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PURPOSE: Fast-track surgery or enhanced recovery programmes (ERP) have been shown to improve patient outcomes with shorter post-operative recovery times, fewer complications and more cost-effective care amongst the reported benefits. Traditionally, the effectiveness of ERPs have been assessed by measuring clinical outcomes, with the patient experience often being neglected. The aim of this qualitative study was to ascertain patients' expectations and experiences of fast-track surgery and recovery at home within the setting of an enhanced recovery programme (ERP). METHOD: Twenty patients enrolled in the treatment group of the randomised controlled trial 'Enhanced recovery in liver resection surgery' were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using thematic analysis. RESULTS: Patients approached the surgery with a sense of renewed hope. Involvement with the ERP was viewed positively, and having milestones to aim for gave patients a sense of purpose. Many felt that real recovery from surgery began at home and so felt positive about having an early discharge. Patients did report some concerns about being discharged early and those who failed to meet milestones or were readmitted to hospital experienced this as failure. CONCLUSIONS: This qualitative data demonstrates some of the complexities of patients' expectations and experiences of the ERP. Whilst patients generally experience the ERP positively, they also have concerns about the process. The study highlights areas where additional support may be needed for patients enrolled in ERPs and discharged early.

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Government and policymakers want to engage the public in a dialogue about the conduct and consequences of science and increasingly seek to actively involve citizens in decision-making processes. Implicit in this thinking is that greater transparency and public inclusion will help dispel fears associated with new scientific advancements, foster greater public trust in those accountable, and ultimately increase the acceptability of new technologies. Less understood, however, are public perceptions about such high-level involvement in science and how these map onto public trust and attitudes within a diverse population. This article uses the concept of public efficacy -- the extent to which people believe that the public might be able to affect the course of decision making -- to explore differences in trust, attentiveness, and attitudes toward modern genetic science. Using nationally representative data from the 2003 British Social Attitudes Survey, we begin by examining the characteristics of those who have a positive belief about public involvement in this area of scientific inquiry. We then focus on how this belief maps on to indicators of public trust in key stakeholder groups, including the government and genetic scientists. Finally, we consider the relationship between public efficacy and trust and attitudes toward different applications of genetic technology. Our findings run contrary to assumptions that public involvement in science will foster greater trust and lead to a climate of greater acceptance for genetic technology. A belief in public efficacy does not uniformly equate with more trusting attitudes toward stakeholders but is associated with less trust in government rules. Whereas trust is positively correlated with more permissive attitudes about technologies such as cloning and gene therapy, people who believe in high-level public involvement are less likely to think that these technologies should be allowed than those who do not.

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A group of 19 individuals who had been infected with methicillin-resistant Staphylococcus aureus (MRSA) and placed in source isolation were interviewed about their views of MRSA infection and the experience of source isolation. Participants were unclear about the nature of MRSA, and generally did not perceive the infection to have a significant impact upon their life (either in terms of the presence of symptoms or in restriction of activities). Despite this, roughly half the sample thought that an MRSA infection was 'serious'. Only one participant clearly viewed their MRSA as hospital-acquired, most being uncertain about the mode of transmission or viewing it as unrelated to the behaviour of care staff. Few respondents displayed an accurate knowledge of the reasons for source isolation and barrier nursing. Isolation was viewed as having advantages and disadvantages. There was little evidence of a detrimental psychological effect of isolation. Patients infected with MRSA appear to understand little about their condition or the necessity for barrier nursing and source isolation. This has implications for understanding patients' adherence with infection control procedures.

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OBJECTIVES: To describe women's understanding of a negative smear test result when presented using the term "normal smear result," as required by the NHS cervical screening programme, and to evaluate the impact on understanding of different ways of presenting the residual risk inherent in such a result. DESIGN: Experimental questionnaire based study. INTERVENTIONS: Participants were asked to imagine that they had received a normal smear result. The meaning of this result was then presented using different combinations of three different expressions of residual risk of having or developing cervical cancer over the next five years: a verbal probability of absolute risk (low risk), a numerical probability of absolute risk (1 in 5000), or a numerical probability of risk relative to an unscreened woman (five times lower). PARTICIPANTS: 1027 women aged 20 to 64. RESULTS: When informed only that their smear result was normal, 52% (80 of 153 women) of participants correctly understood that this entailed a residual risk of cervical cancer, compared with 70% (107 of 152) given the additional sentence explaining the meaning of a normal smear result using a verbal probability of absolute risk (difference 18%; 95% confidence interval 7% to 29%). Additionally, explaining the results using a numerical probability of absolute or relative risk did not increase the proportion who correctly understood that there was a residual risk of cervical cancer. CONCLUSIONS: NHS policy for reporting normal smears needs to change to make it a definite requirement that the reporting of a "normal smear result" is accompanied by a sentence stating that this means a low risk for having or developing cervical cancer in the next five years.

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A battery of self-report psychosocial measures was mailed to 116 patients who had been referred for clinical management (clinic attenders) or laboratory diagnosis (non-clinic attenders) to the London Supraregional Assay Service Centre for Porphyria over the past decade and who tested positive for porphyria. Usable replies were received from 81 (70%) patients. Our interest focused on the prevalence of psychosocial symptoms in acute porphyrias and the perceived effects of porphyria on quality of life and patient experience. Research questions examined included (i), lifestyle factors; (ii) life events; (iii) mental health; (iv) general health; and (v) perceptions of illness of patients receiving specialist clinical management compared to respondents referred for diagnostic investigations, between patients with latent or manifest symptomology and between patients with different types of porphyria. Patients with porphyria have an impaired quality of life, particularly manifest cases, compared to controls and to diabetic patients. Depression, and particularly anxiety, is more common than in the general population or general medical outpatient attenders. Quality oflife is lower in acute intermittent porphyria (AIP) than in other forms of porphyria and a significant number of patients had major life event consequences, e.g. failure to secure, or loss of, employment, limitation of family size. Patients attending a clinic providing specialist porphyria advice, management and counselling received some perceived lifestyle benefits.

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There is increasing evidence that in some diseases such as coronary heart disease, risk factors may interact synergistically, resulting in greater likelihood of disease than would be produced by the sum of the risk factors. These two studies aimed to examine the extent to which 210 undergraduate students and 28 heart attack patients perceive risk factors to combine synergistically. Respondents read one of four vignettes, describing information about risk factors (with high and low smoking and family history), and estimated a man's likelihood of a heart attack in a hypothetical case. In both studies an interaction was found with either a family history or smoking eliciting ratings of high likelihood of heart attack, providing no evidence of synergistic models. This finding may reflect respondents' beliefs or the insensitivity of this paper-and-pencil method in detecting synergistic effects.

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Abstract An analogue study investigated the impact of genetic testing on perceptions of disease. Using a 2 × 2 design, participants (n = 212) imagined receiving the information that they were at increased risk for either heart disease or arthritis. The type of risk information was either genetic or unspecified. Presentation of genetic risk information resulted in the condition being perceived as less preventable. Causal models of disease where investigated using principal components analysis. When hem disease was the stimulus condition, attributions to genes and chance were positively associated following unspecified risk information, and negatively associated following genetic risk information. When arthritis was the stimulus condition, presentation of genetic risk information was associated with attributions to genes becoming separated from the other attributions. One explanation for this is that providing genetic risk information may decrease perceptions of a sense of randomness or uncertainty in disease causation. The extent to which these effects occur in clinical populations. and their behavioural consequences. needs to be established.

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OBJECTIVE: to describe parents' perceptions of familial hypercholesterolaemia (FH), an inherited predisposition to heart disease, following population-based neonatal screening. DESIGN: a qualitative analysis of semi-structured interviews with the parents of 24 children who had received a positive screening test result informing them that their child was at-risk for having FH. RESULTS: responses to screening seemed to vary according to perceptions of the underlying cause of the positive screening test result. When parents perceived the test as detecting raised cholesterol the condition was perceived as familiar, dietary in origin, controllable and less threatening. When the test was seen as detecting a genetic problem, the condition was perceived as uncontrollable and, hence, more threatening. CONCLUSION: these pilot data raise questions about the extent to which assessing disease risks by DNA analysis may result in a sense of fatalism, adversely affecting motivation to change behaviour and to reduce risks.

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