal paper was submitted to the administration bodies of the college and the hospital. The proposal was suggesting short term, mid-term and long-term quality improvement segments implemented in institutionally convenient manner. Objective To describe the transformation of emergency and critical care medical services at University of Gondar Comprehensive specialized hospital from scratch to the current status. Method A descriptive case study design was applied to narrate critical care service transformation at UoG Comprehensive Specialized Hospital. Since this case study is a data review from gathered secondary data, desk reviews of the emergency department, quality directorate data review, and the annual audit report review, there was no need for IRB approval. Result and recommendation After a year of renovation, we were able to organize a newly refurbished emergency room having a triage area with adequate reception space, Red resuscitation area with 10 beds (considering patient overflow), Orange with 18 beds, Yellow with 10 beds and floater area, isolation room, decontamination room, ED laboratory, main store, disaster store and piped oxygen system to all beds. we have gone a long journey in bringing those promised practices into demonstrable practice and finally replicable prototypic best practice. Even though we paced extra miles in achieving this status. Standard emergency room work flow implementation enable us to control the day-to-day patient and attendant crowding that impedes the anticipated medical treatment outcome and result in a significant dissatisfaction.Despite this achievement the trauma center establishment and high-quality patient care is recommended.

Acceptance and commitment therapy to alleviate climate-induced psychological distress

ABSTRACT The aim of this clinical article is to propose the relevance of the acceptance and commitment therapy (ACT) model Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. [2011. Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7(1), 141–168. https://doi.org/10.1146/annurev-clinpsy-032210-104449] to alleviate climate-induced psychological suffering. After a brief introduction establishing the need for climate-informed mental health intervention, the article is divided into three sections. The first section briefly presents ACT, highlighting the six core components of psychological flexibility. The second section provides a discussion to broaden and deepen psychotherapists’ understanding of eco-emotions, particularly eco-anxiety and eco-anger. The third section presents how this framework is relevant to assessing psychological flexibility in the context of climate change, using a hypothetical clinical example partly based on empirical findings.

Annual Reviewer Acknowledgement

Annual Reviewer Acknowledgement

Scotland's internal medicine simulation strategy: A 5-year journey

In 2019, the internal medicine (IM) stage 1 curriculum was implemented in the UK. This introduced a revised 3-year training programme for physicians in training. The new IM stage 1 curriculum emphasised simulation-based education, triggering the integration of simulation training on a national scale in Scotland. Bespoke training courses were developed for IM trainees in Scotland, spanning all 3 years of their training programme. Each course was meticulously designed with input from key stakeholders and trainees, aligning learning objectives with curriculum outcomes. The Scottish IM simulation strategy encompasses a 3-day bootcamp in IM year 1, a 1-day skills day in IM year 2, and a 2-day ‘registrar ready’ course in IM year 3. These courses, delivered at central locations, focus on immersive simulation, communication workshops, and simulation-based mastery learning of procedural skills. Evaluation of the programme includes pre- and post-course questionnaires, data tracking over the training programme, interviews with trainees and faculty, and annual review days to gather feedback and make necessary adaptations. The impact of the programme for trainees includes transfer to clinical practice of communication skills, improved non-technical skills, and increased confidence in procedural skills. Alignment with the IM stage 1 curriculum supports trainees’ annual reviews of competence progression. The IM simulation training also offers valuable social benefits and remains crucial, especially with increased pressure in the NHS. It is our belief that ongoing delivery of this training is invaluable to the IM stage 1 programme in Scotland.

In between the neoliberal reality and the humanities imagination: a narrative inquiry of an English major’s identity construction in China

ABSTRACT This study reports an ethnographic case study of a Chinese female English major of a working-class background – Faye (pseudonym) and her English learning and use experience in an elite community in the Chinese context. Drawing on the data collected from a 13-month longitudinal inquiry, the study employs Darvin and Norton’s [2015. ‘Identity and a Model of Investment in Applied Linguistics.’ Annual Review of Applied Linguistics 35:36–56. https://doi.org/10.1017/S0267190514000191] model of investment to explore her identity transformation through English-as-a-foreign-language (EFL) practices. Findings suggest that Faye’s investment in EFL practices appeared to transform with her evolving perceptions of EFL learning and imagined identities, which were shaped largely under the influence of neoliberal and humanities discourses. The study argues for a critical interrogation of the impact of neoliberalism on EFL learning and humanities education, cautioning against its tendency to constrain identity potentials and sustain structural inequalities. Pedagogical implications are suggested at the end of the article.

Sociotechnical governance of misinformation: An Annual Review of Information Science and Technology (ARIST) paper

Sociotechnical governance of misinformation: An Annual Review of Information Science and Technology (ARIST) paper

Prevalence and predictors of annual asthma reviews in Scottish primary care data.

People with asthma are recommended to have regular reviews in primary care, with assessment of symptoms, adjustment of treatment and self-management processes, and the delivery of a written action plan for emergencies. Our study aimed to investigate the incidence and factors associated with attendance of annual reviews. electronic health records for approximately 50 000 Scottish asthma patients, between 2008 and 2016. Multivariable logistic regression using linked primary care prescription data and primary care registration demographic data. There was a median of 381 days between subsequent reviews. Reviews in the index year were strongly associated with reviews in the following year (odds ratio 1.76 [1.68-1.84]). In contrast, asthma consultations (excluding reviews) in the index year were associated with a lower odds of having a review in the following year (0.48 [0.46-0.51]). Those aged 18-35 in the index year, or with missing address in the practice registration data, were the least likely age group to have an asthma review in the following year. Reviewing the delivery of asthma care identifies patients who may be slipping through the gaps by receiving only reactive asthma care rather than the structured, preventative care which can be delivered through annual reviews. Understanding the risk factors for not receiving an annual review can be leveraged to create more effective review invitations, such as explaining the specific content of reviews, introducing new contact methods to improve health equity, and reviewing the algorithm used to determine who is invited.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

The Future of Performance Management: Shifting from Annual Reviews to Continuous Feedback

Abstract: The landscape of performance management is undergoing a significant transformation, moving away from the traditional model of annual reviews toward a more dynamic and continuous feedback approach. This shift is driven by the need to adapt to the rapidly changing work environment, where agility, employee engagement, and real-time performance improvement are becoming increasingly critical. This chapter explores the evolution of performance management, examining the limitations of annual reviews and the growing demand for more frequent, constructive feedback mechanisms. Continuous feedback not only fosters a culture of ongoing development but also aligns employee objectives with organizational goals in realtime, enhancing overall productivity and job satisfaction. The discussion highlights the technological advancements, such as performance management software and AI-driven analytics, that are enabling this shift, making it easier for organizations to implement and sustain continuous feedback systems. Additionally, the chapter delves into the challenges and considerations that come with this transition, including the need for managerial training, the potential for feedback overload, and the importance of maintaining a balanced approach that supports both individual growth and team collaboration. Through a combination of theoretical insights and practical case studies, this chapter provides a comprehensive overview of the future of performance management, offering actionable strategies for organizations looking to foster a more responsive and employee-centric work culture. The move toward continuous feedback represents not just a trend but a fundamental rethinking of how performance is managed, with the potential to significantly enhance both individual and organizational success in the modern workplace