Structured cues or modafinil for fatigue amelioration in clinicians? A double-blind, randomized controlled trial of critical clinical information recall in fatigued clinicians.

Science.gov (United States)

Flindall, Ian; Leff, Daniel Richard; Goodship, Jonathan; Sugden, Colin; Darzi, Ara

2016-04-01

To evaluate the impact of modafinil on "free" and "cued" recall of clinical information in fatigued but nonsleep-deprived clinicians. Despite attempts to minimize sleep deprivation through redesign of the roster of residents and staff surgeons, evidence suggests that fatigue remains prevalent. The wake-promoting agent modafinil improves cognition in the sleep-deprived fatigued state and may improve information recall in fatigued nonsleep-deprived clinicians. Twenty-four medical undergraduates participated in a double-blind, parallel, randomized controlled trial (modafinil-200 mg:placebo). Medication was allocated 2 hours before a 90-minute fatigue-inducing, continuous performance task (dual 2-back task). A case history memorization task was then performed. Clinical information recall was assessed as "free"(no cognitive aids) and "cued"(using aid memoirs). Open and closed cues represent information of increasing specificity to aid the recall of clinical information. Fatigue was measured objectively using the psychomotor vigilance task at induction, before and after the dual 2-back task. Modafinil decreased false starts and lapses (modafinil = 0.50, placebo = 9.83, P recall (modafinil = 137.8, placebo = 106.0, P recalled with open (modafinil = 62.3, placebo = 52.8, P = .1) and closed cues (modafinil = 80.1, placebo = 75.9, P = .3). Modafinil attenuated fatigue and improved free recall of clinical information without improving cue-based recall under the design of our experimental conditions. Memory cues to aid retrieval of clinical information are convenient interventions that could decrease fatigue-related error without adverse effects of the neuropharmacology. Copyright © 2016 Elsevier Inc. All rights reserved.

Disseminating effective clinician communication techniques: Engaging clinicians to want to learn how to engage patients.

Science.gov (United States)

Pollak, Kathryn I; Back, Anthony L; Tulsky, James A

2017-10-01

Patient-clinician communication that promotes patient engagement enhances health care quality. Yet, disseminating effective communication interventions to practicing clinicians remains challenging. Current methods do not have large and sustainable effects. In this paper, we argue that both top-down approaches (mandated by institutions) should be coupled with bottom-up approaches that address clinician motivation, confidence, and barriers. We need to engage clinicians in the same way we ask them to engage patients - strategically and with empathy. We discuss potentially innovative strategies to integrate top-down and bottom-up approaches in ways that fit clinicians' busy schedules and can inform policy. Copyright © 2017. Published by Elsevier B.V.

Foraging for Information in the EHR: The Search for Adherence Related Information by Mental Health Clinicians.

Science.gov (United States)

Gibson, Bryan; Butler, Jorie; Zirkle, Maryan; Hammond, Kenric; Weir, Charlene

2016-01-01

In this project we sought to qualitatively describe clinician's search for information related to the complex construct of adherence. Nineteen think aloud observations and semi-structured interviews were conducted with mental health providers as they prepared for a patient visit. The transcripts were coded according to constructs from information foraging theory (information goal, patch, scent, enrichment, and opportunity cost). The search strategies uncovered were complicated: provider's searches were sometimes multi-staged (e.g. a search of the EHR led to further enquiry when interviewing the patient), and involved multiple 'patches' (i.e. data from the EHR, the patient and other providers were all sought out). In addition, some information that providers considered relevant to understand adherence related questions was non-obvious (e.g. the absence of specific information was considered a useful cue). Providers' information search strategies for complex constructs are at times non-intuitive; implications for the design of EHR summarization tools are discussed.

Malaria Cases in the U.S. Reach 40-Year High: Information and Guidance for Clinicians

Centers for Disease Control (CDC) Podcasts

This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Malaria Cases in the U.S. Reach 40-Year High: Information and Guidance for Clinicians. The number of malaria cases reported in the United States in 2011 was the largest since 1971, representing a 14 percent increase from 2010 and a 48 percent increase from 2008. A CDC subject matter expert describes malaria prevention strategies aimed at reducing the risk of malaria in travelers, discusses the diagnosis of malaria in patients with suspect malaria, and explains the treatment options for confirmed malaria cases.

How do practising clinicians and students apply newly learned causal information about mental disorders?

Science.gov (United States)

de Kwaadsteniet, Leontien; Kim, Nancy S; Yopchick, Jennelle E

2013-02-01

New causal theories explaining the aetiology of psychiatric disorders continuously appear in the literature. How might such new information directly impact clinical practice, to the degree that clinicians are aware of it and accept it? We investigated whether expert clinical psychologists and students use new causal information about psychiatric disorders according to rationalist norms in their diagnostic reasoning. Specifically, philosophical and Bayesian analyses suggest that it is rational to draw stronger inferences about the presence of a disorder when a client's presenting symptoms are from disparate locations in a causal theory of the disorder than when they are from proximal locations. In a controlled experiment, we presented experienced clinical psychologists and students with recently published causal theories for different disorders; specifically, these theories proposed how the symptoms of each disorder stem from a root cause. Participants viewed hypothetical clients with presenting proximal or diverse symptoms, and indicated either the likelihood that the client has the disorder, or what additional information they would seek out to help inform a diagnostic decision. Clinicians and students alike showed a strong preference for diverse evidence, over proximal evidence, in making diagnostic judgments and in seeking additional information. They did not show this preference in the control condition, in which they gave their own opinions prior to learning the causal information. These findings suggest that experienced clinical psychologists and students are likely to use newly learned causal knowledge in a normative, rational way in diagnostic reasoning. © 2011 Blackwell Publishing Ltd.

A snapshot of health information exchange across five nations: an investigation of frontline clinician experiences in emergency care.

Science.gov (United States)

Klapman, Seth; Sher, Emily; Adler-Milstein, Julia

2018-06-01

Ensuring the ability to exchange patient information among disparate electronic health records systems is a top priority and a domain of substantial public investment across countries. However, we know little about the extent to which current capabilities meet the needs of frontline clinicians. We conducted in-person, semistructured interviews with emergency care physicians and nurses in select hospitals in Canada, Denmark, Finland, Germany, and the USA. We characterized the state of health information exchange (HIE) by country and used thematic analysis to identify the perceived benefits of access to complete past medical history (PMH), the conditions under which PMH is sought, and the challenges to accessing and using HIE capabilities. HIE approaches, and the information electronically accessible to clinicians, differed by country. Benefits of access to PMH included safer care, reduced patient length of stay, and fewer lab and imaging orders. Conditions under which PMH was sought included moderate-acuity patients, patients with chronic conditions, and instances where accessing PMH was convenient. Challenges to HIE access and use included difficulty knowing where information is located, delay in receiving information, and difficulty finding information within documents. Even with different HIE approaches across countries, all clinicians reported shortcomings in their country's approach. Notably, challenges were similar and shaped the conditions under which PMH was sought. As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another.

Watson will see you now: a supercomputer to help clinicians make informed treatment decisions.

Science.gov (United States)

Doyle-Lindrud, Susan

2015-02-01

IBM has collaborated with several cancer care providers to develop and train the IBM supercomputer Watson to help clinicians make informed treatment decisions. When a patient is seen in clinic, the oncologist can input all of the clinical information into the computer system. Watson will then review all of the data and recommend treatment options based on the latest evidence and guidelines. Once the oncologist makes the treatment decision, this information can be sent directly to the insurance company for approval. Watson has the ability to standardize care and accelerate the approval process, a benefit to the healthcare provider and the patient.

Once a clinician, always a clinician: a systematic review to develop a typology of clinician-researcher dual-role experiences in health research with patient-participants

Directory of Open Access Journals (Sweden)

E. Jean C. Hay-Smith

2016-08-01

Full Text Available Abstract Background Many health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clinician-researchers plan and implement methodologically and ethically sound research. Methods Systematic searching of Medline, CINAHL, PsycINFO, Embase and Scopus (inception to 28.07.2014 for primary studies or first-person reflexive reports of clinician-researchers’ dual-role experiences, supplemented by reference list checking and Google Scholar scoping searches. Included articles were loaded in NVivo for analysis. The coding was focused on how dual-role was evidenced for the clinician-researchers in research involving patients. Procedures were completed by one researcher (MB and independently cross-checked by another (JHS. All authors contributed to extensive discussions to resolve all disagreements about initial coding and verify the final themes. Results Database searching located 7135 records, resulting in 29 included studies, with the addition of 7 studies through reference checks and scoping searches. Two overarching themes described the most common catalysts for dual-role experiences – ways a research role can involve patterns of behaviour typical of a clinical role, and the developing connection that starts to resemble a clinician-patient relationship. Five subthemes encapsulated the clinical patterns commonly repeated in research settings (clinical queries, perceived agenda, helping hands, uninvited clinical expert, and research or therapy and five subthemes described concerns about the researcher-participant relationship (clinical assumptions, suspicion and holding back, revelations, over-identification, and manipulation. Clinician-researchers use their clinical skills in health

The role of technology in clinician-to-clinician communication.

Science.gov (United States)

McElroy, Lisa M; Ladner, Daniela P; Holl, Jane L

2013-12-01

Incomplete, fragmented and poorly organised communications contribute to more than half the errors that lead to adverse and sentinel events. Meanwhile, communication software and devices with expanding capabilities are rapidly proliferating and being introduced into the healthcare setting. Clinicians face a large communication burden, which has been exacerbated by the additional challenge of selecting a mode of communication. In addition to specific communication devices, some hospitals have implemented advanced technological systems to assist with communication. However, few studies have provided empirical evidence of the specific advantages and disadvantages of the different devices used for communication. Given the increasing quantities of information transmitted to and by clinicians, evaluations of how communication methods and devices can improve the quality, safety and outcomes of healthcare are needed.

Engaging clinicians in health informatics projects.

Science.gov (United States)

Caballero Muñoz, Erika; Hullin Lucay Cossio, Carola M

2010-01-01

This chapter gives an educational overview of: * The importance of the engagement of clinicians within a health informatics project * Strategies required for an effective involvement of clinicians throughout a change management process within a clinical context for the implementation of a health informatics project * The critical aspects for a successful implementation of a health informatics project that involves clinicians as end users * Key factors during the administration of changes during the implementation of an informatics project for an information system in clinical practice.

[Italian physician's needs for medical information. Retrospective analysis of the medical information service provided by Novartis Pharma to clinicians].

Science.gov (United States)

Speroni, Elisabetta; Poggi, Susanna; Vinaccia, Vincenza

2013-10-01

The physician's need for medical information updates has been studied extensively in recent years but the point of view of the pharmaceutical industry on this need has rarely been considered. This paper reports the results of a retrospective analysis of the medical information service provided to Italian physicians by an important pharmaceutical company, Novartis Pharma, from 2004 to 2012. The results confirm clinicians' appreciation of a service that gives them access to tailored scientific documentation and the number of requests made to the network of medical representatives has been rising steadily, peaking whenever new drugs become available to physicians. The analysis confirms what -other international studies have ascertained, that most queries are about how to use the drugs and what their properties are. The results highlight some differences between different medical specialties: for example, proportionally, neurologists seem to be the most curious. This, as well as other interesting snippets, is worth further exploration. Despite its limits in terms of representativeness, what comes out of the study is the existence of an real unmet need for information by healthcare institutions and that the support offered by the pharmaceutical industry could be invaluable; its role could go well beyond that of a mere supplier to National Healthcare Systems, to that of being recognised as an active partner the process of ensuring balanced and evidence-based information. At the same time, closer appraisal of clinicians' needs could help the pharma industries to improve their communication and educational strategies in presenting their latest clinical research and their own products.

Blood transfusion: patient identification and empowerment.

Science.gov (United States)

Stout, Lynn; Joseph, Sundari

Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful.

Malaria Cases in the U.S. Reach 40-Year High: Information and Guidance for Clinicians

Centers for Disease Control (CDC) Podcasts

2014-02-26

This podcast is an overview of the Clinician Outreach and Communication Activity (COCA) Call: Malaria Cases in the U.S. Reach 40-Year High: Information and Guidance for Clinicians. The number of malaria cases reported in the United States in 2011 was the largest since 1971, representing a 14 percent increase from 2010 and a 48 percent increase from 2008. A CDC subject matter expert describes malaria prevention strategies aimed at reducing the risk of malaria in travelers, discusses the diagnosis of malaria in patients with suspect malaria, and explains the treatment options for confirmed malaria cases.  Created: 2/26/2014 by Center for Global Health (CGH); Malaria Branch; Emergency Risk Communication Branch (ERCB); Office of Public Health Preparedness and Response (OPHPR).   Date Released: 2/26/2014.

System identification with information theoretic criteria

NARCIS (Netherlands)

A.A. Stoorvogel; J.H. van Schuppen (Jan)

1995-01-01

textabstractAttention is focused in this paper on the approximation problem of system identification with information theoretic criteria. For a class of problems it is shown that the criterion of mutual information rate is identical to the criterion of exponential-of-quadratic cost and to

Burns education for non-burn specialist clinicians in Western Australia.

Science.gov (United States)

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

2015-03-01

Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Turning attention to clinician engagement in Victoria.

Science.gov (United States)

Jorm, Christine; Hudson, Robyn; Wallace, Euan

2017-11-16

The engagement of clinicians with employing organisations and with the broader health system results in better safer care for patients. Concerns about the adequacy of clinician engagement in the state of Victoria led the Victorian Department of Health and Human Services to commission a scoping study. During this investigation more than 100 clinicians were spoken with and 1800 responded to surveys. The result was creation of a clear picture of what engagement and disengagement looked like at all levels - from the clinical microsystem to state health policy making. Multiple interventions are possible to enhance clinician engagement and thus the care of future patients. A framework was developed to guide future Victorian work with four elements: setting the agenda, informing, involving and empowering clinicians. Concepts of work or employee engagement that are used in other industries don't directly translate to healthcare and thus the definition of engagement chosen for use centred on involvement. This was designed to encourage system managers to ensure clinicians are full participants in design, planning and evaluation and in all decisions that affect them and their patients.

Interactions between non-physician clinicians and industry: a systematic review.

Directory of Open Access Journals (Sweden)

Quinn Grundy

2013-11-01

Full Text Available BACKGROUND: With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. METHODS AND FINDINGS: We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the

Interactions between non-physician clinicians and industry: a systematic review.

Science.gov (United States)

Grundy, Quinn; Bero, Lisa; Malone, Ruth

2013-11-01

With increasing restrictions placed on physician-industry interactions, industry marketing may target other health professionals. Recent health policy developments confer even greater importance on the decision making of non-physician clinicians. The purpose of this systematic review is to examine the types and implications of non-physician clinician-industry interactions in clinical practice. We searched MEDLINE and Web of Science from January 1, 1946, through June 24, 2013, according to PRISMA guidelines. Non-physician clinicians eligible for inclusion were: Registered Nurses, nurse prescribers, Physician Assistants, pharmacists, dieticians, and physical or occupational therapists; trainee samples were excluded. Fifteen studies met inclusion criteria. Data were synthesized qualitatively into eight outcome domains: nature and frequency of industry interactions; attitudes toward industry; perceived ethical acceptability of interactions; perceived marketing influence; perceived reliability of industry information; preparation for industry interactions; reactions to industry relations policy; and management of industry interactions. Non-physician clinicians reported interacting with the pharmaceutical and infant formula industries. Clinicians across disciplines met with pharmaceutical representatives regularly and relied on them for practice information. Clinicians frequently received industry "information," attended sponsored "education," and acted as distributors for similar materials targeted at patients. Clinicians generally regarded this as an ethical use of industry resources, and felt they could detect "promotion" while benefiting from industry "information." Free samples were among the most approved and common ways that clinicians interacted with industry. Included studies were observational and of varying methodological rigor; thus, these findings may not be generalizable. This review is, however, the first to our knowledge to provide a descriptive analysis

Data Science Meets the Clinician: Challenges and Future Directions.

Science.gov (United States)

Charitos, Efstratios I; Wilbring, Manuel; Treede, Hendrik

2018-01-01

In the last three decades a profound transformation of the medical profession has taken place. The modern clinician is required to consume vast amounts of information from clinical studies, critically reviewing evidence that may or may not lead to changes in clinical practice. The present article presents some challenges that this era of information poses to clinicians and patients. Georg Thieme Verlag KG Stuttgart · New York.

Clinicians' Knowledge and Perception of Telemedicine Technology.

Science.gov (United States)

Ayatollahi, Haleh; Sarabi, Fatemeh Zahra Pourfard; Langarizadeh, Mostafa

2015-01-01

Telemedicine is an application of information and communication technology in the healthcare environment. This study aimed to compare knowledge and perceptions of telemedicine technology among different groups of clinicians. This survey study was conducted in 2013. The potential participants included 532 clinicians who worked in two hospitals and three clinics in a northern province of Iran. Data were collected using a five-point Likert-scale questionnaire. The content validity of the questionnaire was checked, and the reliability was calculated using Cronbach's alpha coefficient (α = 0.73). The results showed that most of the clinicians (96.1 percent) had little knowledge about telemedicine. They perceived the advantages of telemedicine at a moderate level and its disadvantages at a low level. The knowledge of dentists about this technology was less than that of other groups, and as a result they were less positive about the advantages of telemedicine compared to nurses, general physicians, and specialists. The limited knowledge of clinicians about telemedicine seems to have influenced their perceptions of the technology. Therefore, providing healthcare professionals with more information about new technologies in healthcare, such as telemedicine, can help to gain a more realistic picture of their perceptions.

Clinicians and journalists responding to disasters.

Science.gov (United States)

Newman, Elana; Shapiro, Bruce

2014-02-01

Mass casualty events pose dilemmas for community clinicians, often challenging their existing clinical toolkits. However, few clinicians were trained to be experts in explaining the unfolding events to the community, creating resources, and interacting with journalists. The objective of this article is to explain knowledge, skills, and attitudes that mental health professionals need to consider when working with journalists, especially those covering children affected by disaster. In service of these objectives, this article reviews controversies, evidence, and best practices to facilitate effective collaborations and consultations with journalists. Advice includes information on how to be a good source to journalists. Clinicians can ethically and effectively help journalists tell accurate and compelling stories about the psychological effects of disasters when they understand and respect the aims, culture, and ethics of journalism.

Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting.

Science.gov (United States)

Tang, Terence; Lim, Morgan E; Mansfield, Elizabeth; McLachlan, Alexander; Quan, Sherman D

2018-02-01

User involvement is vital to the success of health information technology implementation. However, involving clinician users effectively and meaningfully in complex healthcare organizations remains challenging. The objective of this paper is to share our real-world experience of applying a variety of user involvement methods in the design and implementation of a clinical communication and collaboration platform aimed at facilitating care of complex hospitalized patients by an interprofessional team of clinicians. We designed and implemented an electronic clinical communication and collaboration platform in a large community teaching hospital. The design team consisted of both technical and healthcare professionals. Agile software development methodology was used to facilitate rapid iterative design and user input. We involved clinician users at all stages of the development lifecycle using a variety of user-centered, user co-design, and participatory design methods. Thirty-six software releases were delivered over 24 months. User involvement has resulted in improvement in user interface design, identification of software defects, creation of new modules that facilitated workflow, and identification of necessary changes to the scope of the project early on. A variety of user involvement methods were complementary and benefited the design and implementation of a complex health IT solution. Combining these methods with agile software development methodology can turn designs into functioning clinical system to support iterative improvement. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Electronic medical records and communication with patients and other clinicians: are we talking less?

Science.gov (United States)

O'Malley, Ann S; Cohen, Genna R; Grossman, Joy M

2010-04-01

Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

Clinician search behaviors may be influenced by search engine design.

Science.gov (United States)

Lau, Annie Y S; Coiera, Enrico; Zrimec, Tatjana; Compton, Paul

2010-06-30

Searching the Web for documents using information retrieval systems plays an important part in clinicians' practice of evidence-based medicine. While much research focuses on the design of methods to retrieve documents, there has been little examination of the way different search engine capabilities influence clinician search behaviors. Previous studies have shown that use of task-based search engines allows for faster searches with no loss of decision accuracy compared with resource-based engines. We hypothesized that changes in search behaviors may explain these differences. In all, 75 clinicians (44 doctors and 31 clinical nurse consultants) were randomized to use either a resource-based or a task-based version of a clinical information retrieval system to answer questions about 8 clinical scenarios in a controlled setting in a university computer laboratory. Clinicians using the resource-based system could select 1 of 6 resources, such as PubMed; clinicians using the task-based system could select 1 of 6 clinical tasks, such as diagnosis. Clinicians in both systems could reformulate search queries. System logs unobtrusively capturing clinicians' interactions with the systems were coded and analyzed for clinicians' search actions and query reformulation strategies. The most frequent search action of clinicians using the resource-based system was to explore a new resource with the same query, that is, these clinicians exhibited a "breadth-first" search behaviour. Of 1398 search actions, clinicians using the resource-based system conducted 401 (28.7%, 95% confidence interval [CI] 26.37-31.11) in this way. In contrast, the majority of clinicians using the task-based system exhibited a "depth-first" search behavior in which they reformulated query keywords while keeping to the same task profiles. Of 585 search actions conducted by clinicians using the task-based system, 379 (64.8%, 95% CI 60.83-68.55) were conducted in this way. This study provides evidence that

21 CFR 880.6300 - Implantable radiofrequency transponder system for patient identification and health information.

Science.gov (United States)

2010-04-01

... patient identification and health information. 880.6300 Section 880.6300 Food and Drugs FOOD AND DRUG... radiofrequency transponder system for patient identification and health information. (a) Identification. An implantable radiofrequency transponder system for patient identification and health information is a device...

33 CFR 181.27 - Information displayed near hull identification number.

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Information displayed near hull... displayed near hull identification number. With the exception of the characters “US-”, which constitute the... the 12-character hull identification number (HIN), that information must be separated from the HIN by...

Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms

Science.gov (United States)

De Los Reyes, Andres; Marsh, Jessecae K.

2011-01-01

The purpose of this study was to examine whether contextual information about patients' clinical presentations affected clinicians' judgments of conduct disorder symptoms. Forty-five clinicians read vignettes describing hypothetical patients who displayed one conduct disorder symptom alongside information about the patients' home, school, and peer…

Clinicians completion rate of radiology request card in a Nigerian ...

African Journals Online (AJOL)

The importance of adequately completing the radiology request card by the clinicians, in management of patient cannot be overemphasized. Omission of information on the request card may lead to reporting error. This study investigated the compliance rate of filling the radiology request card by clinicians received in a ...

Gatekeepers or intermediaries? The role of clinicians in commercial genomic testing.

Directory of Open Access Journals (Sweden)

Michelle L McGowan

Full Text Available Many commentators on "direct-to-consumer" genetic risk information have raised concerns that giving results to individuals with insufficient knowledge and training in genomics may harm consumers, the health care system, and society. In response, several commercial laboratories offering genomic risk profiling have shifted to more traditional "direct-to-provider" (DTP marketing strategies, repositioning clinicians as the intended recipients of advertising of laboratory services and as gatekeepers to personal genomic information. Increasing popularity of next generation sequencing puts a premium on ensuring that those who are charged with interpreting, translating, communicating and managing commercial genomic risk information are appropriately equipped for the job. To shed light on their gatekeeping role, we conducted a study to assess how and why early clinical users of genomic risk assessment incorporate these tools in their clinical practices and how they interpret genomic information for their patients.We conducted qualitative in-depth interviews with 18 clinicians providing genomic risk assessment services to their patients in partnership with DNA Direct and Navigenics. Our findings suggest that clinicians learned most of what they knew about genomics directly from the commercial laboratories. Clinicians rely on the expertise of the commercial laboratories without the ability to critically evaluate the knowledge or assess risks.DTP service delivery model cannot guarantee that providers will have adequate expertise or sound clinical judgment. Even if clinicians want greater genomic knowledge, the current market structure is unlikely to build the independent substantive expertise of clinicians, but rather promote its continued outsourcing. Because commercial laboratories have the most "skin in the game" financially, genetics professionals and policymakers should scrutinize the scientific validity and clinical soundness of the process by which

Gatekeepers or intermediaries? The role of clinicians in commercial genomic testing.

Science.gov (United States)

McGowan, Michelle L; Fishman, Jennifer R; Settersten, Richard A; Lambrix, Marcie A; Juengst, Eric T

2014-01-01

Many commentators on "direct-to-consumer" genetic risk information have raised concerns that giving results to individuals with insufficient knowledge and training in genomics may harm consumers, the health care system, and society. In response, several commercial laboratories offering genomic risk profiling have shifted to more traditional "direct-to-provider" (DTP) marketing strategies, repositioning clinicians as the intended recipients of advertising of laboratory services and as gatekeepers to personal genomic information. Increasing popularity of next generation sequencing puts a premium on ensuring that those who are charged with interpreting, translating, communicating and managing commercial genomic risk information are appropriately equipped for the job. To shed light on their gatekeeping role, we conducted a study to assess how and why early clinical users of genomic risk assessment incorporate these tools in their clinical practices and how they interpret genomic information for their patients. We conducted qualitative in-depth interviews with 18 clinicians providing genomic risk assessment services to their patients in partnership with DNA Direct and Navigenics. Our findings suggest that clinicians learned most of what they knew about genomics directly from the commercial laboratories. Clinicians rely on the expertise of the commercial laboratories without the ability to critically evaluate the knowledge or assess risks. DTP service delivery model cannot guarantee that providers will have adequate expertise or sound clinical judgment. Even if clinicians want greater genomic knowledge, the current market structure is unlikely to build the independent substantive expertise of clinicians, but rather promote its continued outsourcing. Because commercial laboratories have the most "skin in the game" financially, genetics professionals and policymakers should scrutinize the scientific validity and clinical soundness of the process by which these laboratories

15 CFR 718.2 - Identification of confidential business information.

Science.gov (United States)

2010-01-01

... business information. 718.2 Section 718.2 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS CONFIDENTIAL BUSINESS INFORMATION 718.2 Identification of confidential business...

Selling health data: de-identification, privacy, and speech.

Science.gov (United States)

Kaplan, Bonnie

2015-07-01

Two court cases that involve selling prescription data for pharmaceutical marketing affect biomedical informatics, patient and clinician privacy, and regulation. Sorrell v. IMS Health Inc. et al. in the United States and R v. Department of Health, Ex Parte Source Informatics Ltd. in the United Kingdom concern privacy and health data protection, data de-identification and reidentification, drug detailing (marketing), commercial benefit from the required disclosure of personal information, clinician privacy and the duty of confidentiality, beneficial and unsavory uses of health data, regulating health technologies, and considering data as speech. Individuals should, at the very least, be aware of how data about them are collected and used. Taking account of how those data are used is needed so societal norms and law evolve ethically as new technologies affect health data privacy and protection.

The role of the national general medical journal: surveys of which journals UK clinicians read to inform their clinical practice.

Science.gov (United States)

Jones, Teresa H; Hanney, Stephen; Buxton, Martin J

2008-12-01

For biomedical research findings to contribute toward health gains they must reach clinicians. Academic journals have historically been considered important information sources. Birken and Parkin found seven journals to most consistently contain the best pediatric evidence and, of these seven, four were general medical journals. We surveyed clinicians in three UK medical specialties (psychiatry, surgery and pediatrics), asking which journals they read and which they considered important to inform their clinical practice. The readership of general medical journals, in comparison to specialty and sub-specialty journals, is widespread across the three UK medical specialties, although the importance of general medical journals varies widely. The BMJ is the most prominent general medical journal in terms of readership and importance but a dominant specialty or sub-specialty journal was usually more important for most groups. The Lancet is less widely read and less important, although more academics than non-academics consider it important. Overall, key general medical journals play an important role. Journal availability and cost, particularly in relation to membership for UK clinicians, and the position of academics and non-academics have to be considered in any analysis. Three of the four general medical journals containing the best pediatric evidence were found to be widely read by UK pediatricians and two UK-based general medical journals, the BMJ and The Lancet, were also considered important in our survey. Further investigation of the reasons for the importance of a journal and studies that would allow international comparisons would provide greater input to the discussion.

Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department.

Science.gov (United States)

Pun, Jack Kh; Chan, Engle Angela; Murray, Kristen A; Slade, Diana; Matthiessen, Christian Mim

2017-11-01

To understand the challenges that clinicians face in communicating with patients and other clinicians within a Hong Kong trilingual emergency department. Effective communication has long been recognised as fundamental to the delivery of quality health care, especially in high-risk and time-constrained environments such as emergency departments. The issue of effective communication is particularly relevant in Hong Kong emergency departments, due to the high volume of patients and the linguistic complexity of this healthcare context. In Hong Kong, emergency department clinicians are native speakers of Chinese, but have received their medical training in English. The clinicians read and record virtually all of their medical documentation in English, yet they communicate verbally with patients in Cantonese and Mandarin. In addition, communication between clinicians occurs in spoken Cantonese, mixed with medical English. Thus, medical information is translated numerous times within one patient journey. This complex linguistic environment creates the potential for miscommunication. A mixed-methods design consisting of a quantitative survey with a sequential qualitative interview. Data were collected in a survey from a purposive sample of 58 clinicians and analysed through descriptive statistics. Eighteen of the clinicians were then invited to take part in semi-structured interviews, the data from which were then subjected to a manifest content analysis. Nearly half of the clinicians surveyed believed that medical information may be omitted or altered through repeated translation in a trilingual emergency department. Eighty-three per cent of clinicians stated that there are communication problems at triage. Over 40% said that they have difficulties in documenting medical information. Around 50% believed that long work hours reduced their ability to communicate effectively with patients. In addition, 34% admitted that they rarely or never listen to patients during a

Use of SERVQUAL to assess clinicians' satisfaction with the blood transfusion service.

Science.gov (United States)

Raspollini, E; Pappalettera, M; Riccardi, D; Parravicini, A; Sestili, S; Rebulla, P; Sirchia, G

1997-01-01

Limited information is available on the level of satisfaction of clinicians with services delivered by blood banks. The purpose of this study was to evaluate the satisfaction of clinicians with our blood transfusion service. We prepared a questionnaire based on SERVQUAL, a method used to measure customers' appreciation of quality of service, by assessing the gap between perceived and expected quality. The questionnaire consisted of 14 items grouped according to five dimensions of quality of service: assurance, empathy, responsiveness, reliability, tangibles. Clinicians were asked to give two scores on a scale from 1 to 7 for each item, score (e) representing what they expected from an 'excellent' service, score (r) how they graded the service received. We considered wide differences in scores of service expectation and receipt for a question to be indicative of either service above expected levels (r > e) or service below expectation (r SERVQUAL was useful to gather information on the level of clinicians' satisfaction with our transfusion service.

Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

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Soo, Martin; Robertson, Lynn M; Ali, Tariq; Clark, Laura E; Fluck, Nicholas; Johnston, Marjorie; Marks, Angharad; Prescott, Gordon J; Smith, William Cairns S; Black, Corri

2014-04-21

In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was

Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study.

Science.gov (United States)

Hollenbach, Jessica P; Cushing, Anna; Melvin, Emilie; McGowan, Bryanna; Cloutier, Michelle M; Manice, Melissa

2017-09-01

Mobile technology for childhood asthma can provide real-time data to enhance care. What real-time adherence information clinicians want, how they may use it, and if the data meet their clinical needs have not been fully explored. Our goal was to determine whether pediatric primary care and pulmonary clinicians believe if a sensor-based mobile intervention is useful in caring for patients with asthma. We recruited participants from 3 urban, primary care and 1 pulmonary practice from July to September 2015 in Hartford, CT. Forty-one participated in four focus groups, which included a demonstration of the technology. Participants were probed with open-ended questions on the type, frequency, and format of inter-visit patient information they found useful. 41 participants (mean age 49 (±13.7) years) were board-certified clinicians (41% MDs and 20% mid-level practitioners), practiced medicine on an average of 19 (±14) years, were primarily white (59%) and women (78%). Clinicians wanted 1) adherence to prescribed inhaler therapy and 2) data on inhaler technique. Clinicians wanted it at the time of a scheduled clinic visit but also wanted inter-visit alerts for excessive use of rescue therapy. Pulmonologists liked the mobile spirometer's provision of inter-visit lung function data; pediatricians did not share this view. Concerns with data accuracy were raised due to families who shared inhalers, access to smartphones, and protection of health information. Overall, clinicians view an asthma mobile health technology as enhancing the patient-centered medical home. Pediatric primary care clinicians and pulmonologists want different information from a mobile app.

Parent and Adolescent Interest in Receiving Adolescent Health Communication Information From Primary Care Clinicians.

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Ford, Carol A; Cheek, Courtney; Culhane, Jennifer; Fishman, Jessica; Mathew, Leny; Salek, Elyse C; Webb, David; Jaccard, James

2016-08-01

Patient-centered health care recognizes that adolescents and parents are stakeholders in adolescent health. We investigate adolescent and parent interest in receiving information about health topics and parent-teen communication from clinicians. Ninety-one parent-adolescent dyads in one practice completed individual interviews. Items assessed levels of interest in receiving health and health communication information from the adolescent's doctor about 18 topics, including routine, mental health, sexual health, substance use, and injury prevention issues. Analyses tested differences between parents and adolescents, within-dyad correlations, and associations with adolescent gender and age. Most parents were female (84%). Adolescents were evenly divided by gender; 36 were aged 12-13 years, 35 were aged 14-15 years, and 20 were aged 16-17 years. Adolescent race reflected the practice population (60% black; 35% white). The vast majority of parents and adolescents reported moderate or high levels of interest in receiving information about all 18 health issues and information to increase parent-teen communication about these topics. Parents' interest in receiving information varied by adolescent age when the expected salience of topics varied by age (e.g., acne, driving safety), whereas adolescents reported similar interest regardless of age. Adolescent gender influenced parent and adolescent interest. Level of interest in receiving information from doctors within adolescent-parent pairs was not significantly correlated for one-half of topics. Parents and adolescents want health care professionals to help them learn and talk about a wide range of adolescent health topics. Feasible primary care interventions that effectively improve parent-teen health communication, and specific adolescent health outcomes are needed. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Customized lifting multiwavelet packet information entropy for equipment condition identification

International Nuclear Information System (INIS)

Chen, Jinglong; Zi, Yanyang; He, Zhengjia; Chen, Xuefeng; Zuo, Ming J; Yuan, Jing

2013-01-01

Condition identification of mechanical equipment from vibration measurement data is significant to avoid economic loss caused by unscheduled breakdowns and catastrophic accidents. However, this task still faces challenges due to the complexity of equipment and the harsh environment. This paper provides a possibility for equipment condition identification by proposing a method called customized lifting multiwavelet packet information entropy. Benefiting from the properties of multi-resolution analysis and multiple wavelet basis functions, the multiwavelet method has advantages in characterizing non-stationary vibration signals. In order to realize the accurate detection and identification of the condition features, a customized lifting multiwavelet packet is constructed via a multiwavelet lifting scheme. Then the vibration signal from the mechanical equipment is processed by the customized lifting multiwavelet packet transform. The relative energy in each frequency band of the multiwavelet packet transform coefficients that equals a percentage of the whole signal energy is taken as the probability. The normalized information entropy is obtained based on the relative energy to describe the condition of a mechanical system. The proposed method is applied to the condition identification of a rolling mill and a demountable disk–drum aero-engine. The results support the feasibility of the proposed method in equipment condition identification. (paper)

Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians

Science.gov (United States)

Salgado de Souza, Ricardo; Gallego Arias Pecorari, Vanessa; Lauria Dib, Luciano

2018-01-01

The present study assessed the level of dentists' knowledge regarding oral cancer in the city of São Paulo, Brazil. A questionnaire was used to compare the level of knowledge among newly graduated and senior clinicians. A total of 20,154 e-mails were correctly delivered to the dentists registered in the database of the Regional Dentistry Council of São Paulo, and 477 (2.36%) responses were received. This sample consisted of 84 newly graduated clinicians and 105 senior clinicians. For the statistical analysis, the chi-square test and the logistic regression analysis were performed with α = 0.05, and the results were described herein. According to their knowledge level, the results were statistically different between the groups, since 19% of the newly graduated clinicians were evaluated with knowledge grade A (excellent) in comparison to 6.7% of the senior clinicians. In spite of the results indicated that newly graduated clinicians' knowledge regarding oral cancer was 2.1 times higher, 34.5% of the professionals in this group had regular or poor knowledge on the subject, and several questions relating to clinical characteristics and risk factors indicated that there still exist some knowledge gaps, demonstrating that there is a need for further studies and information activities addressing oral cancer. PMID:29666649

[Measures to prevent patient identification errors in blood collection/physiological function testing utilizing a laboratory information system].

Science.gov (United States)

Shimazu, Chisato; Hoshino, Satoshi; Furukawa, Taiji

2013-08-01

We constructed an integrated personal identification workflow chart using both bar code reading and an all in-one laboratory information system. The information system not only handles test data but also the information needed for patient guidance in the laboratory department. The reception terminals at the entrance, displays for patient guidance and patient identification tools at blood-sampling booths are all controlled by the information system. The number of patient identification errors was greatly reduced by the system. However, identification errors have not been abolished in the ultrasound department. After re-evaluation of the patient identification process in this department, we recognized that the major reason for the errors came from excessive identification workflow. Ordinarily, an ultrasound test requires patient identification 3 times, because 3 different systems are required during the entire test process, i.e. ultrasound modality system, laboratory information system and a system for producing reports. We are trying to connect the 3 different systems to develop a one-time identification workflow, but it is not a simple task and has not been completed yet. Utilization of the laboratory information system is effective, but is not yet perfect for patient identification. The most fundamental procedure for patient identification is to ask a person's name even today. Everyday checks in the ordinary workflow and everyone's participation in safety-management activity are important for the prevention of patient identification errors.

A qualitative analysis of oncology clinicians' perceptions and barriers for physical activity counseling in breast cancer survivors.

Science.gov (United States)

Fong, Angela J; Faulkner, Guy; Jones, Jennifer M; Sabiston, Catherine M

2018-03-24

Few breast cancer survivors (BCS) engage in sufficient physical activity (PA) to gain physical and mental health benefits. This may be due to a lack of appropriate PA information and support. While key messengers of PA information could be oncology clinicians, many do not consistently counsel their patients on PA. To examine factors affecting PA counseling in clinicians and inform future strategies. Focus groups were conducted with clinicians (N = 27) at four cancer hospitals to better understand factors that affect PA counseling. Focus group discussions were transcribed verbatim and analyzed using inductive thematic analysis. Clinicians perceived a lack of training and knowledge related to PA and BCS. Clinicians also discussed being unsure of when to integrate PA counseling into different phases of survivorship. Similarly, clinicians experienced barriers from hospital administration to maintain patient flow in-clinic, which decreased opportunities for PA counseling. Additionally, lack of awareness of community-based programs within large areas served by hospitals also decreased clinicians' self-efficacy for counseling. In order to facilitate PA counseling, clinicians wanted resources that promote patient-managed PA, available on multiple platforms (e.g., printed and online). Continued education, highlighting recent research and effective implementation of PA, was noted as an important facilitator. Researchers are encouraged to develop research agendas and test educational strategies that are integrated into current practice, empirically test barriers that developed from this study with a larger, representative sample to determine salient barriers and develop PA counseling strategies that are clinician-initiated but not dependent on clinicians.

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians.

Science.gov (United States)

Berry, Marc P; Martí, Joan-Daniel; Ntoumenopoulos, George

2016-10-01

Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full

Using language models to identify relevant new information in inpatient clinical notes.

Science.gov (United States)

Zhang, Rui; Pakhomov, Serguei V; Lee, Janet T; Melton, Genevieve B

2014-01-01

Redundant information in clinical notes within electronic health record (EHR) systems is ubiquitous and may negatively impact the use of these notes by clinicians, and, potentially, the efficiency of patient care delivery. Automated methods to identify redundant versus relevant new information may provide a valuable tool for clinicians to better synthesize patient information and navigate to clinically important details. In this study, we investigated the use of language models for identification of new information in inpatient notes, and evaluated our methods using expert-derived reference standards. The best method achieved precision of 0.743, recall of 0.832 and F1-measure of 0.784. The average proportion of redundant information was similar between inpatient and outpatient progress notes (76.6% (SD=17.3%) and 76.7% (SD=14.0%), respectively). Advanced practice providers tended to have higher rates of redundancy in their notes compared to physicians. Future investigation includes the addition of semantic components and visualization of new information.

Enhancing shared decision making through assessment of patient-clinician concordance on decision quality

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Selby, Warwick; Salkeld, Glenn

to quantify, document, and suggest how future dyadic decisions can be enhanced by criterion prioritisation. Associations between patient’s MDQ-W before, and MDQ-R after consultation with their clinician were analysed along with patient scores from the Satisfaction With Decision (SWD) instrument. Results...... and clinician using the dually-personalised decomposable MyDecisionQuality (MDQ) instrument. This has the potential to guide future work on optimising dyad-specific patient-clinician communication for shared decision making and informed consent....

The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: a longitudinal study.

Science.gov (United States)

Welp, Annalena; Meier, Laurenz L; Manser, Tanja

2016-04-19

Effectively managing patient safety and clinicians' emotional exhaustion are important goals of healthcare organizations. Previous cross-sectional studies showed that teamwork is associated with both. However, causal relationships between all three constructs have not yet been investigated. Moreover, the role of different dimensions of teamwork in relation to emotional exhaustion and patient safety is unclear. The current study focused on the long-term development of teamwork, emotional exhaustion, and patient safety in interprofessional intensive care teams by exploring causal relationships between these constructs. A secondary objective was to disentangle the effects of interpersonal and cognitive-behavioral teamwork. We employed a longitudinal study design. Participants were 2100 nurses and physicians working in 55 intensive care units. They answered an online questionnaire on interpersonal and cognitive-behavioral aspects of teamwork, emotional exhaustion, and patient safety at three time points with a 3-month lag. Data were analyzed with cross-lagged structural equation modeling. We controlled for professional role. Analyses showed that emotional exhaustion had a lagged effect on interpersonal teamwork. Furthermore, interpersonal and cognitive-behavioral teamwork mutually influenced each other. Finally, cognitive-behavioral teamwork predicted clinician-rated patient safety. The current study shows that the interrelations between teamwork, clinician burnout, and clinician-rated patient safety unfold over time. Interpersonal and cognitive-behavioral teamwork play specific roles in a process leading from clinician emotional exhaustion to decreased clinician-rated patient safety. Emotionally exhausted clinicians are less able to engage in positive interpersonal teamwork, which might set in motion a vicious cycle: negative interpersonal team interactions negatively affect cognitive-behavioral teamwork and vice versa. Ultimately, ineffective cognitive

Bed occupancy monitoring: data processing and clinician user interface design.

Science.gov (United States)

Pouliot, Melanie; Joshi, Vilas; Goubran, Rafik; Knoefel, Frank

2012-01-01

Unobtrusive and continuous monitoring of patients, especially at their place of residence, is becoming a significant part of the healthcare model. A variety of sensors are being used to monitor different patient conditions. Bed occupancy monitoring provides clinicians a quantitative measure of bed entry/exit patterns and may provide information relating to sleep quality. This paper presents a bed occupancy monitoring system using a bed pressure mat sensor. A clinical trial was performed involving 8 patients to collect bed occupancy data. The trial period for each patient ranged from 5-10 weeks. This data was analyzed using a participatory design methodology incorporating clinician feedback to obtain bed occupancy parameters. The parameters extracted include the number of bed exits per night, the bed exit weekly average (including minimum and maximum), the time of day of a particular exit, and the amount of uninterrupted bed occupancy per night. The design of a clinical user interface plays a significant role in the acceptance of such patient monitoring systems by clinicians. The clinician user interface proposed in this paper was designed to be intuitive, easy to navigate and not cause information overload. An iterative design methodology was used for the interface design. The interface design is extendible to incorporate data from multiple sensors. This allows the interface to be part of a comprehensive remote patient monitoring system.

Human Identification at a Distance Using Body Shape Information

International Nuclear Information System (INIS)

Rashid, N K A M; Yahya, M F; Shafie, A A

2013-01-01

Shape of human body is unique from one person to another. This paper presents an intelligent system approach for human identification at a distance using human body shape information. The body features used are the head, shoulder, and trunk. Image processing techniques for detection of these body features were developed in this work. Then, the features are recognized using fuzzy logic approach and used as inputs to a recognition system based on a multilayer neural network. The developed system is only applicable for recognizing a person from its frontal view and specifically constrained to male gender to simplify the algorithm. In this research, the accuracy for human identification using the proposed method is 77.5%. Thus, it is proved that human can be identified at a distance using body shape information

Communicating prognosis with parents of critically ill infants: direct observation of clinician behaviors.

Science.gov (United States)

Boss, R D; Lemmon, M E; Arnold, R M; Donohue, P K

2017-11-01

Delivering prognostic information to families requires clinicians to forecast an infant's illness course and future. We lack robust empirical data about how prognosis is shared and how that affects clinician-family concordance regarding infant outcomes. Prospective audiorecording of neonatal intensive care unit family conferences, immediately followed by parent/clinician surveys. Existing qualitative analysis frameworks were applied. We analyzed 19 conferences. Most prognostic discussion targeted predicted infant functional needs, for example, medications or feeding. There was little discussion of how infant prognosis would affect infant/family quality of life. Prognostic framing was typically optimistic. Most parents left the conference believing their infant's prognosis to be more optimistic than did clinicians. Clinician approach to prognostic disclosure in these audiotaped family conferences tended to be broad and optimistic, without detail regarding implications of infant health for infant/family quality of life. Families and clinicians left these conversations with little consensus about infant prognosis.

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

Directory of Open Access Journals (Sweden)

Andrew S. Bossick

2017-08-01

Full Text Available Purpose: This study aimed to examine family (patient, parent/guardian and clinician preferences for identification and management of obesity and obesity-related conditions during the well-child visit. Methods: Four focus groups with teen patients (n = 16, four focus groups with parents (n = 15 and one focus group with providers (n = 12 were conducted using a structured moderator guide tailored to each population. Eligible patients had a well-child visit during the past 12 months and a diagnosis of overweight, obesity, hyperlipidemia or elevated blood pressure. Parents who attended their child’s well-child visit and whose child met the diagnostic criteria were eligible. Teen focus groups were divided by gender (male/female and age (14–15/16–17 years. Focus group transcripts were coded for concepts and themes using qualitative data and thematic analysis. Analysis was performed across groups to determine common themes and domains of intersect. Results: Teens and parents expect weight to be discussed at well-child visits and prefer discussions to come from a trusted clinician who uses serious, consistent language. Teens did not recognize the health implications from excess weight, and both parents and teens express the need for more information on strategies to change behavior. Providers recognize several challenges and barriers to discussing weight management in the well-child visit. Conclusions: A clinician-teen-family relationship built on trust, longevity, teamwork, support and encouragement can create a positive atmosphere and may improve understanding for weight-related messages for teens and families during a well-child visit.

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

Science.gov (United States)

Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C

2006-01-01

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

Use of laboratory test results in patient management by clinicians in Malawi.

Science.gov (United States)

Moyo, Kundai; Porter, Carol; Chilima, Ben; Mwenda, Reuben; Kabue, Mark; Zungu, Lutho; Sarr, Abdoulaye

2015-11-18

Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment. To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services. A cross-sectional study was conducted in 2012 to survey practising clinicians. Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted. A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these, 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%), followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility ( P management. Key informants reported that the quality of laboratory services was good and useful, but that services were often unavailable. Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain, reduce turn-around times, improve the test menu and improve the laboratory infrastructure.

Effects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians.

Science.gov (United States)

Wu, Robert C; Tran, Kim; Lo, Vivian; O'Leary, Kevin J; Morra, Dante; Quan, Sherman D; Perrier, Laure

2012-11-01

To conduct a systematic review of the literature to identify, describe and assess interventions of information and communication technology on the processes of communication and associated patient outcomes within hospital settings. Studies published from the years 1996 to 2010 were considered and were selected if they described an evaluation of information and communication technology interventions to improve clinical communication within hospitals. Two authors abstracted data from full text articles, and the quality of individual articles were appraised. Results of interventions were summarized by their effect. There were 18 identified studies that evaluated the use of interventions that included alphanumeric paging, hands-free communication devices, mobile phones, smartphones, task management systems and a display based paging system. Most quantitative studies used a before and after study design and were of lower quality. Of all the studies, there was only one prospective randomized study, but this study used only simulated communication events. Quantitative studies identified improved perceptions of communication and some improvement in communication metrics. Qualitative studies described improvements in efficiency of communication but also issues of loss of control and reliability. Despite the rapid advancement in information and communications technology over the last decade, there is limited evidence suggesting improvements in the ability of health professionals to communicate effectively. Given the critical nature of communication, we advocate further evaluation of information and communication technology designed to improve communication between clinicians. Outcome measures should include measures of patient-oriented outcomes and efficiency for clinicians. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The effect of texture on face identification and configural information processing

Directory of Open Access Journals (Sweden)

Tzschaschel Eva Alica

2014-01-01

Full Text Available Shape and texture are an integral part of face identity. In the present study, the importance of face texture for face identification and detection of configural manipulation (i.e., spatial relation among facial features was examined by comparing grayscale face photographs (i.e., real faces and line drawings of the same faces. Whereas real faces provide information about texture and shape of faces, line drawings are lacking texture cues. A change-detection task and a forced-choice identification task were used with both stimuli categories. Within the change detection task, participants had to decide whether the size of the eyes of two sequentially presented faces had changed or not. After having made this decision, three faces were shown to the subjects and they had to identify the previously shown face among them. Furthermore, context (full vs. cropped faces and orientation (upright vs. inverted were manipulated. The results obtained in the change detection task suggest that configural information was used in processing real faces, while part-based and featural information was used in processing line-drawings. Additionally, real faces were identified more accurately than line drawings, and identification was less context but more orientation sensitive than identification of line drawings. Taken together, the results of the present study provide new evidence stressing the importance of face texture for identity encoding and configural face processing.

Boosting healthy heart employer-sponsored health dissemination efforts: identification and information-sharing intentions.

Science.gov (United States)

Stephens, Keri K; Pastorek, Angie; Crook, Brittani; Mackert, Michael; Donovan, Erin E; Shalev, Heidi

2015-01-01

Health information dissemination options have expanded to include workplaces and employer-sponsored efforts. This study focuses on a core relational concept found in workplaces, organizational identification-the feeling of belongingness-and the impact of partnering with employers and health clinics in health information dissemination. We use social-identity theory and multiple identification to test our predictions from a sample of working adults representing more than 100 different employers. We found that when people strongly identify with their employer, they have increased health behavioral intentions and they intend to talk about the health information with coworkers. The significant models explain more than 50% and 30% of the variance in these two outcomes. The experimental results examining single and multiple organizational sources revealed no differences on any outcomes. These findings offer a contribution to health information dissemination research by articulating how identification with an employer functions to affect behavioral intentions.

Language identification of information blocks based on lexico-grammatic markers

Directory of Open Access Journals (Sweden)

Sergey N. Kalegin

2017-12-01

Full Text Available This article is a continuation of the author's series of publications on the subjects of language identification of texts. In the article is being considered the creation of a technological basis for language identification systems of unstructured information blocks based on lexico-grammatical markers, in which are used the forms of verbs, verbal formations or functionally analogous constructions, are described method and algorithm for its software implementation. These developments will significantly reduce the resource intensity and improve the quality of such systems, which will give a significant economic effect and the possibility of creating fundamentally new technologies for determining the linguistic affiliation of information in a multilingual environment. Consequently, the study is of interest for computer linguists and developers of automatic word processing systems, such as: global monitoring systems, multilingual knowledge bases, automatic translation systems, information retrieval systems, document summarizing systems, literature catalogers, etc.

A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians

Directory of Open Access Journals (Sweden)

Patel D

2017-12-01

Full Text Available Drasti Patel,1 Christine Koehmstedt,1 Rebecca Jones,1 Nathan T Coffey,1 Xinsheng Cai,2 Steven Garfinkel,2 Dahlia M Shaewitz,2 Ali A Weinstein1 1Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, 2American Institutes for Research, Washington, DC, USA Purpose: Research examining the utilization of evidence-based practice (EBP specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice.Methods: A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed.Results: There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information.Conclusion: Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur. Keywords: health information, information behavior, knowledge utilization

40 CFR 91.113 - Requirement of certification-emission control information label and engine identification number.

Science.gov (United States)

2010-07-01

... control information label and engine identification number. 91.113 Section 91.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM... certification—emission control information label and engine identification number. (a) The engine manufacturer...

Gamification as a strategy to engage and motivate clinicians to improve care.

Science.gov (United States)

McKeown, Shari; Krause, Christina; Shergill, Meher; Siu, Andrew; Sweet, David

2016-03-01

Approaching change through seeking commitment rather than requiring compliance is an effective way to promote desired behaviours in healthcare. Gamification was explored as a technique to engage clinicians in the adoption of sepsis identification and management tools. Positive extrinsic (eg, feedback and rewards) and intrinsic (eg, mastery, autonomy, relatedness, and purpose) motivators were integrated into a campaign to save lives, leading to a significant reduction in severe sepsis mortality and improvement in processes of care. © 2016 The Canadian College of Health Leaders.

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications.

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Alpert, Jordan M; Krist, Alex H; Aycock, Rebecca A; Kreps, Gary L

2017-03-01

Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology.

On a learning curve for shared decision making: Interviews with clinicians using the knee osteoarthritis Option Grid.

Science.gov (United States)

Elwyn, Glyn; Rasmussen, Julie; Kinsey, Katharine; Firth, Jill; Marrin, Katy; Edwards, Adrian; Wood, Fiona

2018-02-01

Tools used in clinical encounters to illustrate to patients the risks and benefits of treatment options have been shown to increase shared decision making. However, we do not have good information about how these tools are viewed by clinicians and how clinicians think patients would react to their use. Our aim was to examine clinicians' views about the possible and actual use of tools designed to support patients and clinicians to collaborate and deliberate about treatment options, namely, Option Grid decision aids. We conducted a thematic analysis of qualitative interviews embedded in the intervention phase of a trial of an Option Grid decision aid for osteoarthritis of the knee. Interviews were conducted with 6 participating clinicians before they used the tool and again after clinicians had used the tool with 6 patients. In the first interview, clinicians voiced concerns that the tool would lead to an increase in encounter duration, patient resistance regarding involvement in decision making, and potential information overload. At the second interview, after minimal training, the clinicians reported that the tool had changed their usual way of communicating, and it was generally acceptable and helpful to integrate it into practice. After experiencing the use of Option Grids, clinicians became more willing to use the tools in their clinical encounters with patients. How best to introduce Option Grids to clinicians and adopt their use into practice will need careful consideration of context, workflow, and clinical pathways. © 2016 John Wiley & Sons, Ltd.

Text de-identification for privacy protection: a study of its impact on clinical text information content.

Science.gov (United States)

Meystre, Stéphane M; Ferrández, Óscar; Friedlin, F Jeffrey; South, Brett R; Shen, Shuying; Samore, Matthew H

2014-08-01

As more and more electronic clinical information is becoming easier to access for secondary uses such as clinical research, approaches that enable faster and more collaborative research while protecting patient privacy and confidentiality are becoming more important. Clinical text de-identification offers such advantages but is typically a tedious manual process. Automated Natural Language Processing (NLP) methods can alleviate this process, but their impact on subsequent uses of the automatically de-identified clinical narratives has only barely been investigated. In the context of a larger project to develop and investigate automated text de-identification for Veterans Health Administration (VHA) clinical notes, we studied the impact of automated text de-identification on clinical information in a stepwise manner. Our approach started with a high-level assessment of clinical notes informativeness and formatting, and ended with a detailed study of the overlap of select clinical information types and Protected Health Information (PHI). To investigate the informativeness (i.e., document type information, select clinical data types, and interpretation or conclusion) of VHA clinical notes, we used five different existing text de-identification systems. The informativeness was only minimally altered by these systems while formatting was only modified by one system. To examine the impact of de-identification on clinical information extraction, we compared counts of SNOMED-CT concepts found by an open source information extraction application in the original (i.e., not de-identified) version of a corpus of VHA clinical notes, and in the same corpus after de-identification. Only about 1.2-3% less SNOMED-CT concepts were found in de-identified versions of our corpus, and many of these concepts were PHI that was erroneously identified as clinical information. To study this impact in more details and assess how generalizable our findings were, we examined the overlap between

The clinician's dilemma: two dimensions of ethical care.

Science.gov (United States)

Gillett, Grant; Chamberlain, Joshua

2013-01-01

There is a continuing intense medico-ethico-legal debate around legalized euthanasia and physician assisted suicide such that ethically informed clinicians often agree with the arguments but feel hesitant about the conclusion, especially when it may bring about a change in law. We argue that this confusion results from the convergence of two continua that underpin the conduct of a clinician and are especially prominent in psychiatry. The two continua concern the duty of care and the importance of patient autonomy and they do not quite map into traditional divides in debates about sanctity of life, paternalism, and autonomy. As ethical dimensions, they come into sharp focus in the psychological complexities of end-of-life care and they form two key factors in most ethical and legal or disciplinary deliberations about a clinician's actions. Whereas both dimensions are important when a clinician reflects on what s/he has done or should do, they need careful balancing in a request for euthanasia or physician assisted suicide where the patient wants to take a decisive role in his or her own end-of-life care. However, end-of-life is also a situation where clinicians often encounter 'cries for help' so that both continua are importantly in play. Balancing these two continua without using blunt legal instruments is often required in psychiatric care in such a way as to problematize the idea that patient decisions should dominate the care options available. A simplistic approach to that issue arguably plays into what has been called an 'impoverished construction of life and death' and, some would say, devalues the basic commitments fundamental to medical care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Stigma in the mental health workplace: perceptions of peer employees and clinicians.

Science.gov (United States)

Stromwall, Layne K; Holley, Lynn C; Bashor, Kathy E

2011-08-01

Informed by a structural theory of workplace discrimination, mental health system employees' perceptions of mental health workplace stigma and discrimination against service recipients and peer employees were investigated. Fifty-one peer employees and 52 licensed behavioral health clinicians participated in an online survey. Independent variables were employee status (peer or clinician), gender, ethnicity, years of mental health employment, age, and workplace social inclusion of peer employees. Analysis of covariance on workplace discrimination against service recipients revealed that peer employees perceived more discrimination than clinicians and whites perceived more discrimination than employees of color (corrected model F = 9.743 [16, 87], P = .000, partial ŋ (2) = .644). Analysis of covariance on workplace discrimination against peer employees revealed that peer employees perceived more discrimination than clinicians (F = 4.593, [6, 97], P = .000, partial ŋ (2) = .223).

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014.

Science.gov (United States)

Adam, Jessica K; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L; Han, George; Sharp, Tyler M; Waterman, Stephen H; Tomashek, Kay M

2017-03-01

AbstractDengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

Science.gov (United States)

Adam, Jessica K.; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L.; Han, George; Sharp, Tyler M.; Waterman, Stephen H.; Tomashek, Kay M.

2017-01-01

Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July–December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training. PMID:28138048

An overview of meta-analysis for clinicians

Science.gov (United States)

Lee, Young Ho

2018-01-01

The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions. PMID:29277096

An overview of meta-analysis for clinicians.

Science.gov (United States)

Lee, Young Ho

2018-03-01

The number of medical studies being published is increasing exponentially, and clinicians must routinely process large amounts of new information. Moreover, the results of individual studies are often insufficient to provide confident answers, as their results are not consistently reproducible. A meta-analysis is a statistical method for combining the results of different studies on the same topic and it may resolve conflicts among studies. Meta-analysis is being used increasingly and plays an important role in medical research. This review introduces the basic concepts, steps, advantages, and caveats of meta-analysis, to help clinicians understand it in clinical practice and research. A major advantage of a meta-analysis is that it produces a precise estimate of the effect size, with considerably increased statistical power, which is important when the power of the primary study is limited because of a small sample size. A meta-analysis may yield conclusive results when individual studies are inconclusive. Furthermore, meta-analyses investigate the source of variation and different effects among subgroups. In summary, a meta-analysis is an objective, quantitative method that provides less biased estimates on a specific topic. Understanding how to conduct a meta-analysis aids clinicians in the process of making clinical decisions.

'Learning Organizations': a clinician's primer.

Science.gov (United States)

O'Connor, Nick; Kotze, Beth

2008-06-01

Most clinicians are poorly informed in relation to the key concepts of organizational learning. Yet the paradigm may offer clinicians a powerful method for using their knowledge and skills to respond to the demands of a changing environment through experimentation and learning. The concept is critically examined. Organizational learning principles are presented, including a conceptual framework for assessing health services as Learning Organizations. Barriers to organizational learning and strategies to overcome these are discussed. The seminal works of Argyris and Senge are reviewed and a framework for assessing organizational learning in health services is proposed. Current area health service actions are evaluated against the 'diagnostic' framework for a Learning Organization. Although critical examination reveals a poor empirical basis for the concept, the metaphor of the Learning Organization provides a useful conceptual framework and tools for individuals and organizations to apply in developing knowledge and effecting change. The Clinical Practice Improvement and Root Cause Analysis programs being conducted across NSW area health services meet the criteria for effective organizational learning. Key concepts from organizational learning theory provide a diagnostic framework for evaluating area health services as Learning Organizations and support two current strategies for overcoming barriers to organizational learning.

Evaluating common de-identification heuristics for personal health information.

Science.gov (United States)

El Emam, Khaled; Jabbouri, Sam; Sams, Scott; Drouet, Youenn; Power, Michael

2006-11-21

With the growing adoption of electronic medical records, there are increasing demands for the use of this electronic clinical data in observational research. A frequent ethics board requirement for such secondary use of personal health information in observational research is that the data be de-identified. De-identification heuristics are provided in the Health Insurance Portability and Accountability Act Privacy Rule, funding agency and professional association privacy guidelines, and common practice. The aim of the study was to evaluate whether the re-identification risks due to record linkage are sufficiently low when following common de-identification heuristics and whether the risk is stable across sample sizes and data sets. Two methods were followed to construct identification data sets. Re-identification attacks were simulated on these. For each data set we varied the sample size down to 30 individuals, and for each sample size evaluated the risk of re-identification for all combinations of quasi-identifiers. The combinations of quasi-identifiers that were low risk more than 50% of the time were considered stable. The identification data sets we were able to construct were the list of all physicians and the list of all lawyers registered in Ontario, using 1% sampling fractions. The quasi-identifiers of region, gender, and year of birth were found to be low risk more than 50% of the time across both data sets. The combination of gender and region was also found to be low risk more than 50% of the time. We were not able to create an identification data set for the whole population. Existing Canadian federal and provincial privacy laws help explain why it is difficult to create an identification data set for the whole population. That such examples of high re-identification risk exist for mainstream professions makes a strong case for not disclosing the high-risk variables and their combinations identified here. For professional subpopulations with published

To act or not to act: responses to electronic health record prompts by family medicine clinicians.

Science.gov (United States)

Zazove, Philip; McKee, Michael; Schleicher, Lauren; Green, Lee; Kileny, Paul; Rapai, Mary; Mulhem, Elie

2017-03-01

A major focus of health care today is a strong emphasis on improving the health and quality of care for entire patient populations. One common approach utilizes electronic clinical alerts to prompt clinicians when certain interventions are due for individual patients being seen. However, these alerts have not been consistently effective, particularly for less visible (though important) conditions such as hearing loss (HL) screening. We conducted hour-long cognitive task analysis interviews to explore how family medicine clinicians view, perceive, and use electronic clinical alerts, and to utilize this information to design a more effective alert using HL identification and referral as a model diagnosis. Four key direct barriers were identified that impeded alert use: poor standardization and formatting, time pressures in primary care, clinic workflow variations, and mental models of the condition being prompted (in this case, HL). One indirect barrier was identified: electronic health record and institution/government regulations. We identified that clinicians' mental model of the condition being prompted was probably the major barrier, though this was often expressed as time pressure. We discuss solutions to each of the 5 identified barriers, such as addressing physicians' mental models, by focusing on physicians' expertise rather than knowledge to improve their comfort when caring for patients with the conditions being prompted. To unleash the potential of electronic clinical alerts, electronic health record and health care institutions need to address some key barriers. We outline these barriers and propose solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression.

Science.gov (United States)

Barr, Paul J; Forcino, Rachel C; Mishra, Manish; Blitzer, Rachel; Elwyn, Glyn

2016-01-08

To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 'important features' in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. Online cross-sectional surveys fielded in September to December 2014. We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was 'Will the treatment work?' Clinicians were aware of consumers' priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

Science.gov (United States)

Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle; Lasser, Karen E; Borrelli, Belinda; Au, David H; Slatore, Christopher G; Clark, Jack A; Kathuria, Hasmeena

2018-02-21

Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. Qualitative study entailing semi-structured interviews and focus groups. We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. Due to multiple perceived barriers, patient-clinician

A clinician-driven home care delivery system.

Science.gov (United States)

August, D A; Faubion, W C; Ryan, M L; Haggerty, R H; Wesley, J R

1993-12-01

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

Systematic Heuristic Evaluation of Computerized Consultation Order Templates: Clinicians' and Human Factors Engineers' Perspectives.

Science.gov (United States)

Savoy, April; Patel, Himalaya; Flanagan, Mindy E; Weiner, Michael; Russ, Alissa L

2017-08-01

We assessed the usability of consultation order templates and identified problems to prioritize in design efforts for improving referral communication. With a sample of 26 consultation order templates, three evaluators performed a usability heuristic evaluation. The evaluation used 14 domain-independent heuristics and the following three supplemental references: 1 new domain-specific heuristic, 6 usability goals, and coded clinicians' statements regarding ease of use for 10 sampled templates. Evaluators found 201 violations, a mean of 7.7 violations per template. Minor violations outnumbered major violations almost twofold, 115 (57%) to 62 (31%). Approximately 68% of violations were linked to 5 heuristics: aesthetic and minimalist design (17%), error prevention (16%), consistency and standards (14%), recognition rather than recall (11%), and meet referrers' information needs (10%). Severe violations were attributed mostly to meet referrers' information needs and recognition rather than recall. Recorded violations yielded potential negative consequences for efficiency, effectiveness, safety, learnability, and utility. Evaluators and clinicians demonstrated 80% agreement in usability assessment. Based on frequency and severity of usability heuristic violations, the consultation order templates reviewed may impede clinical efficiency and risk patient safety. Results support the following design considerations: communicate consultants' requirements, facilitate information seeking, and support communication. While the most frequent heuristic violations involved interaction design and presentation, the most severe violations lacked information desired by referring clinicians. Violations related to templates' inability to support referring clinicians' information needs had the greatest potential negative impact on efficiency and safety usability goals. Heuristics should be prioritized in future design efforts.

Identification of the operating crew's information needs for accident management

International Nuclear Information System (INIS)

Nelson, W.R.; Hanson, D.J.; Ward, L.W.; Solberg, D.E.

1988-01-01

While it would be very difficult to predetermine all of the actions required to mitigate the consequences of every potential severe accident for a nuclear power plant, development of additional guidance and training could improve the likelihood that the operating crew would implement effective sever-accident management measures. The US Nuclear Regulatory Commission (NRC) is conducting an Accident Management Research Program that emphasizes the application of severe-accident research results to enhance the capability of the plant operating crew to effectively manage severe accidents. One element of this program includes identification of the information needed by the operating crew in severe-accident situations. This paper discusses a method developed for identifying these information needs and its application. The methodology has been applied to a generic reactor design representing a PWR with a large dry containment. The information needs were identified by systematically determining what information is needed to assess the health of the critical functions, identify the presence of challenges, select strategies, and assess the effectiveness of these strategies. This method allows the systematic identification of information needs for a broad range of severe-accident scenarios and can be validated by exercising the functional models for any specific event sequence

Eyewitness identification: Bayesian information gain, base-rate effect equivalency curves, and reasonable suspicion.

Science.gov (United States)

Wells, Gary L; Yang, Yueran; Smalarz, Laura

2015-04-01

We provide a novel Bayesian treatment of the eyewitness identification problem as it relates to various system variables, such as instruction effects, lineup presentation format, lineup-filler similarity, lineup administrator influence, and show-ups versus lineups. We describe why eyewitness identification is a natural Bayesian problem and how numerous important observations require careful consideration of base rates. Moreover, we argue that the base rate in eyewitness identification should be construed as a system variable (under the control of the justice system). We then use prior-by-posterior curves and information-gain curves to examine data obtained from a large number of published experiments. Next, we show how information-gain curves are moderated by system variables and by witness confidence and we note how information-gain curves reveal that lineups are consistently more proficient at incriminating the guilty than they are at exonerating the innocent. We then introduce a new type of analysis that we developed called base rate effect-equivalency (BREE) curves. BREE curves display how much change in the base rate is required to match the impact of any given system variable. The results indicate that even relatively modest changes to the base rate can have more impact on the reliability of eyewitness identification evidence than do the traditional system variables that have received so much attention in the literature. We note how this Bayesian analysis of eyewitness identification has implications for the question of whether there ought to be a reasonable-suspicion criterion for placing a person into the jeopardy of an identification procedure. (c) 2015 APA, all rights reserved).

A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians.

Science.gov (United States)

Patel, Drasti; Koehmstedt, Christine; Jones, Rebecca; Coffey, Nathan T; Cai, Xinsheng; Garfinkel, Steven; Shaewitz, Dahlia M; Weinstein, Ali A

2017-01-01

Research examining the utilization of evidence-based practice (EBP) specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice. A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed. There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information. Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur.

Clinicians' management strategies for patients with dyspepsia: a qualitative approach

Directory of Open Access Journals (Sweden)

Ohlsson Bodil

2005-05-01

Full Text Available Abstract Background Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own. Methods Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted. Results For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced. Conclusion Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate

Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications

Science.gov (United States)

Krist, Alex H.; Aycock, Rebecca A.; Kreps, Gary L.

2017-01-01

Abstract Background: Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). Materials and Methods: In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. Results: Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). Conclusions: Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology. PMID:27333468

Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability

Science.gov (United States)

Holloway, Kristi; Riley, Geoffrey; Auret, Kirsten

2013-01-01

Background Online mental health resources have been proposed as an innovative means of overcoming barriers to accessing rural mental health services. However, clinicians tend to express lower satisfaction with online mental health resources than do clients. Objective To understand rural clinicians’ attitudes towards the acceptability of online mental health resources as a treatment option in the rural context. Methods In-depth interviews were conducted with 21 rural clinicians (general practitioners, psychologists, psychiatrists, and clinical social workers). Interviews were supplemented with rural-specific vignettes, which described clinical scenarios in which referral to online mental health resources might be considered. Symbolic interactionism was used as the theoretical framework for the study, and interview transcripts were thematically analyzed using a constant comparative method. Results Clinicians were optimistic about the use of online mental health resources into the future, showing a preference for integration alongside existing services, and use as an adjunct rather than an alternative to traditional approaches. Key themes identified included perceptions of resources, clinician factors, client factors, and the rural and remote context. Clinicians favored resources that were user-friendly and could be integrated into their clinical practice. Barriers to use included a lack of time to explore resources, difficulty accessing training in the rural environment, and concerns about the lack of feedback from clients. Social pressure exerted within professional clinical networks contributed to a cautious approach to referring clients to online resources. Conclusions Successful implementation of online mental health resources in the rural context requires attention to clinician perceptions of acceptability. Promotion of online mental health resources to rural clinicians should include information about resource effectiveness, enable integration with existing

Comparison of Trained Clinician Ratings with Expert Ratings of Aspiration on Videofluoroscopic Images from a Randomized Clinical Trial

Science.gov (United States)

Hind, Jacqueline A.; Gensler, Gary; Brandt, Diane K.; Miller Gardner, Patricia J.; Blumenthal, Loreen; Gramigna, Gary D.; Kosek, Steven; Lundy, Donna; McGarvey-Toler, Susan; Rockafellow, Susan; Sullivan, Paula A.; Villa, Marybell; Gill, Gary D.; Lindblad, Anne S.; Logemann, Jeri A.; Robbins, JoAnne

2009-01-01

Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that inter-judge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin down posture with thin-liquids and thickened liquids (nectar-thick and honey-thick consistencies) in a head neutral posture. The subject population included patients with Parkinson’s disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all К > .86) and variable accuracy (range 69%–76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale. PMID:18953607

Clinician researcher career pathway for registered nurses and midwives: A proposal.

Science.gov (United States)

Smith, Sheree; Gullick, Janice; Ballard, Jacqueline; Perry, Lin

2018-06-01

To consider clinician researcher career frameworks and propose a new pathway, integrating university and health service components to support research career progression within nursing and midwifery practice. Hospitals with research-active clinicians report fewer adverse events and better patient outcomes. Nursing clinician researcher career development is therefore an international priority, yet positions and expectations associated with this are not always well articulated, with nurses and midwives challenged to accommodate research and clinical careers. This discussion paper describes nurse/midwife clinician researcher career frameworks and a new pathway that aligns academic and nursing role descriptions. The new framework was informed by a brief literature search for international framework documents, three Australian state-based Nurses and Midwives Awards: the Australian Qualifications Framework, publically available University Academic (Research) Award schedules and academic staff descriptions, and state health department and health services publications. The implementation of research-based practice is a key element of nursing and midwifery roles and "advanced practice" position descriptions have well-defined research expectations. This paper considers structures to support their achievement. This paper provides a blueprint for clinician researcher career development. It elevates the research domain as an equal alongside clinical, managerial and educational clinical career development. © 2018 John Wiley & Sons Australia, Ltd.

The power of clinicians' affective communication: how reassurance about non-abandonment can reduce patients' physiological arousal and increase information recall in bad news consultations. An experimental study using analogue patients.

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Sep, Milou S C; van Osch, Mara; van Vliet, Liesbeth M; Smets, Ellen M A; Bensing, Jozien M

2014-04-01

The diagnosis of incurable cancer may evoke physiological arousal in patients. Physiological arousal can negatively impact patients' recall of information provided in the medical consultation. We aim to investigate whether clinicians' affective communication during a bad news consultation will decrease patients' physiological arousal and will improve recall. Healthy women (N=50), acting as analogue patients, were randomly assigned to watch one out of the two versions of a scripted video-vignette of a bad news consultation in which clinician's communication differed: standard vs. affective communication. Participants' skin conductance levels were obtained during video-watching, and afterwards their recall was assessed. While the diagnosis increased skin conductance levels in all analogue patients, skin conductance levels during the remainder of the consultation decreased more in the affective communication condition than in the standard condition. Analogue patients' recall was significantly higher in the affective condition. Breaking bad news evokes physiological arousal. Affective communication can decrease this evoked physiological arousal and might be partly responsible for analogue patients' enhanced information recall. Although our findings need to be translated to clinical patients, they suggest that clinicians need to deal with patients' emotions before providing additional medical information. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review.

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Henry, Stephen G; Matthias, Marianne S

2018-02-01

Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research. © 2018 American Academy of Pain Medicine. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Clinicians' perceptions of organizational readiness for change in the context of clinical information system projects: insights from two cross-sectional surveys.

Science.gov (United States)

Paré, Guy; Sicotte, Claude; Poba-Nzaou, Placide; Balouzakis, George

2011-02-28

The adoption and diffusion of clinical information systems has become one of the critical benchmarks for achieving several healthcare organizational reform priorities, including home care, primary care, and integrated care networks. However, these systems are often strongly resisted by the same community that is expected to benefit from their use. Prior research has found that early perceptions and beliefs play a central role in shaping future attitudes and behaviors such as negative rumors, lack of involvement, and resistance to change. In this line of research, this paper builds on the change management and information systems literature and identifies variables associated with clinicians' early perceptions of organizational readiness for change in the specific context of clinical information system projects. Two cross-sectional surveys were conducted to test our research model. First, a questionnaire was pretested and then distributed to the future users of a mobile computing technology in 11 home care organizations. The second study took place in a large teaching hospital that had approved a budget for the acquisition of an electronic medical records system. Data analysis was performed using partial least squares. Scale items used in this study showed adequate psychometric properties. In Study 1, four of the hypothesized links in the research model were supported, with change appropriateness, organizational flexibility, vision clarity, and change efficacy explaining 75% of the variance in organizational readiness. In Study 2, four hypotheses were also supported, two of which differed from those supported in Study 1: the presence of an effective project champion and collective self-efficacy. In addition to these variables, vision clarity and change appropriateness also helped explain 75% of the variance in the dependent variable. Explanations for the similarities and differences observed in the two surveys are provided. Organizational readiness is arguably a key

Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

Science.gov (United States)

Farri, Oladimeji Feyisetan

2012-01-01

Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

The nature of excellent clinicians at an academic health science center: a qualitative study.

Science.gov (United States)

Mahant, Sanjay; Jovcevska, Vesna; Wadhwa, Anupma

2012-12-01

To understand the nature of excellent clinicians at an academic health science center by exploring how and why excellent clinicians achieve high performance. From 2008 to 2010, the authors conducted a qualitative study using a grounded theory approach. Members of the Clinical Advisory Committee in the Department of Pediatrics at the University of Toronto nominated peers whom they saw as excellent clinicians. The authors then conducted in-depth interviews with the most frequently nominated clinicians. They audio-recorded and transcribed the interviews and coded the transcripts to identify emergent themes. From interviews with 13 peer-nominated, excellent clinicians, a model emerged. Dominant themes fell into three categories: (1) core philosophy, (2) deliberate activities, and (3) everyday practice. Excellent clinicians are driven by a core philosophy defined by high intrinsic motivation and passion for patient care and humility. They refine their clinical skills through two deliberate activities-reflective clinical practice and scholarship. Their high performance in everyday practice is characterized by clinical skills and cognitive ability, people skills, engagement, and adaptability. A rich theory emerged explaining how excellent clinicians, driven by a core philosophy and engaged in deliberate activities, achieve high performance in everyday practice. This theory of the nature of excellent clinicians provides a holistic perspective of individual performance, informs medical education, supports faculty career development, and promotes clinical excellence in the culture of academic medicine.

The electronic identification, signature and security of information systems

Directory of Open Access Journals (Sweden)

Horovèák Pavel

2002-12-01

Full Text Available The contribution deals with the actual methods and technologies of information and communication systems security. It introduces the overview of electronic identification elements such as static password, dynamic password and single sign-on. Into this category belong also biometric and dynamic characteristics of verified person. Widespread is authentication based on identification elements ownership, such as various cards and authentication calculators. In the next part is specified a definition and characterization of electronic signature, its basic functions and certificate categories. Practical utilization of electronic signature consists of electronic signature acquirement, signature of outgoing email message, receiving of electronic signature and verification of electronic signature. The use of electronic signature is continuously growing and in connection with legislation development it exercises in all resorts.

Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration

Science.gov (United States)

Pieterse, A H; Baas-Thijssen, M C M; Marijnen, C A M; Stiggelbout, A M

2008-01-01

Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, ⩾81% thought not all patients are able to participate and ⩾74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points. PMID:18781148

The effect of core clinician interpersonal behaviours on depression.

Science.gov (United States)

Barnicot, K; Wampold, B; Priebe, S

2014-01-01

It is well-established that core clinician interpersonal behaviours are important when treating depression, but few studies have evaluated whether outcome is determined by clinicians׳ general behaviour rather than by the perception of the individual being treated. In the NIMH TDCRP, 157 patients rated their clinician׳s genuineness, positive regard, empathy and unconditional regard during cognitive behavioural therapy, interpersonal therapy or clinical management with placebo. The association between averaged ratings for each of 27 clinicians and their patients׳ self- and observer-rated depression outcomes was evaluated, adjusting for the deviation of individual patient ratings from the average for their clinician and other potential confounders. Clinicians in the clinical management condition were rated on average as less genuine and less empathic than those in the psychotherapy conditions. Clinicians׳ average genuineness, positive regard and empathy were significantly associated with lower depression severity during treatment, but not with recovery from depression, after adjusting for the deviation of the individual patient׳s rating of their clinician from the average for that clinician, treatment condition and baseline depression severity. Clinician unconditional regard was not significantly associated with outcome. Using averaged ratings of clinician behaviour likely reduced statistical power. Clinicians׳ ability to demonstrate genuineness, positive regard and empathy may represent a stable personal characteristic that influences the treatment of depression beyond the individual clinician-patient relationship or an individual patient׳s perception of their clinician. However, clinicians׳ ability to demonstrate these behaviours may be poorer when delivering an intervention without a specific rationale or treatment techniques. Copyright © 2014 Elsevier B.V. All rights reserved.

'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents.

Science.gov (United States)

Heflin, Mitchell T; Pinheiro, Sandro; Kaminetzky, Catherine P; McNeill, Diana

2009-06-01

Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer 'resident-as-teacher' programs to assist residents in developing teaching skills, the need exists to expand training opportunities in this area. The authors conducted a workshop at a national meeting to develop a description of essential components of a training pathway for internal medicine residents. Through open discussion and small group work, participants defined the various roles of clinician-educators and described goals, training opportunities, assessment and resource needs for such a program. Workshop participants posited that the clinician-educator has several roles to fulfill beyond that of clinician, including those of teacher, curriculum developer, administrator and scholar. A pathway for residents aspiring to become clinician educators must offer structured training in each of these four areas to empower residents to effectively practice clinical education. In addition, the creation of such a track requires securing time and resources to support resident learning experiences and formal faculty development programs to support institutional mentors and leaders. This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

US Health Care Clinicians' Knowledge, Attitudes, and Practices Regarding Human Papillomavirus Vaccination: A Qualitative Systematic Review.

Science.gov (United States)

Rosen, Brittany L; Shepard, Allie; Kahn, Jessica A

2018-03-01

Clinicians' recommendation for the human papillomavirus (HPV) vaccine appears to be an important driver of parental decisions about vaccination. Our aim was to synthesize the best available evidence exploring the perceptions and experiences regarding HPV vaccination, from the perspective of the US clinician. We conducted a comprehensive literature search of Academic Search Complete, CINAHL Plus, Communication & Mass Media Complete, Consumer Health Complete (EBSCOhost), ERIC, Health and Psychosocial Instruments, MEDLINE with full text, and PsycINFO databases. We identified 60 eligible articles: 48 quantitative and 12 qualitative. We extracted the following information: study purpose, use of theory, location, inclusion criteria, and health care provider classification. Results were organized into 5 categories: 1) clinicians' knowledge and beliefs about HPV and the HPV vaccine, 2) clinicians' attitudes and beliefs about recommending HPV vaccines, 3) clinicians' intention to recommend HPV vaccines, 4) clinicians' professional practices regarding HPV vaccination, and 5) patient HPV vaccination rates. Although clinicians were generally supportive of HPV vaccination, there was a discrepancy between clinicians' intentions, recommendation practices, and patient vaccination rates. Studies reported that clinicians tended not to provide strong, consistent recommendations, and were more likely to recommend HPV vaccines to girls versus boys and to older versus younger adolescents. Analyses revealed a number of facilitating factors and barriers to HPV vaccination at the clinician, parent/patient, and systems levels, including clinician knowledge, clinician beliefs, and office procedures that promote vaccination. This review provides an evidence base for multilevel interventions to improve clinician HPV vaccine recommendations and vaccination rates. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Rehabilitation goal setting with community dwelling adults with acquired brain injury: a theoretical framework derived from clinicians' reflections on practice.

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Prescott, Sarah; Fleming, Jennifer; Doig, Emmah

2017-06-11

The aim of this study was to explore clinicians' experiences of implementing goal setting with community dwelling clients with acquired brain injury, to develop a goal setting practice framework. Grounded theory methodology was employed. Clinicians, representing six disciplines across seven services, were recruited and interviewed until theoretical saturation was achieved. A total of 22 clinicians were interviewed. A theoretical framework was developed to explain how clinicians support clients to actively engage in goal setting in routine practice. The framework incorporates three phases: a needs identification phase, a goal operationalisation phase, and an intervention phase. Contextual factors, including personal and environmental influences, also affect how clinicians and clients engage in this process. Clinicians use additional strategies to support clients with impaired self-awareness. These include structured communication and metacognitive strategies to operationalise goals. For clients with emotional distress, clinicians provide additional time and intervention directed at new identity development. The goal setting practice framework may guide clinician's understanding of how to engage in client-centred goal setting in brain injury rehabilitation. There is a predilection towards a client-centred goal setting approach in the community setting, however, contextual factors can inhibit implementation of this approach. Implications for Rehabilitation The theoretical framework describes processes used to develop achievable client-centred goals with people with brain injury. Building rapport is a core strategy to engage clients with brain injury in goal setting. Clients with self-awareness impairment benefit from additional metacognitive strategies to participate in goal setting. Clients with emotional distress may need additional time for new identity development.

Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond.

Science.gov (United States)

Hlubocky, Fay J; Back, Anthony L; Shanafelt, Tait D

2016-01-01

Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.

The Problem of Informational Object Identification in Case of the Considerable Quantity of Identifying Features

Directory of Open Access Journals (Sweden)

S. D. Kulik

2010-03-01

Full Text Available The modification of the algorithm of identification of the informational object, used for identification of the hand-written texts performer in an automated workplace of the forensic expert, is presented. As modification, it is offered to use a method of association rules discovery for definition of statistically dependent sets of feature of hand-written capital letters of the Russian language. The algorithm is approved on set of 691 samples of hand-written documents for which about 2000 identifying feature are defined. The modification of the identification algorithm allows to lower level of errors and to raise quality of accepted decisions for information security.

Experiences of parenting and clinical intervention for mothers affected by personality disorder: a pilot qualitative study combining parent and clinician perspectives.

Science.gov (United States)

Wilson, Ruth; Weaver, Tim; Michelson, Daniel; Day, Crispin

2018-05-25

Evidence-based parenting programmes are recommended for the treatment of child mental health difficulties. Families with complex psychosocial needs show poorer retention and outcomes when participating in standard parenting programmes. The Helping Families Programme (HFP) is a 16-week community-based parenting intervention designed to meet the needs of these families, including families with parental personality disorder. This study aimed to explore the help seeking and participatory experiences of parents with a diagnosis of personality disorder. It further aimed to examine the acceptability of referral and intervention processes for the HFP from the perspectives of (i) clinicians referring into the programme; and (ii) referred parents. Semi-structured interviews were conducted with parents recruited to receive HFP (n = 5) as part of a research case series and the referring NHS child and adolescent mental health service (CAMHS) clinicians (n = 5). Transcripts were analysed using Interpretive Phenomenological Analysis. Four themes were identified for parents: (i) the experience of parenthood, (ii) being a parent affected by personality disorder, (iii) experience of the intervention, and (iv) qualities of helping. Three themes emerged for clinicians: (i) challenges of addressing parental need, (ii) experience of engaging parents with personality disorders and (iii) limited involvement during HFP. Comparison of parent and clinician themes led to the identification of two key interlinked themes: (i) concerns prior to receiving the intervention, and (ii) the challenges of working together without a mutual understanding. This pilot study identifies potentially significant challenges of working with parents affected by personality disorder and engaging them in HFP and other similar interventions. Results have important wider clinical implications by highlighting potential barriers to engagement and participation and providing insights on how these barriers might be

Allied health clinicians using translational research in action to develop a reliable stroke audit tool.

Science.gov (United States)

Abery, Philip; Kuys, Suzanne; Lynch, Mary; Low Choy, Nancy

2018-05-23

To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. Design: Two-stage study involving a modified Delphi process to inform stroke audit tool development and inter-tester reliability. Allied health clinicians. A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter-tester reliability was determined using intra-class correlation coefficients (ICCs) across 10 clinical records. Twenty-two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice. © 2018 John Wiley & Sons, Ltd.

Improving clinicians' access to cost data.

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Kenagy, John; Shah, Ben

2014-08-01

Bringing clinical and financial data together is critical to effectively running and operating service lines. Helping clinicians use cost data to make decisions requires a shared vision and a partnership between finance leaders and physicians. Hosting a "jam session" of technical, financial, and clinical experts can accelerate an organization's business intelligence strategy. Labor and supply costs represent the most actionable cost data for clinicians. Clinician buy-in hinges on education and support. It is important to focus on easy wins at the beginning of the project.

Identifying Non-Volatile Data Storage Areas: Unique Notebook Identification Information as Digital Evidence

Directory of Open Access Journals (Sweden)

Nikica Budimir

2007-03-01

Full Text Available The research reported in this paper introduces new techniques to aid in the identification of recovered notebook computers so they may be returned to the rightful owner. We identify non-volatile data storage areas as a means of facilitating the safe storing of computer identification information. A forensic proof of concept tool has been designed to test the feasibility of several storage locations identified within this work to hold the data needed to uniquely identify a computer. The tool was used to perform the creation and extraction of created information in order to allow the analysis of the non-volatile storage locations as valid storage areas capable of holding and preserving the data created within them.  While the format of the information used to identify the machine itself is important, this research only discusses the insertion, storage and ability to retain such information.

Information identification, evaluation and utilisation for decision-making by managers in South West Nigeria

Directory of Open Access Journals (Sweden)

Omotola Osunrinde

2017-11-01

Full Text Available Background: Managers’ organisational decisions and subsequent actions flow from their understanding of the business environment in which they operate. This study sought to understand how managers in various organisations identify, evaluate and use information for effective current and future decision-making. Objectives: The study focused on the types of information needed by managers for decision-making, the methods used to identify and acquire the information and the sources of information consulted, their satisfaction with the information used and their decision-making behaviours. Methods: The study employed descriptive study design. Simple random sampling was used. A pre-tested self-administered questionnaire was used to gather information from 219 managers, randomly selected from the registers of the Ibadan, Abeokuta and Lagos chapters of Nigerian Institute of Management. Results: Results indicated that the types of information considered very important for decision-making included industry information followed by government policies and economic development/forecasts. Conclusion: Investigation revealed the extent of information identification, information evaluation and information utilisation individually predict the perceived effectiveness of decision-making by the managers. Nevertheless, information evaluation was found to have greater predictive relationship with perceived effectiveness of decision-making than information use and information identification.

Identification and summary characterization of materials potentially requiring vitrification: Background information

International Nuclear Information System (INIS)

Croff, A.G.

1996-01-01

This document contains background information for the Workshop in general and the presentation entitled 'Identification and Summary Characterization of Materials Potentially Requiring Vitrification' that was given during the first morning of the workshop. summary characteristics of 9 categories of US materials having some potential to be vitrified are given. This is followed by a 1-2 page elaborations for each of these 9 categories. References to more detailed information are included

A Student Information Management System Based on Fingerprint Identification and Data Security Transmission

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Pengtao Yang

2017-01-01

Full Text Available A new type of student information management system is designed to implement student information identification and management based on fingerprint identification. In order to ensure the security of data transmission, this paper proposes a data encryption method based on an improved AES algorithm. A new S-box is cleverly designed, which can significantly reduce the encryption time by improving ByteSub, ShiftRow, and MixColumn in the round transformation of the traditional AES algorithm with the process of look-up table. Experimental results show that the proposed algorithm can significantly improve the encryption time compared with the traditional AES algorithm.

Percussion use and training: a survey of music therapy clinicians.

Science.gov (United States)

Scheffel, Stephanie; Matney, Bill

2014-01-01

Percussion instruments are commonly used in music therapy practice; however, the body of published literature regarding music therapy-related percussion training and practice is limited. The purpose of our survey study was to describe: (a) clinician perspectives of their academic percussion training; (b) use of percussion testing during academic training; (c) clinician perspectives on relevance, adequacy, and importance of academic percussion training; (d) clinician perspectives of their nonacademic percussion training; and (e) current use of percussion in clinical practice. Through comparisons of these parameters, we sought to provide information that may inform future percussion use and training. Participants were selected using an email list from the Certification Board for Music Therapists. Board-certified music therapists (MT-BC) were provided with a researcher-created survey about academic percussion training, nonacademic percussion training, and use of percussion in clinical practice. Survey response rate was 14.4% (611/4234). We used demographic data to address potential nonresponse error and ensure population representation for region of residence and region of academic training. Results revealed concerns about perceived adequacy of percussion training received during music therapy education (14.6% reported receiving no academic percussion training; 40.6% reported training was not adequate), and absence of percussion-specific proficiency exams. Of the training received, 62.8% indicated that training was relevant; however, a majority (76.5%) recommended current music therapy students receive more percussion training on instruments and skills most relevant to clinical practice. Comparisons between academic training, perceived needs in academic training, and clinical usage may inform future training and clinical competency. We provide suggestions for developing future training, as well as for furthering clinical implementation and research. © the American

Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study.

Science.gov (United States)

Giguere, Anik M C; Labrecque, Michel; Haynes, R Brian; Grad, Roland; Pluye, Pierre; Légaré, France; Cauchon, Michel; Greenway, Matthew; Carmichael, Pierre-Hugues

2014-10-05

Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice. We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information. One hundred clinicians completed the web surveys. In 54% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6±1.2, scale 1-7, with 7 being "high"), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (Pdecision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked

Postoperative Pain Management: Clinicians' Knowledge and ...

African Journals Online (AJOL)

Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital. ... A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of ...

A Qualitative Case Study of Smartphone-Connected Hearing Aids: Influences on Patients, Clinicians, and Patient-Clinician Interactions.

Science.gov (United States)

Ng, Stella L; Phelan, Shanon; Leonard, MaryAnn; Galster, Jason

2017-06-01

Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients' needs, and attentive to society's influence. The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. "Connected" refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. The clinician case highlighted clinicians' heuristic-based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed

MALDI-TOF mass spectrometry for the rapid identification of aetiological agents of sepsis

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Roberto Degl’Innocenti

2013-04-01

Full Text Available Introduction: The MALDI-TOF has recently become part of the methods of microbiological investigation in many laboratories of bacteriology with advantages both practical and economical.The use of this technique for the rapid identification of the causative agents of sepsis is of strategic importance to the ability to provide the clinician with useful information for a prompt and rapid establishment of an empirical antimicrobial “targeted” therapy. Methods: It was tested a total of 343 positive blood culture bottles from 211 patients. The samples after collection were incubated in the BACTEC FX (Becton Dickinson, USA. From these bottles were taken a few milliliters of broth culture and transferred into a vacutainer tube containing gel. This was centrifuged, the supernatant was decanted, and finally recovered the bacterial suspension on the gel. With micro-organisms recovered in this way, after several washes with distilled water, was prepared a slide for microscopic examination with Gram stain, and a plate for mass spectrometry (MS-Vitek, bioMérieux, France.Then, the same samples were inoculated on solid agar media according to the protocol in use in our laboratory.The next day was checked the possible bacterial growth on solid media; we then proceeded to the identification of the colonies by Vitek MS and / or with the system Vitek2 (bioMérieux, France. Results: 258 (75.2% positive vials show concordant results between direct identification and identification after growth on agar. For 83 (24.2% positive bottles there has been full compliance with the microscopic examination but not with culture. In particular, two bottles (0.6% have given complete discordance between the direct identification and that after growth. Conclusions: The protocol we use for the direct identification of organisms responsible for sepsis, directly on positive bottles, seems to be a quick and inexpensive procedure, which in less than 60 minutes can give valuable

The power of clinicians' affective communication: how reassurance about non-abandonment can reduce patients' physiological arousal and increase information recall in bad news consultations. An experimental study using analogue patients

NARCIS (Netherlands)

Sep, Milou S. C.; van Osch, Mara; van Vliet, Liesbeth M.; Smets, Ellen M. A.; Bensing, Jozien M.

2014-01-01

The diagnosis of incurable cancer may evoke physiological arousal in patients. Physiological arousal can negatively impact patients' recall of information provided in the medical consultation. We aim to investigate whether clinicians' affective communication during a bad news consultation will

USER FRUSTRATION IN HIT INTERFACES: EXPLORING PAST HCI RESEARCH FOR A BETTER UNDERSTANDING OF CLINICIANS' EXPERIENCES.

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Opoku-Boateng, Gloria A

2015-01-01

User frustration research has been one way of looking into clinicians' experience with health information technology use and interaction. In order to understand how clinician frustration with Health Information Technology (HIT) use occurs, there is the need to explore Human-Computer Interaction (HCI) literature that addresses both frustration and HIT use. In the past three decades, HCI frustration research has increased and expanded. Researchers have done a lot of work to understand emotions, end-user frustration and affect. This paper uses a historical literature review approach to review the origins of emotion and frustration research and explore the research question; Does HCI research on frustration provide insights on clinicians' frustration with HIT interfaces? From the literature review HCI research on emotion and frustration provides additional insights that can indeed help explain user frustration in HIT. Different approaches and HCI perspectives also help frame HIT user frustration research as well as inform HIT system design. The paper concludes with a suggested directions on how future design and research may take.

Multimedia reviews: multimedia convergence for clinicians.

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Taintor, Zebulon

2003-12-01

Introduction by the column editor: In this final column of the year, Dr. Taintor provides an overview of exciting technological developments via his report on the 2003 annual meeting of the American Association for Technology in Psychiatry (AATP). Advances-and convergences-in technology are providing clinicians with increasingly useful tools to enhance the effectiveness of their treatments, increase access to care, reduce errors, and save time. As Dr. Taintor notes, AATP's meeting is traditionally held in conjunction with the annual meeting of the American Psychiatric Association (APA). I hope that his report will encourage APA's members to attend some of next year's informative sessions.

Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction.

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Mazurenko, Olena; Richter, Jason; Kazley, Abby Swanson; Ford, Eric

2017-04-25

The aim of this study was to explore the relationship between managers and clinicians' agreement on deeming the patient safety climate as high or low and the patients' satisfaction with those organizations. We used two secondary data sets: the Hospital Survey on Patient Safety Culture (2012) and the Hospital Consumer Assessment of Healthcare Providers and Systems (2012). We used ordinary least squares regressions to analyze the relationship between the extent of agreement between managers and clinicians' perceptions of safety climate in relationship to patient satisfaction. The dependent variables were four Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores: communication with nurses, communication with doctors, communication about medicines, and discharge information. The main independent variables were four groups that were formed based on the extent of managers and clinicians' agreement on four patient safety climate domains: communication openness, feedback and communication about errors, teamwork within units, and teamwork across units. After controlling for hospital and market-level characteristics, we found that patient satisfaction was significantly higher if managers and clinicians reported that patient safety climate is high or if only clinicians perceived the climate as high. Specifically, manager and clinician agreement on high levels of communication openness (β = 2.25, p = .01; β = 2.46, p = .05), feedback and communication about errors (β = 3.0, p = .001; β = 2.89, p = .01), and teamwork across units (β = 2.91, p = .001; β = 3.34, p = .01) was positively and significantly associated with patient satisfaction with discharge information and communication about medication. In addition, more favorable perceptions about patient safety climate by clinicians only yielded similar findings. Organizations should measure and examine patient safety climate from multiple perspectives and be aware that individuals

Clinicians' experiences of becoming a clinical manager: a qualitative study.

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Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

2012-11-22

There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

A Genome-Wide Association Study Primer for Clinicians

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Tzu-Hao Wang

2009-06-01

Full Text Available Genome-wide association studies (GWAS use high-throughput genotyping technology to relate hundreds of thousands of genetic markers (genotypes to clinical conditions and measurable traits (phenotypes. This review is intended to serve as an introduction to GWAS for clinicians, to allow them to better appreciate the value and limitations of GWAS for genotype-disease association studies. The input of clinicians is vital for GWAS, since disease heterogeneity is frequently a confounding factor that can only really be solved by clinicians. For diseases that are difficult to diagnose, clinicians should ensure that the cases do indeed have the disease; for common diseases, clinicians should ensure that the controls are truly disease-free.

Identification of the operating crew's information needs for accident management

Energy Technology Data Exchange (ETDEWEB)

Nelson, W.R.; Hanson, D.J.; Ward, L.W.; Solberg, D.E.

1988-01-01

While it would be very difficult to predetermine all of the actions required to mitigate the consequences of every potential severe accident for a nuclear power plant, development of additional guidance and training could improve the likelihood that the operating crew would implement effective sever-accident management measures. The US Nuclear Regulatory Commission (NRC) is conducting an Accident Management Research Program that emphasizes the application of severe-accident research results to enhance the capability of the plant operating crew to effectively manage severe accidents. One element of this program includes identification of the information needed by the operating crew in severe-accident situations. This paper discusses a method developed for identifying these information needs and its application. The methodology has been applied to a generic reactor design representing a PWR with a large dry containment. The information needs were identified by systematically determining what information is needed to assess the health of the critical functions, identify the presence of challenges, select strategies, and assess the effectiveness of these strategies. This method allows the systematic identification of information needs for a broad range of severe-accident scenarios and can be validated by exercising the functional models for any specific event sequence.

Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition.

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Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

2016-01-01

Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems.

Endoscopic Sex Identification in Chelonians and Birds (Psittacines, Passerines, and Raptors).

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Divers, Stephen J

2015-09-01

Despite the advent of DNA probes for sex identification of many avian and some reptile species, clinicians involved with zoos, conservation projects, or breeders may still be asked to perform "surgical sexing." This article describes the practical approach to performing endoscopic sex identification in psittacines and chelonians, including patient preparation, anesthesia, and endoscopic procedure. Copyright © 2015 Elsevier Inc. All rights reserved.

A Time-Space Domain Information Fusion Method for Specific Emitter Identification Based on Dempster-Shafer Evidence Theory.

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Jiang, Wen; Cao, Ying; Yang, Lin; He, Zichang

2017-08-28

Specific emitter identification plays an important role in contemporary military affairs. However, most of the existing specific emitter identification methods haven't taken into account the processing of uncertain information. Therefore, this paper proposes a time-space domain information fusion method based on Dempster-Shafer evidence theory, which has the ability to deal with uncertain information in the process of specific emitter identification. In this paper, radars will generate a group of evidence respectively based on the information they obtained, and our main task is to fuse the multiple groups of evidence to get a reasonable result. Within the framework of recursive centralized fusion model, the proposed method incorporates a correlation coefficient, which measures the relevance between evidence and a quantum mechanical approach, which is based on the parameters of radar itself. The simulation results of an illustrative example demonstrate that the proposed method can effectively deal with uncertain information and get a reasonable recognition result.

How do intake clinicians use patient characteristics to select treatment for patients with personality disorders?

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van Manen, Janine; Kamphuis, Jan Henk; Visbach, Geny; Ziegler, Uli; Gerritsen, Ad; Van Rossum, Bert; Rijnierse, Piet; Timman, Reinier; Verheul, Roel

2008-11-01

Treatment selection in clinical practice is a poorly understood, often largely implicit decision process, perhaps especially for patients with personality disorders. This study, therefore, investigated how intake clinicians use information about patient characteristics to select psychotherapeutic treatment for patients with personality disorder. A structured interview with a forced-choice format was administered to 27 experienced intake clinicians working in five specialist mental health care institutes in the Netherlands. Substantial consensus was evident among intake clinicians. The results revealed that none of the presented patient characteristics were deemed relevant for the selection of the suitable treatment setting. The appropriate duration and intensity are selected using severity or personal strength variables. The theoretical orientation is selected using personal strength variables.

Development of a clinician reputation metric to identify appropriate problem-medication pairs in a crowdsourced knowledge base.

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McCoy, Allison B; Wright, Adam; Rogith, Deevakar; Fathiamini, Safa; Ottenbacher, Allison J; Sittig, Dean F

2014-04-01

Correlation of data within electronic health records is necessary for implementation of various clinical decision support functions, including patient summarization. A key type of correlation is linking medications to clinical problems; while some databases of problem-medication links are available, they are not robust and depend on problems and medications being encoded in particular terminologies. Crowdsourcing represents one approach to generating robust knowledge bases across a variety of terminologies, but more sophisticated approaches are necessary to improve accuracy and reduce manual data review requirements. We sought to develop and evaluate a clinician reputation metric to facilitate the identification of appropriate problem-medication pairs through crowdsourcing without requiring extensive manual review. We retrieved medications from our clinical data warehouse that had been prescribed and manually linked to one or more problems by clinicians during e-prescribing between June 1, 2010 and May 31, 2011. We identified measures likely to be associated with the percentage of accurate problem-medication links made by clinicians. Using logistic regression, we created a metric for identifying clinicians who had made greater than or equal to 95% appropriate links. We evaluated the accuracy of the approach by comparing links made by those physicians identified as having appropriate links to a previously manually validated subset of problem-medication pairs. Of 867 clinicians who asserted a total of 237,748 problem-medication links during the study period, 125 had a reputation metric that predicted the percentage of appropriate links greater than or equal to 95%. These clinicians asserted a total of 2464 linked problem-medication pairs (983 distinct pairs). Compared to a previously validated set of problem-medication pairs, the reputation metric achieved a specificity of 99.5% and marginally improved the sensitivity of previously described knowledge bases. A

Take the money and run? Redemption of a gift card incentive in a clinician survey.

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Chen, Jane S; Sprague, Brian L; Klabunde, Carrie N; Tosteson, Anna N A; Bitton, Asaf; Onega, Tracy; MacLean, Charles D; Harris, Kimberly; Schapira, Marilyn M; Haas, Jennifer S

2016-02-24

Clinician surveys provide critical information about many facets of health care, but are often challenging to implement. Our objective was to assess use by participants and non-participants of a prepaid gift card incentive that could be later reclaimed by the researchers if unused. Clinicians were recruited to participate in a mailed or online survey as part of a study to characterize women's primary health care provider attitudes towards breast and cervical cancer screening guidelines and practices (n = 177). An up-front incentive of a $50 gift card to a popular online retailer was included with the study invitation. Clinicians were informed that the gift card would expire if it went unused after 4 months. Outcome measures included use of gift cards by participants and non-participants and comparison of hypothetical costs of different incentive strategies. 63.5% of clinicians who responded to the survey used the gift card, and only one provider who didn't participate used the gift card (1.6%). Many of those who participated did not redeem their gift cards (36.5% of respondents). The price of the incentives actually claimed totaled $3700, which was less than half of the initial outlay. Since some of the respondents did not redeem their gift cards, the cost of incentives was less than it might have been if we had provided a conditional incentive of $50 to responders after they had completed the survey. Redeemable online gift card codes may provide an effective way to motivate clinicians to participate in surveys.

Smart use of data, information and communication: the INFORM-ed Best Local Practice Project--Grafton Base Hospital.

Science.gov (United States)

Lloyd, Sheree; Collie, Jean; McInnes, Alastair; King, Kevin; Lollback, Alison; Garland, Angie

This paper describes current progress for an information management project in a medium-sized rural hospital after the first four months of the one-year project. In particular, the article examines some of the project outcomes to date as these relate to the National Hospitals and Health Reform recommendations for the smart use of data, information and communication. The paper identifies a number of important challenges and issues that have been addressed by the project and proposes that the project findings may be used to inform similar projects in other settings. These findings relate to clinician requirements for reports, investment in human resources, development, and time for information management activities. An understanding of data collected, information systems, and presentation of clinician data are also important. The benefits of information sharing in assisting quality improvement activities are particularly relevant but, more importantly, they can engage and involve clinicians in the use of information. The importance of local data, information, and knowledge is described. Finally, issues for the health information management profession, such as working collegially and sharing knowledge and expertise, are outlined.

Letter-case information and the identification of brand names.

Science.gov (United States)

Perea, Manuel; Jiménez, María; Talero, Fernanda; López-Cañada, Soraya

2015-02-01

A central tenet of most current models of visual-word recognition is that lexical units are activated on the basis of case-invariant abstract letter representations. Here, we examined this assumption by using a unique type of words: brand names. The rationale of the experiments is that brand names are archetypically printed either in lowercase (e.g., adidas) or uppercase (e.g., IKEA). This allows us to present the brand names in their standard or non-standard case configuration (e.g., adidas, IKEA vs. ADIDAS, ikea, respectively). We conducted two experiments with a brand-decision task ('is it a brand name?'): a single-presentation experiment and a masked priming experiment. Results in the single-presentation experiment revealed faster identification times of brand names in their standard case configuration than in their non-standard case configuration (i.e., adidas faster than ADIDAS; IKEA faster than ikea). In the masked priming experiment, we found faster identification times of brand names when they were preceded by an identity prime that matched its standard case configuration than when it did not (i.e., faster response times to adidas-adidas than to ADIDAS-adidas). Taken together, the present findings strongly suggest that letter-case information forms part of a brand name's graphemic information, thus posing some limits to current models of visual-word recognition. © 2014 The British Psychological Society.

The clinician factor: Personality characteristics of clinicians and their impact upon clinical outcomes in the management of children and adolescents with type 1 diabetes.

Science.gov (United States)

Cameron, Fergus J; Russell, Ellyn; McCombe, Julia; O'Connell, Michele A; Skinner, Timothy

2018-06-01

The purpose of this study was to estimate clinician qualities that influence metabolic outcomes in youth with type 1 diabetes. Data were gathered over two 3 month periods in a large tertiary diabetes center (1500 patients, 8 clinicians) from patients with type 1 diabetes who received continuous care from each clinician. Data included sex, age, diabetes duration, insulin regimen, body mass index (BMI), insulin dose and episodes of severe hypoglycemia. Clinician data included target blood glucose levels, target glycated hemoglobin (HbA1c), Diabetes Attitude Scale and Big 5 Personality Inventory Scale. Mean HbA1c per clinician was the primary outcome variable. The 8 clinicians saw a total of 464 patients during the first time period, and 603 in the second time period. Lowest to highest mean HbA1c per clinician varied by 0.7%. There were small but statistically significant differences between clinicians with their patients' age at diagnosis, duration of diabetes, age, gender, treatment type and BMI SD score. After controlling for these differences, the clinician characteristics that were associated with lower mean HbA1c were having no lower limit in target HbA1c and being self-reportedly "less agreeable." The impact of these clinician attitudinal traits was equivalent to the combined effects of patient characteristics and treatment type. There was a significant variation in metabolic outcomes between treating clinicians. After controlling for patient clinical differences, clinician mean HbA1c was associated with lower limit in target HbA1c and being "less agreeable." Clinicians who were more demanding and dogmatic appeared to have better outcomes. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinician Perspectives on an Electronic Portal to Improve Communication with Patients and Families in the Intensive Care Unit.

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Bell, Sigall K; Roche, Stephanie D; Johansson, Anna C; O'Reilly, Kristin P; Lee, Barbara S; Sands, Kenneth E; Talmor, Daniel S; Brown, Samuel M

2016-12-01

Communication in the intensive care unit (ICU) often falls short of patient and family needs, putting them at risk for significant physical and emotional harm. As electronic patient portals rapidly evolve, one designed specifically for the ICU might potentially enhance communication among patients, family members, and clinicians; however, the views of frontline ICU staff on such technology are unknown. To identify clinician perspectives on the current state of communication among patients, families, and clinicians in the ICU, and assess their views on whether and how an electronic portal may address existing communication deficits and improve care. Three focus groups comprised altogether of 26 clinicians from 6 ICUs, representing several disciplines in an academic medical center in Boston, Massachusetts. Transcripts were analyzed inductively for major themes using grounded theory. We identified seven themes reflecting clinician perspectives on communication challenges and desired portal functionality: (1) comprehension and literacy; (2) results and updates; (3) patient and family preferences; (4) interclinician communication; (5) family informational needs; (6) the ICU as an unfamiliar environment; and (7) enhancing humanism through technology. Each theme included current gaps in practice, potential benefits and concerns related to an ICU communication portal, and participant recommendations. Benefits included enhanced education, patient/family engagement, and clinician workflow. Challenges included the stress and uncertainty of ICU care, fear of technology replacing human connection, existing interclinician communication failures, and the tension between informing families without overwhelming them. Overall, clinicians were cautiously supportive of an electronic portal to enhance communication in the ICU and made several specific recommendations for design and implementation. As new technologies expand opportunities for greater transparency and participation in

Going Tobacco-Free: Predictors of Clinician Reactions and Outcomes of the NY State OASAS Tobacco-Free Regulation

Science.gov (United States)

de Tormes Eby, Lillian Turner; George, Kerrin; Brown, B. Lindsay

2012-01-01

In an effort to reduce patient tobacco dependence and create healthier work environments, New York State (NYS) mandated 100% tobacco-free addiction treatment programs for state funded or certified facilities in 2008. We present the results of a longitudinal study examining how local implementation features shape clinician reactions to the regulation and influence post-regulation clinician behavior and strain. A cohort of 147 clinicians associated with 13 treatment organizations throughout NYS completed a survey prior to the passage of the regulation and again approximately 1 year post-regulation. Findings reveal that local implementation features of clinician participation in the planning for change, the provision of change-related information, and perceived organizational support predicted perceptions of change management fairness, which in turn predicted clinical practice behaviors to support smoking cessation, as well as psychological and behavioral strain. In contrast, self-efficacy for change was neither related to local implementation or clinician outcomes. Practical implications are discussed. PMID:22959978

Supporting the information domains of fall-risk management in home care via health information technology.

Science.gov (United States)

Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

2016-01-01

In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

Randomised clinical trials with clinician-preferred treatment.

Science.gov (United States)

Korn, E L; Baumrind, S

1991-01-19

The standard design for randomised clinical trials may be inappropriate when the clinician believes that one of the treatments being tested is superior for the patient, or when the clinician has a preference for one of the treatments. For such instances the suggestion is that the patient is randomly allocated to treatment only when there is clinical disagreement about treatment of choice for that patient, and then the patient is assigned to a clinician who had thought that the regimen allocated is the one most appropriate for that patient.

Unfamiliar voice identification: Effect of post-event information on accuracy and voice ratings

Directory of Open Access Journals (Sweden)

Harriet Mary Jessica Smith

2014-04-01

Full Text Available This study addressed the effect of misleading post-event information (PEI on voice ratings, identification accuracy, and confidence, as well as the link between verbal recall and accuracy. Participants listened to a dialogue between male and female targets, then read misleading information about voice pitch. Participants engaged in verbal recall, rated voices on a feature checklist, and made a lineup decision. Accuracy rates were low, especially on target-absent lineups. Confidence and accuracy were unrelated, but the number of facts recalled about the voice predicted later lineup accuracy. There was a main effect of misinformation on ratings of target voice pitch, but there was no effect on identification accuracy or confidence ratings. As voice lineup evidence from earwitnesses is used in courts, the findings have potential applied relevance.

Take the money and run? Redemption of a gift card incentive in a clinician survey

Directory of Open Access Journals (Sweden)

Jane S. Chen

2016-02-01

Full Text Available Abstract Background Clinician surveys provide critical information about many facets of health care, but are often challenging to implement. Our objective was to assess use by participants and non-participants of a prepaid gift card incentive that could be later reclaimed by the researchers if unused. Methods Clinicians were recruited to participate in a mailed or online survey as part of a study to characterize women’s primary health care provider attitudes towards breast and cervical cancer screening guidelines and practices (n = 177. An up-front incentive of a $50 gift card to a popular online retailer was included with the study invitation. Clinicians were informed that the gift card would expire if it went unused after 4 months. Outcome measures included use of gift cards by participants and non-participants and comparison of hypothetical costs of different incentive strategies. Results 63.5 % of clinicians who responded to the survey used the gift card, and only one provider who didn’t participate used the gift card (1.6 %. Many of those who participated did not redeem their gift cards (36.5 % of respondents. The price of the incentives actually claimed totaled $3700, which was less than half of the initial outlay. Since some of the respondents did not redeem their gift cards, the cost of incentives was less than it might have been if we had provided a conditional incentive of $50 to responders after they had completed the survey. Conclusions Redeemable online gift card codes may provide an effective way to motivate clinicians to participate in surveys.

Clinician perspectives of an intensive comprehensive aphasia program.

Science.gov (United States)

Babbitt, Edna M; Worrall, Linda E; Cherney, Leora R

2013-01-01

Intensive comprehensive aphasia programs (ICAPs) have increased in number in recent years in the United States and abroad. To describe the experiences of clinicians working in an ICAP. A phenomenological approach was taken. Seven clinicians from 3 ICAPs were interviewed in person or on the phone. Their interviews were transcribed and coded for themes relating to their experiences. Clinicians described 3 major themes. The first theme related to the intensity component of the ICAP that allowed clinicians to provide in-depth treatment and gave them a different perspective with regard to providing treatment and the potential impact on the person with aphasia. The second theme of rewards for the clinicians included learning and support, seeing progress, and developing relationships with their clients and family members. Third, challenges were noted, including the time involved in learning new therapy techniques, patient characteristics such as chronicity of the aphasia, and the difficulty of returning to work in typical clinical settings after having experienced an ICAP. Although there is a potential for bias with the small sample size, this pilot study gives insight into the clinician perspective of what makes working in an ICAP both worthwhile and challenging.

Examination of Routine Practice Patterns in the Hospital Information Data Warehouse: Use of OLAP and Rough Set Analysis with Clinician Feedback

Science.gov (United States)

Grant, Andrew; Grant, Gwyneth; Gagné, Jean; Blanchette, Carl; Comeau, Émilie; Brodeur, Guillaume; Dionne, Jonathon; Ayite, Alphonse; Synak, Piotr; Wroblewski, Jakub; Apanowitz, Cas

2001-01-01

The patient centred electronic patient record enables retrospective analysis of practice patterns as one means to assist clinicians adjust and improve their practice. An interrogation of the data-warehouse linking test use to Diagnostic Related Group (DRG) of one years data of the Sherbrooke University Hospital showed that one-third of patients used two-thirds of these diagnostic tests. Using RoughSets analysis, zones of repeated tests were demonstrated where results remained within stable limits. It was concluded that 30% of fluid and electrolyte testing was probably unnecessary. These findings led to an endorsement of changing the test request formats in the hospital information system from profiles to individual tests requiring justification.

Clinician preferences and the estimation of causal treatment differences

OpenAIRE

Korn, Edward L.; Baumrind, Sheldon

1998-01-01

Clinician treatment preferences affect the ability to perform randomized clinical trials and the ability to analyze observational data for treatment effects. In clinical trials, clinician preferences that are based on a subjective analysis of the patient can make it difficult to define eligibility criteria for which clinicians would agree to randomize all patients who satisfy the criteria. In addition, since each clinician typically has some preference for the choice of treatment for a given ...

Online Health Searches and their Perceived Effects on Patients and Patient-Clinician Relationships: A Systematic Review,,✯✯✯.

Science.gov (United States)

Wang, Jane; Ashvetiya, Tamara; Quaye, Emmanuel; Parakh, Kapil; Martin, Seth S

2018-05-03

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from 1 January 1990 to 29 January 2016 for studies in which patients searched online for any aspect of healthcare and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, though the nature of the effect could depend on the clinician's response to patient queries regarding the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship, and commonly raised concerns about accuracy of online content. Significant methodological heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking. Copyright © 2018. Published by Elsevier Inc.

Enhanced statistical damage identification using frequency-shift information with tunable piezoelectric transducer circuitry

International Nuclear Information System (INIS)

Zhao, J; Tang, J; Wang, K W

2008-01-01

The frequency-shift-based damage detection method entertains advantages such as global detection capability and easy implementation, but also suffers from drawbacks that include low detection accuracy and sensitivity and the difficulty in identifying damage using a small number of measurable frequencies. Moreover, the damage detection/identification performance is inevitably affected by the uncertainty/variations in the baseline model. In this research, we investigate an enhanced statistical damage identification method using the tunable piezoelectric transducer circuitry. The tunable piezoelectric transducer circuitry can lead to much enriched information on frequency shift (before and after damage occurrence). The circuitry elements, meanwhile, can be directly and accurately measured and thus can be considered uncertainty-free. A statistical damage identification algorithm is formulated which can identify both the mean and variance of the elemental property change. Our analysis indicates that the integration of the tunable piezoelectric transducer circuitry can significantly enhance the robustness of the frequency-shift-based damage identification approach under uncertainty and noise

Ring-shaped Calorimetry Information for a Neural eGamma Identification with ATLAS Detector

CERN Document Server

Da Fonseca Pinto, Joao Victor; The ATLAS collaboration; Oliveira Damazio, Denis; Seixas, Jose

2016-01-01

\\title{Ring-shaped Calorimetry Information for a Neural e/$\\gamma$ Identification with ATLAS Detector} After the successful operation of the Large Hadron Collider resulting with the discovery of the Higgs boson, a new data-taking period (Run 2) has started. For the first time, collisions are produced with energies of 13 TeV in the centre of mass. It is foreseen the luminosity increase, reaching values as high as $10^{34}cm^{-2}s^{-1}$ yet in 2015. These changes in experimental conditions bring a proper environment for possible new physics key-findings. ATLAS is the largest LHC detector and was designed for general-purpose physics studies. Many potential physics channels have electrons or photons in their final states. For efficient studies on these channels precise measurement and identification of such particles is necessary. The identification task consists of disentangling those particles (signal) from collimated hadronic jets (background). Reported work concerns the identification process based on the cal...

Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective.

Science.gov (United States)

Frederick, Natasha N; Campbell, Kevin; Kenney, Lisa B; Moss, Kerry; Speckhart, Ashley; Bober, Sharon L

2018-04-26

Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, the focus of current SRH conversations on fertility, the meaning of "sexual health" as safe sex and contraception only, clinician-reported barriers to SRH conversations, and the need for education and support. Communication barriers included lack of knowledge/experience, lack of resources/referrals, low priority, parents/family, patient discomfort, clinician discomfort, time, and lack of rapport. Clinicians identified resource and support needs, including formal education and SRH education materials for patients and families. Although the study participants identified a role for pediatric oncology clinicians in SRH care for AYA patients with cancer, multiple barriers interfere with such discussions taking place on a regular basis. Future efforts must focus on resource development and provider education and training in SRH to optimize the care provided to this unique patient population. © 2018 Wiley Periodicals, Inc.

Oncology clinicians' defenses and adherence to communication skills training with simulated patients: an exploratory study.

Science.gov (United States)

Bernard, Mathieu; de Roten, Yves; Despland, Jean-Nicolas; Stiefel, Friedrich

2012-06-01

The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N=31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6 months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) =5.26, p=0.03, d=0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10

Memory for stereotype (in)consistent information : The role of in-group identification

NARCIS (Netherlands)

Doosje, Bertjan; Spears, Russell; de Redelijkheid, Hans; van Onna, Joost

Effects of identification with one's group on memory of stereotype consistent and inconsistent information about one's group were examined in two studies. In the first study, we focused on supporters of a low status soccer team, and observed that diehard fans were more likely to remember

Feedback mechanisms of change: How problem alerts reported by youth clients and their caregivers impact clinician-reported session content

Science.gov (United States)

Douglas, Susan R.; Jonghyuk, Bae; de Andrade, Ana Regina Vides; Tomlinson, M. Michele; Hargraves, Ryan Pamela; Bickman, Leonard

2015-01-01

Objective This study explored how clinician-reported content addressed in treatment sessions was predicted by clinician feedback group and multi-informant cumulative problem alerts that appeared in computerized feedback reports for 299 clients aged 11 to 18 years receiving home-based community mental health treatment. Method Measures included a clinician-report of content addressed in sessions and additional measures of treatment progress and process (e.g., therapeutic alliance) completed by clinicians, clients, and their caregivers. Item responses in the top 25th percentile in severity from these measures appeared as ‘problem alerts’ on corresponding computerized feedback reports. Clinicians randomized to the feedback group received feedback weekly while the control group did not. Analyses were conducted using the Cox proportional hazards regression for recurrent events. Results For all content domains, the results of the survival analyses indicated a robust effect of the feedback group on addressing specific content in sessions, with feedback associated with shorter duration to first occurrence and increased likelihood of addressing or focusing on a topic compared to the non-feedback group. Conclusion There appears to be an important relationship between feedback and cumulative problem alerts reported by multiple informants as they influence session content. PMID:26337327

Loyalty in the trenches: practical teleology for office clinicians responding to terrorism.

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Trotter, Griffin

2004-08-01

Were terrorists ever to effectively deploy weapons of mass destruction, medical practice would be quickly transformed. Many ordinary clinicians would be asked or required to treat unfamiliar yet serious medical conditions in a setting of overwhelming urgency and impossible odds. Clinical focus would shift from doing good things for a succession of individual patients to considering many patients at once, a change that could beget loss of trust and rapport with patients. Clinicians might also experience restrictions in personal liberties and appropriation of their property. The purpose of this essay is to develop a teleological framework for undertaking this transformation. In ordinary clinical medicine, the elusiveness of the individual telos (i.e.,the good for the individual) is acknowledged in procedures (such as social history taking,informed consent and outpatient scheduling) designed to protect patients' (and clinicians')prerogatives to interpret the telos for themselves. In mass casualty scenarios, on the other hand, the telos is standardized and regarded as an Immediate Object (usually as a state of affairs in which survival is maximized and permanent disability is minimized). Clinicians who provide mass casualty care will face a number of ethical challenges that can be negotiated by appealing to the political and ethical rationale, and limits, pertaining to the pursuit of aggregate survival as an Immediate Object.

Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings.

Science.gov (United States)

Perkins, Amorette; Ridler, Joseph; Browes, Daniel; Peryer, Guy; Notley, Caitlin; Hackmann, Corinna

2018-04-18

Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis. Copyright © 2018 Elsevier Ltd. All rights reserved.

Postnatal gestational diabetes mellitus follow-up: Perspectives of Australian hospital clinicians and general practitioners.

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Kilgour, Catherine; Bogossian, Fiona Elizabeth; Callaway, Leonie; Gallois, Cindy

2018-05-04

The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Purposive sampling and convergent interviews explored participants' communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Clinicians who provided maternity care at a tertiary referral hospital (n=13) in Queensland, Australia, and general practitioners (n=16) who provided maternity shared care with that hospital between December 2012 and July 2013. Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights

Usability testing of two e-learning resources: methods to maximize potential for clinician use.

Science.gov (United States)

Menon, Anita; Korner-Bitensky, Nicol; Chignell, Mark; Straus, Sharon

2012-04-01

Rigorous usability testing of e-learn-ing resources is an important prerequisite to their wide-spread use among clinicians. This study demonstrates the application of an evidence-based approach to usability testing of two stroke-related e-learning resources (StrokEngine). 14 stroke rehabilitation clinicians (occupational therapists and physiotherapists) from Ontario, Canada participated in a 1.5 h in-person testing session. Clinicians navigated StrokEngine in search of information to answer questions on stroke assessment/intervention. Their search patterns were observed and clinicians provided verbal/written feedback about StrokEngine. Content analysis was used to generate themes and categorize them under two broad categories: facilitators and barriers to use. Five key facilitators and three key barriers to Strok-Engine use were identified and related to screen format, layout/organization, ease of navigation, quality of content, likelihood of using StrokEngine in the future, and system dysfunctions. All 14 clinicians were very or extremely satisfied with the layout/organization, quality and clinical relevance of the content, stating that they were likely to use StrokEngine in the future. All identified barriers from this study were addressed with website modifications in order to maximize the usability and navigability of StrokEngine. This rigorous methodology for usability testing can be applied during the design process of any e-learning resource.

Maternity care for trafficked women: Survivor experiences and clinicians' perspectives in the United Kingdom's National Health Service.

Science.gov (United States)

Bick, Debra; Howard, Louise M; Oram, Sian; Zimmerman, Cathy

2017-01-01

Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians' perspectives of maternity care for trafficked persons. Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women. Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women's movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low. More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care

On-line ethics education for occupational therapy clinician-educators: a single-group pre-/post-test study.

Science.gov (United States)

VanderKaay, Sandra; Letts, Lori; Jung, Bonny; Moll, Sandra E

2018-05-20

Ethics education is a critical component of training rehabilitation practitioners. There is a need for capacity-building among ethics educators regarding facilitating ethical decision-making among students. The purpose of this study was to evaluate the utility of an on-line ethics education module for occupational therapy clinician-educators (problem-based learning tutors/clinical placement preceptors/evidence-based practice facilitators). The Knowledge-to-Action Process informed development and evaluation of the module. Clinician-educators (n = 33) viewed the module and reported on its impact on knowledge and facilitation practices via pre, post, and follow-up questionnaires. Pre- and post-test data indicated improvement in self-reported ethics knowledge (t = 8.275, p ethics education module for clinician-educators. Future recommendations include broader consideration of context, adding supplemental knowledge translation components, and further research exploring outcomes with larger samples, longer follow-up and randomized trial methodology. Implications for Rehabilitation The on-line ethics module has potential to improve rehabilitation practice by addressing the noted gap in knowledge among clinician-educators. Viewing an on-line module regarding approaches to ethics education may not be sufficient to change clinician-educators' teaching practices. More time and opportunities to discuss ethics with student occupational therapists may be required to effect practice change among clinician-educators. Developing ethics education tools for clinician-educators requires ongoing and iterative input from knowledge users to optimize translation of ideas to practice.

Identification and Management of Statin-Associated Symptoms in Clinical Practice: Extension of a Clinician Survey to 12 Further Countries.

Science.gov (United States)

Rosenson, Robert S; Gandra, Shravanthi R; McKendrick, Jan; Dent, Ricardo; Wieffer, Heather; Cheng, Lung-I; Catapano, Alberico L; Oh, Paul; Kees Hovingh, G; Stroes, Erik S

2017-04-01

Statins are the first-choice pharmacological treatment for patients with hypercholesterolemia and at risk for cardiovascular disease; however, a minority of patients experience statin-associated symptoms (SAS) and are considered to have reduced statin tolerance. The objective of this study was to establish how patients with SAS are identified and managed in clinical practice in Austria, Belgium, Colombia, Croatia, the Czech Republic, Denmark, Portugal, Switzerland, Russia, Saudi Arabia, Turkey, and the United Arab Emirates. A cross-sectional survey was conducted (2015-2016) among clinicians (n = 60 per country; Croatia: n = 30) who are specialized/experienced in the treatment of hypercholesterolemia. Participants were asked about their experience of patients presenting with potential SAS and how such patients were identified and treated. Muscle-related symptoms were the most common presentation of potential SAS (average: 51%; range across countries [RAC] 17-74%); other signs/symptoms included persistent elevation in transaminases. To establish whether symptoms are due to statins, clinicians required rechallenge after discontinuation of statin treatment (average: 77%; RAC 40-90%); other requirements included trying at least one alternative statin. Clinicians reported that half of high-risk patients with confirmed SAS receive a lower-dose statin (average: 53%; RAC 43-72%), and that most receive another non-statin lipid-lowering therapy with or without a concomitant statin (average: 65%; RAC 52-83%). The specialists and GPs surveyed use stringent criteria to establish causality between statin use and signs or symptoms, and persevere with statin treatment where possible.

Reducing Negative Outcomes of Online Consumer Health Information: Qualitative Interpretive Study with Clinicians, Librarians, and Consumers

Science.gov (United States)

Pluye, Pierre; Thoër, Christine; Rodriguez, Charo

2018-01-01

Background There has been an exponential increase in the general population’s usage of the internet and of information accessibility; the current demand for online consumer health information (OCHI) is unprecedented. There are multiple studies on internet access and usage, quality of information, and information needs. However, few studies explored negative outcomes of OCHI in detail or from different perspectives, and none examined how these negative outcomes could be reduced. Objective The aim of this study was to describe negative outcomes associated with OCHI use in primary care and identify potential preventive strategies from consumers’, health practitioners’, and health librarians’ perspectives. Methods This included a two-stage interpretive qualitative study. In the first stage, we recruited through a social media survey, a purposeful sample of 19 OCHI users who had experienced negative outcomes associated with OCHI. We conducted semistructured interviews and performed a deductive-inductive thematic analysis. The results also informed the creation of vignettes that were used in the next stage. In the second stage, we interviewed a convenient sample of 10 key informants: 7 health practitioners (3 family physicians, 2 nurses, and 2 pharmacists) and 3 health librarians. With the support of the vignettes, we asked participants to elaborate on (1) their experience with patients who have used OCHI and experienced negative outcomes and (2) what strategies they suggest to reduce these outcomes. We performed a deductive-inductive thematic analysis. Results We found that negative outcomes of OCHI may occur at three levels: internal (such as increased worrying), interpersonal (such as a tension in the patient-clinician relationship), and service-related (such as postponing a clinical encounter). Participants also proposed three types of strategies to reduce the occurrence of these negative outcomes, namely, providing consumers with reliable OCHI, educating

Trust Your Boss or Listen to the Union? Information, Social Identification, Trust, and Strike Participation

NARCIS (Netherlands)

Born, Marieke J.; Akkerman, Agnes; Torenvlied, René

2013-01-01

We investigate two questions regarding the effect of information on participation in labor strikes: First, how are social identification and trust used as filters for information? Second, we investigate how cross-pressures affect willingness to participate. Using a dataset of 468 union members, we

AphasiaBank: a resource for clinicians.

Science.gov (United States)

Forbes, Margaret M; Fromm, Davida; Macwhinney, Brian

2012-08-01

AphasiaBank is a shared, multimedia database containing videos and transcriptions of ~180 aphasic individuals and 140 nonaphasic controls performing a uniform set of discourse tasks. The language in the videos is transcribed in Codes for the Human Analysis of Transcripts (CHAT) format and coded for analysis with Computerized Language ANalysis (CLAN) programs, which can perform a wide variety of language analyses. The database and the CLAN programs are freely available to aphasia researchers and clinicians for educational, clinical, and scholarly uses. This article describes the database, suggests some ways in which clinicians and clinician researchers might find these materials useful, and introduces a new language analysis program, EVAL, designed to streamline the transcription and coding processes, while still producing an extensive and useful language profile. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinicians and their cameras: policy, ethics and practice in an Australian tertiary hospital.

Science.gov (United States)

Burns, Kara; Belton, Suzanne

2013-09-01

Medical photography illustrates what people would prefer to keep private, is practiced when people are vulnerable, and has the power to freeze a moment in time. Given it is a sensitive area of health, lawful and ethical practice is paramount. This paper recognises and seeks to clarify the possibility of widespread clinician-taken medical photography in a tertiary hospital in northern Australia, examining the legal and ethical implications of this practice. A framework of Northern Territory law, state Department of Health policy and human rights theory were used to argue the thesis. Clinicians from 13 purposively chosen wards were asked to participate in an anonymous survey and confidential in-depth interviews. Questions were generated from the literature and local knowledge on the topics of 'occurrence', 'image use', 'quality of consent', 'cameras and technology', 'confidentiality', 'data storage and security', 'hospital policy and law' and 'cultural issues'. One hundred and seventy surveys and eights interviews were analysed using descriptive statistics and theme and content analysis, then triangulated for similarity, difference and unique responses. Forty-eight percent of clinicians surveyed take medical photographs, with the majority using hospital-owned cameras. However, one-fifth of clinicians reported photographing with personal mobile phones. Non-compliance with written consent requirements articulated in policy was endemic, with most clinicians surveyed obtaining only verbal consent. Labeling, storage, copyright and cultural issues were generally misunderstood, with a significant number of clinicians risking the security of patient information by storing images on personal devices. If this tertiary hospital does not develop a clinical photography action plan to address staff lack of knowledge, and noncompliance with policy and mobile phone use, patients' data is at risk of being distributed into the public domain where unauthorised publication may cause

Knowledge transfer to clinicians and consumers by the Cochrane Musculoskeletal Group.

Science.gov (United States)

Santesso, Nancy; Maxwell, Lara; Tugwell, Peter S; Wells, George A; O'connor, Annette M; Judd, Maria; Buchbinder, Rachelle

2006-11-01

The Cochrane Musculoskeletal Group (CMSG) is one of 50 groups of the Cochrane Collaboration that prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. Once systematic reviews are completed, the next challenge is presenting the results in useful formats to be integrated into the healthcare decisions of clinicians and consumers. The CMSG recommends 3 methods to aid knowledge translation and exchange between clinicians and patients: produce clinical relevance tables, create graphical displays using face figures, and write consumer summaries and patient decision aids. Accordingly, CMSG has developed specific guidelines to help researchers and authors convert the pooled estimates of metaanalyses in the systematic reviews to user-friendly numbers. First, clinical relevance tables are developed that include absolute and relative benefits or harms and the numbers needed to treat. Next, the numbers from the clinical relevance tables are presented graphically using faces. The faces represent a group of 100 people and are shaded according to how many people out of 100 benefited or were harmed by the interventions. The user-friendly numbers are also included in short summaries and decision aids written for patients. The different levels of detail in the summaries and decision aids provide patients with tools to prepare them to discuss treatment options with their clinicians. Methods to improve the effects and usability of systematic reviews by providing results in more clinically relevant formats are essential. Both clinicians and consumers can use these products to use evidence-based information in individual and shared decision-making.

Mental Status Documentation: Information Quality and Data Processes.

Science.gov (United States)

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses' assessment, documentation, decisionmaking and communication regarding patients' mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm.

Canary: An NLP Platform for Clinicians and Researchers.

Science.gov (United States)

Malmasi, Shervin; Sandor, Nicolae L; Hosomura, Naoshi; Goldberg, Matt; Skentzos, Stephen; Turchin, Alexander

2017-05-03

Information Extraction methods can help discover critical knowledge buried in the vast repositories of unstructured clinical data. However, these methods are underutilized in clinical research, potentially due to the absence of free software geared towards clinicians with little technical expertise. The skills required for developing/using such software constitute a major barrier for medical researchers wishing to employ these methods. To address this, we have developed Canary, a free and open-source solution designed for users without natural language processing (NLP) or software engineering experience. It was designed to be fast and work out of the box via a user-friendly graphical interface.

"You never know who are Sami or speak Sami" Clinicians' experiences with language-appropriate care to Sami-speaking patients in outpatient mental health clinics in Northern Norway.

Science.gov (United States)

Dagsvold, Inger; Møllersen, Snefrid; Stordahl, Vigdis

2016-01-01

The Indigenous population in Norway, the Sami, have a statutory right to speak and be spoken to in the Sami language when receiving health services. There is, however, limited knowledge about how clinicians deal with this in clinical practice. This study explores how clinicians deal with language-appropriate care with Sami-speaking patients in specialist mental health services. This study aims to explore how clinicians identify and respond to Sami patients' language data, as well as how they experience provision of therapy to Sami-speaking patients in outpatient mental health clinics in Sami language administrative districts. Data were collected using qualitative method, through individual interviews with 20 therapists working in outpatient mental health clinics serving Sami populations in northern Norway. A thematic analysis inspired by systematic text reduction was employed. Two themes were identified: (a) identification of Sami patients' language data and (b) experiences with provision of therapy to Sami-speaking patients. Findings indicate that clinicians are not aware of patients' language needs prior to admission and that they deal with identification of language data and offer of language-appropriate care ad hoc when patients arrive. Sami-speaking participants reported always offering language choice and found more profound understanding of patients' experiences when Sami language was used. Whatever language Sami-speaking patients may choose, they are found to switch between languages during therapy. Most non-Sami-speaking participants reported offering Sami-speaking services, but the patients chose to speak Norwegian. However, a few of the participants maintained language awareness and could identify language needs despite a patient's refusal to speak Sami in therapy. Finally, some non-Sami-speaking participants were satisfied if they understood what the patients were saying. They left it to patients to address language problems, only to discover patients

Clinicians' views and experiences of offering two alternative consent pathways for participation in a preterm intrapartum trial: a qualitative study.

Science.gov (United States)

Chhoa, Celine Y; Sawyer, Alexandra; Ayers, Susan; Pushpa-Rajah, Angela; Duley, Lelia

2017-04-26

The Cord Pilot Trial compared alternative policies for timing of cord clamping at very preterm birth at eight UK hospitals. Preterm birth can be rapid and unexpected, allowing little time for the usual consent process. Therefore, in addition to the usual procedure for written consent, a two-stage pathway for consent for use when birth was imminent was developed. The aims of this study were to explore clinicians' views and experiences of offering two consent pathways for recruitment to a randomised trial of timing of cord clamping at very preterm birth. This was a qualitative study using semi-structured interviews. Clinicians from eight hospitals in the UK who had been involved in offering consent to the Cord Pilot Trial were invited to take part in an interview. Clinicians were interviewed in person or by telephone. Interviews were analysed using inductive systematic thematic analysis. Seventeen clinicians who had either offered usual written consent only (n = 6) or both the two-stage pathway (with oral assent before the birth and written consent after the birth) and usual written consent (n = 11) were interviewed. Six themes were identified: (1) team approach to offering participation; (2) consent form as a record; (3) consent and participation as a continual process; (4) different consent pathways for different trials; (5) balance between time, information, and understanding; and (6) validity of consent. Overall, clinicians were supportive of the two-stage consent pathway. Some clinicians felt that in time-critical situations oral assent presented an advantage over the usual written consent as they provided information on a "need to know" basis. However, there was some concern about how much information should be given for oral assent, and how this is understood by women when birth is imminent. The two-stage pathway for consent developed for use in the Cord Pilot Trial when birth was imminent was acceptable to clinicians for comparable low-risk studies

Do clinicians assess patients' religiousness? An audit of an aged psychiatry community team.

Science.gov (United States)

Payman, Vahid; Lim, Zheng Jie

2018-03-01

To determine the frequency and quality of religious history taking of patients by clinicians working in an old age psychiatry service. A retrospective audit of 80 randomised patient files from the Koropiko Mental Health Services for Older People (MHSOP) in Middlemore Hospital, Auckland, New Zealand. A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient's religiousness. The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.

Mentoring for clinician-educators.

Science.gov (United States)

Farrell, Susan E; Digioia, Natalie M; Broderick, Kerry B; Coates, Wendy C

2004-12-01

Mentorship has been shown to have a positive impact on academic faculty members in terms of career advancement. The guidance of a mentor has been shown to increase academic outcome measures such as peer-reviewed publications and grant support for junior academic faculty. In addition, career satisfaction of mentored faculty is greater than those with no mentorship. There is little research on the effects of mentorship on the careers of clinician-educators. This group has also been reported to have a lower scholarly productivity rate than the typical research-based faculty. This article addresses the current state of mentorship as it applies specifically to clinician-educators, offers advice on how a potential protégé might seek out a potential mentor, and finally, suggests a possible mentoring system for academic emergency physicians who are focusing on careers in medical education.

Identification of mycobacterium tuberculosis in sputum smear slide using automatic scanning microscope

Science.gov (United States)

Rulaningtyas, Riries; Suksmono, Andriyan B.; Mengko, Tati L. R.; Saptawati, Putri

2015-04-01

Sputum smear observation has an important role in tuberculosis (TB) disease diagnosis, because it needs accurate identification to avoid high errors diagnosis. In development countries, sputum smear slide observation is commonly done with conventional light microscope from Ziehl-Neelsen stained tissue and it doesn't need high cost to maintain the microscope. The clinicians do manual screening process for sputum smear slide which is time consuming and needs highly training to detect the presence of TB bacilli (mycobacterium tuberculosis) accurately, especially for negative slide and slide with less number of TB bacilli. For helping the clinicians, we propose automatic scanning microscope with automatic identification of TB bacilli. The designed system modified the field movement of light microscope with stepper motor which was controlled by microcontroller. Every sputum smear field was captured by camera. After that some image processing techniques were done for the sputum smear images. The color threshold was used for background subtraction with hue canal in HSV color space. Sobel edge detection algorithm was used for TB bacilli image segmentation. We used feature extraction based on shape for bacilli analyzing and then neural network classified TB bacilli or not. The results indicated identification of TB bacilli that we have done worked well and detected TB bacilli accurately in sputum smear slide with normal staining, but not worked well in over staining and less staining tissue slide. However, overall the designed system can help the clinicians in sputum smear observation becomes more easily.

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment.

Science.gov (United States)

Baker-Ericzén, Mary J; Jenkins, Melissa M; Park, Soojin; Garland, Ann F

2015-02-01

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

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Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

2013-11-01

U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.

Informational dissimilarity and organizational citizenship behavior : The role of intrateam interdependence and team identification

NARCIS (Netherlands)

Van der Vegt, GS; Van de Vliert, E; Oosterhof, A

2003-01-01

A questionnaire study of 129 members of 20 multidisciplinary project teams examined the relationship between informational dissimilarity and both team identification and organizational citizenship behavior (OCB) for individuals working under different interdependence configurations. Results revealed

Evaluating current automatic de-identification methods with Veteran’s health administration clinical documents

Directory of Open Access Journals (Sweden)

Ferrández Oscar

2012-07-01

Full Text Available Abstract Background The increased use and adoption of Electronic Health Records (EHR causes a tremendous growth in digital information useful for clinicians, researchers and many other operational purposes. However, this information is rich in Protected Health Information (PHI, which severely restricts its access and possible uses. A number of investigators have developed methods for automatically de-identifying EHR documents by removing PHI, as specified in the Health Insurance Portability and Accountability Act “Safe Harbor” method. This study focuses on the evaluation of existing automated text de-identification methods and tools, as applied to Veterans Health Administration (VHA clinical documents, to assess which methods perform better with each category of PHI found in our clinical notes; and when new methods are needed to improve performance. Methods We installed and evaluated five text de-identification systems “out-of-the-box” using a corpus of VHA clinical documents. The systems based on machine learning methods were trained with the 2006 i2b2 de-identification corpora and evaluated with our VHA corpus, and also evaluated with a ten-fold cross-validation experiment using our VHA corpus. We counted exact, partial, and fully contained matches with reference annotations, considering each PHI type separately, or only one unique ‘PHI’ category. Performance of the systems was assessed using recall (equivalent to sensitivity and precision (equivalent to positive predictive value metrics, as well as the F2-measure. Results Overall, systems based on rules and pattern matching achieved better recall, and precision was always better with systems based on machine learning approaches. The highest “out-of-the-box” F2-measure was 67% for partial matches; the best precision and recall were 95% and 78%, respectively. Finally, the ten-fold cross validation experiment allowed for an increase of the F2-measure to 79% with partial matches

Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems.

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Woods, Susan Swartz; Jaén, Carlos Roberto

2010-03-01

Health professionals play an important role in addressing patient tobacco use in clinical settings. While there is clear evidence that identifying tobacco use and assisting smokers in quitting affects outcomes, challenges to improve routine, clinician-delivered tobacco intervention persist. The Consumer Demand Initiative has identified simple design principles to increase consumers' use of proven tobacco treatments. Applying these design strategies to activities across the healthcare system, we articulate ten recommendations that can be implemented in the context of most clinical systems where most clinicians work. The recommendations are: (1) reframe the definition of success, (2) portray proven treatments as the best care, (3) redesign the 5A's of tobacco intervention, (4) be ready to deliver the right treatment at the right time, (5) move tobacco from the social history to the problem list, (6) use words as therapy and language that makes sense, (7) fit tobacco treatment into clinical team workflows, (8) embed tobacco treatment into health information technology, (9) make every encounter an opportunity to intervene, and (10) end social disparities for tobacco users. Clinical systems need to change to improve tobacco treatment implementation. The consumer- and clinician-centered recommendations provide a roadmap that focuses on increasing clinician performance through greater understanding of the clinician's role in helping tobacco users, highlighting the value of evidence-based tobacco treatments, employing shared decision-making skills, and integrating routine tobacco treatment into clinical system routines. Published by Elsevier Inc.

Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

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Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

2013-01-01

Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual

Clinicians' perception of the preventability of inpatient mortality.

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Nash, Robert; Srinivasan, Ramya; Kenway, Bruno; Quinn, James

2018-03-12

Purpose The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients' mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable. Design/methodology/approach The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality. Findings Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values ( p<0.0001). Clinicians were also more likely to rate the quality of care as "good," and less likely to identify areas of substandard clinical or organizational management. Research limitations/implications The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area. Practical implications There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a "knowledge gap" between reviewers and treating clinicians, or an "objectivity gap" meaning clinicians may not recognize preventability of death of patients under their care. Social implications This study gives some insight into deficiencies in clinical governance processes. Originality/value No similar study has been performed. This has significant implications for the idea of the preventability of mortality.

Towards reinforcing telemedicine adoption amongst clinicians in Nigeria.

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Adenuga, Kayode I; Iahad, Noorminshah A; Miskon, Suraya

2017-08-01

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (ptelemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians. Copyright © 2017. Published by Elsevier B.V.

Radiographic identification of the equine ventral conchal bulla.

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Finnegan, C M; Townsend, N B; Barnett, T P; Barakzai, S Z

Involvement of the ventral conchal sinus (VCS) is an important diagnostic and prognostic feature in cases of the equine sinus disease. The authors aimed to ascertain if the caudo-dorsal extension of the VCS, the ventral conchal bulla (VCB) is identifiable on plain radiographs of cadaver skulls without sinus disease. Bilateral frontonasal sinus flaps were made in 10 equine cadaver skulls. Plain lateral, lateral oblique and dorso-ventral radiographs were then obtained followed by the same views taken with stainless steel wire outlining the caudal border of the VCB. Plain radiographs were randomised and blindly evaluated by two observers who marked where they believed the VCB to be positioned. This was then correlated with the true position of the VCB using radiographs with wires in place. The ease of identification of the VCB was classified as 'easy' or 'difficult'. The VCB was correctly identified in 70 per cent of lateral radiographs, but only 45 per cent of lateral oblique radiographs and 17 per cent of dorso-ventral radiographs. If a clinician was confident that he or she could identify the VCB, they were usually correct. Conversely if the clinician judged VCB identification as 'difficult', they usually identified it incorrectly. In the authors' clinical experience, the VCB of horses with sinusitis involving this compartment is more radiologically evident than in clinically normal horses. Knowledge of the normal radiographic anatomy of this structure should aid clinicians in identifying horses with sinusitis affecting the VCS.

Primary caregivers' satisfaction with clinicians' response to them as informal carers of young people with first-episode psychosis: a qualitative study.

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McCann, Terence V; Lubman, Dan I; Clark, Eileen

2012-01-01

To explore first-time primary caregivers' experience of the way mental health nurses and other mental health clinicians respond to them as carers of young people with first-episode psychosis. Caregivers have a key role in supporting family members/relatives with mental illness, but their contribution is undervalued frequently by mental health nurses and other mental health clinicians. Design.  Qualitative interpretative phenomenological analysis. A qualitative interpretative design was undertaken, using semi-structured, audio-recorded interviews. Twenty primary caregivers were recruited through Orygen Youth Health, a first-episode psychosis centre in Melbourne. Interpretative phenomenological analysis was used to identify themes in the data. Two competing themes were identified in the data, highlighting caregivers' contrasting experience with mental health nurses and other mental health clinicians. First, most clinical staff were approachable and supportive. Second, several carers felt their contribution was undervalued by some clinical staff. This was as a consequence of being excluded from clinical deliberations because of clinical staffs' concerns and young people's requests about maintaining confidentiality regarding treatment, as well as carers feeling their role was not taken seriously by clinical staff. First-time primary carers have positive and negative experiences with first-episode psychosis mental health nurses and other clinicians, and these competing events are interrelated. Experiences are affected directly by the manner they are treated by clinical staff and this may, in turn, affect carers' commitment to caring, the way they engage with clinical staff on subsequent occasions and towards the first-episode psychosis service generally. Greater appreciation is needed of the contribution, experience and difficulties caregivers encounter in their role and in engaging with mental health nurses and other clinicians. Additional training is required for

The use of traditional Chinese medicine among breast cancer patients: implications for the clinician.

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Wong, Kar Yong; Tan, Ern Yu; Chen, Juliana J C; Teo, Christine; Chan, Patrick M Y

2014-02-01

Traditional Chinese Medicine or Traditional Complementary Medicine (TCM) is commonly used in our culture. There are several concerns regarding its use in patients undergoing conventional treatments for breast cancer. In this study, we aimed to evaluate the prevalence and pattern of TCM use among our breast cancer patients, and to identify patients who were most likely to choose TCM. A total of 300 patients on active follow-up with Breast Service at Tan Tock Seng Hospital were interviewed using a structured questionnaire. A total of 35% (104 of 296) of patients reported using TCM. The majority of the patients were introduced to TCM by family and friends following the diagnosis of breast cancer. All except 3 patients continued with recommended conventional therapy although most did not inform their clinicians of TCM use. None of the patients reported any serious adverse events and 75% of them perceived a benefit from TCM use. Younger patients and those of Chinese ethnicity were more likely to use TCM (P 0.05). TCM use is common among our breast cancer patients, particularly the younger women. However, most patients do not inform their clinicians of TCM use while on recommended conventional therapies. It is therefore important for clinicians to initiate discussions regarding TCM use in order to be aware of potential unwanted drug interactions.

Clinician-Reported Barriers to Implementing Breast Cancer Chemoprevention in the UK: A Qualitative Investigation.

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Smith, Samuel G; Side, Lucy; Meisel, Susanne F; Horne, Rob; Cuzick, Jack; Wardle, Jane

2016-01-01

The use of tamoxifen and raloxifene as preventive therapy for women at increased risk of breast cancer was approved by the National Institute for Health and Care Excellence (NICE) in 2013. We undertook a qualitative investigation to investigate the factors affecting the implementation of preventive therapy within the UK. We recruited general practitioners (GPs) (n = 10) and clinicians working in family history or clinical genetics settings (FHCG clinicians) (n = 15) to participate in semi-structured interviews. Data were coded thematically within the Consolidated Framework for Implementation Research. FHCG clinicians focussed on the perceived lack of benefit of preventive therapy and difficulties interpreting the NICE guidelines. FHCG clinicians felt poorly informed about preventive therapy, and this discouraged patient discussions on the topic. GPs were unfamiliar with the concept of preventive therapy, and were not aware that they may be asked to prescribe it for high-risk women. GPs were reluctant to initiate therapy because it is not licensed, but were willing to continue a prescription if it had been started in secondary or tertiary care. Barriers to implementing preventive therapy within routine clinical practice are common and could be addressed by engaging all stakeholders during the development of policy documents. © 2016 The Author(s) Published by S. Karger AG, Basel.

Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians.

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Davies, Myfanwy; Elwyn, Glyn; Papadopoulos, Irena; Fleming, Lon; Williams, Gareth

2009-01-01

Patient autonomy in health care decision making is increasingly advocated as a means of promoting patients' 'responsibilities' for treatments and costs. However, little is known with regard to clinicians' understanding of patients' potential responsibilities in decision making. We explore how clinicians may view decision making as a 'moral' obligation and examine how moral virtue is discursively constructed in this context and in the face of ethnic and social difference. Data reported are derived from an interview study that examined perceptions of maternity decision making among Arab Muslim women and clinicians. Results reported here are from the clinician sample which includes obstetricians, general practitioners (GPs) and midwives. Clinicians perceived that a key element of their role involved imparting relevant information to their clients and, increasingly, involving them in making autonomous decisions about their care. However, by analysing and assessing the attribution of specific cultural differences in clinicians' discussion of decision making processes with minority group women, we demonstrate how some clinicians justified their failure to promote autonomy through shared decision making with women from these groups. We will demonstrate these attributes to be those of passivity and non-rationality which entail some negative moral judgements and which have a complex relationship to gender and power

Ultrasonographic identification of the cricothyroid membrane

DEFF Research Database (Denmark)

Kristensen, M S; Teoh, W H; Rudolph, S S

2016-01-01

Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review summarizes the current evidence for application of airway ultrasonography for identification of the cricothyroid membrane compare...... ultrasonographic identification; a service that we should aim at making available in all locations where anaesthesia is undertaken and where patients with difficult airways could be encountered.......Inability to identify the cricothyroid membrane by inspection and palpation contributes substantially to the high failure rate of cricothyrotomy. This narrative review summarizes the current evidence for application of airway ultrasonography for identification of the cricothyroid membrane compared...... with the clinical techniques. We identified the best-documented techniques for bedside use, their success rates, and the necessary training for airway-ultrasound-naïve clinicians. After a short but structured training, the cricothyroid membrane can be identified using ultrasound in difficult patients by previously...

The decision to extract: part II. Analysis of clinicians' stated reasons for extraction.

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Baumrind, S; Korn, E L; Boyd, R L; Maxwell, R

1996-04-01

In a recently reported study, the pretreatment records of each subject in a randomized clinical trial of 148 patients with Class I and Class II malocclusions presenting for orthodontic treatment were evaluated independently by five experienced clinicians (drawn from a panel of 14). The clinicians displayed a higher incidence of agreement with each other than had been expected with respect to the decision as to whether extraction was indicated in each specific case. To improve our understanding of how clinicians made their decisions on whether to extract or not, the records of a subset of 72 subjects randomly selected from the full sample of 148, have now been examined in greater detail. In 21 of these cases, all five clinicians decided to treat without extraction. Among the remaining 51 cases, there were 202 decisions to extract (31 unanimous decision cases and 20 split decision cases). The clinicians cited a total of 469 reasons to support these decisions. Crowding was cited as the first reason in 49% of decisions to extract, followed by incisor protrusion (14%), need for profile correction (8%), Class II severity (5%), and achievement of a stable result (5%). When all the reasons for extraction in each clinician's decision were considered as a group, crowding was cited in 73% of decisions, incisor protrusion in 35%, need for profile correction in 27%, Class II severity in 15% and posttreatment stability in 9%. Tooth size anomalies, midline deviations, reduced growth potential, severity of overjet, maintenance of existing profile, desire to close the bite, periodontal problems, and anticipation of poor cooperation accounted collectively for 12% of the first reasons and were mentioned in 54% of the decisions, implying that these considerations play a consequential, if secondary, role in the decision-making process. All other reasons taken together were mentioned in fewer than 20% of cases. In this sample at least, clinicians focused heavily on appearance

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users.

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Toro, Maria Luisa; Bird, Emily; Oyster, Michelle; Worobey, Lynn; Lain, Michael; Bucior, Samuel; Cooper, Rory A; Pearlman, Jonathan

2017-11-01

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users. The WMTP and WMT-Q were developed through an iterative process. A convenience sample of clinicians (n = 17), manual wheelchair (n ∞ 5), power wheelchair users (n = 4) and caregivers (n = 4) provided feedback on the training programme. A convenience sample of clinicians (n = 38), manual wheelchair (n = 25), and power wheelchair users (n = 30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1) = 0.48 to ICC(3,1) = 0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p users. This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers. This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown. This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

What patient characteristics make clinicians recommend brief treatment?

NARCIS (Netherlands)

Schaefer, B. A.; Koeter, M. W. J.; Wouters, L.; Emmelkamp, P. M. G.; Schene, A. H.

2003-01-01

Objective: Assessing self-rated items that might have an impact on clinicians recommending brief treatment (BT) over unlimited or long-term treatment (ULT). Method: On the basis of patient self-report data we compared patients referred by clinicians to BT (n =71) with those referred to ULT (n =145).

OPTICAL correlation identification technology applied in underwater laser imaging target identification

Science.gov (United States)

Yao, Guang-tao; Zhang, Xiao-hui; Ge, Wei-long

2012-01-01

The underwater laser imaging detection is an effective method of detecting short distance target underwater as an important complement of sonar detection. With the development of underwater laser imaging technology and underwater vehicle technology, the underwater automatic target identification has gotten more and more attention, and is a research difficulty in the area of underwater optical imaging information processing. Today, underwater automatic target identification based on optical imaging is usually realized with the method of digital circuit software programming. The algorithm realization and control of this method is very flexible. However, the optical imaging information is 2D image even 3D image, the amount of imaging processing information is abundant, so the electronic hardware with pure digital algorithm will need long identification time and is hard to meet the demands of real-time identification. If adopt computer parallel processing, the identification speed can be improved, but it will increase complexity, size and power consumption. This paper attempts to apply optical correlation identification technology to realize underwater automatic target identification. The optics correlation identification technology utilizes the Fourier transform characteristic of Fourier lens which can accomplish Fourier transform of image information in the level of nanosecond, and optical space interconnection calculation has the features of parallel, high speed, large capacity and high resolution, combines the flexibility of calculation and control of digital circuit method to realize optoelectronic hybrid identification mode. We reduce theoretical formulation of correlation identification and analyze the principle of optical correlation identification, and write MATLAB simulation program. We adopt single frame image obtained in underwater range gating laser imaging to identify, and through identifying and locating the different positions of target, we can improve

Clinician-scientists in Canada: barriers to career entry and progress.

Directory of Open Access Journals (Sweden)

Bryn Lander

Full Text Available BACKGROUND: Clinician-scientists play an important role in translating between research and clinical practice. Significant concerns about a decline in their numbers have been raised. Potential barriers for career entry and progress are explored in this study. METHODS: Case-study research methods were used to identify barriers perceived by clinician-scientists and their research teams in two Canadian laboratories. These perceptions were then compared against statistical analysis of data from Canadian Institutes of Health Research (CIHR databases on grant and award performance of clinician-scientists and non-clinical PhDs for fiscal years 2000 to 2008. RESULTS: Three main barriers were identified through qualitative analysis: research training, research salaries, and research grants. We then looked for evidence of these barriers in the Canada-wide statistical dataset for our study period. Clinician-scientists had a small but statistically significant higher mean number of degrees (3.3 than non-clinical scientists (3.2, potentially confirming the perception of longer training times. But evidence of the other two barriers was equivocal. For example, while overall growth in salary awards was minimal, awards to clinician-scientists increased by 45% compared to 6.3% for non-clinical PhDs. Similarly, in terms of research funding, awards to clinician-scientists increased by more than 25% compared with 5% for non-clinical PhDs. However, clinician-scientist-led grants funded under CIHR's Clinical thematic area decreased significantly from 61% to 51% (p-value<0.001 suggesting that clinician-scientists may be shifting their attention to other research domains. CONCLUSION: While clinician-scientists continue to perceive barriers to career entry and progress, quantitative results suggest improvements over the last decade. Clinician-scientists are awarded an increasing proportion of CIHR research grants and salary awards. Given the translational importance of

The meaning of co- production for clinicians: an exploratory case study of Practitioner Trainers in one Recovery College.

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Dalgarno, Mark; Oates, Jennifer

2018-05-15

Co-production between service users and clinicians is a desirable element of recovery-oriented practice in mental health but the effect of co-production on clinicians has not been explored thoroughly. to explore the meaning of co-production for clinicians based on their experience of co-production in a Recovery College Method: Thematic analysis of eight semi-structured interviews with clinicians who have co-produced and co-delivered workshops with a Recovery College Peer Trainer. The 'meaning of co-production' had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians' experience of co-production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterised by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co-produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Engaging in co-produced educational workshops can alter clinicians' perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Remote clinical decision-making: a clinician's definition.

Science.gov (United States)

Brady, Mike; Northstone, Kate

2017-05-12

Aims Remote clinical decision-making (RCDM), commonly known as 'telephone triage' or 'hear and treat', describes clinicians' non-face-to-face involvement with patient care, and is an established strategy in UK ambulance services for managing increasing demand. However, there is no suitable definition of RCDM that fully explains the roles undertaken by clinicians in 999 hubs, or for its use as an ambulance quality indicator (AQI). The aim of this study, which is part of a larger evaluation of a new RCDM module in higher education, is to determine how clinicians define RCDM. Methods Three participants were asked, during semi-structured interviews, to define RCDM. The interviews were recorded, transcribed and thematically analysed. Results Clinicians do not focus on outcomes when defining RCDM, but on the efficacy of the process and the appropriateness of the determined outcome. Conclusion There is no precise description of the role of healthcare professionals in 999 clinical hubs, but there is a need for role clarity, for employees and organisations. The study questions the suitability of the definition of hear and treat as an AQI, as it does not appear to represent fully the various duties undertaken by 999 clinical hub healthcare professionals. More research is needed to consider the definition of RCDM in all its forms.

Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination.

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Widman, Christy A; Rodriguez, Elisa M; Saad-Harfouche, Frances; Twarozek, Annamaria Masucci; Erwin, Deborah O; Mahoney, Martin C

2018-04-01

Human papillomavirus (HPV)-related morbidity and mortality remain a significant public health burden despite the availability of HPV vaccines for cancer prevention. We engaged clinicians and parents to identify barriers and opportunities related to adolescent HPV vaccination within a focused geographic region. This mixed-method study design used an interviewer-administered semi-structured interview with clinicians (n = 52) and a written self-administered survey with similar items completed by parents (n = 54). Items focused on experiences, opinions, and ideas about HPV vaccine utilization in the clinical setting, family, and patient perceptions about HPV vaccination and potential future efforts to increase vaccine utilization. Quantitative items were analyzed using descriptive statistics, while qualitative content was analyzed thematically. Suggested solutions for achieving higher rates of HPV vaccination noted by clinicians included public health education, the removal of stigma associated with vaccines, media endorsements, and targeting parents as the primary focus of educational messages. Parents expressed the need for more information about HPV-related disease, HPV vaccines, vaccine safety, sexual concerns, and countering misinformation on social media. Results from this mixed-method study affirm that educational campaigns targeting both health care professionals and parents represent a key facilitator for promoting HPV vaccination; disease burden and cancer prevention emerged as key themes for this messaging.

The kidney cancer research priority-setting partnership: Identifying the top 10 research priorities as defined by patients, caregivers, and expert clinicians.

Science.gov (United States)

Jones, Jennifer; Bhatt, Jaimin; Avery, Jonathan; Laupacis, Andreas; Cowan, Katherine; Basappa, Naveen; Basiuk, Joan; Canil, Christina; Al-Asaaed, Sohaib; Heng, Daniel; Wood, Lori; Stacey, Dawn; Kollmannsberger, Christian; Jewett, Michael A S

2017-12-01

It is critically important to define disease-specific research priorities to better allocate limited resources. There is growing recognition of the value of involving patients and caregivers, as well as expert clinicians in this process. To our knowledge, this has not been done this way for kidney cancer. Using the transparent and inclusive process established by the James Lind Alliance, the Kidney Cancer Research Network of Canada (KCRNC) sponsored a collaborative consensus-based priority-setting partnership (PSP) to identify research priorities in the management of kidney cancer. The final result was identification of 10 research priorities for kidney cancer, which are discussed in the context of current initiatives and gaps in knowledge. This process provided a systematic and effective way to collaboratively establish research priorities with patients, caregivers, and clinicians, and provides a valuable resource for researchers and funding agencies.

Perspective: Entering uncharted waters: navigating the transition from trainee to career for the nonphysician clinician-scientist.

Science.gov (United States)

MacDonald, Shannon E; Sharpe, Heather M; Shikako-Thomas, Keiko; Larsen, Bodil; MacKay, Lyndsay

2013-01-01

The transition from trainee to career clinician-scientist can be a stressful and challenging time, particularly for those entering the less established role of nonphysician clinician-scientist. These individuals are typically PhD-prepared clinicians in the allied health professions, who have either a formal or informal joint appointment between a clinical institution and an academic or research institution. The often poorly defined boundaries and expectations of these developing roles can pose additional challenges for the trainee-to-career transition.It is important for these trainees to consider what they want and need in a position in order to be successful, productive, and fulfilled in both their professional and personal lives. It is also critical for potential employers, whether academic or clinical (or a combination of both), to be fully aware of the supports and tools necessary to recruit and retain new nonphysician clinician-scientists. Issues of relevance to the trainee and the employer include finding and negotiating a position; the importance of mentorship; the value of effective time management, particularly managing clinical and academic time commitments; and achieving work-life balance. Attention to these issues, by both the trainee and those in a position to hire them, will facilitate a smooth transition to the nonphysician clinician-scientist role and ultimately contribute to individual and organizational success.

Importance ratings on patient-reported outcome items for survivorship care: comparison between pediatric cancer survivors, parents, and clinicians.

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Jones, Conor M; Baker, Justin N; Keesey, Rachel M; Eliason, Ruth J; Lanctot, Jennifer Q; Clegg, Jennifer L; Mandrell, Belinda N; Ness, Kirsten K; Krull, Kevin R; Srivastava, Deokumar; Forrest, Christopher B; Hudson, Melissa M; Robison, Leslie L; Huang, I-Chan

2018-04-18

To compare importance ratings of patient-reported outcomes (PROs) items from the viewpoints of childhood cancer survivors, parents, and clinicians for further developing short-forms to use in survivorship care. 101 cancer survivors, 101 their parents, and 36 clinicians were recruited from St. Jude Children's Research Hospital. Participants were asked to select eight items that they deemed useful for clinical decision making from each of the four Patient-Reported Outcomes Measurement Information System Pediatric item banks. These item banks were pain interference (20 items), fatigue (23 items), psychological stress (19 items), and positive affect (37 items). Compared to survivors, clinicians rated more items across four domains that were statistically different than did parents (23 vs. 13 items). Clinicians rated five items in pain interference domain (ORs 2.33-6.01; p's important but rated three items in psychological stress domain (ORs 0.14-0.42; p's important than did survivors. In contrast, parents rated seven items in positive affect domain (ORs 0.25-0.47; p's important than did survivors. Survivors, parents, and clinicians viewed importance of PRO items for survivorship care differently. These perspectives should be used to assist the development of PROs tools.

Clinicians' interpretations of point of care urine culture versus laboratory culture results: analysis from the four-country POETIC trial of diagnosis of uncomplicated urinary tract infection in primary care.

Science.gov (United States)

Hullegie, Saskia; Wootton, Mandy; Verheij, Theo J M; Thomas-Jones, Emma; Bates, Janine; Hood, Kerenza; Gal, Micaela; Francis, Nick A; Little, Paul; Moore, Michael; Llor, Carl; Pickles, Timothy; Gillespie, David; Kirby, Nigel; Brugman, Curt; Butler, Christopher C

2017-08-01

Urine culture at the point of care minimises delay between obtaining the sample and agar inoculation in a microbiology laboratory, and quantification and sensitivity results can be available more rapidly in primary care. To identify the degree to which clinicians' interpretations of a point-of-care-test (POCT) urine culture (Flexicult™ SSI-Urinary Kit) agrees with laboratory culture in women presenting to primary care with symptoms of uncomplicated urinary tract infections (UTI). Primary care clinicians used the Flexicult™-POCT, recorded their findings and took a photograph of the result, which was interpreted by microbiology laboratory technicians. Urine samples were additionally processed in routine care laboratories. Cross tabulations were used to identify important differences in organism identification, quantification and antibiotic susceptibility between these three sources of data. The influence of various laboratory definitions for UTI on culture were assessed. Primary care clinicians identified 202/289 urine samples (69.9%) as positive for UTI using the Flexicult™-POCT, whereas laboratory culture identified 94-190 (32.5-65.7%) as positive, depending on definition thresholds. 82.9% of samples identified positive for E. coli on laboratory culture were also considered positive for E. coli using the Flexicult™ -POCT, and susceptibilities were reasonably concordant. There were major discrepancies between laboratory staff interpretation of Flexicult™ photographs, clinicians' interpretation of the Flexicult™ test, and laboratory culture results. Flexicult™-POCT overestimated the positivity rate of urine samples for UTI when laboratory culture was used as the reference standard. However, it is unclear whether point-of-care or laboratory based urine culture provides the most valid diagnostic information. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Primary care clinicians' experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters.

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Krakower, Douglas S; Maloney, Kevin M; Grasso, Chris; Melbourne, Katherine; Mayer, Kenneth H

2016-01-01

An estimated 1.2 million Americans have indications for using antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. For many of these at-risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists. During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics. Thirty-two clinicians (response rate=91%) completed the surveys. Nearly all clinicians (97%) had prescribed PrEP (median 20 patients, interquartile range 11-33). Most clinicians reported testing and risk-reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians' practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79%) rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future. In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this efficacious intervention.

Successful recruitment to a study of first-episode psychosis by clinicians: a qualitative account of outcomes and influences on process.

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Patterson, Sue; Duhig, Michael; Connell, Melissa; Scott, James

2014-10-01

Abstract Background: Strategies proposed to promote recruitment of representative samples to trials and mental health research have focused on researchers external to clinical services. How clinicians approach recruitment as researchers and particularities of recruiting people with first episode of psychosis warrant investigation. To describe recruitment, by clinicians, of people with first-episode psychosis (FEP) and factors influencing process and enrolment. Observational study nested within longitudinal examination of trauma and outcomes for patients experiencing first psychotic episode. Data collected during 20 scheduled meetings of clinicians recruiting from services in Australia. Timely recruitment of 60 young people demonstrates that clinicians can successfully engage patients in research. Success depends on satisfaction of organisational preconditions and clinician motivation grounded in considering the study worthwhile. Pre-selection of participants was informed by judgments about health, insight and quality of the therapeutic alliance. Patients' decisions were influenced by family support, acceptance of diagnosis and altruism. Honoraria had variable effect. Clinicians are well placed to recruit when appropriately supported, and people with FEP are willing to engage in research that fits their personal circumstances. Research should examine the meaning of participation in such studies and ways participation could support recovery.

Assessment of mood: guides for clinicians.

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Furukawa, Toshi A

2010-06-01

This article is one of the series of review articles aiming to present a convenient guideline for practicing clinicians in their selection of scales for clinical and research purposes. This article focuses on assessment scales for mood (depression, mania). After reviewing the basic principles of clinical psychometrics, we present a selective review of representative scales measuring depressed or manic mood. We reviewed and reported on reliability, validity, interpretability, and feasibility of the following rating scales: Patient Health Questionnaire-9 (PHQ-9), K6, Beck Depression Inventory II (BDI-II), and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) as self-report scales for depressed mood; Hamilton Rating Scale for Depression (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS) as clinician-administered measure for depression; and Young Mania Rating Scale (YMRS) as a clinician-administered instrument for mania. Although the rating scales for mood represent a well-trodden terrain, this brief review of the most frequently used scales in the literature revealed there is still some room for improvement and for further research, especially with regard to their clinical interpretability. Copyright 2010 Elsevier Inc. All rights reserved.

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians.

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Haik, Josef; Brown, Stav; Liran, Alon; Visentin, Denis; Sokolov, Amit; Zilinsky, Isaac; Kornhaber, Rachel

2017-01-01

Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory), depression (PRIME-MD), health-related quality of life (SF-8), and compassion fatigue (Professional Quality of Life version 5). Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2%) among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P =0.017). Additional factors contributing to compassion fatigue were those without children ( P =0.016), divorced ( P =0.035), of a younger age ( P =0.019), and a registered nurse ( P =0.05). Burnout increased clinicians' risk of adverse professional and personal outcomes and correlated with less free time ( P work-home disputes ( P =0.05), increased depression ( P =0.001) and decreased career satisfaction ( P =0.01). Burnout was also associated with higher physical (mean difference =3.8, P <0.001) and lower mental (mean difference =-3.5, P <0.001) Quality of Life scores. Caring for burn survivors can lead to burnout, compassion fatigue, and vicarious trauma. Identifying strategies to abate these issues is essential to ensure improved clinicial environments and patient outcomes.

Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians.

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Main, Barry G; McNair, Angus G K; Huxtable, Richard; Donovan, Jenny L; Thomas, Steven J; Kinnersley, Paul; Blazeby, Jane M

2017-04-26

Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient's values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient. The aim of this paper is to describe 'core information sets' which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this 'core information'. We propose that such information addresses the 'reasonable patient' standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate

Professional identity in clinician-scientists: brokers between care and science.

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Kluijtmans, Manon; de Haan, Else; Akkerman, Sanne; van Tartwijk, Jan

2017-06-01

Despite increasing numbers of publications, science often fails to significantly improve patient care. Clinician-scientists, professionals who combine care and research activities, play an important role in helping to solve this problem. However, despite the ascribed advantages of connecting scientific knowledge and inquiry with health care, clinician-scientists are scarce, especially amongst non-physicians. The education of clinician-scientists can be complex because they must form professional identities at the intersection of care and research. The successful education of clinician-scientists requires insight into how these professionals view their professional identity and how they combine distinct practices. This study sought to investigate how recently trained nurse- and physiotherapist-scientists perceive their professional identities and experience the crossing of boundaries between care and research. Semi-structured interviews were conducted with 14 nurse- and physiotherapist-scientists at 1 year after they had completed MSc research training. Interviews were thematically analysed using insights from the theoretical frameworks of dialogical self theory and boundary crossing. After research training, the initial professional identity, of clinician, remained important for novice clinician-scientists, whereas the scientist identity was experienced as additional and complementary. A meta-identity as broker, referred to as a 'bridge builder', seemed to mediate competing demands or tensions between the two positions. Obtaining and maintaining a dual work position were experienced as logistically demanding; nevertheless, it was considered beneficial for crossing the boundaries between care and research because it led to reflection on the health profession, knowledge integration, inquiry and innovation in care, improved data collection, and research with a focus on clinical applicability. Novice clinician-scientists experience dual professional identities as care

Dimensions of personality: clinicians' perspectives

NARCIS (Netherlands)

Mullins-Sweatt, S.N.; Smit, V.; Verheul, R.; Oldham, J.; Widiger, T.A.

2009-01-01

Objective: To obtain the opinions and preferences of practising clinicians about the clinical utility of personality scales included within 8 alternative dimensional models of personality disorder for inclusion within an official diagnostic nomenclature. Method: Psychiatrists (n = 226) and

Physicians' opinions of a health information exchange.

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Hincapie, Ana Lucia; Warholak, Terri L; Murcko, Anita C; Slack, Marion; Malone, Daniel C

2011-01-01

Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE). To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs. A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding. A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of "doctor shopping"; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system. Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.

Clinician characteristics, communication, and patient outcome in oncology: a systematic review.

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De Vries, A M M; de Roten, Y; Meystre, C; Passchier, J; Despland, J-N; Stiefel, F

2014-04-01

The aim of this study was to review the literature on clinician characteristics influencing patient-clinician communication or patient outcome in oncology. Studies investigating the association of clinician characteristics with quality of communication and with outcome for adult cancer patients were systematically searched in MEDLINE, PSYINFO, PUBMED, EMBASE, CINHAL, Web of Science and The Cochrane Library up to November 2012. We used the preferred reporting items for systematic reviews and meta-analyses statement to guide our review. Articles were extracted independently by two of the authors using predefined criteria. Twenty seven articles met the inclusion criteria. Clinician characteristics included a variety of sociodemographic, relational, and personal characteristics. A positive impact on quality of communication and/or patient outcome was reported for communication skills training, an external locus of control, empathy, a socioemotional approach, shared decision-making style, higher anxiety, and defensiveness. A negative impact was reported for increased level of fatigue and burnout and expression of worry. Professional experience of clinicians was not related to communication and/or to patient outcome, and divergent results were reported for clinician gender, age, stress, posture, and confidence or self-efficacy. Various clinician characteristics have different effects on quality of communication and/or patient outcome. Research is needed to investigate the pathways leading to effective communication between clinicians and patients. Copyright © 2013 John Wiley & Sons, Ltd.

Binomial probability distribution model-based protein identification algorithm for tandem mass spectrometry utilizing peak intensity information.

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Xiao, Chuan-Le; Chen, Xiao-Zhou; Du, Yang-Li; Sun, Xuesong; Zhang, Gong; He, Qing-Yu

2013-01-04

Mass spectrometry has become one of the most important technologies in proteomic analysis. Tandem mass spectrometry (LC-MS/MS) is a major tool for the analysis of peptide mixtures from protein samples. The key step of MS data processing is the identification of peptides from experimental spectra by searching public sequence databases. Although a number of algorithms to identify peptides from MS/MS data have been already proposed, e.g. Sequest, OMSSA, X!Tandem, Mascot, etc., they are mainly based on statistical models considering only peak-matches between experimental and theoretical spectra, but not peak intensity information. Moreover, different algorithms gave different results from the same MS data, implying their probable incompleteness and questionable reproducibility. We developed a novel peptide identification algorithm, ProVerB, based on a binomial probability distribution model of protein tandem mass spectrometry combined with a new scoring function, making full use of peak intensity information and, thus, enhancing the ability of identification. Compared with Mascot, Sequest, and SQID, ProVerB identified significantly more peptides from LC-MS/MS data sets than the current algorithms at 1% False Discovery Rate (FDR) and provided more confident peptide identifications. ProVerB is also compatible with various platforms and experimental data sets, showing its robustness and versatility. The open-source program ProVerB is available at http://bioinformatics.jnu.edu.cn/software/proverb/ .

Mental health/illness and prisons as place: frontline clinicians׳ perspectives of mental health work in a penal setting.

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Wright, Nicola; Jordan, Melanie; Kane, Eddie

2014-09-01

This article takes mental health and prisons as its two foci. It explores the links between social and structural aspects of the penal setting, the provision of mental healthcare in prisons, and mental health work in this environment. This analysis utilises qualitative interview data from prison-based fieldwork undertaken in Her Majesty׳s Prison Service, England. Two themes are discussed: (1) the desire and practicalities of doing mental health work and (2) prison staff as mental health work allies. Concepts covered include equivalence, training, ownership, informal communication, mental health knowledge, service gatekeepers, case identification, and unmet need. Implications for practice are (1) the mental health knowledge and understanding of prison wing staff could be appraised and developed to improve mental healthcare and address unmet need. Their role as observers and gatekeepers could be considered. (2) The realities of frontline mental health work for clinicians in the penal environment should be embraced and used to produce and implement improved policy and practice guidance, which is in better accord with the actuality of the context - both socially and structurally. Copyright © 2014 Elsevier Ltd. All rights reserved.

Prison Clinicians' Perceptions of Antisocial Personality Disorder as a Formal Diagnosis.

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Stevens, Gail Flint

1994-01-01

Surveyed and interviewed 53 clinicians who work with prison inmates. Results indicated that clinicians used diagnosis of antisocial personality disorder liberally among inmates and felt majority of inmates could be so diagnosed. Large minority of clinicians went beyond Diagnostic and Statistical Manual of Mental Disorders criteria and reported…

Effective communication of public health guidance to emergency department clinicians in the setting of emerging incidents: a qualitative study and framework.

Science.gov (United States)

Khan, Yasmin; Sanford, Sarah; Sider, Doug; Moore, Kieran; Garber, Gary; de Villa, Eileen; Schwartz, Brian

2017-04-28

Evidence to inform communication between emergency department clinicians and public health agencies is limited. In the context of diverse, emerging public health incidents, communication is urgent, as emergency department clinicians must implement recommendations to protect themselves and the public. The objectives of this study were to: explore current practices, barriers and facilitators at the local level for communicating public health guidance to emergency department clinicians in emerging public health incidents; and develop a framework that promotes effective communication of public health guidance to clinicians during emerging incidents. A qualitative study was conducted using semi-structured interviews with 26 key informants from emergency departments and public health agencies in Ontario, Canada. Data were analyzed inductively and the analytic approach was guided by concepts of complexity theory. Emergent themes corresponded to challenges and strategies for effective communication of public health guidance. Important challenges related to the coordination of communication across institutions and jurisdictions, and differences in work environments across sectors. Strategies for effective communication were identified as the development of partnerships and collaboration, attention to specific methods of communication used, and the importance of roles and relationship-building prior to an emerging public health incident. Following descriptive analysis, a framework was developed that consists of the following elements: 1) Anticipate; 2) Invest in building relationships and networks; 3) Establish liaison roles and redundancy; 4) Active communication; 5) Consider and respond to the target audience; 6) Leverage networks for coordination; and 7) Acknowledge and address uncertainty. The qualities inherent in local relationships cut across framework elements. This research indicates that relationships are central to effective communication between public health

Prediction of mandibular rotation: an empirical test of clinician performance.

Science.gov (United States)

Baumrind, S; Korn, E L; West, E E

1984-11-01

An experiment was conducted in an attempt to determine empirically how effective a number of expert clinicians were at differentiating "backward rotators" from "forward rotators" on the basis of head-film information which might reasonably have been available to them prior to instituting treatment for the correction of Class II malocclusion. As a result of a previously reported ongoing study, pre- and posttreatment head films were available for 188 patients treated in the mixed dentition for the correction of Class II malocclusion and for 50 untreated Class II subjects. These subjects were divided into 14 groups (average size of group, 17; range, 6 to 23) solely on the basis of type of treatment and the clinician from whose clinic the records had originated. From within each group, we selected the two or three subjects who had exhibited the most extreme backward rotation and the two or three subjects who had exhibited the most extreme forward rotation of the mandible during the interval between films. The sole criterion for classification was magnitude of change in the mandibular plane angle of Downs between the pre- and posttreatment films of each patient. The resulting sample contained 32 backward-rotator subjects and 32 forward-rotator subjects. Five expert judges (mean clinical experience, 28 years) were asked to identify the backward-rotator subjects by examination of the pretreatment films. The findings may be summarized as follows: (1) No judge performed significantly better than chance. (2) There was strong evidence that the judges used a shared, though relatively ineffective, set of rules in making their discriminations between forward and backward rotators. (3) Statistical analysis of the predictive power of a set of standard cephalometric measurements which had previously been made for this set of subjects indicated that the numerical data also failed to identify potential backward rotators at a rate significantly better than chance. We infer from these

Brand crisis management: the use of information for prevention, identification and management

Directory of Open Access Journals (Sweden)

Alexandre Borba Salvador

2018-01-01

Full Text Available Purpose – To understand, from the management perspective, the use of information on brand crisis management in moments involving prevention, identification and management. Design/methodology/approach – This article is the result of an exploratory, qualitative study. Primary data was collected through interviews with marketing executives and crisis management specialists. Findings – We concluded that managers use information in very different ways, and, taking possession of information and decisionmaking attitudes into account, four groups of crisis managers were found. Originality/value – In order to contribute to the expansion of academic knowledge in the field of marketing administration and brand crisis management, this study presented the crossing of three different fields (information systems, brand crisis management and organizational development to structure knowledge concerning brand crisis management. From the managerial perspective, certain crises could be avoided by monitoring internal and external information, and by identifying problems in their early stages. From the social perspective, reducing brand crisis cases positively affects society as a whole (organizations and individuals.

Emotional exhaustion and workload predict clinician-rated and objective patient safety

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Welp, Annalena; Meier, Laurenz L.; Manser, Tanja

2015-01-01

Aims: To investigate the role of clinician burnout, demographic, and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables, and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. Regression analysis (multilevel) was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience) and organizational (e.g., workload, predictability) characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety was associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios. Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables and support to the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety. PMID:25657627

Emotional Exhaustion and Workload Predict Clinician-Rated and Objective Patient Safety

Directory of Open Access Journals (Sweden)

Annalena eWelp

2015-01-01

Full Text Available Aims: To investigate the role of clinician burnout, demographic and organizational characteristics in predicting subjective and objective indicators of patient safety. Background: Maintaining clinician health and ensuring safe patient care are important goals for hospitals. While these goals are not independent from each other, the interplay between clinician psychological health, demographic and organizational variables and objective patient safety indicators is poorly understood. The present study addresses this gap. Method: Participants were 1425 physicians and nurses working in intensive care. (Multilevel regression analysis was used to investigate the effect of burnout as an indicator of psychological health, demographic (e.g., professional role and experience and organizational (e.g., workload, predictability characteristics on standardized mortality ratios, length of stay and clinician-rated patient safety. Results: Clinician-rated patient safety were associated with burnout, trainee status, and professional role. Mortality was predicted by emotional exhaustion. Length of stay was predicted by workload. Contrary to our expectations, burnout did not predict length of stay, and workload and predictability did not predict standardized mortality ratios.Conclusion: At least in the short-term, clinicians seem to be able to maintain safety despite high workload and low predictability. Nevertheless, burnout poses a safety risk. Subjectively, burnt-out clinicians rated safety lower, and objectively, units with high emotional exhaustion had higher standardized mortality ratios. In summary, our results indicate that clinician psychological health and patient safety could be managed simultaneously. Further research needs to establish causal relationships between these variables or and support the development of managerial guidelines to ensure clinicians’ psychological health and patients’ safety.

Experiences of randomization: interviews with patients and clinicians in the SPCG-IV trial.

Science.gov (United States)

Bill-Axelson, Anna; Christensson, Anna; Carlsson, Marianne; Norlén, Bo Johan; Holmberg, Lars

2008-01-01

Recruitment of both patients and clinicians to randomized trials is difficult. Low participation carries the risk of terminating studies early and making them invalid owing to insufficient statistical power. This study investigated patients' and clinicians' experiences of randomization with the aim of facilitating trial participation in the future. This was a qualitative study using content analysis. Patients offered to participate in a randomized trial and randomizing clinicians were interviewed. Five participants, four non-participants and five randomizing clinicians were interviewed, 2-8 years from randomization. Clinicians used strategies in interaction with the patients to facilitate decision making. Patients' attitudes differed and experiences of relatives or friends were often stated as reasons for treatment preferences. Patients described that letting chance decide treatment was a difficult barrier to overcome for randomization. The clinicians used a number of different strategies perceived to make randomization more acceptable to their patients. The clinicians' own motivation for randomizing patients for trials depended on the medical relevance of the study question and the clinicians' major obstacle was to maintain equipoise over time. Regular meetings with the study group helped to maintain equipoise and motivation. To establish a good platform for randomization the clinician needs to know about the patient's treatment preferences and the patient's attitude concerning the role of the clinician to facilitate decision making. The strategies used by the clinicians were perceived as helpful and could be tested in an intervention study.

Ten clinician-driven strategies for maximising value of Australian health care.

Science.gov (United States)

Scott, Ian

2014-05-01

To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia. What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of

Identification and Characterization of Inter-Organizational Information Flows in the Portuguese National Health Service

Science.gov (United States)

Brito, António Carvalho; Cruz-Correia, Ricardo João

2016-01-01

Summary Objectives To understand and build a collective vision of all existing institutions in the Portuguese National Health Service as well as to perceive how and how far the interaction between those multiple institutions is supported by Information Systems (IS). Methods Upon identification of the institutions involved in the healthcare process, a set of interviews with experienced people from those institutions was conducted, which produced about five hours of tape. The research was focused exclusively on processes involving two different organizations and any internal processes were altogether excluded from it. Results The study allowed the identification of about 50 recurrent interaction processes, which were classified into four different varieties in accordance with the nature of the information flow: administrative, clinical, identificational and statistical. In addition, these processes were divided in accordance with the way how that integration is achieved, from completely automated to email or telephone-based. Conclusions Funds/Money related processes are technologically more rigid and standardized, whereas auditing and inspection ones are less supported by automatic systems. There emerged an interesting level of sharing and integration in clinical processes, although the integration is mostly made at the interface level. The authors identified 5 particularly relevant and dominant actors (2 classes of individuals and 3 institutions) with which there is a need for coordination and cooperation. The authors consider that, in future works, an effort should be made to provide the various institutions with guidelines/interfaces and prompt such institutions to elaborate upon these. PMID:27999840

Bioethics for clinicians: 25. Teaching bioethics in the clinical setting

Science.gov (United States)

McKneally, Martin F.; Singer, Peter A.

2001-01-01

BIOETHICS IS NOW TAUGHT IN EVERY CANADIAN MEDICAL SCHOOL. Canada needs a cadre of teachers who can help clinicians learn bioethics. Our purpose is to encourage clinician teachers to accept this important responsibility and to provide practical advice about teaching bioethics to clinicians as an integral part of good clinical medicine. We use 5 questions to focus the discussion: Why should I teach? What should I teach? How should I teach? How should I evaluate? How should I learn? PMID:11338804

Leadership, clinician managers and a thing called "hybridity".

Science.gov (United States)

Fulop, Liz

2012-01-01

In many countries leadership theories and leadership development programs in healthcare have been dominated by individualistic and heroic approaches that focus on developing the skills and competencies of health professionals. Alternative approaches have been proffered but mainly in the form of post-heroic and distributed forms of leadership. The notion of "hybridity" has emerged to challenge the assumptions of distributed leadership. The paper seeks to explore how the concept of hybridity can be used to re-theorize leadership in healthcare as it relates to clinician managers (or hybrid-professional managers). The theoretical developments are explored and empirical material is presented from research in Australian public hospitals to support the case for the existence of hybridized forms of leadership in healthcare. The paper discusses whether hybridity needs re-theorizing to adequately account for clinician leadership. It contributes to debates surrounding the role of clinician leadership in healthcare reform particularly in relation to those doctors who occupy management positions at the division or unit levels as distinct to CEOs. The study uses qualitative research, i.e. interactive interviews to present accounts of how healthcare professionals describe leadership. It undertakes both deductive and inductive theme analysis of the interview material. There is support for hybridized configurations of leadership in interview materials of healthcare professionals but other aspects were also noted that cannot be explained by this approach alone. The paper is the first to examine the concept of hybridity in the context of clinician leadership. Many approaches to leadership in healthcare fail to address the complexity of leadership within the ranks of clinician managers and thus are unable to deal adequately with the role of leadership in healthcare reform and change.

Managing diabetic foot infections: a survey of Australasian infectious diseases clinicians.

Science.gov (United States)

Commons, Robert J; Raby, Edward; Athan, Eugene; Bhally, Hasan; Chen, Sharon; Guy, Stephen; Ingram, Paul R; Lai, Katy; Lemoh, Chris; Lim, Lyn-Li; Manning, Laurens; Miyakis, Spiros; O'Reilly, Mary; Roberts, Adam; Sehu, Marjoree; Torda, Adrienne; Vicaretti, Mauro; Lazzarini, Peter A

2018-01-01

Diabetic foot infections (DFI) present a major morbidity, mortality and economic challenge for the tertiary health sector. However, lack of high quality evidence for specific treatment regimens for patients with DFIs may result in inconsistent management. This study aimed to identify DFI caseload proportion and patterns of clinical practice of Infectious Diseases (ID) Physicians and Trainees within Australia and New Zealand. A cross-sectional online survey of Australian and New Zealand ID Physicians and Trainees was undertaken, to estimate the overall ID caseload devoted to patients with DFIs and assess clinicians' management practices of patients with DFIs. Approximately 28% (142/499) of ID Physicians and Trainees from Australia and New Zealand responded to the survey. DFI made up 19.2% of all ID consultations. Involvement in multidisciplinary teams (MDT) was common as 77.5% (93/120) of those responding indicated their patients had access to an inpatient or outpatient MDT. Significant heterogeneity of antimicrobial treatments was reported, with 82 unique treatment regimens used by 102 respondents in one scenario and 76 unique treatment regimens used by 101 respondents in the second scenario. The duration of therapy and the choice of antibiotics for microorganisms isolated from superficial swabs also varied widely. Patients with DFIs represent a significant proportion of an ID clinician's caseload. This should be reflected in the ID training program. Large heterogeneity in practice between clinicians reflects a lack of evidence from well-designed clinical trials for patients with DFI and highlights the need for management guidelines informed by future trials.

UK medical students' perceptions, attitudes, and interest toward medical leadership and clinician managers.

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Rouhani, Maral J; Burleigh, Eleanor J; Hobbis, Chloe; Dunford, Charlotte; Osman, Nadir I; Gan, Christine; Gibbons, Norma B; Ahmed, Hashim U; Miah, Saiful

2018-01-01

We aimed to determine UK medical students' perceptions and attitudes and interest toward medical leadership and clinician managers. A cross-sectional study was conducted during the academic year 2015-2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree) when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership training they received during medical school as "very poor" or "poor" (54.4%). Our study suggests that UK medical students have an appetite for management and leadership training and appreciate its importance but feel that the training they are receiving is poor. This suggests that there is a gap between the demand for management and leadership training and the quality of training supplied by UK medical schools.

An approach to medical knowledge sharing in a hospital information system using MCLink.

Science.gov (United States)

Shibuya, Akiko; Inoue, Ryusuke; Nakayama, Masaharu; Kasahara, Shin; Maeda, Yukihiro; Umesato, Yoshimasa; Kondo, Yoshiaki

2013-08-01

Clinicians often need access to electronic information resources that answer questions that occur in daily clinical practice. This information generally comes from publicly available resources. However, clinicians also need knowledge on institution-specific information (e.g., institution-specific guidelines, choice of drug, choice of laboratory test, information on adverse events, and advice from professional colleagues). This information needs to be available in real time. This study characterizes these needs in order to build a prototype hospital information system (HIS) that can help clinicians get timely answers to questions. We previously designed medical knowledge units called Medical Cells (MCs). We developed a portal server of MCs that can create and store medical information such as institution-specific information. We then developed a prototype HIS that embeds MCs as links (MCLink); these links are based on specific terms (e.g., drug, laboratory test, and disease). This prototype HIS presents clinicians with institution-specific information. The HIS clients (e.g., clinicians, nurses, pharmacists, and laboratory technicians) can also create an MCLink in the HIS using the portal server in the hospital. The prototype HIS allowed efficient sharing and use of institution-specific information to clinicians at the point of care. This study included institution-specific information resources and advice from professional colleagues, both of which might have an important role in supporting good clinical decision making.

Child Health Disparities: What Can a Clinician Do?

OpenAIRE

Cheng, Tina L.; Emmanuel, Mickey; Levy, Daniel J.; Jenkins, Renee R.

2015-01-01

Pediatric primary and specialty practice has changed with more to do, more regulation and more family needs. Similarly, the needs of patients have changed with more demographic diversity, family stress and continued health disparities by race, ethnicity and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This paper outlines specific, practical, actionable and evidence-based activities for clinicians t...

[Projective identification in human relations].

Science.gov (United States)

Göka, Erol; Yüksel, Fatih Volkan; Göral, F Sevinç

2006-01-01

Melanie Klein, one of the pioneers of Object Relations Theory, first defined "projective identification", which is regarded as one of the most efficacious psychoanalytic concepts after the discovery of the "unconscious". Examination of the literature on "projective identification" shows that there are various perspectives and theories suggesting different uses of this concept. Some clinicians argue that projective identification is a primitive defense mechanism observed in severe psychopathologies like psychotic disorder and borderline personality disorder, where the intra-psychic structure has been damaged severely. Others suggest it to be an indispensable part of the transference and counter-transference between the therapist and the patient during psychotherapy and it can be used as a treatment material in the therapy by a skillful therapist. The latter group expands the use of the concept through normal daily relationships by stating that projective identification is one type of communication and part of the main human relation mechanism operating in all close relationships. Therefore, they suggest that projective identification has benign forms experienced in human relations as well as malign forms seen in psychopathologies. Thus, discussions about the definition of the concept appear complex. In order to clarify and overcome the complexity of the concept, Melanie Klein's and other most important subsequent approaches are discussed in this review article. Thereby, the article aims to explain its important function in understanding the psychopathologies, psychotherapeutic relationships and different areas of normal human relations.

Identification of suicidal ideations with the help of projective tests: a review.

Science.gov (United States)

Kumar, Devvarta; Nizamie, S Haque; Abhishek, Priyadarshee; Prasanna, Lavanya Tumkur

2014-12-01

Identification of the presence of suicidal ideations in an individual is crucial for the timely intervention. However, these ideations may remain unidentified as an individual with serious intentions of self-harm may not express them explicitly. Various projective tests can provide crucial clues to clinicians about the presence of suicidal ideations in an individual's mind. The present review is intended to update clinicians working in the field of suicide prevention about salient findings on these tests which can serve as a ready reckoner for them. We also highlight the status of research in this domain. Copyright © 2014 Elsevier B.V. All rights reserved.

Are Clinicians Better Than Lay Judges at Recalling Case Details? An Evaluation of Expert Memory.

Science.gov (United States)

Webb, Christopher A; Keeley, Jared W; Eakin, Deborah K

2016-04-01

This study examined the role of expertise in clinicians' memory for case details. Clinicians' diagnostic formulations may afford mechanisms for retaining and retrieving information. Experts (N = 41; 47.6% males, 23.8% females; 28.6% did not report gender; age: mean [M] = 54.69) were members of the American Board of Professional Psychologists. Lay judges (N = 156; 25.4% males, 74.1% females; age: M = 18.85) were undergraduates enrolled in general psychology. Three vignettes were presented to each group, creating a 2 (group: expert, lay judge) x 3 (vignettes: simple, complex-coherent, complex-incoherent) mixed factorial design. Recall accuracy for vignette details was the dependent variable. Data analyses used multivariate analyses of variance to detect group differences among multiple continuous variables. Experts recalled more information than lay judges, overall. However, experts also exhibited more false memories for the complex-incoherent case because of their schema-based knowledge. This study supported clinical expertise as beneficial. Nonetheless, negative influences from experts' schema-based knowledge, as exhibited, could adversely affect clinical practices. © 2016 Wiley Periodicals, Inc.

Identification of Chemical Toxicity Using Ontology Information of Chemicals

Directory of Open Access Journals (Sweden)

Zhanpeng Jiang

2015-01-01

Full Text Available With the advance of the combinatorial chemistry, a large number of synthetic compounds have surged. However, we have limited knowledge about them. On the other hand, the speed of designing new drugs is very slow. One of the key causes is the unacceptable toxicities of chemicals. If one can correctly identify the toxicity of chemicals, the unsuitable chemicals can be discarded in early stage, thereby accelerating the study of new drugs and reducing the R&D costs. In this study, a new prediction method was built for identification of chemical toxicities, which was based on ontology information of chemicals. By comparing to a previous method, our method is quite effective. We hope that the proposed method may give new insights to study chemical toxicity and other attributes of chemicals.

PubMed searches: overview and strategies for clinicians.

Science.gov (United States)

Lindsey, Wesley T; Olin, Bernie R

2013-04-01

PubMed is a biomedical and life sciences database maintained by a division of the National Library of Medicine known as the National Center for Biotechnology Information (NCBI). It is a large resource with more than 5600 journals indexed and greater than 22 million total citations. Searches conducted in PubMed provide references that are more specific for the intended topic compared with other popular search engines. Effective PubMed searches allow the clinician to remain current on the latest clinical trials, systematic reviews, and practice guidelines. PubMed continues to evolve by allowing users to create a customized experience through the My NCBI portal, new arrangements and options in search filters, and supporting scholarly projects through exportation of citations to reference managing software. Prepackaged search options available in the Clinical Queries feature also allow users to efficiently search for clinical literature. PubMed also provides information regarding the source journals themselves through the Journals in NCBI Databases link. This article provides an overview of the PubMed database's structure and features as well as strategies for conducting an effective search.

Inclusion probability for DNA mixtures is a subjective one-sided match statistic unrelated to identification information.

Science.gov (United States)

Perlin, Mark William

2015-01-01

DNA mixtures of two or more people are a common type of forensic crime scene evidence. A match statistic that connects the evidence to a criminal defendant is usually needed for court. Jurors rely on this strength of match to help decide guilt or innocence. However, the reliability of unsophisticated match statistics for DNA mixtures has been questioned. The most prevalent match statistic for DNA mixtures is the combined probability of inclusion (CPI), used by crime labs for over 15 years. When testing 13 short tandem repeat (STR) genetic loci, the CPI(-1) value is typically around a million, regardless of DNA mixture composition. However, actual identification information, as measured by a likelihood ratio (LR), spans a much broader range. This study examined probability of inclusion (PI) mixture statistics for 517 locus experiments drawn from 16 reported cases and compared them with LR locus information calculated independently on the same data. The log(PI(-1)) values were examined and compared with corresponding log(LR) values. The LR and CPI methods were compared in case examples of false inclusion, false exclusion, a homicide, and criminal justice outcomes. Statistical analysis of crime laboratory STR data shows that inclusion match statistics exhibit a truncated normal distribution having zero center, with little correlation to actual identification information. By the law of large numbers (LLN), CPI(-1) increases with the number of tested genetic loci, regardless of DNA mixture composition or match information. These statistical findings explain why CPI is relatively constant, with implications for DNA policy, criminal justice, cost of crime, and crime prevention. Forensic crime laboratories have generated CPI statistics on hundreds of thousands of DNA mixture evidence items. However, this commonly used match statistic behaves like a random generator of inclusionary values, following the LLN rather than measuring identification information. A quantitative

Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment.

Science.gov (United States)

Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten

2018-04-01

The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from eating disorders. Oppositely to traditional pen-and-paper meal diaries, the app allows for in-app patient-clinician linkage enabling clinicians to access patient app data anytime. The aim of our study was to explore the interdisciplinary clinical perspective on Recovery Record and its impact on treatment. Thirty-one clinicians from a Danish eating disorder treatment facility participated in field studies and 23 of these in interviews. Data were generated and analyzed concurrently applying the inductive methodology of Interpretive Description. We found two overarching themes: "Access to app data between treatment sessions", and "The patient-clinician relationship". Sub-themes associated with the former were "Online obligations" in relation to the added workload of continuously monitoring patient app data, and "Prepared or prejudiced" relating to advantages and disadvantages of using patient app data as preparation for treatment sessions. Sub-themes pertaining to the latter were "Expectation discrepancy" in relation to patients' and clinicians' divergent expectations for app usage, and "Pacified patients" regarding the clinicians' experience that the app potentially compromised the patient initiative in treatment sessions. Recovery Record induced new and affected pre-existing treatment and work conditions for clinicians. Clinicians were preoccupied with challenges associated with the app, for example, an added work load and potential harm to the patient-clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines for patient and clinician app usage. © 2018 Wiley Periodicals, Inc.

Concordance Between Administrator and Clinician Ratings of Organizational Culture and Climate.

Science.gov (United States)

Beidas, Rinad S; Williams, Nathaniel J; Green, Philip D; Aarons, Gregory A; Becker-Haimes, Emily M; Evans, Arthur C; Rubin, Ronnie; Adams, Danielle R; Marcus, Steven C

2018-01-01

Organizational culture and climate are important determinants of behavioral health service delivery for youth. The Organizational Social Context measure is a well validated assessment of organizational culture and climate that has been developed and extensively used in public sector behavioral health service settings. The degree of concordance between administrators and clinicians in their reports of organizational culture and climate may have implications for research design, inferences, and organizational intervention. However, the extent to which administrators' and clinicians' reports demonstrate concordance is just beginning to garner attention in public behavioral health settings in the United States. We investigated the concordance between 73 administrators (i.e., supervisors, clinical directors, and executive directors) and 247 clinicians in 28 child-serving programs in a public behavioral health system. Findings suggest that administrators, compared to clinicians, reported more positive cultures and climates. Organizational size moderated this relationship such that administrators in small programs (climate in contrast to administrators in large programs (≥466 youth clients served annually) who reported more positive cultures and climates than clinicians. We propose a research agenda that examines the effect of concordance between administrators and clinicians on organizational outcomes in public behavioral health service settings.

How Do Clinicians Learn About Knowledge Translation? An Investigation of Current Web-Based Learning Opportunities.

Science.gov (United States)

Damarell, Raechel A; Tieman, Jennifer J

2017-07-13

Clinicians are important stakeholders in the translation of well-designed research evidence into clinical practice for optimal patient care. However, the application of knowledge translation (KT) theories and processes may present conceptual and practical challenges for clinicians. Online learning platforms are an effective means of delivering KT education, providing an interactive, time-efficient, and affordable alternative to face-to-face education programs. This study investigates the availability and accessibility of online KT learning opportunities for health professionals. It also provides an analysis of the types of resources and associated disciplines retrieved by a range of KT synonyms. We searched a range of bibliographic databases and the Internet (Google advanced option) using 9 KT terms to identify online KT learning resources. To be eligible, resources had to be free, aimed at clinicians, educational in intent, and interactive in design. Each term was searched using two different search engines. The details of the first 100 websites captured per browser (ie, n=200 results per term) were entered into EndNote. Each site was subsequently visited to determine its status as a learning resource. Eligible websites were appraised for quality using the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) tool. We identified 971 unique websites via our multiple search strategies. Of these, 43 were health-related and educational in intent. Once these sites were evaluated for interactivity, a single website matched our inclusion criteria (Dementia Knowledge Translation Learning Centre). KT is an important but complex system of processes. These processes overlap with knowledge, practice, and improvement processes that go by a range of different names. For clinicians to be informed and competent in KT, they require better access to free learning opportunities. These resources should be designed from the viewpoint of the clinician, presenting KT

Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

International Nuclear Information System (INIS)

McQueen, A.S.; Worthy, S.; Keir, M.J.

2008-01-01

Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

Equity of access to elective surgery: reflections from NZ clinicians.

Science.gov (United States)

McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

Clinician-Driven Design of VitalPAD–An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit

Science.gov (United States)

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings. PMID:29552425

Lack of school requirements and clinician recommendations for human papillomavirus vaccination

Directory of Open Access Journals (Sweden)

Linda M. Niccolai

2018-04-01

Full Text Available Background: A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations. Design and Methods: Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. Results: Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. Conclusions: The current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.

What motivates senior clinicians to teach medical students?

Directory of Open Access Journals (Sweden)

Owen Cathy

2005-07-01

Full Text Available Abstract Background This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. Methods The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia. Their motivations to teach medical students were assessed applying Q methodology. Results Of the 75 participants, 18 (24% were female and 57 (76% were male. The age distribution was as follows: 30–40 years = 16 participants (21.3%, 41–55 years = 46 participants (61.3% and >55 years = 13 participants (17.3%. Most participants (n = 48, 64% were staff specialists and 27 (36% were visiting medical officers. Half of the participants were internists (n = 39, 52%, 12 (16% were surgeons, and 24 (32% were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41–55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. Conclusion This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

Strengthening the working alliance through a clinician's familiarity with the 12-step approach.

Science.gov (United States)

Dennis, Cory B; Roland, Brian D; Loneck, Barry M

2018-01-01

The working alliance plays an important role in the substance use disorder treatment process. Many substance use disorder treatment providers incorporate the 12-Step approach to recovery into treatment. With the 12-Step approach known among many clients and clinicians, it may well factor into the therapeutic relationship. We investigated how, from the perspective of clients, a clinician's level of familiarity with and in-session time spent on the 12-Step approach might affect the working alliance between clients and clinicians, including possible differences based on a clinician's recovery status. We conducted a secondary study using data from 180 clients and 31 clinicians. Approximately 81% of client participants were male, and approximately 65% of clinician participants were female. We analyzed data with Stata using a population-averaged model. From the perspective of clients with a substance use disorder, clinicians' familiarity with the 12-Step approach has a positive relationship with the working alliance. The client-estimated amount of in-session time spent on the 12-Step approach did not have a statistically significant effect on ratings of the working alliance. A clinician's recovery status did not moderate the relationship between 12-Step familiarity and the working alliance. These results suggest that clinicians can influence, in part, how their clients perceive the working alliance by being familiar with the 12-Step approach. This might be particularly salient for clinicians who provide substance use disorder treatment at agencies that incorporate, on some level, the 12-Step approach to recovery.

Service users' perceptions about their hospital admission elicited by service user-researchers or by clinicians.

LENUS (Irish Health Repository)

O'Donoghue, Brian

2013-05-01

OBJECTIVE Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer-service user-researcher or clinician-influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study. METHODS Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user-researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire. RESULTS A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user-researcher (24% versus 8%, p=.003). CONCLUSIONS Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users\\' positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user-researchers.

Attitudes toward antipsychotic treatment among patients with bipolar disorders and their clinicians: a systematic review

Directory of Open Access Journals (Sweden)

Sajatovic M

2017-08-01

Full Text Available Martha Sajatovic,1 Faith DiBiasi,2 Susan N Legacy3 1Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA; 3US Medical Affairs, Neuroscience, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA Introduction: Antipsychotics are recommended as first-line therapy for acute mania and maintenance treatment of bipolar disorder; however, published literature suggests their real-world use remains limited. Understanding attitudes toward these medications may help identify barriers and inform personalized therapy. This literature review evaluated patient and clinician attitudes toward the use of antipsychotics for treating bipolar disorder. Materials and methods: A systematic search of the Cochrane Library, Ovid MEDLINE, Embase, and BIOSIS Previews identified English language articles published between January 1, 2000, and June 15, 2016, that reported attitudinal data from patients, health care professionals, or caregivers; treatment decision-making; or patient characteristics that predicted antipsychotic use for bipolar disorder. Results were analyzed descriptively. Results: Of the 209 references identified, 11 met the inclusion criteria and were evaluated. These articles provided attitudinal information from 1,418 patients with bipolar disorder and 1,282 treating clinicians. Patients’ attitudes toward antipsychotics were generally positive. Longer duration of clinical stability was associated with positive attitudes. Implementation of psychoeducational and adherence enhancement strategies could improve patient attitudes. Limited data suggest clinicians’ perceptions of antipsychotic efficacy and tolerability may have the greatest impact on their prescribing patterns. Because the current real-world evidence base is inadequate, clinician attitudes

Investigating the need for clinicians to use tablet computers with a newly envisioned electronic health record.

Science.gov (United States)

Saleem, Jason J; Savoy, April; Etherton, Gale; Herout, Jennifer

2018-02-01

The Veterans Health Administration (VHA) has deployed a large number of tablet computers in the last several years. However, little is known about how clinicians may use these devices with a newly planned Web-based electronic health record (EHR), as well as other clinical tools. The objective of this study was to understand the types of use that can be expected of tablet computers versus desktops. Semi-structured interviews were conducted with 24 clinicians at a Veterans Health Administration (VHA) Medical Center. An inductive qualitative analysis resulted in findings organized around recurrent themes of: (1) Barriers, (2) Facilitators, (3) Current Use, (4) Anticipated Use, (5) Patient Interaction, and (6) Connection. Our study generated several recommendations for the use of tablet computers with new health information technology tools being developed. Continuous connectivity for the mobile device is essential to avoid interruptions and clinician frustration. Also, making a physical keyboard available as an option for the tablet was a clear desire from the clinicians. Larger tablets (e.g., regular size iPad as compared to an iPad mini) were preferred. Being able to use secure messaging tools with the tablet computer was another consistent finding. Finally, more simplicity is needed for accessing patient data on mobile devices, while balancing the important need for adequate security. Published by Elsevier B.V.

Producing patient-avatar identification in animation video information on spinal anesthesia by different narrative strategies.

Science.gov (United States)

Høybye, Mette Terp; Vesterby, Martin; Jørgensen, Lene Bastrup

2016-06-01

Visual approaches to health information reduce complexity and may bridge challenges in health literacy. But the mechanisms and meanings of using animated video in communication with patients undergoing surgery are not well described. By comparing two versions of a two-dimensional animated video on spinal anesthesia, this study tested the patient-avatar identification within two different narrative models. To explore the perspectives of total hip arthroplasty, we employed qualitative methods of interviews and ethnographic observation. The animated presentation of the spinal anesthesia procedure was immediately recognized by all participants as reflecting their experience of the procedure independent of the narrative form. The avatar gender did not affect this identification. We found no preference for either narrative form. This study supports the potential of animation video in health informatics as a didactic model for qualifying patient behavior. Animation video creates a high degree of identification that may work to reduce pre-surgical anxiety. © The Author(s) 2014.

Essential laboratory knowledge for the clinician

African Journals Online (AJOL)

As clinicians place huge emphasis on the numerical values obtained from the clinical ... where clinical management is based on medical decision limits that ... One area of laboratory medicine in which standardisation has been difficult to ...

The clinician-educator track: training internal medicine residents as clinician-educators.

Science.gov (United States)

Smith, C Christopher; McCormick, Ian; Huang, Grace C

2014-06-01

Although resident-as-teacher programs bring postgraduate trainees' teaching skills to a minimum threshold, intensive, longitudinal training is lacking for residents who wish to pursue careers in medical education. The authors describe the development, implementation, and preliminary assessment of the novel track for future clinician-educators that they introduced in the internal medicine residency program at Beth Israel Deaconess Medical Center in 2010. Categorical medical interns with a career interest in medical education apply to participate in the clinician-educator track (CET) at the midpoint of their first postgraduate year. CET residents complete a 2.5-year curriculum in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. They apply these skills in a variety of clinical settings and receive frequent feedback from faculty and peers. All CET residents design and implement at least one medical education research project. A comprehensive evaluation plan to assess the impact of the CET on resident teaching skills, scholarly productivity, career selection, and advancement is under way. A preliminary evaluation demonstrates high satisfaction with the track among the first cohort of CET residents, who graduated in 2012. Compared with residents in the traditional resident-as-teacher program, CET residents reported higher gains in their confidence in core medical education skills. Although these preliminary data are promising, data will be collected over the next several years to explore whether the additional curricular time, faculty time, and costs and potential expansion to other institutions are justified.

Information-sharing to promote informed choice in prenatal screening in the spirit of the SOGC clinical practice guideline: a proposal for an alternative model.

Science.gov (United States)

Vanstone, Meredith; Kinsella, Elizabeth Anne; Nisker, Jeff

2012-03-01

The 2011 SOGC clinical practice guideline "Prenatal Screening for Fetal Aneuploidy in Singleton Pregnancies" recommends that clinicians offer prenatal screening to all pregnant women and provide counselling in a non-directive manner. Non-directive counselling is intended to facilitate autonomous decision-making and remove the clinician's views regarding a particular course of action. However, recent research in genetic counselling raises concerns that non-directive counselling is neither possible nor desirable, and that it may not be the best way to facilitate informed choice. We propose an alternative model of information-sharing specific to prenatal screening that combines attributes of the models of informative decision-making and shared decision-making. Our proposed model is intended to provide clinicians with a strategy to communicate information about prenatal screening in a way that facilitates a shared deliberative process and autonomous decision-making. Our proposed model may better prepare a pregnant woman to make an informed choice about participating in prenatal screening on the basis of her consideration of the medical information provided by her clinician and her particular circumstances and values.

Microbiological contamination of mobile phones of clinicians in intensive care units and neonatal care units in public hospitals in Kuwait.

Science.gov (United States)

Heyba, Mohammed; Ismaiel, Mohammad; Alotaibi, Abdulrahman; Mahmoud, Mohamed; Baqer, Hussain; Safar, Ali; Al-Sweih, Noura; Al-Taiar, Abdullah

2015-10-15

The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination. This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological identification using standard laboratory methods. Self-administered questionnaire was used to gather data on mobile phones disinfection practices. Out of 213 mobile phones, 157 (73.7 %, 95 % CI [67.2-79.5 %]) were colonized. Coagulase-negative staphylococci followed by Micrococcus were predominantly isolated from the mobile phones; 62.9 % and 28.6 % of all mobile phones, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria were identified in 1.4 % and 7.0 % of the mobile phones, respectively. Sixty-eight clinicians (33.5 %) reported that they disinfected their mobile phones, with the majority disinfecting their mobile phones only when they get dirty. The only factor that was significantly associated with mobile phone contamination was whether a clinician has ever disinfected his/her mobile phone; adjusted odds ratio 2.42 (95 % CI [1.08-5.41], p-value = 0.031). The prevalence of mobile phone contamination is high in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Although some of the isolated organisms can be considered non-pathogenic, various reports described their potential harm particularly among patients in ICU and NCU settings. Isolation of MRSA and Gram-negative bacteria from mobile phones of clinicians treating patients in high-risk healthcare

Clinicians' recognition and management of emotions during difficult healthcare conversations.

Science.gov (United States)

Martin, Elliott B; Mazzola, Natalia M; Brandano, Jessica; Luff, Donna; Zurakowski, David; Meyer, Elaine C

2015-10-01

To examine the most commonly reported emotions encountered among healthcare practitioners when holding difficult conversations, including frequency and impact on care delivery. Interprofessional learners from a range of experience levels and specialties completed self-report questionnaires prior to simulation-based communication workshops. Clinicians were asked to describe up to three emotions they experienced when having difficult healthcare conversations; subsequent questions used Likert-scales to measure frequency of each emotion, and whether care was affected. 152 participants completed questionnaires, including physicians, nurses, and psychosocial professionals. Most commonly reported emotions were anxiety, sadness, empathy, frustration, and insecurity. There were significant differences in how clinicians perceived these different emotions affecting care. Empathy and anxiety were emotions perceived to influence care more than sadness, frustration, and insecurity. Most clinicians, regardless of clinical experience and discipline, find their emotional state influences the quality of their care delivery. Most clinicians rate themselves as somewhat to quite capable of recognizing and managing their emotions, acknowledging significant room to grow. Further education designed to increase clinicians' recognition of, reflection on, and management of emotion would likely prove helpful in improving their ability to navigate difficult healthcare conversations. Interventions aimed at anxiety management are particularly needed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Clinicians' Choices in Selecting Orthodontic Archwires

Directory of Open Access Journals (Sweden)

Silvia-Izabella Pop

2013-08-01

Full Text Available Objective: The aim of this study was to assess the choices made by clinicians in selecting archwires during the initial, intermediate and final stages of orthodontic treatment with fixed appliances. Methods: We carried out a questionnaire-based study at the Orthodontics and Pedodontics Clinic Târgu Mureș, between March 2012 and September 2012. The questionnaires consisted of two parts: the first included questions related to the dimension, alloy used in fabrication, section (round or rectangular and manufacturer of the archwires used by the orthodontists in their orthodontic practice, the second part was concerned with their personal opinion about the physical properties and disadvantages of the archwires. Results: From a total number of 90 distributed questionnaires, 62 were returned. The majority of clinicians are using stainless steel (SS and nickel-titanium alloy (NiTi wires in their fixed orthodontic treatments, very few are using beta-titanium (Beta Ti, copper nickel-titanium (Co- NiTi and esthetic archwires. The preferred dimension seem to be 0.022 inches in the appliance system. Regarding the wire dimensions, 0.014, 0.016 inch wires are mostly used from the round section group and 0.016 × 0.022 inch, 0.017 × 0.025 inch from the rectangular ones. Conclusions: There is a general lack of agreement between the clinicians surveyed regarding the properties of an ideal archwire and the disadvantages of the used wires. The most frequently used alloys seemed to be the SS and NiTi

Family members' informal roles in end-of-life decision making in adult intensive care units.

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Quinn, Jill R; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A; Dombeck, Mary T; Sellers, Craig R

2012-01-01

To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process. To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units. Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit. Health care clinicians, patients, and family members. Informal roles for family members consistently observed were primary caregiver, primary decision maker, family spokesperson, out-of-towner, patient's wishes expert, protector, vulnerable member, and health care expert. The identified informal roles were part of families' decision-making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision making within the family system and between the family and health care domains. These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these informal roles of family members can help clinicians recognize and understand the functions of these roles in families' decision making at the end of life and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes.

Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment.

Science.gov (United States)

Rosen, Brittany L; Bishop, James M; McDonald, Skye L; Kahn, Jessica A; Kreps, Gary L

2018-02-16

Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions' content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. A total of 21 interventions were identified, out of which 7 (33%) were webinars, 7 (33%) were videos or lectures, and 7 (33%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81%) identified the purpose of the intervention, 12 (57%) provided the

Feelings of Clinician-Patient Similarity and Trust Influence Pain: Evidence From Simulated Clinical Interactions.

Science.gov (United States)

Losin, Elizabeth A Reynolds; Anderson, Steven R; Wager, Tor D

2017-07-01

Pain is influenced by many factors other than external sources of tissue damage. Among these, the clinician-patient relationship is particularly important for pain diagnosis and treatment. However, the effects of the clinician-patient relationship on pain remain underexamined. We tested the hypothesis that patients who believe they share core beliefs and values with their clinician will report less pain than patients who do not. We also measured feelings of perceived clinician-patient similarity and trust to see if these interpersonal factors influenced pain. We did so by experimentally manipulating perceptions of similarity between participants playing the role of clinicians and participants playing the role of patients in simulated clinical interactions. Participants were placed in 2 groups on the basis of their responses to a questionnaire about their personal beliefs and values, and painful thermal stimulation was used as an analog of a painful medical procedure. We found that patients reported feeling more similarity and trust toward their clinician when they were paired with clinicians from their own group. In turn, patients' positive feelings of similarity and trust toward their clinicians-but not clinicians' feelings toward patients or whether the clinician and patient were from the same group-predicted lower pain ratings. Finally, the most anxious patients exhibited the strongest relationship between their feelings about their clinicians and their pain report. These findings increase our understanding of context-driven pain modulation and suggest that interventions aimed at increasing patients' feelings of similarity to and trust in health care providers may help reduce the pain experienced during medical care. We present novel evidence that the clinician-patient relationship can affect the pain experienced during medical care. We found that "patients" in simulated clinical interactions who reported feeling more similarity and trust toward their

Ring-shaped Calorimetry Information for a Neural EGamma Identification with ATLAS Detector

CERN Document Server

AUTHOR|(SzGeCERN)762100; The ATLAS collaboration

2016-01-01

This work concerns the identification process of electrons based only on calorimeter information. It is proposed the usage of ring-shaped description for a region of interest of the calorimeter which explores the shower shape propagation throughout the ATLAS calorimeters. This information is fed into a multivariate discriminator, currently an artificial neural network, responsible for hypothesis testing. The concept is evaluated for online selection (trigger), used for reducing storage rate into viable levels while preserving collision events containing desired signals. Preliminary results from Monte Carlo data point out that the background rejection can be reduced by as much as 50 % over the current method used in the High-Level Trigger, allowing for high-latency reconstruction algorithms such as tracking to run over at a later stage of the trigger.

Ring-shaped Calorimetry Information for a Neural Egamma Identification with ATLAS Detector

International Nuclear Information System (INIS)

Victor da Fonseca Pinto, João

2016-01-01

This article presents the identification process of electrons based only on calorimeter information. It is based on the usage of ring-shaped description for a region of interest of the calorimeter which explores the shower shape propagation throughout the ATLAS calorimeters. This information is fed into a multivariate discriminator, currently an artificial neural network, responsible for hypothesis testing. The concept is evaluated for online selection (trigger), used for reducing storage rate into viable levels while preserving collision events containing desired signals. Preliminary results from Monte Carlo simulation data indicate that the background rejection can be reduced by as much as 50 % over the current method used in the High-Level Trigger, allowing for high-latency reconstruction algorithms such as tracking to run at a later stage of the trigger. (paper)

Identification of Classified Information in Unclassified DoD Systems During the Audit of Internal Controls and Data Reliability in the Deployable Disbursing System

Science.gov (United States)

2009-02-17

Identification of Classified Information in Unclassified DoD Systems During the Audit of Internal Controls and Data Reliability in the Deployable...TITLE AND SUBTITLE Identification of Classified Information in Unclassified DoD Systems During the Audit of Internal Controls and Data Reliability...Systems During the Audit ofInternal Controls and Data Reliability in the Deployable Disbursing System (Report No. D-2009-054) Weare providing this

Moving beyond 'not enough time': factors influencing paediatric clinicians' participation in research.

Science.gov (United States)

Paget, Simon P; Caldwell, Patrina H Y; Murphy, Joyce; Lilischkis, Kimberley J; Morrow, Angie M

2017-03-01

Increasing the amount of clinical research that occurs in healthcare settings has been identified as an important mechanism to improve healthcare outcomes. While clinicians are key persons in achieving this aim, research participation amongst clinicians is generally limited. To identify the factors (barriers and facilitators) influencing clinician research participation and determine how professional culture impacts on these factors. Forty clinicians working at a tertiary children's hospital participated in six discipline-specific focus groups. Thematic analysis was performed using an inductive process based in grounded theory. Four major themes (cultural factors, personal factors, resources and solutions) and 16 subthemes were identified. Participants described how the current health system discourages clinician research. They reported that their research participation requires personal sacrifice of their own time; income or career progression. Research participation was seen to compete with other priorities in clinicians' workload and is disadvantaged because of the primacy of clinical work and the lack of immediate tangible benefit from research projects. Solutions suggested by our participants included better alignment of clinical and research goals, improved availability of research mentors and collaborative opportunities. Nurses and allied health professionals reported a changing professional culture that values research. Only doctors identified research participation to be important for career progression. For clinician research participation to flourish, significant changes in healthcare structure and priorities will be required that result in research becoming more embedded in healthcare delivery. Initiatives to improve collaboration between clinicians and universities may also support these aims. © 2016 Royal Australasian College of Physicians.

Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines.

Science.gov (United States)

Martin, Seth S; Sperling, Laurence S; Blaha, Michael J; Wilson, Peter W F; Gluckman, Ty J; Blumenthal, Roger S; Stone, Neil J

2015-04-07

Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chapter 08: Comments on, and additional information for, wood identification

Science.gov (United States)

Alex C. Wiedenhoeft

2011-01-01

This manual has described the theory of identification (Chapter 1), the botanical basis of wood structure (Chapter 2), the use of a hand lens (Chapter 3), how to use cutting tools to prepare wood for observation with a lens (Chapter 4), and the characters used in hand lens wood identification (Chapter 5) before leading you through an identification key (Chapter 6) and...

[Quo vadis pathologia? An elderly clinicians meditations about autopsies].

Science.gov (United States)

Iványi, J

1998-02-08

Relying on his own experience and the relevant literature of the past 15 years, the author analyzes the causes of the decrease in the number of autopsies. He disagrees with those who, referring to the application of state-of-the art examination methods, dismiss "the ultimate audit" as unnecessary and only suggest selection. Careful autopsies can still be rendered an authentic and reliable picture of treatment of the deceased on the one hand, and provide information about diagnostic difficulties as well as the possible mistakes and errors on the other. This is especially true of the elderly deceased usually with multimorbidity. As well as several aspects of the cooperation between the pathologist and the clinician there is the didactic importance of autopsies that should also be emphasized.

Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings.

Science.gov (United States)

Walsh, Cian; Ryan, Patrick; Flynn, Daniel

2018-01-01

This article presents a detailed idiographic analysis of Dialectical Behaviour Therapy (DBT) clinicians' experiences of team consultation meetings. DBT is an evidence-based psychological intervention with a demonstrated efficacy in the treatment of borderline personality disorder (BPD). Team consultation meetings encompass one of the primary components involved in this treatment model; where DBT clinicians regularly meet to discuss client work and enhance further learning. The present study's aim was to assess what are DBT clinicians' experiences of the consultation meeting component and whether it is useful or not. Semi-structured interviews were completed with 11 DBT clinicians (nine females, two males) from three different consultation teams. The research project utilised an interpretative phenomenological analysis (IPA) framework. Audio-recorded interview data was analysed using this framework. Four superordinate themes emerged from the interview data, which included ten subordinate themes. The superordinate themes focused on: (1) the acquisition of DBT technical knowledge and other MDT related expertise (2) participants' emotional experiences of DBT and consultation meetings, and how this can evolve over time (3) the underlying processes that occur in the consultation team including the development of a team bond and the impact of membership changes and (4) the largely consistent and reliable nature of consultation meetings and how they help maintain clinician motivation. Team consultation meetings were found to be supportive; playing an important role in maintaining clinician motivation through the availability of team support, opportunities to reflect and learn, and assistance in regulating emotions. Challenges arose in relation to team membership changes and acclimatisation to the type of feedback utilised in team consultation. The study's implications for practise are considered.

Real-time feedback on nonverbal clinical communication. Theoretical framework and clinician acceptance of ambient visual design.

Science.gov (United States)

Hartzler, A L; Patel, R A; Czerwinski, M; Pratt, W; Roseway, A; Chandrasekaran, N; Back, A

2014-01-01

This article is part of the focus theme of Methods of Information in Medicine on "Pervasive Intelligent Technologies for Health". Effective nonverbal communication between patients and clinicians fosters both the delivery of empathic patient-centered care and positive patient outcomes. Although nonverbal skill training is a recognized need, few efforts to enhance patient-clinician communication provide visual feedback on nonverbal aspects of the clinical encounter. We describe a novel approach that uses social signal processing technology (SSP) to capture nonverbal cues in real time and to display ambient visual feedback on control and affiliation--two primary, yet distinct dimensions of interpersonal nonverbal communication. To examine the design and clinician acceptance of ambient visual feedback on nonverbal communication, we 1) formulated a model of relational communication to ground SSP and 2) conducted a formative user study using mixed methods to explore the design of visual feedback. Based on a model of relational communication, we reviewed interpersonal communication research to map nonverbal cues to signals of affiliation and control evidenced in patient-clinician interaction. Corresponding with our formulation of this theoretical framework, we designed ambient real-time visualizations that reflect variations of affiliation and control. To explore clinicians' acceptance of this visual feedback, we conducted a lab study using the Wizard-of-Oz technique to simulate system use with 16 healthcare professionals. We followed up with seven of those participants through interviews to iterate on the design with a revised visualization that addressed emergent design considerations. Ambient visual feedback on non- verbal communication provides a theoretically grounded and acceptable way to provide clinicians with awareness of their nonverbal communication style. We provide implications for the design of such visual feedback that encourages empathic patient

Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department.

Science.gov (United States)

Nigrovic, Lise E; Bennett, Jonathan E; Balamuth, Fran; Levas, Michael N; Chenard, Rachel L; Maulden, Alexandra B; Garro, Aris C

2017-12-01

To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease. We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease. We enrolled 1021 children with a median age of 9 years (interquartile range, 5-13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71-0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1-3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8-10), 39 (31%) did not have Lyme disease. Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis. Copyright © 2017 by the American Academy of Pediatrics.

Inclusion probability for DNA mixtures is a subjective one-sided match statistic unrelated to identification information

Directory of Open Access Journals (Sweden)

Mark William Perlin

2015-01-01

Full Text Available Background: DNA mixtures of two or more people are a common type of forensic crime scene evidence. A match statistic that connects the evidence to a criminal defendant is usually needed for court. Jurors rely on this strength of match to help decide guilt or innocence. However, the reliability of unsophisticated match statistics for DNA mixtures has been questioned. Materials and Methods: The most prevalent match statistic for DNA mixtures is the combined probability of inclusion (CPI, used by crime labs for over 15 years. When testing 13 short tandem repeat (STR genetic loci, the CPI -1 value is typically around a million, regardless of DNA mixture composition. However, actual identification information, as measured by a likelihood ratio (LR, spans a much broader range. This study examined probability of inclusion (PI mixture statistics for 517 locus experiments drawn from 16 reported cases and compared them with LR locus information calculated independently on the same data. The log(PI -1 values were examined and compared with corresponding log(LR values. Results: The LR and CPI methods were compared in case examples of false inclusion, false exclusion, a homicide, and criminal justice outcomes. Statistical analysis of crime laboratory STR data shows that inclusion match statistics exhibit a truncated normal distribution having zero center, with little correlation to actual identification information. By the law of large numbers (LLN, CPI -1 increases with the number of tested genetic loci, regardless of DNA mixture composition or match information. These statistical findings explain why CPI is relatively constant, with implications for DNA policy, criminal justice, cost of crime, and crime prevention. Conclusions: Forensic crime laboratories have generated CPI statistics on hundreds of thousands of DNA mixture evidence items. However, this commonly used match statistic behaves like a random generator of inclusionary values, following the LLN

Reviewing social media use by clinicians.

Science.gov (United States)

von Muhlen, Marcio; Ohno-Machado, Lucila

2012-01-01

Adoption studies of social media use by clinicians were systematically reviewed, up to July 26th, 2011, to determine the extent of adoption and highlight trends in institutional responses. This search led to 370 articles, of which 50 were selected for review, including 15 adoption surveys. The definition of social media is evolving rapidly; the authors define it broadly to include social networks and group-curated reference sites such as Wikipedia. Facebook accounts are very common among health science students (64-96%) and less so for professional clinicians (13-47%). Adoption rates have increased sharply in the past 4 years. Wikipedia is widely used as a reference tool. Attempts at incorporating social media into clinical training have met with mixed success. Posting of unprofessional content and breaches of patient confidentiality, especially by students, are not uncommon and have prompted calls for social media guidelines.

Clinicians' perceptions of the benefits and harms of prostate and colorectal cancer screening.

Science.gov (United States)

Elstad, Emily A; Sutkowi-Hemstreet, Anne; Sheridan, Stacey L; Vu, Maihan; Harris, Russell; Reyna, Valerie F; Rini, Christine; Earp, Jo Anne; Brewer, Noel T

2015-05-01

Clinicians' perceptions of screening benefits and harms influence their recommendations, which in turn shape patients' screening decisions. We sought to understand clinicians' perceptions of the benefits and harms of cancer screening by comparing 2 screening tests that differ in their balance of potential benefits to harms: colonoscopy, which results in net benefit for many adults, and prostate-specific antigen (PSA) testing, which may do more harm than good. In this cross-sectional study, 126 clinicians at 24 family/internal medicine practices completed surveys in which they listed and rated the magnitude of colonoscopy and PSA testing benefits and harms for a hypothetical 70-year-old male patient and then estimated the likelihood that these tests would cause harm and lengthen the life of 100 similar men in the next 10 years. We tested the hypothesis that the availability heuristic would explain the association of screening test to perceived likelihood of benefit/harm and a competing hypothesis that clinicians' gist of screening tests as good or bad would mediate this association. Clinicians perceived PSA testing to have a greater likelihood of harm and a lower likelihood of lengthening life relative to colonoscopy. Consistent with our gist hypothesis, these associations were mediated by clinicians' gist of screening (balance of perceived benefits to perceived harms). Generalizability beyond academic clinicians remains to be established. Targeting clinicians' gist of screening, for example through graphical displays that allow clinicians to make gist-based relative magnitude comparisons, may influence their risk perception and possibly reduce overrecommendation of screening. © The Author(s) 2015.

Inter-rater Agreement of Clinicians' Treatment Recommendations Based on Modified Barium Swallow Study Reports.

Science.gov (United States)

Slovarp, Laurie; Danielson, Jennifer; Liss, Julie

2018-06-07

The modified barium swallow study (MBSS) is a commonly used radiographic procedure for diagnosis and treatment of swallowing disorders. Despite attempts by dysphagia specialists to standardize the MBSS, most institutions have not adopted such standardized procedures. High variability of assessment patterns arguably contribute to variability of treatment recommendations made from diagnostic information derived from the MBSS report. An online survey was distributed to speech-language pathologists (SLPs) participating in American Speech Language Hearing Association (ASHA) listservs. Sixty-three SLPs who treat swallowing disorders participated. Participating SLPs reviewed two MBSS reports and chose physiologic treatment targets (e.g., tongue base retraction) based on each report. One report primarily contained symptomatology (e.g., aspiration, pharyngeal residue) with minimal information on impaired physiology (e.g., laryngeal incompetence, reduced hyolaryngeal elevation/excursion). In contrast, the second report contained a clear description of impaired physiology to explain the dysphagia symptoms. Fleiss kappa coefficients were used to analyze inter-rater agreement across the high and low physiology report types. Results revealed significantly higher inter-rater agreement across clinicians when reviewing reports with clear explanation(s) of physiologic impairment relative to reports that primarily focused on symptomatology. Clinicians also reported significantly greater satisfaction and treatment confidence following review of reports with clear description(s) of impaired physiology.

Evaluation of the informatician perspective: determining types of research papers preferred by clinicians.

Science.gov (United States)

Ru, Boshu; Wang, Xiaoyan; Yao, Lixia

2017-07-05

To deliver evidence-based medicine, clinicians often reference resources that are useful to their respective medical practices. Owing to their busy schedules, however, clinicians typically find it challenging to locate these relevant resources out of the rapidly growing number of journals and articles currently being published. The literature-recommender system may provide a possible solution to this issue if the individual needs of clinicians can be identified and applied. We thus collected from the CiteULike website a sample of 96 clinicians and 6,221 scientific articles that they read. We examined the journal distributions, publication types, reading times, and geographic locations. We then compared the distributions of MeSH terms associated with these articles with those of randomly sampled MEDLINE articles using two-sample Z-test and multiple comparison correction, in order to identify the important topics relevant to clinicians. We determined that the sampled clinicians followed the latest literature in a timely manner and read papers that are considered landmarks in medical research history. They preferred to read scientific discoveries from human experiments instead of molecular-, cellular- or animal-model-based experiments. Furthermore, the country of publication may impact reading preferences, particularly for clinicians from Egypt, India, Norway, Senegal, and South Africa. These findings provide useful guidance for developing personalized literature-recommender systems for clinicians.

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians

Directory of Open Access Journals (Sweden)

Haik J

2017-06-01

Full Text Available Josef Haik,1–3 Stav Brown,1,2 Alon Liran,1 Denis Visentin,4 Amit Sokolov,2 Isaac Zilinsky,1,2 Rachel Kornhaber1,4 1Department of Plastic and Reconstruction Surgery, The National Burns Center, Sheba Medical Center, Tel Hashomer, 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 3Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel; 4School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia Abstract: Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory, depression (PRIME-MD, health-related quality of life (SF-8, and compassion fatigue (Professional Quality of Life version 5. Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2% among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P=0.017. Additional factors contributing to compassion fatigue were those without children (P=0.016, divorced (P=0.035, of a younger age (P=0.019, and a registered nurse (P=0.05. Burnout increased clinicians’ risk of adverse professional and personal outcomes and correlated with less free time (P<0.001, increased risk of experiencing work-home disputes (P=0.05, increased depression (P=0

Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis.

Science.gov (United States)

Montague, Enid; Xu, Jie; Chen, Ping-Yu; Asan, Onur; Barrett, Bruce P; Chewning, Betty

2011-10-01

The aim of this study was to examine whether lag sequential analysis could be used to describe eye gaze orientation between clinicians and patients in the medical encounter. This topic is particularly important as new technologies are implemented into multiuser health care settings in which trust is critical and nonverbal cues are integral to achieving trust. This analysis method could lead to design guidelines for technologies and more effective assessments of interventions. Nonverbal communication patterns are important aspects of clinician-patient interactions and may affect patient outcomes. The eye gaze behaviors of clinicians and patients in 110 videotaped medical encounters were analyzed using the lag sequential method to identify significant behavior sequences. Lag sequential analysis included both event-based lag and time-based lag. Results from event-based lag analysis showed that the patient's gaze followed that of the clinician, whereas the clinician's gaze did not follow the patient's. Time-based sequential analysis showed that responses from the patient usually occurred within 2 s after the initial behavior of the clinician. Our data suggest that the clinician's gaze significantly affects the medical encounter but that the converse is not true. Findings from this research have implications for the design of clinical work systems and modeling interactions. Similar research methods could be used to identify different behavior patterns in clinical settings (physical layout, technology, etc.) to facilitate and evaluate clinical work system designs.

Discharge planning for a patient with a new ostomy: best practice for clinicians.

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Prinz, Anita; Colwell, Janice C; Cross, Heidi H; Mantel, Janet; Perkins, Jacqueline; Walker, Cynthia A

2015-01-01

A comprehensive discharge plan for a patient with a new stoma is needed to ensure the individual receives the necessary ostomy education prior to discharge. The plan should include teaching basic skills and providing information about how to manage the ostomy (ie, emptying and changing the pouch, how to order supplies, available manufacturers, dietary/fluid guidelines, potential complications, medications, and managing gas and odor), assisting with transitions in care, and providing information about resources for support and assistance. The purpose of this best practice guideline is to provide clinicians with a brief overview of the essential elements that should be included in the discharge plan to facilitate patient education and the transition of care from hospital to home.

[Meanings attributed to management as an explanation for clinician managers' attitudes and professional identity].

Science.gov (United States)

Cascón-Pereira, Rosalía; Valverde, Mireia

2014-01-01

To understand the process by which clinician managers construct their professional identities and develop their attitudes toward managing. A qualitative study was performed, based on grounded theory, through in-depth interviews with 20 clinician managers selected through theoretical sampling in two public hospitals of Catalonia (Spain), participant observation, and documentation. Clinician managers' role meanings are constructed by comparing their roles with those of senior managers and clinicians. In this process, clinician managers seek to differentiate themselves from senior managers through the meanings constructed. In particular, they use proximity with reality and clinical knowledge as the main sources of differentiation. This study sheds light on why clinician managers develop adverse attitudes to managing and why they define themselves as clinicians rather than as managers. The explanation lies in the construction of the meanings they assign to managing as the basis of their attitudes to this role and professional identity. These findings have some practical implications for healthcare management. Copyright © 2014. Published by Elsevier Espana.

A comparison of clinicians' racial biases in the United States and France.

Science.gov (United States)

Khosla, Natalia N; Perry, Sylvia P; Moss-Racusin, Corinne A; Burke, Sara E; Dovidio, John F

2018-04-13

Clinician bias contributes to racial disparities in healthcare, but its effects may be indirect and culturally specific. The present work aims to investigate clinicians' perceptions of Black versus White patients' personal responsibility for their health, whether this variable predicts racial bias against Black patients, and whether this effect differs between the U.S. and France. American (N = 83) and French (N = 81) clinicians were randomly assigned to report their impressions of an identical Black or White male patient based on a physician's notes. We measured clinicians' views of the patient's anticipated improvement and adherence to treatment and their perceptions concerning how personally responsible the patient was for his health. Whereas French clinicians did not exhibit significant racial bias on the measures of interest, American clinicians rated a hypothetical White patient, compared to an identical Black patient, as significantly more likely to improve, adhere to treatment, and be personally responsible for his health. Moreover, in the U.S., personal responsibility mediated the racial difference in expected improvement, such that as the White patient was seen as more personally responsible for his health, he was also viewed as more likely to improve. The present work indicates that American clinicians displayed less optimistic expectations for the medical treatment and health of a Black male patient, relative to a White male patient, and that this racial bias was related to their view of the Black patient as being less personally responsible for his health relative to the White patient. French clinicians did not show this pattern of racial bias, suggesting the importance of considering cultural influences for understanding racial biases in healthcare and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

From leader to leadership: clinician managers and where to next?

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Fulop, Liz; Day, Gary E

2010-08-01

Individual clinician leadership is at the forefront of health reforms in Australia as well as overseas with many programs run by health departments (and hospitals) generally focus on the development of individual leaders. This paper argues, along with others, that leadership in the clinician management context cannot be understood from an individualistic approach alone. Clinician managers, especially in the ranks of doctors, are usually described as 'hybrid-professional managers' as well as reluctant leaders for whom most leadership theories do not easily apply. Their experiences of leadership development programs run by health departments both in Australia and internationally are likely to be based on an individual leader-focussed approach that is driving health care reforms. These approaches work from three key assumptions: (1) study and fix the person; (2) give them a position or title; and (3) make them responsible for results. Some would argue that the combination of these three approaches equates to heroic and transformational leadership. Several alternative approaches to leadership development are presented to illustrate how reforms in healthcare, and notably in hospitals, must incorporate alternative approaches, such as those based on collective and relational forms of leadership. This does not mean eschewing individual approaches to leadership but rather, thinking of them differently and making them more relevant to the daily experiences of clinician managers. We conclude by highlighting several significant challenges facing leadership development for clinician managers that arise from these considerations.

Mapping of information and identification of construction waste at project life cycle

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Wibowo, Mochamad Agung; Handayani, Naniek Utami; Nurdiana, Asri; Sholeh, Moh Nur; Pamungkas, Gita Silvia

2018-03-01

The development of construction project towards green construction is needed in order to improve the efficiency of construction projects. One that needs to be minimized is construction waste. Construction waste is waste generated from construction project activities, both solid waste and non solid waste. More specifically, the waste happens at every phase of the project life cycle. Project life cycle are the stage of idea, design, construction, and operation/maintenance. Each phase is managed by different stakeholders. Therefore it requires special handling from the involved stakeholders. The objective of the study is to map the information and identify the waste at each phase of the project life cycle. The purpose of mapping is to figure out the process of information and product flow and with its timeline. This mapping used Value Stream Mapping (VSM). Identification of waste was done by distributing questionnaire to respondents to know the waste according to owner, consultant planner, contractor, and supervisory consultant. The result of the study is the mapping of information flow and product flow at the phases of idea, design, construction, and operation/ maintenance.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children.

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Blaine, Kevin; Rogers, Jayne; OʼNeill, Margaret R; McBride, Sarah; Faerber, Jennifer; Feudtner, Chris; Berry, Jay G

Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians. March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states. The DCE consisted of 14 discharge care components randomly presented two at a time for a total of 28 choice tasks. Best-worst scaling of participants' choices generated mean relative importance (RI) scores for each component, which allowed for ranking from least to most important. Participants, regardless of field or practice setting, perceived "Discharge Education/Teach-Back" (RI 11.1 [95% confidence interval, CI: 11.0-11.3]) and "Involve the Child's Care Team" (RI 10.6 [95% CI: 10.4-10.8]) as the most important discharge components, and "Information Reconciliation" (RI 4.1 [95% CI: 3.9-4.4]) and "Assigning Roles/Responsibilities of Discharge Care" (RI 2.8 [95% CI: 2.6-3.0]) as least important. A diverse group of pediatric clinicians value certain components of the pediatric discharge care process much more than others. Efforts to optimize the quality of hospital discharge for children should consider these findings.

Transthoracic Ultrasonography for Clinicians

Directory of Open Access Journals (Sweden)

Morné Johan Vorster

2015-04-01

Full Text Available Transthoracic ultrasonography (US has become an essential tool for respiratory, emergency, and critical care physicians. It can be performed with basic equipment and by personnel with minimum training as a modality for the evaluation of a wide range of thoracic pathologies. Its advantages include immediate application at the point of care, low cost, and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumors. Transthoracic US is also useful in visualizing pulmonary pathologies that abut the pleura, such as pneumonic consolidation and interstitial syndromes, including pulmonary edema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and it is useful in diagnosing skeletal abnormalities such as rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, transthoracic US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. Transthoracic US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes and lesions arising from the chest wall, pleura, peripheral lung, and mediastinum are safe to perform and have a high yield in the of hands of experienced clinicians. Transthoracic US can also potentially guide the aspiration and biopsy of diffuse pulmonary infiltrates, consolidations, and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism

Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment

DEFF Research Database (Denmark)

Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten

2018-01-01

Objective: The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from eating disorders. Oppositely to traditional pen-and-paper meal diaries, the app allows for in-app patient–clinician linkage enabling clinicians to access patient app data anytime. The aim of our...... with challenges associated with the app, for example, an added work load and potential harm to the patient–clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines...

Bunch identification module

International Nuclear Information System (INIS)

Fox, J.D.

1981-01-01

This module provides bunch identification and timing signals for the PEP Interaction areas. Timing information is referenced to the PEP master oscillator, and adjusted in phase as a function of region. Identification signals are generated in a manner that allows observers in all interaction regions to agree on an unambiguous bunch identity. The module provides bunch identification signals via NIM level logic, upon CAMAC command, and through LED indicators. A front panel ''region select'' switch allows the same module to be used in all regions. The module has two modes of operation: a bunch identification mode and a calibration mode. In the identification mode, signals indicate which of the three bunches of electrons and positrons are interacting, and timing information about beam crossing is provided. The calibration mode is provided to assist experimenters making time of flight measurements. In the calibration mode, three distinct gating signals are referenced to a selected bunch, allowing three timing systems to be calibrated against a common standard. Physically, the bunch identifier is constructed as a single width CAMAC module. 2 figs., 1 tab

Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome.

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Grosman-Rimon, Liza; Clarke, Hance; Chan, Aaron K; Mills, Patricia Branco; Rathbone, Alasdair Timothy Llewelyn; Kumbhare, Dinesh

2017-01-01

Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.

Irish Clinicians' Views of Interventions for Children with Autistic Spectrum Disorders

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Ridge, Katie; Guerin, Suzanne

2011-01-01

The current study investigated clinicians' perspectives on the effectiveness of interventions designed to support the development of children with autistic spectrum disorders (ASDs). Researchers developed a semi-structured interview which was administered to 11 clinicians involved in the assessment and treatment of ASDs (5 = clinical…

Communication channels to promote evidence-based practice: a survey of primary care clinicians to determine perceived effects.

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Dadich, Ann; Hosseinzadeh, Hassan

2016-08-11

Research suggests that the channels through which evidence-based practices are communicated to healthcare professionals can shape the ways they engage with, and use, this information. For instance, there is evidence to suggest that information should be communicated via sources that are deemed to be credible, like government departments, professional bodies and peers. This article examines the contention that information should be communicated via credible sources. More specifically, the article examines the different communication channels through which primary care clinicians learnt of resources on evidence-based sexual healthcare - namely, clinical aides and online training programs. Furthermore, the article determines whether these communication channels influenced the perceived impact of the resources. Primary care clinicians in Australia (n = 413), notably General Practitioners (n = 214) and Practice Nurses (n = 217), were surveyed on the GP Project - a suite of resources to promote evidence-based sexual healthcare within primary care. Survey items pertained to the source of information about the resources (or communication channel), perceived usefulness of the resources, frequency of use, subsequent contact with the Sexual Health Infoline and a sexual health clinic, as well as the perceived impact of the resources. To determine the relationships between the different communication channels and the perceived impact of the resources, a one-way ANOVA using Tukey's post-hoc test, an independent sample t-test, a χ(2) test, and a Kruskal-Wallis H test were performed where appropriate. Of the respondents who were aware of the clinical aides (49.9%), the largest proportion became aware of these through an educational event or a colleague. Of those who were aware of the online training programs (36.9%), the largest proportion became aware of these through a professional body or government organisation, either directly or via their website. Although both resource

Child Health Disparities: What Can a Clinician Do?

Science.gov (United States)

Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

2015-11-01

Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

Clinician styles of care: transforming patient care at the intersection of leadership and medicine.

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Huynh, Ho P; Sweeny, Kate

2014-11-01

A key role of clinicians is to motivate their patients to initiate and maintain beneficial health behaviors. This article integrates research on transformational leadership, clinician-patient communication, and health behavior to introduce a novel approach to understanding and improving clinicians' effectiveness as motivators. We describe three dominant clinician styles or patterned approaches to patient care that derive from leadership theory (in order of least to most effective): laissez-faire, transactional, and transformational. Additionally, we suggest potential mediators and effects of the transformational style of care. Finally, we discuss future research directions for the study of clinician styles of care. © The Author(s) 2013.

Science discovery in clinician-economist collaboration: legacy and future challenges.

Science.gov (United States)

Wells, Kenneth B

2002-06-01

2002 Carl Taube Lecture at the NIMH Mental Health Economics Meeting. To analyze the contribution and process of clinician/economist collaboration. Personal scientific autobiography, using relationships with three economists as case examples. In joint efforts by clinicians and economists, clinicians bring an interest in case examples and in responding to unmet need, while economists bring structured analysis methods and respect for a societal perspective. Through mutual respect and discovery, both clinicians and economists can define unmet need in clinical and economic terms and help develop models and programs to improve clinical care, while maintaining a societal evaluation perspective. Key to scientific discovery is the principle that the emotions generated by data, such as hope and despair, need to be acknowledged and utilized rather than avoided or buried, provided that such feelings are used in a balanced manner in research. According to the author, collaboration helps maintain such a balance. Collaboration requires and builds trust, and improves the depth of research by combining different personal and disciplinary perspectives and strengths. Young investigators should be encouraged to explore collaboration and to consider their feelings in response to health and economic data as an important scientific and creative resource.

[Relationship of personality with job burnout and psychological stress risk in clinicians].

Science.gov (United States)

Huang, Lei; Zhou, Dinglun; Yao, Yongcheng; Lan, Yajia

2015-02-01

To analyze the job burnout and mental health status of clinicians and the relationship of personality with job burnout and psychological stress, and to investigate the direct or indirect effects of personality on psychological stress. Maslach Burnout Inventory-General Survey (MBI-GS), Eysenck Personality Questionnaire-Revised Short Scale (EPQ-RSC), and Kessler 10 Scale were administered to 775 clinicians. Of all clinicians, 29.5% had mild burnout, with a score of 22.7 ± 8.18 for psychological stress risk. The effect of personality on emotional exhaustion and cynicism was greater than that on personal accomplishment. Clinicians with a personality of introversion, neuroticism, and psychoticism suffered a higher risk of psychological stress. Personality had both direct and indirect effects on psychological stress. Neuroticism had the strongest effect on psychological stress, with an effect size of 0.55. Clinicians have a high level of both job burnout and mental psychological stress risk. Personality is significantly correlated with job burnout and psychological stress risk. Measures depending on personality should be taken for effective intervention.

UK medical students’ perceptions, attitudes, and interest toward medical leadership and clinician managers

Directory of Open Access Journals (Sweden)

Rouhani MJ

2018-02-01

Full Text Available Maral J Rouhani,1 Eleanor J Burleigh,2 Chloe Hobbis,2 Charlotte Dunford,1 Nadir I Osman,3 Christine Gan,1 Norma B Gibbons,1 Hashim U Ahmed,1,4 Saiful Miah1,5 1Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; 2Medical School, University of Sheffield, Sheffield, UK; 3Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 4Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; 5Division of Surgery and Interventional Science, University College London, London, UK Background: We aimed to determine UK medical students’ perceptions and attitudes and interest toward medical leadership and clinician managers. Methods: A cross-sectional study was conducted during the academic year 2015–2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. Results: In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership

Information-theoretical analysis of private content identification

NARCIS (Netherlands)

Voloshynovskiy, S.; Koval, O.; Beekhof, F.; Farhadzadeh, F.; Holotyak, T.

2010-01-01

In recent years, content identification based on digital fingerprinting attracts a lot of attention in different emerging applications. At the same time, the theoretical analysis of digital fingerprinting systems for finite length case remains an open issue. Additionally, privacy leaks caused by

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

Directory of Open Access Journals (Sweden)

Andrew M. Harrison

2017-03-01

Full Text Available Background Electronic Health Record (EHR-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148 and 51% (N = 156 from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5 and median 2 min (N = 80 from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.

Effects of a communication course for clinicians on parents' perception of care

DEFF Research Database (Denmark)

Ammentorp, Jette; Sabroe, Svend; Kofoed, Poul-Erik

2009-01-01

. The intervention group completed a 5-day communication course, whereas the control group had no intervention. The intervention was evaluated using questionnaires measuring parents' perception of the communication and their satisfaction. The questionnaires were filled out by parents to children consulting....... There were no significant differences between the satisfaction of parents visiting clinicians from the intervention group and those visiting clinicians from the control group; however, the proportion of parents who had a positive perception of the communication was up to 9.8% higher in the intervention group...... compared with the control group. For example: 'the clinician told my child what he/she could do in order to feel better'. Discussion: Although no statistically significant differences were found, the study indicates that parents who had visited a clinician from the intervention group have experienced...

Informed consent in blood transfusion : Knowledge and administrative issues in Uganda hospitals

NARCIS (Netherlands)

Kajja, Isaac; Bimenya, Gabriel S.; Smit Sibinga, Cees Th.

Blood as a transplant is not free of risks. Clinicians and patients ought to know the parameters of a transfusion informed consent. A mixed methodology to explore patients' and clinicians' knowledge and opinions of administration and strategies to improve the transfusion informed consent process was

Ethical implications of digital communication for the patient-clinician relationship: analysis of interviews with clinicians and young adults with long term conditions (the LYNC study).

Science.gov (United States)

Ignatowicz, Agnieszka; Slowther, Anne-Marie; Elder, Patrick; Bryce, Carol; Hamilton, Kathryn; Huxley, Caroline; Forjaz, Vera; Sturt, Jackie; Griffiths, Frances

2018-02-23

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom (UK)-based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites (cancer, liver, renal, cystic fibrosis and mental health) were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician's duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical

Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives.

Science.gov (United States)

Dibley, Lesley; Czuber-Dochan, Wladyslawa; Wade, Tiffany; Duncan, Julie; Burch, Jennie; Warusavitarne, Janindra; Norton, Christine; Artom, Micol; O'Sullivan, Liam; Verjee, Azmina; Cann, Denise

2018-01-18

Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes. We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive. Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support. Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment. © 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University

Staff Clinician | Center for Cancer Research

Science.gov (United States)

The Neuro-Oncology Branch (NOB), Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH) is seeking staff clinicians to provide high-quality patient care for individuals with primary central nervous system (CNS) malignancies.  The NOB is comprised of a multidisciplinary team of physicians, healthcare providers, and scientists who

Impact of a radio-frequency identification system and information interchange on clearance processes for cargo at border posts

Directory of Open Access Journals (Sweden)

Ernest Bhero

2015-11-01

Full Text Available Background: Improved operational efficiency is important to role players in cross-border logistics and trade corridors. Cargo owners and cargo forwarders have been particularly concerned about long delays in the processing and clearing of cargo at border posts. Field studies suggest that these delays are due to a combination of factors, such as a lack of optimum system configurations and non-optimised human-dependent operations, which make the operations prone to corruption and other malpractices. Objectives: This article presents possible strategies for improving some of the operations in this sector. The research hinges on two key questions: (1 what is the impact of information interchange between stakeholders on the cargo transit time and (2 how will cargo transit time be impacted upon by automatic identification of cargo and the status of cargo seals on arriving vehicles at the border? Method: The use of information communication systems enabled by automatic identification systems (incorporating radio-frequency identification technology is suggested. Results: Results obtained by the described simulation model indicate that improvements of up to 82% with regard to transit time are possible using these techniques. Conclusion: The findings therefore demonstrate how operations at border posts can be improved through the use of appropriate technology and configuration of the operations.

Differences in clinician understanding and management of early menopause after breast cancer.

Science.gov (United States)

Sayakhot, P; Teede, H J; Gibson-Helm, M; Vincent, A

2013-08-01

Investigation of clinicians' understanding of early menopause diagnosis/management in women with breast cancer. A cross-sectional study of 176 randomly recruited Australian clinicians (35 gynecologists, 35 endocrinologists, 36 oncologists, 35 breast surgeons and 35 general practitioners (GPs)) involved in the care of women with breast cancer. This questionnaire study utilized an index case to assess understanding of early menopause diagnosis and management. Analysis involved descriptive statistics, χ² tests and Student's t-test. Significant differences between clinician groups regarding diagnostic criteria for early menopause were observed; gynecologists, endocrinologists and GPs selected amenorrhea > 12 months, whereas oncologists and breast surgeons selected elevated serum follicle stimulating hormone level (p breast surgeons (57%), gynecologists (54%) and endocrinologists (49%) compared to oncologists (28%) or GPs (9%) (p = 0.0001). Exercise (63%) and nutrition (66%) were selected by most gynecologists for treatment of hot flushes, whereas endocrinologists (91%), oncologists (94%), breast surgeons (69%) and GPs (63%) prescribed venlafaxine. Hormone therapy was mainly prescribed by breast surgeons (43%) compared to other groups (p = 0.001). Most clinicians reported that the main problem with menopausal therapies was failure to resolve hot flushes. Exercise, lifestyle and stress management were recommended by all clinician groups for treatment of anxiety/depression. This exploratory study demonstrated a lack of consensus between clinician groups in their investigation, diagnosis and management of early menopause in women with breast cancer, with implications for both diagnosis and treatment.

The role of clinician emotion in clinical reasoning: Balancing the analytical process.

Science.gov (United States)

Langridge, Neil; Roberts, Lisa; Pope, Catherine

2016-02-01

This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Working overtime in community mental health: Associations with clinician burnout and perceived quality of care.

Science.gov (United States)

Luther, Lauren; Gearhart, Timothy; Fukui, Sadaaki; Morse, Gary; Rollins, Angela L; Salyers, Michelle P

2017-06-01

Funding cuts have increased job demands and threatened clinicians' ability to provide high-quality, person-centered care. One response to increased job demands is for clinicians to work more than their official scheduled work hours (i.e., overtime). We sought to examine the frequency of working overtime and its relationships with job characteristics, work-related outcomes, and quality of care in community health clinicians. One hundred eighty-two clinicians completed demographic and job characteristics questions and measures of burnout, job satisfaction, turnover intention, work-life conflict, and perceived quality of care. Clinicians also reported the importance of reducing stress and their confidence in reducing their stress. Clinicians who reported working overtime were compared to clinicians that did not on demographic and job characteristics and work-related outcomes. Ninety-four clinicians (52%) reported working overtime in a typical week. Controlling for exempt status and group differences in time spent supervising others, those working overtime reported significantly increased burnout and work-life conflict and significantly lower job satisfaction and quality of care than those not working overtime. Clinicians working overtime also reported significantly greater importance in reducing stress but less confidence in their ability to reduce stress than those not working overtime. There were no significant group differences for turnover intention. Working overtime is associated with negative consequences for clinician-related work outcomes and perceived quality of care. Policies and interventions aimed at reducing overtime and work-related stress and burnout may be warranted in order to improve quality of care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Barriers and enablers in primary care clinicians' management of osteoarthritis: protocol for a systematic review and qualitative evidence synthesis.

Science.gov (United States)

Egerton, T; Diamond, L; Buchbinder, R; Bennell, K; Slade, S C

2016-05-27

Osteoarthritis is a highly prevalent and disabling condition. Primary care management of osteoarthritis is generally suboptimal despite evidence for several modestly effective interventions and the availability of high-quality clinical practice guidelines. This report describes a planned study to synthesise the views of primary care clinicians on the barriers and enablers to following recommended management of osteoarthritis, with the aim of providing new interpretations that may facilitate the uptake of recommended treatments, and in turn improve patient care. A systematic review and meta-synthesis of qualitative studies. 5 databases will be searched using key search terms for qualitative research, evidence-based practice, clinical practice guidelines, osteoarthritis, beliefs, perceptions, barriers, enablers and adherence. A priori inclusion/exclusion criteria include availability of data from primary care clinicians, reports on views regarding management of osteoarthritis, and studies using qualitative methods for both data collection and analysis. At least 2 independent reviewers will identify eligible reports, conduct a critical appraisal of study conduct, extract data and synthesise reported findings and interpretations. Synthesis will follow thematic analysis within a grounded theory framework of inductive coding and iterative theme identification. The reviewers plus co-authors will contribute to the meta-synthesis to find new themes and theories. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be used to determine a confidence profile of each finding from the meta-synthesis. The protocol has been registered on PROSPERO and is reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The results will help to inform policy and practice and assist in the

Reiki Reduces Burnout Among Community Mental Health Clinicians.

Science.gov (United States)

Rosada, Renee M; Rubik, Beverly; Mainguy, Barbara; Plummer, Julie; Mehl-Madrona, Lewis

2015-08-01

Clinicians working in community mental health clinics are at high risk for burnout. Burnout is a problem involving emotional exhaustion, depersonalization, and reduced personal accomplishment. Reiki is a holistic biofield energy therapy beneficial for reducing stress. The purpose of this study was to determine if 30 minutes of healing touch could reduce burnout in community mental health clinicians. We utilized a crossover design to explore the efficacy of Reiki versus sham Reiki, a pseudo treatment designed to mimic true Reiki, as a means to reduce symptoms of burnout. Subjects were randomized to whether they started with Reiki or sham. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Measure Your Medical Outcome Profile Version 2 (MYMOP-2) were used as outcome measures. Multilevel modeling was used to represent the relations among variables. Reiki was statistically significantly better than sham Reiki in reducing burnout among community mental health clinicians (p=0.011). Reiki was significant in reducing depersonalization (pReiki reduced the primary symptom on the MYMOP also only among single people (p=0.03). The effects of Reiki were differentiated from sham Reiki. Reiki could be helpful in community mental health settings for the mental health of the practitioners.

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance.

Science.gov (United States)

Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

2010-06-08

Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Would guidance from a technician be as effective as guidance from a clinician? Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (ptechnician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression. This form of treatment has potential to increase the capacity of existing mental health services. Australian New

Objective identification of informative wavelength regions in galaxy spectra

Energy Technology Data Exchange (ETDEWEB)

Yip, Ching-Wa; Szalay, Alexander S.; Budavári, Tamás; Wyse, Rosemary F. G. [Department of Physics and Astronomy, The Johns Hopkins University, 3701 San Martin Drive, Baltimore, MD 21218 (United States); Mahoney, Michael W. [Department of Mathematics, Stanford University, Stanford, CA 94305 (United States); Csabai, István; Dobos, Laszlo, E-mail: cwyip@pha.jhu.edu, E-mail: szalay@jhu.edu, E-mail: mmahoney@cs.stanford.edu [Department of Physics of Complex Systems, Eötvös Loránd University, H-1117 Budapest (Hungary)

2014-05-01

Understanding the diversity in spectra is the key to determining the physical parameters of galaxies. The optical spectra of galaxies are highly convoluted with continuum and lines that are potentially sensitive to different physical parameters. Defining the wavelength regions of interest is therefore an important question. In this work, we identify informative wavelength regions in a single-burst stellar population model using the CUR Matrix Decomposition. Simulating the Lick/IDS spectrograph configuration, we recover the widely used D {sub n}(4000), Hβ, and Hδ {sub A} to be most informative. Simulating the Sloan Digital Sky Survey spectrograph configuration with a wavelength range 3450-8350 Å and a model-limited spectral resolution of 3 Å, the most informative regions are: first region—the 4000 Å break and the Hδ line; second region—the Fe-like indices; third region—the Hβ line; and fourth region—the G band and the Hγ line. A principal component analysis on the first region shows that the first eigenspectrum tells primarily the stellar age, the second eigenspectrum is related to the age-metallicity degeneracy, and the third eigenspectrum shows an anti-correlation between the strengths of the Balmer and the Ca K and H absorptions. The regions can be used to determine the stellar age and metallicity in early-type galaxies that have solar abundance ratios, no dust, and a single-burst star formation history. The region identification method can be applied to any set of spectra of the user's interest, so that we eliminate the need for a common, fixed-resolution index system. We discuss future directions in extending the current analysis to late-type galaxies. ASCII formatted tables of the regional eigenspectra are available.

Clinicians' beliefs and attitudes toward patient self-management in the Netherlands; translation and testing of the American Clinician Support for Patient Activation Measure (CS-PAM).

Science.gov (United States)

Rademakers, Jany; Jansen, Daphne; van der Hoek, Lucas; Heijmans, Monique

2015-04-03

The aim of this study was to test the Dutch version of the Clinician Support for Patient Activation Measure (CS-PAM), to explore the beliefs of Dutch clinicians about patients' self-management, and to establish whether there are differences in this respect between general practitioners and other primary care providers. The CS-PAM was translated in Dutch and data were collected in a sample of 489 general practitioners and other primary care providers. Statistical analyses (RASCH, Cronbach's α) were performed to establish the psychometric properties of the instrument. The psychometric scores of the Dutch CS-PAM were acceptable to good, and the difficulty level and structure was comparable to that of the original instrument. The average score of Dutch clinicians on the CS-PAM was 65.1 (SD 10.7), somewhat lower compared to their colleagues in the US (69; SD 12.1) and the UK (69, SD 12.8). Dutch general practitioners scored significantly lower on the CS-PAM compared to other primary care providers. The Dutch CS-PAM is a reliable instrument to measure beliefs of clinicians regarding patient self-management. Further validation studies are necessary to establish the distribution of scores in specific provider populations and to assess the clinical relevance of the instrument for different outcomes.

Reliability of video-based identification of footstrike pattern and video time frame at initial contact in recreational runners

DEFF Research Database (Denmark)

Damsted, Camma; Larsen, L H; Nielsen, R.O.

2015-01-01

and video time frame at initial contact during treadmill running using two-dimensional (2D) video recordings. METHODS: Thirty-one recreational runners were recorded twice, 1 week apart, with a high-speed video camera. Two blinded raters evaluated each video twice with an interval of at least 14 days....... RESULTS: Kappa values for within-day identification of footstrike pattern revealed intra-rater agreement of 0.83-0.88 and inter-rater agreement of 0.50-0.63. Corresponding figures for between-day identification of footstrike pattern were 0.63-0.69 and 0.41-0.53, respectively. Identification of video time...... in 36% of the identifications (kappa=0.41). The 95% limits of agreement for identification of video time frame at initial contact may, at times, allow for different identification of footstrike pattern. Clinicians should, therefore, be encouraged to continue using clinical 2D video setups for intra...

The quality of interaction between managers and clinicians: a question of trust

NARCIS (Netherlands)

Brown, P.; Alaszewski, A.; Pilgrim, D.; Calnan, M.

2011-01-01

A lack of trust between clinicians and junior/middle managers is well documented in health care systems but under-theorized. Face-to-face interactions between clinicians and managers, through which trust is constructed, are vitally shaped by assumptions drawn from local organizational

Ethical issues faced by clinician/managers in resource-allocation decisions.

Science.gov (United States)

Lemieux-Charles, L; Meslin, E M; Aird, C; Baker, R; Leatt, P

1993-01-01

This article explores the ethical issues faced by clinicians with management responsibilities (clinician/managers) when making decisions related to resource allocation and utilization at a Canadian teaching hospital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recurred throughout the discussions included fairness, concern with preventing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyzed from two perspectives--a theory of professional-bureaucratic roles and of obligation--that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for clinician/managers and that a better understanding of these issues can be obtained using an interdisciplinary perspective.

Accurate assessment of adherence: self-report and clinician report vs electronic monitoring of nebulizers.

Science.gov (United States)

Daniels, Tracey; Goodacre, Lynne; Sutton, Chris; Pollard, Kim; Conway, Steven; Peckham, Daniel

2011-08-01

People with cystic fibrosis have a high treatment burden. While uncertainty remains about individual patient level of adherence to medication, treatment regimens are difficult to tailor, and interventions are difficult to evaluate. Self- and clinician-reported measures are routinely used despite criticism that they overestimate adherence. This study assessed agreement between rates of adherence to prescribed nebulizer treatments when measured by self-report, clinician report, and electronic monitoring suitable for long-term use. Seventy-eight adults with cystic fibrosis were questioned about their adherence to prescribed nebulizer treatments over the previous 3 months. Self-report was compared with clinician report and stored adherence data downloaded from the I-Neb nebulizer system. Adherence measures were expressed as a percentage of the prescribed regimen, bias was estimated by the paired difference in mean (95% CI) patient and clinician reported and actual adherence. Agreement between adherence measures was calculated using intraclass correlation coefficients (95% CI), and disagreements for individuals were displayed using Bland-Altman plots. Patient-identified prescriptions matched the medical record prescription. Median self-reported adherence was 80% (interquartile range, 60%-95%), whereas median adherence measured by nebulizer download was 36% (interquartile range, 5%-84.5%). Nine participants overmedicated and underreported adherence. Median clinician report ranged from 50% to 60%, depending on profession. Extensive discrepancies between self-report and clinician report compared with nebulizer download were identified for individuals. Self- and clinician-reporting of adherence does not provide accurate measurement of adherence when compared with electronic monitoring. Using inaccurate measures has implications for treatment burden, clinician prescribing practices, cost, and accuracy of trial data.

Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership.

Science.gov (United States)

Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L

2017-09-01

The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

The Influence of High-Frequency Envelope Information on Low-Frequency Vowel Identification in Noise.

Directory of Open Access Journals (Sweden)

Wiebke Schubotz

Full Text Available Vowel identification in noise using consonant-vowel-consonant (CVC logatomes was used to investigate a possible interplay of speech information from different frequency regions. It was hypothesized that the periodicity conveyed by the temporal envelope of a high frequency stimulus can enhance the use of the information carried by auditory channels in the low-frequency region that share the same periodicity. It was further hypothesized that this acts as a strobe-like mechanism and would increase the signal-to-noise ratio for the voiced parts of the CVCs. In a first experiment, different high-frequency cues were provided to test this hypothesis, whereas a second experiment examined more closely the role of amplitude modulations and intact phase information within the high-frequency region (4-8 kHz. CVCs were either natural or vocoded speech (both limited to a low-pass cutoff-frequency of 2.5 kHz and were presented in stationary 3-kHz low-pass filtered masking noise. The experimental results did not support the hypothesized use of periodicity information for aiding low-frequency perception.

The Influence of High-Frequency Envelope Information on Low-Frequency Vowel Identification in Noise.

Science.gov (United States)

Schubotz, Wiebke; Brand, Thomas; Kollmeier, Birger; Ewert, Stephan D

2016-01-01

Vowel identification in noise using consonant-vowel-consonant (CVC) logatomes was used to investigate a possible interplay of speech information from different frequency regions. It was hypothesized that the periodicity conveyed by the temporal envelope of a high frequency stimulus can enhance the use of the information carried by auditory channels in the low-frequency region that share the same periodicity. It was further hypothesized that this acts as a strobe-like mechanism and would increase the signal-to-noise ratio for the voiced parts of the CVCs. In a first experiment, different high-frequency cues were provided to test this hypothesis, whereas a second experiment examined more closely the role of amplitude modulations and intact phase information within the high-frequency region (4-8 kHz). CVCs were either natural or vocoded speech (both limited to a low-pass cutoff-frequency of 2.5 kHz) and were presented in stationary 3-kHz low-pass filtered masking noise. The experimental results did not support the hypothesized use of periodicity information for aiding low-frequency perception.

A qualitative analysis of adolescent, caregiver, and clinician perceptions of the impact of migraines on adolescents' social functioning.

Science.gov (United States)

Donovan, Elizabeth; Mehringer, Stacey; Zeltzer, Lonnie K

2013-12-01

Migraines dramatically affect adolescents' quality of life. One area of particular importance is the impact of migraines on adolescents' social functioning. To understand the impact of migraines on adolescents' social functioning from multiple informants, we performed semistructured interviews with adolescents who have migraines, their caregivers, and clinicians who treat adolescents who have migraines. Three major themes related to social functioning were identified from the adolescent interviews: The need to be alone; lack of support from siblings; and the feeling of not being understood by others. The caregiver interviews yielded three main themes related to family functioning: that plans can change quickly; that family life revolves around helping the child with the migraine; and parents' feelings of inadequacy in helping their child. There were two main themes derived from the clinician interviews related to perception of family functioning: the importance of parental involvement; and the role of adolescents' school and social lives in migraine prevention. There are a number of unmet needs among adolescents with recurrent migraine and their families. Interviews with adolescents, caregivers, and clinicians suggest a number of areas for intervention. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Going private: clinicians' experience of working in UK independent sector treatment centres.

Science.gov (United States)

Waring, Justin; Bishop, Simon

2012-02-01

With increased possibility that public healthcare services in the UK will be outsourced to the private sector, this study investigates how clinicians working in Independent Sector Treatment Centres perceive the differences between public and private sectors. Qualitative interviews with 35 clinicians recruited from two ISTCs. All participants were transferred to the independent sector from the public National Health Service. Interview data were analysed to identify shared experience about the variable organisation and delivery of services. Clinicians perceived differences between public and independent sectors in the areas of 'environment and facilities', 'management', 'work organisation and care delivery', and 'patient experience'. The independent sector was described as offering a positive alternative to public services in regard to service environment and patient experience, but there were concerns about management priorities and the reconfiguration of work. Clinicians' experience of moving between sectors reveals mixed experiences. Although some improvements might legitimise the growing role of the independent sector, there remain doubts about the commercialisation of services, the motives of managers and the impact of clinical roles and capabilities. With policies looking to expand the mixed economy of public healthcare services, the study suggests clinicians will not automatically embrace a move between sectors. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Training clinicians in how to use patient-reported outcome measures in routine clinical practice.

Science.gov (United States)

Santana, Maria J; Haverman, Lotte; Absolom, Kate; Takeuchi, Elena; Feeny, David; Grootenhuis, Martha; Velikova, Galina

2015-07-01

Patient-reported outcome measures (PROs) were originally developed for comparing groups of people in clinical trials and population studies, and the results were used to support treatment recommendations or inform health policy, but there was not direct benefit for the participants providing PROs data. However, as the experience in using those measures increased, it became obvious the clinical value in using individual patient PROs profiles in daily practice to identify/monitor symptoms, evaluate treatment outcomes and support shared decision-making. A key issue limiting successful implementation is clinicians' lack of knowledge on how to effectively utilize PROs data in their clinical encounters. Using a change management theoretical framework, this paper describes the development and implementation of three programs for training clinicians to effectively use PRO data in routine practice. The training programs are in three diverse clinical areas (adult oncology, lung transplant and paediatrics), in three countries with different healthcare systems, thus providing a rare opportunity to pull out common approaches whilst recognizing specific settings. For each program, we describe the clinical and organizational setting, the program planning and development, the content of the training session with supporting material, subsequent monitoring of PROs use and evidence of adoption. The common successful components and practical steps are identified, leading to discussion and future recommendations. The results of the three training programs are described as the implementation. In the oncology program, PRO data have been developed and are currently evaluated; in the lung transplant program, PRO data are used in daily practice and the integration with electronic patient records is under development; and in the paediatric program, PRO data are fully implemented with around 7,600 consultations since the start of the implementation. Adult learning programs teaching clinicians

The influence of framing on clinicians' judgments of the biological basis of behaviors.

Science.gov (United States)

Kim, Nancy S; Ahn, Woo-kyoung; Johnson, Samuel G B; Knobe, Joshua

2016-03-01

Practicing clinicians frequently think about behaviors both abstractly (i.e., in terms of symptoms, as in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., DSM-5; American Psychiatric Association, 2013) and concretely (i.e., in terms of individual clients, as in DSM-5 Clinical Cases; Barnhill, 2013). Does abstract/concrete framing influence clinical judgments about behaviors? Practicing mental health clinicians (N = 74) were presented with hallmark symptoms of 6 disorders framed abstractly versus concretely, and provided ratings of their biological and psychological bases (Experiment 1) and the likely effectiveness of medication and psychotherapy in alleviating them (Experiment 2). Clinicians perceived behavioral symptoms in the abstract to be more biologically and less psychologically based than when concretely described, and medication was viewed as more effective for abstractly than concretely described symptoms. These findings suggest a possible basis for miscommunication and misalignment of views between primarily research-oriented and primarily practice-oriented clinicians; furthermore, clinicians may accept new neuroscience research more strongly in the abstract than for individual clients. (c) 2016 APA, all rights reserved).

Evidence gaps in advanced cancer care: community-based clinicians' perspectives and priorities for CER.

Science.gov (United States)

Lowry, Sarah J; Loggers, Elizabeth T; Bowles, Erin J A; Wagner, Edward H

2012-05-01

Although much effort has focused on identifying national comparative effectiveness research (CER) priorities, little is known about the CER priorities of community-based practitioners treating patients with advanced cancer. CER priorities of managed care-based clinicians may be valuable as reflections of both payer and provider research interests. We conducted mixed methods interviews with 10 clinicians (5 oncologists and 5 pharmacists) at 5 health plans within the Health Maintenance Organization Cancer Research Network. We asked, "What evidence do you most wish you had when treating patients with advanced cancer" and questioned participants on their impressions and knowledge of CER and pragmatic clinical trials (PCTs). We conducted qualitative analyses to identify themes across interviews. Ninety percent of participants had heard of CER, 20% had heard of PCTs, and all rated CER/PCTs as highly relevant to patient and health plan decision making. Each participant offered between 3 and 10 research priorities. Half (49%) involved head-to-head treatment comparisons; another 20% involved comparing different schedules or dosing regimens of the same treatment. The majority included alternative outcomes to survival (eg, toxicity, quality of life, noninferiority). Participants cited several limitations to existing evidence, including lack of generalizability, funding biases, and rapid development of new treatments. Head-to-head treatment comparisons remain a major evidence need among community- based oncology clinicians, and CER/PCTs are highly valued methods to address the limitations of traditional randomized trials, answer questions of cost-effectiveness or noninferiority, and inform data-driven dialogue and decision making by all stakeholders.

Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment.

Science.gov (United States)

Jochems, Eline C; van Dam, Arno; Duivenvoorden, Hugo J; Scheffer, Sylvia C M; van der Feltz-Cornelis, Christina M; Mulder, Niels L

2016-09-01

The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self-determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician-rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd. Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a

Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App.

Science.gov (United States)

Miller, Katherine E; Kuhn, Eric; Owen, Jason E; Taylor, Katherine; Yu, Jessica S; Weiss, Brandon J; Crowley, Jill J; Trockel, Mickey

2017-11-09

Clinicians' perceptions of CBT-I Coach, a patient-facing mobile app for cognitive-behavioral therapy for insomnia (CBT-I), are critical to its adoption and integration into practice. Diffusion of innovations theory emphasizes the influence of perceptions, including the relative advantage to current practice, the compatibility to clinicians' needs, the complexity, the innovation's trialability, and observability. This study intended to evaluate the use and perceptions of CBT-I Coach among Veterans Affairs (VA)-trained CBT-I clinicians. Clinicians (N = 108) were surveyed about their use, feedback, and perceptions of CBT-I Coach a year after the app became available. Overall perceptions of CBT-I Coach were favorable. Fifty percent of clinicians reported using CBT-I Coach, with 98% intending to continue use. The app was perceived to increase sleep diary completion and homework compliance. Clinicians viewed the app as providing accessibility to helpful tools and improving patient engagement. Of those not using the app, 83% endorsed intention to use it. Reasons for nonuse were lack of patient access to smart phones, not being aware of the app, not having time to learn it, and inability to directly access app data. Those who reported using CBT-I Coach had more favorable perceptions across all constructs (p CBT-I Coach, as well as study if reported benefits can be evidenced more directly.

Australian clinicians and chemoprevention for women at high familial risk for breast cancer

Directory of Open Access Journals (Sweden)

Keogh Louise A

2009-05-01

Full Text Available Abstract Objectives Effective chemoprevention strategies exist for women at high risk for breast cancer, yet uptake is low. Physician recommendation is an important determinant of uptake, but little is known about clinicians' attitudes to chemoprevention. Methods Focus groups were conducted with clinicians at five Family Cancer Centers in three Australian states. Discussions were recorded, transcribed and analyzed thematically. Results Twenty three clinicians, including genetic counselors, clinical geneticists, medical oncologists, breast surgeons and gynaecologic oncologists, participated in six focus groups in 2007. The identified barriers to the discussion of the use of tamoxifen and raloxifene for chemoprevention pertained to issues of evidence (evidence for efficacy not strong enough, side-effects outweigh benefits, oophorectomy superior for mutation carriers, practice (drugs not approved for chemoprevention by regulatory authorities and not government subsidized, chemoprevention not endorsed in national guidelines and not many women ask about it, and perception (clinicians not knowledgeable about chemoprevention and women thought to be opposed to hormonal treatments. Conclusion The study demonstrated limited enthusiasm for discussing breast cancer chemoprevention as a management option for women at high familial risk. Several options for increasing the likelihood of clinicians discussing chemoprevention were identified; maintaining up to date national guidelines on management of these women and education of clinicians about the drugs themselves, the legality of "off-label" prescribing, and the actual costs of chemopreventive medications.

A New Method of Reliability Evaluation Based on Wavelet Information Entropy for Equipment Condition Identification

International Nuclear Information System (INIS)

He, Z J; Zhang, X L; Chen, X F

2012-01-01

Aiming at reliability evaluation of condition identification of mechanical equipment, it is necessary to analyze condition monitoring information. A new method of reliability evaluation based on wavelet information entropy extracted from vibration signals of mechanical equipment is proposed. The method is quite different from traditional reliability evaluation models that are dependent on probability statistics analysis of large number sample data. The vibration signals of mechanical equipment were analyzed by means of second generation wavelet package (SGWP). We take relative energy in each frequency band of decomposed signal that equals a percentage of the whole signal energy as probability. Normalized information entropy (IE) is obtained based on the relative energy to describe uncertainty of a system instead of probability. The reliability degree is transformed by the normalized wavelet information entropy. A successful application has been achieved to evaluate the assembled quality reliability for a kind of dismountable disk-drum aero-engine. The reliability degree indicates the assembled quality satisfactorily.

Effects of Shame and Guilt on Error Reporting Among Obstetric Clinicians.

Science.gov (United States)

Zabari, Mara Lynne; Southern, Nancy L

2018-04-17

To understand how the experiences of shame and guilt, coupled with organizational factors, affect error reporting by obstetric clinicians. Descriptive cross-sectional. A sample of 84 obstetric clinicians from three maternity units in Washington State. In this quantitative inquiry, a variant of the Test of Self-Conscious Affect was used to measure proneness to guilt and shame. In addition, we developed questions to assess attitudes regarding concerns about damaging one's reputation if an error was reported and the choice to keep an error to oneself. Both assessments were analyzed separately and then correlated to identify relationships between constructs. Interviews were used to identify organizational factors that affect error reporting. As a group, mean scores indicated that obstetric clinicians would not choose to keep errors to themselves. However, bivariate correlations showed that proneness to shame was positively correlated to concerns about one's reputation if an error was reported, and proneness to guilt was negatively correlated with keeping errors to oneself. Interview data analysis showed that Past Experience with Responses to Errors, Management and Leadership Styles, Professional Hierarchy, and Relationships With Colleagues were influential factors in error reporting. Although obstetric clinicians want to report errors, their decisions to report are influenced by their proneness to guilt and shame and perceptions of the degree to which organizational factors facilitate or create barriers to restore their self-images. Findings underscore the influence of the organizational context on clinicians' decisions to report errors. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis.

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Schwebke, Jane R; Gaydos, Charlotte A; Nyirjesy, Paul; Paradis, Sonia; Kodsi, Salma; Cooper, Charles K

2018-06-01

Vaginitis is a common complaint, diagnosed either empirically or using Amsel's criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States). Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis Clinician diagnosis and in-clinic testing (Amsel's test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes. All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2 , and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing. The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis. Copyright © 2018 Schwebke et al.

Lyme Disease in West Virginia: An Assessment of Distribution and Clinicians' Knowledge of Disease and Surveillance.

Science.gov (United States)

Singh, Sarah; Parker, David; Mark-Carew, Miguella; White, Robert; Fisher, Melanie

2016-01-01

Lyme disease case misclassification, a top public health concern, may be attributed to the current disconnect between clinical diagnosis and surveillance. This study examines Lyme disease distribution in West Virginia (WV) and determines clinicians' knowledge of both disease and surveillance. Lyme disease surveillance data for 2013 were obtained from the WV Bureau for Public Health. A validated survey, distributed to clinicians at an academic medical center, assessed clinicians' knowledge of disease diagnosis and surveillance. There were 297 adult Lyme disease cases of which 83 were confirmed. Clinician survey responses resulted in a correct response rate of 70% for Lyme disease knowledge questions. Fewer than half of all clinicians were aware of the surveillance criteria for confirming Lyme disease cases. Neither medical specialty nor previous treatment of patients with Lyme disease were significantly associated with clinicians' knowledge of the disease. Clinicians in WV are familiar with symptoms and clinical management of Lyme disease. However, they are less knowledgeable about diagnosis and public health surveillance comprising reporting and confirming cases of the disease. Clinicians and public health authorities should collaborate more closely to promote education and awareness as a key step to successfully reducing the burden of Lymne disease.

Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives.

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Granger, Catherine L; Denehy, Linda; Remedios, Louisa; Retica, Sarah; Phongpagdi, Pimsiri; Hart, Nicholas; Parry, Selina M

2016-12-01

both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer.

Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale.

Science.gov (United States)

Williams, Nathaniel J

2016-05-05

Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians' EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians' intentions to adopt EBTs. The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Findings support the EBTI's factor structure (χ (2) = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians' observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p adoption at a 12-month follow-up (R (2) = .17, p adopt EBTs. Discussion focuses on research and practice applications.

Balancing treatment allocations by clinician or center in randomized trials allows unacceptable levels of treatment prediction.

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Hills, Robert K; Gray, Richard; Wheatley, Keith

2009-08-01

Randomized controlled trials are the standard method for comparing treatments because they avoid the selection bias that might arise if clinicians were free to choose which treatment a patient would receive. In practice, allocation of treatments in randomized controlled trials is often not wholly random with various 'pseudo-randomization' methods, such as minimization or balanced blocks, used to ensure good balance between treatments within potentially important prognostic or predictive subgroups. These methods avoid selection bias so long as full concealment of the next treatment allocation is maintained. There is concern, however, that pseudo-random methods may allow clinicians to predict future treatment allocations from previous allocation history, particularly if allocations are balanced by clinician or center. We investigate here to what extent treatment prediction is possible. Using computer simulations of minimization and balanced block randomizations, the success rates of various prediction strategies were investigated for varying numbers of stratification variables, including the patient's clinician. Prediction rates for minimization and balanced block randomization typically exceed 60% when clinician is included as a stratification variable and, under certain circumstances, can exceed 80%. Increasing the number of clinicians and other stratification variables did not greatly reduce the prediction rates. Without clinician as a stratification variable, prediction rates are poor unless few clinicians participate. Prediction rates are unacceptably high when allocations are balanced by clinician or by center. This could easily lead to selection bias that might suggest spurious, or mask real, treatment effects. Unless treatment is blinded, randomization should not be balanced by clinician (or by center), and clinician-center effects should be allowed for instead by retrospectively stratified analyses. © 2009 Blackwell Publishing Asia Pty Ltd and Chinese

Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know?

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Perkins, Matthew B; Jensen, Peter S; Jaccard, James; Gollwitzer, Peter; Oettingen, Gabriele; Pappadopulos, Elizabeth; Hoagwood, Kimberly E

2007-03-01

Despite major recent research advances, large gaps exist between accepted mental health knowledge and clinicians' real-world practices. Although hundreds of studies have successfully utilized basic behavioral science theories to understand, predict, and change patients' health behaviors, the extent to which these theories-most notably the theory of reasoned action (TRA) and its extension, the theory of planned behavior (TPB)-have been applied to understand and change clinician behavior is unclear. This article reviews the application of theory-driven approaches to understanding and changing clinician behaviors. MEDLINE and PsycINFO databases were searched, along with bibliographies, textbooks on health behavior or public health, and references from experts, to find article titles that describe theory-driven approaches (TRA or TPB) to understanding and modifying health professionals' behavior. A total of 19 articles that detailed 20 studies described the use of TRA or TPB and clinicians' behavior. Eight articles describe the use of TRA or TPB with physicians, four relate to nurses, three relate to pharmacists, and two relate to health workers. Only two articles applied TRA or TPB to mental health clinicians. The body of work shows that different constructs of TRA or TPB predict intentions and behavior among different groups of clinicians and for different behaviors and guidelines. The number of studies on this topic is extremely limited, but they offer a rationale and a direction for future research as well as a theoretical basis for increasing the specificity and efficiency of clinician-targeted interventions.

Attitudes of Medical Students, Clinicians and Sports Scientists Towards Exercise Counselling

OpenAIRE

Gnanendran, Abbyrhamy; Pyne, David B.; Fallon, Kieran E.; Fricker, Peter A.

2011-01-01

We compared the amount of exercise undertaken by medical students, clinicians, and sport scientists with the National Australian Physical Activity (NAPA) Guidelines. A second aim was to compare attitudes to exercise counselling as preventive medicine between university- and clinic-based professionals. The research setting was a university medical school and a sports science sports medicine centre. A 20-item questionnaire was completed by 216 individuals (131 medical students, 43 clinicians an...

Bridging the gap between basic science and clinical practice: The role of organizations in addressing clinician barriers

Directory of Open Access Journals (Sweden)

Taylor Stephanie

2011-04-01

Full Text Available Abstract Background New National Institutes of Health policies call for expansion of practice-based research to improve the clinical research enterprise and facilitate dissemination of evidence-based medicine. Objective This paper describes organizational strategies that influence clinicians' decisions to participate in clinical research. Design We reviewed the literature and interviewed over 200 clinicians and stakeholders. Results The most common barriers to community clinician participation in clinical research relate to beliefs that clinical research is too burdensome and has little benefit for the participating clinician or patient. We identified a number of approaches healthcare organizations can use to encourage clinicians to participate in research, including an outreach campaign to promote the benefits of clinical research; selection of study topics of interest to clinicians; establishment and enforcement of a set of research principles valuing the clinician and patient; development of a transparent schedule of reimbursement for research tasks; provision of technological and technical assistance to practices as needed; and promotion of a sense of community among clinicians involved in practice-based research. Conclusions Many types of existing healthcare organizations could provide the technical and intellectual assistance community clinicians need to participate in clinical research. Multiple approaches are possible.

75 FR 10414 - Researcher Identification Card

Science.gov (United States)

2010-03-08

... capturing administrative information on the characteristics of our users. Other forms of identification are... use bar-codes on researcher identification cards in the Washington, DC, area. The plastic cards we... plastic researcher identification cards as part of their security systems, we issue a plastic card to...

Perspectives of patients with haematological cancer on how clinicians meet their information needs: "Managing" information versus "giving" it.

Science.gov (United States)

Atherton, Kirsten; Young, Bridget; Kalakonda, Nagesh; Salmon, Peter

2018-03-23

Practitioners treating patients with haematological cancers have extensive clinical information available to give to patients, and patients need to be informed. However, many patients want to be protected from having information that is too detailed or threatening. To illuminate how practitioners can address this dilemma and help patients feel appropriately informed, we explored patients' experience of feeling informed or uninformed. Semi-structured interviews were conducted with 20 patients who had been diagnosed with haematological cancer and had recently received results from clinical investigations or from evaluations of treatment response. Inductive and interpretive analysis of the transcribed audio-recorded interviews drew on constant comparison. Patients described the need for practitioners carefully to manage the information that they provided, and many felt alarmed by information that they did not experience as having been managed for them. A few patients who had difficulty trusting practitioners were not content with the information provided. These findings can be understood using attachment theory, whereby practitioners' careful management of information demonstrates their care for patients, and patients' trust in the practitioner enables them to feel informed. It follows that, when patients do not feel informed, the solution will not necessarily be more information but might be to help patients feel more secure in a caring clinical relationship. Copyright © 2018 John Wiley & Sons, Ltd.

Care provision to prevent chronic disease by community mental health clinicians.

Science.gov (United States)

Bartlem, Kate M; Bowman, Jennifer A; Freund, Megan; Wye, Paula M; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H

2014-12-01

People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A clinician's artificial organ? Instant messaging applications in medical care.

Science.gov (United States)

Tazegul, Gokhan; Bozoglan, Humeyra; Ogut, Tahir S; Balcı, Mustafa K

2017-09-15

After the development of the first phone at the end of 19th century, communication technologies took a great leap forward in the 20th century. With the birth of the "smartphone" in the 21st century, communication technologies exponentially evolved and became an important part of our daily routine. Effective communications between clinicians is critical in medical care and miscommunications are a source of errors. Although telecommunication technologies have proliferated dramatically in the last decade, there is scarce evidence-based information on the use of this technology in medical care. For the purposes of medical communication, we can now consult each other about patients individually and within a group via instant messaging applications by using text messages, photos, audio messages and even videos. In this review, we examine the uses and drawbacks of instant messaging applications in medical communications.

A pragmatics' view of patient identification.

Science.gov (United States)

Lichtner, Valentina; Galliers, Julia R; Wilson, Stephanie

2010-10-01

Patient identification is a central safety critical aspect of healthcare work. Most healthcare activities require identification of patients by healthcare staff, often in connection with the use of patient records. Indeed, the increasing reliance on electronic systems makes the correct matching of patients with their records a keystone for patient safety. Most research on patient identification has been carried out in hospital settings. The aim was to investigate the process of identification of patients and their records in the context of a primary healthcare clinic. A qualitative field study was carried out at a Walk-In Centre in London (UK). The identification of patients and their records was found to be a context-dependent process, both when formalised in procedures and when relying on informal practices. The authors discovered a range of formal and informal patient identifiers were used in this setting, depending on the task at hand. The theoretical lens of Pragmatics was applied to offer an explanation of this identification process. Context provides the cognitive scaffolding for a process of 'suitably constrained guesswork' about the identity of patients and their records. Implications for practice and for system design are discussed. Practitioners and technology designers should be aware of the risk for misidentifications inherent in this natural information processing activity.

Understanding academic clinicians' intent to treat pediatric obesity.

Science.gov (United States)

Frankfurter, Claudia; Cunningham, Charles; Morrison, Katherine M; Rimas, Heather; Bailey, Karen

2017-02-08

To examine the extent to which the theory of planned behavior (TPB) predicts academic clinicians' intent to treat pediatric obesity. A multi-disciplinary panel iteratively devised a Likert scale survey based on the constructs of the TPB applied to a set of pediatric obesity themes. A cross-sectional electronic survey was then administered to academic clinicians at tertiary care centers across Canada from January to April 2012. Descriptive statistics were used to summarize demographic and item agreement data. A hierarchical linear regression analysis controlling for demographic variables was conducted to examine the extent to which the TPB subscales predicted intent to treat pediatric obesity. A total of 198 physicians, surgeons, and allied health professionals across Canada (British Columbia, Alberta, Manitoba, Saskatchewan, Nova Scotia, Ontario and Quebec) completed the survey. On step 1, demographic factors accounted for 7.4% of the variance in intent scores. Together in step 2, demographic variables and TPB subscales predicted 56.9% of the variance in a measure of the intent to treat pediatric obesity. Perceived behavioral control, that is, confidence in one's ability to manage pediatric obesity, and subjective norms, congruent with one's context of practice, were the most significant predictors of the intent to treat pediatric obesity. Attitudes and barriers did not predict the intent to treat pediatric obesity in this context. Enhancing self-confidence in the ability to treat pediatric obesity and the existence of supportive treatment environments are important to increase clinician's intent to treat pediatric obesity.

Introduction to health economics and decision-making: Is economics relevant for the frontline clinician?

Science.gov (United States)

Goeree, Ron; Diaby, Vakaramoko

2013-12-01

In a climate of escalating demands for new health care services and significant constraints on new resources, the disciplines of health economics and health technology assessment (HTA) have increasingly been turned to as explicit evidence-based frameworks to help make tough health care access and reimbursement decisions. Health economics is the discipline of economics concerned with the efficient allocation of health care resources, essentially trying to maximize health benefits to society contingent upon available resources. HTA is a broader field drawing upon several disciplines, but which relies heavily upon the tools of health economics and economic evaluation. Traditionally, health economics and economic evaluation have been widely used at the political (macro) and local (meso) decision-making levels, and have progressively had an important role even at informing individual clinical decisions (micro level). The aim of this paper is to introduce readers to health economics and discuss its relevance to frontline clinicians. Particularly, the content of the paper will facilitate clinicians' understanding of the link between economics and their medical practice, and how clinical decision-making reflects on health care resource allocation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Motivation and treatment engagement intervention trial (MotivaTe-IT: the effects of motivation feedback to clinicians on treatment engagement in patients with severe mental illness

Directory of Open Access Journals (Sweden)

Jochems Eline C

2012-11-01

Full Text Available Abstract Background Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1 to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE of severe mentally ill patients in outpatient psychiatric treatment, 2 to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM and TE in this patient population and 3 to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. Methods/design The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. Discussion The current study can provide important insights regarding motivational processes and the way in which motivation

Motivation and treatment engagement intervention trial (MotivaTe-IT): the effects of motivation feedback to clinicians on treatment engagement in patients with severe mental illness.

Science.gov (United States)

Jochems, Eline C; Mulder, Cornelis L; van Dam, Arno; Duivenvoorden, Hugo J; Scheffer, Sylvia C M; van der Spek, Willem; van der Feltz-Cornelis, Christina M

2012-11-24

Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients' motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients' treatment motivation upon the patients' TE. The primary outcome is the patients' TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. The current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment engagement and clinical outcomes. The

Motivation and treatment engagement intervention trial (MotivaTe-IT): the effects of motivation feedback to clinicians on treatment engagement in patients with severe mental illness

Science.gov (United States)

2012-01-01

Background Treatment disengagement and non-completion poses a major problem for the successful treatment of patients with severe mental illness. Motivation for treatment has long been proposed as a major determinant of treatment engagement, but exact mechanisms remain unclear. This current study serves three purposes: 1) to determine whether a feedback intervention based on the patients’ motivation for treatment is effective at improving treatment engagement (TE) of severe mentally ill patients in outpatient psychiatric treatment, 2) to gather insight into motivational processes and possible mechanisms regarding treatment motivation (TM) and TE in this patient population and 3) to determine which of three theories of motivation is most plausible for the dynamics of TM and TE in this population. Methods/design The Motivation and Treatment Engagement Intervention Trial (MotivaTe-IT) is a multi-center cluster randomized trial investigating the effectiveness of feedback generated by clinicians regarding their patients’ treatment motivation upon the patients’ TE. The primary outcome is the patients’ TE. Secondary outcomes are TM, psychosocial functioning and quality of life. Patients whose clinicians generate monthly motivation feedback (additional to treatment as usual) will be compared to patients who receive treatment as usual. An estimated 350 patients, aged 18 to 65 years, with psychotic disorders and/or severe personality disorders will be recruited from outpatient community mental health care. The randomization will be performed by a computerized randomization program, with an allocation ratio of 1:1 (team vs. team or clinician vs. clinician) and patients, but not clinicians, will be blind to treatment allocation at baseline assessment. Due to the nature of the trial, follow-up assessment can not be blinded. Discussion The current study can provide important insights regarding motivational processes and the way in which motivation influences the treatment

Web-based cancer communication and decision making systems: connecting patients, caregivers, and clinicians for improved health outcomes.

Science.gov (United States)

DuBenske, Lori L; Gustafson, David H; Shaw, Bret R; Cleary, James F

2010-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS-the Comprehensive Health Enhancement Support System (CHESS)-for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS.

Rising to the challenge: Training the next generation of clinician scientists for South Africa

Directory of Open Access Journals (Sweden)

B Kramer

2015-12-01

Full Text Available Background. A shortage of clinician scientists globally, particularly in the developing world, including Africa and South Africa (SA, is well known and was recently highlighted in a consensus report by the Academy of Science of South Africa. There is a need to find innovative ways to develop and advance clinician scientists in SA. Objective. To provide opportunities for young clinicians to develop research skills through enrolling for a PhD. Method. To address this need in SA, we developed an innovative programme over 2 years in collaboration with the Carnegie Corporation of New York to support and train young specialist clinicians in research as the next generation of clinician scientists, through a full-time PhD programme. Results. Since initiation of the programme in March 2011, 16 such specialists have been enrolled at intervals in the Fellowship programme, 5 have qualified with PhDs, while a further 3 are expected to qualify shortly. Publications and presentations at congresses have been recorded as well as grant applications. Discussion. Although the programme is seen as an important initial step in addressing the shortage of clinician scientists, its dependence on donor funding and the lack of a secure career path for clinicians wishing to spend more of their career in research pose problems for the programme’s sustainability. It is hoped that the positive outcomes of this experience will initiate further programmes of this kind at academic institutions and attract the attention of funders and universities in order to sustain and enlarge this initiative.

Concordance between patient and clinician assessment of dry eye severity and treatment response in Taiwan.

Science.gov (United States)

Yeh, Po-Ting; Chien, Hsu-Chih; Ng, Kwong; Tseng, Sung-Huei; Chen, Wei-Li; Hou, Yu-Chih; Wang, I-Jong; Chu, Hsiao-Sung; Kao Yang, Yea-Huei; Hu, Fung-Rong

2015-05-01

Accurate diagnosis and early recognition of dry eye symptoms are important in the management of dry eye disease (DED). This study aimed to evaluate concordance between patient and clinician assessment of DED severity and treatment response. This cross-sectional study was conducted in 2 ophthalmology clinics in Taiwan. Clinicians assessed severity based on the Dry Eye Workshop severity grading (levels 1-4; where 4 = most severe), whereas patients completed the Ocular Surface Disease Index questionnaire. To evaluate the treatment response, patients completed the Subject Global Assessment scale, and clinicians independently assessed patients using the Clinical Global Impression scale. A total of 466 patients were included. Clinicians graded 88.3% of patients as level 1/2, 9.0% as level 3, and 2.7% as level 4 Dry Eye Workshop severity, whereas 44.9% of patients reported normal/mild symptoms, 17.1% with moderate severity, and 38.0% with severe DED. Patients were primarily treated with artificial tears. The clinician assessed 10.3% of patients as unchanged on disease severity after treatment and 88.0% as improved, whereas 49.2% of patients reported dry eye symptoms being almost the same after treatment and 34.6% reported improved symptoms. There was low agreement between clinician and patient assessments in terms of disease severity (rho = 0.17, P treatment response (rho = 0.22, P treatment response between patient and clinician assessment. Clinicians may underestimate DED severity and persistence of dry eye symptoms after treatment with artificial tears.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01942226.

The role of the clinician in the multi-omics era: are you ready?

Science.gov (United States)

van Karnebeek, Clara D M; Wortmann, Saskia B; Tarailo-Graovac, Maja; Langeveld, Mirjam; Ferreira, Carlos R; van de Kamp, Jiddeke M; Hollak, Carla E; Wasserman, Wyeth W; Waterham, Hans R; Wevers, Ron A; Haack, Tobias B; Wanders, Ronald J A; Boycott, Kym M

2018-01-23

Since Garrod's first description of alkaptonuria in 1902, and newborn screening for phenylketonuria introduced in the 1960s, P4 medicine (preventive, predictive, personalized, and participatory) has been a reality for the clinician serving patients with inherited metabolic diseases. The era of high-throughput technologies promises to accelerate its scale dramatically. Genomics, transcriptomics, epigenomics, proteomics, glycomics, metabolomics, and lipidomics offer an amazing opportunity for holistic investigation and contextual pathophysiologic understanding of inherited metabolic diseases for precise diagnosis and tailored treatment. While each of the -omics technologies is important to systems biology, some are more mature than others. Exome sequencing is emerging as a reimbursed test in clinics around the world, and untargeted metabolomics has the potential to serve as a single biochemical testing platform. The challenge lies in the integration and cautious interpretation of these big data, with translation into clinically meaningful information and/or action for our patients. A daunting but exciting task for the clinician; we provide clinical cases to illustrate the importance of his/her role as the connector between physicians, laboratory experts and researchers in the basic, computer, and clinical sciences. Open collaborations, data sharing, functional assays, and model organisms play a key role in the validation of -omics discoveries. Having all the right expertise at the table when discussing the diagnostic approach and individualized management plan according to the information yielded by -omics investigations (e.g., actionable mutations, novel therapeutic interventions), is the stepping stone of P4 medicine. Patient participation and the adjustment of the medical team's plan to his/her and the family's wishes most certainly is the capstone. Are you ready?

Identification method of gas-liquid two-phase flow regime based on image wavelet packet information entropy and genetic neural network

International Nuclear Information System (INIS)

Zhou Yunlong; Chen Fei; Sun Bin

2008-01-01

Based on the characteristic that wavelet packet transform image can be decomposed by different scales, a flow regime identification method based on image wavelet packet information entropy feature and genetic neural network was proposed. Gas-liquid two-phase flow images were captured by digital high speed video systems in horizontal pipe. The information entropy feature from transformation coefficients were extracted using image processing techniques and multi-resolution analysis. The genetic neural network was trained using those eigenvectors, which was reduced by the principal component analysis, as flow regime samples, and the flow regime intelligent identification was realized. The test result showed that image wavelet packet information entropy feature could excellently reflect the difference between seven typical flow regimes, and the genetic neural network with genetic algorithm and BP algorithm merits were with the characteristics of fast convergence for simulation and avoidance of local minimum. The recognition possibility of the network could reach up to about 100%, and a new and effective method was presented for on-line flow regime. (authors)

Clinical guideline representation in a CDS: a human information processing method.

Science.gov (United States)

Kilsdonk, Ellen; Riezebos, Rinke; Kremer, Leontien; Peute, Linda; Jaspers, Monique

2012-01-01

The Dutch Childhood Oncology Group (DCOG) has developed evidence-based guidelines for screening childhood cancer survivors for possible late complications of treatment. These paper-based guidelines appeared to not suit clinicians' information retrieval strategies; it was thus decided to communicate the guidelines through a Computerized Decision Support (CDS) tool. To ensure high usability of this tool, an analysis of clinicians' cognitive strategies in retrieving information from the paper-based guidelines was used as requirements elicitation method. An information processing model was developed through an analysis of think aloud protocols and used as input for the design of the CDS user interface. Usability analysis of the user interface showed that the navigational structure of the CDS tool fitted well with the clinicians' mental strategies employed in deciding on survivors screening protocols. Clinicians were more efficient and more complete in deciding on patient-tailored screening procedures when supported by the CDS tool than by the paper-based guideline booklet. The think-aloud method provided detailed insight into users' clinical work patterns that supported the design of a highly usable CDS system.

A new paradigm for known metabolite identification in metabonomics/metabolomics: metabolite identification efficiency.

Science.gov (United States)

Everett, Jeremy R

2015-01-01

A new paradigm is proposed for assessing confidence in the identification of known metabolites in metabonomics studies using NMR spectroscopy approaches. This new paradigm is based upon the analysis of the amount of metabolite identification information retrieved from NMR spectra relative to the molecular size of the metabolite. Several new indices are proposed including: metabolite identification efficiency (MIE) and metabolite identification carbon efficiency (MICE), both of which can be easily calculated. These indices, together with some guidelines, can be used to provide a better indication of known metabolite identification confidence in metabonomics studies than existing methods. Since known metabolite identification in untargeted metabonomics studies is one of the key bottlenecks facing the science currently, it is hoped that these concepts based on molecular spectroscopic informatics, will find utility in the field.

A New Paradigm for Known Metabolite Identification in Metabonomics/Metabolomics: Metabolite Identification Efficiency

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Jeremy R. Everett

2015-01-01

Full Text Available A new paradigm is proposed for assessing confidence in the identification of known metabolites in metabonomics studies using NMR spectroscopy approaches. This new paradigm is based upon the analysis of the amount of metabolite identification information retrieved from NMR spectra relative to the molecular size of the metabolite. Several new indices are proposed including: metabolite identification efficiency (MIE and metabolite identification carbon efficiency (MICE, both of which can be easily calculated. These indices, together with some guidelines, can be used to provide a better indication of known metabolite identification confidence in metabonomics studies than existing methods. Since known metabolite identification in untargeted metabonomics studies is one of the key bottlenecks facing the science currently, it is hoped that these concepts based on molecular spectroscopic informatics, will find utility in the field.

Collaborative research between clinicians and researchers: a multiple case study of implementation

Directory of Open Access Journals (Sweden)

Edlund Carrie

2010-10-01

Full Text Available Abstract Background Bottom-up, clinician-conceived and directed clinical intervention research, coupled with collaboration from researcher experts, is conceptually endorsed by the participatory research movement. This report presents the findings of an evaluation of a program in the Veterans Health Administration meant to encourage clinician-driven research by providing resources believed to be critical. The evaluation focused on the extent to which funded projects: maintained integrity to their original proposals; were methodologically rigorous; were characterized by collaboration between partners; and resulted in sustained clinical impact. Methods Researchers used quantitative (survey and archival and qualitative (focus group data to evaluate the implementation, evaluation, and sustainability of four clinical demonstration projects at four sites. Fourteen research center mentors and seventeen clinician researchers evaluated the level of collaboration using a six-dimensional model of participatory research. Results Results yielded mixed findings. Qualitative and quantitative data suggested that although the process was collaborative, clinicians' prior research experience was critical to the quality of the projects. Several challenges were common across sites, including subject recruitment, administrative support and logistics, and subsequent dissemination. Only one intervention achieved lasting clinical effect beyond the active project period. Qualitative analyses identified barriers and facilitators and suggested areas to improve sustainability. Conclusions Evaluation results suggest that this participatory research venture was successful in achieving clinician-directed collaboration, but did not produce sustainable interventions due to such implementation problems as lack of resources and administrative support.

Feminist Family Therapy: Ethical Considerations for the Clinician.

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Costa, Luann; Sorenson, Jody

1993-01-01

Notes the traditional minimization of gender and power issues in the cultural context by systemic family therapists. Presents five questions that can serve as guidelines in examining ethical and personal issues and provides ethical considerations for the clinician. (Author/NB)

A framework for understanding moral distress among palliative care clinicians.

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Rushton, Cynda H; Kaszniak, Alfred W; Halifax, Joan S

2013-09-01

Palliative care clinicians confront suffering as they care for people living with life-limiting conditions. When the degree of suffering becomes unjustified, moral distress can ensue. Promising work from neuroscience and social psychology has yet to be applied to clinical practice. Our objective was to expand a social psychology model focusing on empathy and compassion in response to suffering to include an ethical dimension and to examine how the interrelationships of its proposed components can assist clinicians in understanding their responses to morally distressing situations. In the clinical context, responses to distressing events are thought to include four dimensions: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). These dynamically intertwined dimensions create the preconditions for how clinicians respond to a triggering event instigated by an ethical conflict or dilemma. We postulate that if the four dimensions are highly aligned, the intensity and valence of emotional arousal will influence ethical appraisal and discernment by engaging a robust view of the ethical issues, conflicts, and possible solutions and cultivating compassionate action and resilience. In contrast, if they are not, ethical appraisal and discernment will be deficient, creating emotional disregulation and potentially leading to personal and moral distress, self-focused behaviors, unregulated moral outrage, burnout, and secondary stress. The adaptation and expansion of a conceptual framework offers a promising approach to designing interventions that help clinicians mitigate the detrimental consequences of unregulated moral distress and to build the resilience necessary to sustain themselves in clinical service.

Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

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McDougall, Rosalind J; Gillam, Lynn; Delany, Clare; Jayasinghe, Yasmin

2018-01-01

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. PMID:29084865

Why patients have a moral obligation to give care to clinicians.

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Buetow, Stephen

2014-12-01

Progress is being made in transitioning from clinicians who are torn between caring for patients and populations, to clinicians who are partnering with patients to care for patients as people. However, the focus is still on what patients and others can do for patients, however defined. For clinicians whose interests must be similarly respected for their own sake and because they are integrally related to those of patients, what can and should patients do? Patients can be exempted from some normal social roles but are generally recognized to have moral obligations in health care. One of these obligations is caregiving to clinicians within the limits of each patient's capability. My paper moves this obligation beyond the ceremonial order of etiquette characterizing public statements on how patients should relate to others. It goes beyond a patient-centred ethic that is consumerist in nature, to a person-centred one that recognizes patients typically as moral agents who are dignified by recognizing the obligation to give as well as receive care as sincere benevolence. This obligation derives objective justification from divine command. It is also consistent, however, both with what people, if ignorant of their social role, would objectively produce for a hypothetical social contract, and with virtues constitutive of human nature and a relational and communitarian understanding of what it is to be a person. Including sentiment (intuition) and personal conscience, this relational identity makes caregiving intrinsically meaningful, yet caregiving also has an instrumental value to patients and clinicians. Its self-enforcement by patients will depend on their moral code and on society making caregiving achievable for them. A moral obligation for patient caregiving may then be specified to require patients to reflect on and invest in relationships in which they can feel and show care for others sincerely and respectfully. © 2014 John Wiley & Sons, Ltd.

Elder Abuse: What's a Clinician To Do?

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Reis, Bruce E.

Incidence rates are critically examined in light of varying definitions of what constitutes elder abuse. It is suggested that the clinician's position of mandatory reporting is an unrealistic response in many cases of elder abuse due to the lack of adequate support services for either the abuser or the elder. Outcome studies are used to support…

Bridging the gap between basic science and clinical practice: a role for community clinicians

Directory of Open Access Journals (Sweden)

Cho Michelle

2011-04-01

Full Text Available Abstract Background Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans. Methods We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program. Results Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior. Conclusions A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.

[Leadership and management courses for clinicians].

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Wichelhaus, Daniel; Fischer, Peter

2017-08-01

The aim of the present study was to evaluate the benefit of Leadership and Management Courses for clinicians, specifically which leadership and management contents are beneficial to their daily clinical work and whether these contents support their individual career. E-mail invitations to participate in the study were sent to all 543 medical doctors of the University Hospital Hanover, Germany, who had taken part in one of the leadership and management courses offered between June 2005 and June 2015. The enquiry was carried out between June 1 and June 30, 2015. 84 e-mail addresses were no longer active; and so, N=459 clinicians actually received the invitation. Of these, 104 participated (22.7%). The study included 59 items. Six were free text items, twelve items were closed questions which could be answered by choosing from a drop down menu, and 41 were answered on a Likert scale from 0 (not fitting at all) to 10 (perfect fit). Based on the items answered on a Likert scale, the following scales and mean values were deduced: Job Satisfaction (M=7.44); Leadership (M=7.77); Trust (M=7.22); Striving for Power (M=7,45); negative Affect (M=4,91); Target Achievement Motivation (M=8.19); Communication (M=8.30) and Management (M=6.48). Regression analysis showed that Job- and Team Satisfaction can predict to what extent the participants regard themselves as good leaders. The study participants defined the following topics as very important: leadership and management style, managerial functions, team management, human resources development and project management. Further topics included rhetoric skills, presentation techniques, as well as basic economics such as understanding balance sheets, profit & loss statements and contribution margin calculation. 55% of the course contents were described as being directly applicable to their daily working environment. In the clinicians' view, the ideal leader acts as a role model (passing on values like respect, appreciation, honesty

Improved Palmprint Identification System

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Harshala C. Salave

2015-03-01

Full Text Available Abstract Generally private information is provided by using passwords or Personal Identification Numbers which is easy to implement but it is very easily stolen or forgotten or hack. In Biometrics for individuals identification uses human physiological which are constant throughout life like palm face DNA iris etc. or behavioral characteristicswhich is not constant in life like voice signature keystroke etc.. But mostly gain more attention to palmprint identification and is becoming more popular technique using for identification and promising alternatives to the traditional password or PIN based authentication techniques. In this paper propose palmprint identification using veins on the palm and fingers. Here use fusion of techniques such as Discrete Wavelet transformDWT Canny Edge Detector Gaussian Filter Principle Component AnalysisPCA.

Clinician-patient E-mail communication: challenges for reimbursement.

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Komives, Eugenie M

2005-01-01

Clinicians are rapidly gaining experience with online clinician-patient consultation, and more tools are becoming available to support these efforts. In addition, we now have evidence that using electronic communication is cost-effective to payers and appealing to patients and providers. At present, there appear to be few barriers to the adoption of these solutions for practices that use other online services. Security concerns can easily be overcome by using programs described in this commentary. Larger and longer studies that evaluate the benefits and cost savings in more detail may help convince other payers and providers of the utility of the Web-based programs. More studies are needed to understand the effect of dinician-patient electronic communication on the costs of caring for chronic illness. When these solutions also include support tools, such as electronic prescribing, which could improve patient safety and quality of care, they should be encouraged. In their article entitled, "Electrons in Flight-Email between Doctors and Patients," Delbanco and Sands postulate that the future of e-communication in medicine will be integrated with a patient-controlled health record and will include secure synchronous and asynchronous communication, video conferencing and messaging, instant transcription into the written record, full-patient access to the record, translation into different languages, connectivity to multiple data sources, incorporation of multi-media educational materials. It-will also allow data from home-based diagnostic technology to be sent to clinicians. "Electronic communication will move medicine inexorably toward such transparency, enabling doctors and patients to share knowledge, responsibility, and decision-making more equally. We need to explore rapidly how this change will affect the quality of care for patients and the quality of life for doctors." The widespread dependence on Internet-based electronic communication to support a variety of

A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity.

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Thomas, Tessy A; Thammasitboon, Satid; Balmer, Dorene F; Roy, Kevin; McCullough, Laurence B

2016-07-01

Our study objectives were to explore moral distress among pediatric team clinicians within the context of resuscitation experiences, and determine whether there were any distinctively ethical perspectives on moral distress that could be conceptualized as challenges to professional integrity, rather than to previously described psychological responses of clinicians. Descriptive, exploratory qualitative study. A large tertiary pediatric academic hospital in Houston, TX. Twenty-five PICU resuscitation team clinicians were interviewed from December 2012 to April 2013. None. All clinicians reported experiencing moral distress during certain resuscitations. Twenty-one of 25 clinicians reflected and acknowledged that their sense of professional integrity had been challenged during those resuscitation events. Four main components of resuscitation experience that induced moral distress were identified: 1) experiences where there was lack of understanding of the big picture; 2) experiences where there was suboptimal team leadership; 3) experiences where there was variable meanings to the word "resuscitation"; and 4) experiences were there was uncertainty of role responsibility. The perception of moral distress exists among pediatric clinicians during resuscitations and could be conceptualized as challenges to professional integrity. This ethical framework offers an alternative approach to understanding and investigating the complex layers of moral distress.

Knowledge, Attitude, and Practice of Clinicians Practicing at the Kenyatta National Hospital on Ionizing Radiation

International Nuclear Information System (INIS)

Gecaga, W.

2015-01-01

The Clinicians practicing is to determine the level of knowledge on ionizing radiation (IR) and their attitudes and practice. All the cadres of clinicians faired poorly when it came to estimating the radiation dose when imaging different body parts. There were no statistically significant differences in unnecessary referrals between health workers who reported having trained in IR 33/53 (62.3%) compared those who had not trained in IR 61/109 (56%), chi = 0.58 (df= 1), p = 0.45. The Clinicians lack knowledge on ionizing radiation. There is a significant knowledge gap between the senior clinicians and junior clinicians when it comes to some aspects of ionizing radiation. Health workers with no IR training are less likely to correctly identify all the techniques that use ionizing radiation compared to those with IR training (50.9% versus 27.5%; OR = 0.37, 95% CI 0.18-0.72)

Facets of clinicians' anxiety and the delivery of cognitive behavioral therapy.

Science.gov (United States)

Levita, Liat; Salas Duhne, Paulina Gonzalez; Girling, Carla; Waller, Glenn

2016-02-01

Psychological therapists commonly fail to adhere to treatment protocols in everyday clinical practice. In part, this pattern of drift is attributable to anxious therapists being less likely to undertake some elements of evidence-based therapies - particularly the exposure-based elements. This study considers what facets of anxiety (cognitive, behavioral, physiological) are related to junior clinicians' reported use of cognitive-behavioral therapy techniques. Thirty-two clinicians (mean age = 28.9 years; mean length of CBT experience = 1.5 years; 23 female, nine male) who offered CBT were assessed for their cognitive, behavioral and physiological characteristics (Intolerance of Uncertainty scale; risk taking; skin conductance response and heart rate variability). While the three different facets of anxiety were relatively poorly associated with each other, as is usual in this literature, each facet was linked differently to the reported delivery of CBT techniques (P behavioral or cognitive methods. Of the three facets of anxiety, only physiological reactivity showed an association with the clinicians' temporal characteristics, with more experienced therapists being more likely to have greater skin conductance responses to positive and negative outcomes. These findings suggest that clinicians who are more anxious are less likely to deliver the full evidence-based form of CBT and to focus instead on less challenging elements of the therapy. Potential ways of overcoming this limitation are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

System Identification with Quantized Observations

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Wang, Le Yi; Zhang, Jifeng; Zhao, Yanlong

2010-01-01

This book presents recently developed methodologies that utilize quantized information in system identification and explores their potential in extending control capabilities for systems with limited sensor information or networked systems. The results of these methodologies can be applied to signal processing and control design of communication and computer networks, sensor networks, mobile agents, coordinated data fusion, remote sensing, telemedicine, and other fields in which noise-corrupted quantized data need to be processed. Providing a comprehensive coverage of quantized identification,

Identification of early cancerous lesion of esophagus with endoscopic images by hyperspectral image technique (Conference Presentation)

Science.gov (United States)

Huang, Shih-Wei; Chen, Shih-Hua; Chen, Weichung; Wu, I.-Chen; Wu, Ming Tsang; Kuo, Chie-Tong; Wang, Hsiang-Chen

2016-03-01

This study presents a method to identify early esophageal cancer within endoscope using hyperspectral imaging technology. The research samples are three kinds of endoscopic images including white light endoscopic, chromoendoscopic, and narrow-band endoscopic images with different stages of pathological changes (normal, dysplasia, dysplasia - esophageal cancer, and esophageal cancer). Research is divided into two parts: first, we analysis the reflectance spectra of endoscopic images with different stages to know the spectral responses by pathological changes. Second, we identified early cancerous lesion of esophagus by principal component analysis (PCA) of the reflectance spectra of endoscopic images. The results of this study show that the identification of early cancerous lesion is possible achieve from three kinds of images. In which the spectral characteristics of NBI endoscopy images of a gray area than those without the existence of the problem the first two, and the trend is very clear. Therefore, if simply to reflect differences in the degree of spectral identification, chromoendoscopic images are suitable samples. The best identification of early esophageal cancer is using the NBI endoscopic images. Based on the results, the use of hyperspectral imaging technology in the early endoscopic esophageal cancer lesion image recognition helps clinicians quickly diagnose. We hope for the future to have a relatively large amount of endoscopic image by establishing a hyperspectral imaging database system developed in this study, so the clinician can take this repository more efficiently preliminary diagnosis.

An integrated clinical and genomic information system for cancer precision medicine.

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Jang, Yeongjun; Choi, Taekjin; Kim, Jongho; Park, Jisub; Seo, Jihae; Kim, Sangok; Kwon, Yeajee; Lee, Seungjae; Lee, Sanghyuk

2018-04-20

Increasing affordability of next-generation sequencing (NGS) has created an opportunity for realizing genomically-informed personalized cancer therapy as a path to precision oncology. However, the complex nature of genomic information presents a huge challenge for clinicians in interpreting the patient's genomic alterations and selecting the optimum approved or investigational therapy. An elaborate and practical information system is urgently needed to support clinical decision as well as to test clinical hypotheses quickly. Here, we present an integrated clinical and genomic information system (CGIS) based on NGS data analyses. Major components include modules for handling clinical data, NGS data processing, variant annotation and prioritization, drug-target-pathway analysis, and population cohort explorer. We built a comprehensive knowledgebase of genes, variants, drugs by collecting annotated information from public and in-house resources. Structured reports for molecular pathology are generated using standardized terminology in order to help clinicians interpret genomic variants and utilize them for targeted cancer therapy. We also implemented many features useful for testing hypotheses to develop prognostic markers from mutation and gene expression data. Our CGIS software is an attempt to provide useful information for both clinicians and scientists who want to explore genomic information for precision oncology.

Magnesium 1993 Maternal-Fetal Toxicology. A Clinician's Guide ...

African Journals Online (AJOL)

I S I G I 0 I M I. Maternal-Fetal Toxicology. A Clinician's. Guide. 2nd edition. Ed. by Gideon Koren. Pp. 824 ... analysis is presented, and survival curve ideas for effects over time. Final chapters ... SPSS-PC+, SAS and Nanostat. Several important.

Clinician perceptions of virtual reality to assess and treat returning veterans.

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Kramer, Teresa L; Pyne, Jeffrey M; Kimbrell, Timothy A; Savary, Patricia E; Smith, Jeffrey L; Jegley, Susan M

2010-11-01

Implementation of evidence-based, innovative treatments is necessary to address posttraumatic stress disorder (PTSD) and related mental health problems of Operation Enduring Freedom and Operation Iraqi Freedom (OEF-OIF) military service personnel. The purpose of this study was to characterize mental health clinicians' perceptions of virtual reality as an assessment tool or adjunct to exposure therapy. Focus groups were conducted with 18 prescribing and nonprescribing mental health clinicians within the Veterans Health Administration. Group discussion was digitally recorded, downloaded into Ethnograph software, and coded to arrive at primary, secondary, and tertiary themes. Most frequently mentioned barriers pertained to aspects of virtual reality, followed by veteran characteristics. Organizational barriers were more relevant when implementing virtual reality as a treatment adjunct. Although the study demonstrated that use of virtual reality as a therapy was feasible and acceptable to clinicians, successful implementation of the technology as an assessment and treatment tool will depend on consideration of the facilitators and barriers that were identified.

The relationship between clinician turnover and adolescent treatment outcomes: An examination from the client perspective

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Garner, Bryan R.; Funk, Rodney R.; Hunter, Brooke D.

2012-01-01

The turnover of substance use disorder (SUD) treatment staff has been assumed to adversely impact treatment effectiveness, yet only limited research has empirically examined this assumption. Representing an extension of prior organizational-level analyses of the impact of staff turnover on client outcomes, this study examined the impact of SUD clinician turnover on adolescent treatment outcomes using a client perspective. Multilevel regression analysis did reveal that relative to those adolescents who did not experience clinician turnover, adolescents who experienced both direct and indirect clinician turnover reported a significantly higher percentage of days using alcohol or drugs at 6-month follow-up. However, clinician turnover was not found to have significant associations (negative or positive) with the other five treatment outcomes examined (e.g., substance-related problems, involvement in illegal activity). Thus, consistent with our prior findings, the current study provides additional evidence that turnover of SUD clinicians is not necessarily associated with adverse treatment outcomes. PMID:23083980

Designing a clinical dashboard to fill information gaps in the emergency department.

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Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting.

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Martin, T; Daffern, M

2006-02-01

Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

Science.gov (United States)

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

The presence of radiological features on chest radiographs: How well do clinicians agree?

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Edwards, M. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Lawson, Z. [Department of Child Health, School of Medicine, Cardiff University (United Kingdom); Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Morris, S.; Evans, A.; Harrison, S.; Isaac, R. [Department of Paediatric Radiology, University Hospital of Wales, Cardiff (United Kingdom); Crocker, J. [Department of Primary Care and Public Health, School of Medicine, Cardiff University (United Kingdom); Powell, C., E-mail: powellc7@cardiff.ac.uk [Department of Child Health, School of Medicine, Cardiff University (United Kingdom)

2012-07-15

Aim: To compare levels of agreement amongst paediatric clinicians with those amongst consultant paediatric radiologists when interpreting chest radiographs (CXRs). Materials and methods: Four paediatric radiologists used picture archiving and communication system (PACS) workstations to evaluate the presence of five radiological features of infection, independently in each of 30 CXRs. The radiographs were obtained over 1 year (2008) from children with fever and signs of respiratory distress, aged 6 months to <16 years. The same CXRs were interpreted a second time by the paediatric radiologists and by 21 clinicians with varying experience levels, using the Web 1000 viewing system and a projector. Intra- and interobserver agreement within groups, split by grade and specialty, were analysed using free-marginal multi-rater kappa. Results: Normal CXRs were identified consistently amongst all 25 participants. The four paediatric radiologists showed high levels of intraobserver agreement between methods (kappa scores between 0.53 and 1.00) and interobserver agreement for each method (kappa scores between 0.67 and 0.96 for PACS assessment). The 21 clinicians showed varying levels of agreement from 0.21 to 0.89. Conclusion: Paediatric radiologists showed high levels of agreement for all features. In general, the clinicians had lower levels of agreement than the radiologists. This study highlights the need for improved training in interpreting CXRs for clinicians and the timely reporting of CXRs by radiologists to allow appropriate patient management.

Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya.

Science.gov (United States)

Hooft, Anneka M; Ripp, Kelsey; Ndenga, Bryson; Mutuku, Francis; Vu, David; Baltzell, Kimberly; Masese, Linnet N; Vulule, John; Mukoko, Dunstan; LaBeaud, A Desiree

2017-09-20

Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing

Relationships between radiologists and clinicians: Results from three surveys

International Nuclear Information System (INIS)

Dalla Palma, L.; Stacul, F.; Meduri, S.; Geitung, J. Te.

2000-01-01

AIM: To analyse reasons for and the nature of clinico-radiological contacts and their clinical impact. MATERIALS AND METHODS: Three different surveys were performed. (1) Data concerning contacts between staff radiologists (n = 20) and clinicians during 10 consecutive working days were collected; (2) staff clinicians (n = 174) filled in a questionnaire asking for their opinions about relationships with radiologists; (3) staff radiologists collected data about contacts with clinicians related to more urgent/complicated cases. Radiologists assessed the clinical impact of the radiological procedure and of the consultation. RESULTS: (1) During 220 working days 20 radiologists had a mean of 3.95 contacts per day (48.2% personal contacts, 51.8% telephone contacts), amounting to a personal total of 21.65 min per day. These contacts amounted to a total of 7.08 h per day, roughly one whole-time equivalent radiologist. (2) These consultations helped to refine the diagnostic strategy often (12.6%) or sometimes (71.4%) and to alter therapeutic decisions often (10.4%) or sometimes (56.6%). (3) The initial clinical diagnosis was changed in 50% of cases and the therapy was substantially changed on the basis of further radiological investigations and clinical-radiological discussion in 60% of cases. CONCLUSION: Clinical-radiological consultations are time consuming but have a beneficial diagnostic and therapeutic impact. Dalla Palma, L. (2000)

Identification and management of patients at increased risk of osteoporotic fracture

DEFF Research Database (Denmark)

Kanis, J A; Cooper, C; Rizzoli, R

2017-01-01

where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced. Conclusions......Summary: Osteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target...... appropriate treatment more precisely and cost-effectively, and should be the focus of future research. Introduction: The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture. Methods: A working group convened by the European...

Factors that influence clinicians' assessment and management of family violence.

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Tilden, V P; Schmidt, T A; Limandri, B J; Chiodo, G T; Garland, M J; Loveless, P A

1994-01-01

OBJECTIVES. High rates of family violence and low rates of detection, report, and therapeutic intervention by health professionals are well documented. This study was undertaken to determine what factors influence clinicians' decision making about identifying abuse and intervening with victims. METHODS. Survey data about clinicians' experiences with and attitudes toward family violence were gathered by mailed questionnaire from a random sample of practicing clinicians in six disciplines (n = 1521). RESULTS. Data showed similarities within and wide differences among three groups of subjects: dentists/dental hygienists, nurses/physicians, and psychologists/social workers. Overall, a third of subjects reported having received no educational content on child, spouse, or elder abuse in their professional training programs. Subjects with education on the topic more commonly suspected abuse in their patients than those without; among all subjects, spouse abuse was suspected more often than child abuse while elder abuse was suspected infrequently. Significant numbers of subjects did not view themselves as responsible for dealing with problems of family violence. Subjects indicated low confidence in and low compliance with mandatory reporting laws. CONCLUSIONS. There is a need for educators to expand curricula on family violence and for legislators to reexamine mandatory reporting laws. PMID:8154568

Nature & prevalence of stalking among New Zealand mental health clinicians.

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Hughes, Frances A; Thom, Katey; Dixon, Robyn

2007-04-01

Stalking involves recurrent and persistent unwanted communication or contact that generates fear for safety in the victims. This pilot study evaluated the nature and prevalence of stalking among New Zealand nurses and physicians working in mental health services. An anonymous questionnaire asking respondents to describe their experiences with 12 stalking behaviors was distributed to 895 clinicians. Results indicated that regardless of discipline, women were more likely than men to have experienced one or more stalking behaviors, including receiving unwanted telephone calls, letters, and approaches; receiving personal threats: and being followed, spied on, or subject to surveillance. Women also reported higher levels of fearfulness as a consequence of stalking behaviors. Nearly half of the stalkers were clients; the remaining were former partners, colleagues, or acquaintances. In client-related cases, the majority of respondents told their colleagues and supervisors first, and the majority found them to be the most helpful resource. The results of this pilot study indicate a need for further research focused on the stalking of mental health clinicians in New Zealand and for development of workplace policies for adequate response to the stalking of mental health clinicians.

What information on measurement uncertainty should be communicated to clinicians, and how?

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Plebani, Mario; Sciacovelli, Laura; Bernardi, Daniela; Aita, Ada; Antonelli, Giorgia; Padoan, Andrea

2018-02-02

The communication of laboratory results to physicians and the quality of reports represent fundamental requirements of the post-analytical phase in order to assure the right interpretation and utilization of laboratory information. Accordingly, the International Standard for clinical laboratories accreditation (ISO 15189) requires that "laboratory reports shall include the information necessary for the interpretation of the examination results". Measurement uncertainty (MU) is an inherent property of any quantitative measurement result which express the lack of knowledge of the true value and quantify the uncertainty of a result, incorporating the factors known to influence it. Even if the MU is not included in the report attributes of ISO 15189 and cannot be considered a post-analytical requirement, it is suggested as an information which should facilitate an appropriate interpretation of quantitative results (quantity values). Therefore, MU has two intended uses: for laboratory professionals, it gives information about the quality of measurements, providing evidence of the compliance with analytical performance characteristics; for physicians (and patients) it may help in interpretation of measurement results, especially when values are compared with reference intervals or clinical decision limits, providing objective information. Here we describe the way that MU should be added to laboratory reports in order to facilitate the interpretation of laboratory results and connecting efforts performed within laboratory to provide more accurate and reliable results with a more objective tool for their interpretation by physicians. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

New Methodology for Known Metabolite Identification in Metabonomics/Metabolomics: Topological Metabolite Identification Carbon Efficiency (tMICE).

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Sanchon-Lopez, Beatriz; Everett, Jeremy R

2016-09-02

A new, simple-to-implement and quantitative approach to assessing the confidence in NMR-based identification of known metabolites is introduced. The approach is based on a topological analysis of metabolite identification information available from NMR spectroscopy studies and is a development of the metabolite identification carbon efficiency (MICE) method. New topological metabolite identification indices are introduced, analyzed, and proposed for general use, including topological metabolite identification carbon efficiency (tMICE). Because known metabolite identification is one of the key bottlenecks in either NMR-spectroscopy- or mass spectrometry-based metabonomics/metabolomics studies, and given the fact that there is no current consensus on how to assess metabolite identification confidence, it is hoped that these new approaches and the topological indices will find utility.

An organizational assessment of disruptive clinician behavior: findings and implications.

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Walrath, Jo M; Dang, Deborah; Nyberg, Dorothy

2013-01-01

This study investigated registered nurses' (RNs) and physicians' (MD) experiences with disruptive behavior, triggers, responses, and impacts on clinicians, patients, and the organization. Using the Disruptive Clinician Behavior Survey for Hospital Settings, it was found that RNs experienced a significantly higher frequency of disruptive behaviors and triggers than MDs; MDs (45% of 295) and RNs (37% of 689) reported that their peer's disruptive behavior affected them most negatively. The most frequently occurring trigger was pressure from high census, volume, and patient flow; 189 incidences of harm to patients as a result of disruptive behavior were reported. Findings provide organizational leaders with evidence to customize interventions to strengthen the culture of safety.

Quality and quantity of information in summary basis of decision documents issued by health Canada.

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Habibi, Roojin; Lexchin, Joel

2014-01-01

Health Canada's Summary Basis of Decision (SBD) documents outline the clinical trial information that was considered in approving a new drug. We examined the ability of SBDs to inform clinician decision-making. We asked if SBDs answered three questions that clinicians might have prior to prescribing a new drug: 1) Do the characteristics of patients enrolled in trials match those of patients in their practice? 2) What are the details concerning the drug's risks and benefits? 3) What are the basic characteristics of trials? 14 items of clinical trial information were identified from all SBDs published on or before April 2012. Each item received a score of 2 (present), 1 (unclear) or 0 (absent). The unit of analysis was the individual SBD, and an overall SBD score was derived based on the sum of points for each item. Scores were expressed as a percentage of the maximum possible points, and then classified into five descriptive categories based on that score. Additionally, three overall 'component' scores were tallied for each SBD: "patient characteristics", "benefit/risk information" and "basic trial characteristics". 161 documents, spanning 456 trials, were analyzed. The majority (126/161) were rated as having information sometimes present (score of >33 to 66%). No SBDs had either no information on any item, or 100% of the information. Items in the patient characteristics component scored poorest (mean component score of 40.4%), while items corresponding to basic trial information were most frequently provided (mean component score of 71%). The significant omissions in the level of clinical trial information in SBDs provide little to aid clinicians in their decision-making. Clinicians' preferred source of information is scientific knowledge, but in Canada, access to such information is limited. Consequently, we believe that clinicians are being denied crucial tools for decision-making.

Concepts, Utility and Limitations of Cord Blood Banking: What Clinicians Need to Know.

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Narayanan, Dhanya Lakshmi; Phadke, Shubha R

2018-03-20

Stem cell transplantation and cord blood banking have received much popularity among general public and medical professionals in the recent past. But information about the scientific aspects, its utility and limitations is incomplete amongst laypersons as well as many medical practitioners. Stem cells differ from all other types of cells in the human body because of their ability to multiply in order to self perpetuate and differentiate into specialized cells. Stems cells could be totipotent, multipotent, pluripotent, oligopotent or unipotent depending on the type of cells that can arise or differentiate from them. Umbilical cord blood serves as a potent source of hematopoeitic stem cells and is being used to treat various disorders like blood cancers, hemoglobinopathies and immunodeficiency disorders for which hematological stem cell transplantation is the standard of care. Cord blood can be collected at ease, without any major complications and has a lower incidence of graft vs. host reaction compared to bone marrow cells or peripheral blood cells. Both public and private banks have been established for collection and storage of umbilical cord blood. However, false claims and misleading commercial advertisements about the use of umbilical cord blood stem cells for the treatment of a variety of conditions ranging from neuromuscular disorders to cosmetic benefits are widespread and create unrealistic expectations in laypersons and clinicians. Many clinicians and laypersons are unaware of the limitations of cord blood banking, as in treating a genetic disorder by autologous cord blood transplant. Knowledge and awareness about the scientific indications of cord blood stem cell transplantation and realistic expectations about the utility of cord blood among medical practitioners are essential for providing accurate information to laypersons before they decide to preserve umbilical cord blood in private banks and thus prevent malpractice.

Clinician's gaze behaviour in simulated paediatric emergencies.

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McNaughten, Ben; Hart, Caroline; Gallagher, Stephen; Junk, Carol; Coulter, Patricia; Thompson, Andrew; Bourke, Thomas

2018-03-07

Differences in the gaze behaviour of experts and novices are described in aviation and surgery. This study sought to describe the gaze behaviour of clinicians from different training backgrounds during a simulated paediatric emergency. Clinicians from four clinical areas undertook a simulated emergency. Participants wore SMI (SensoMotoric Instruments) eye tracking glasses. We measured the fixation count and dwell time on predefined areas of interest and the time taken to key clinical interventions. Paediatric intensive care unit (PICU) consultants performed best and focused longer on the chest and airway. Paediatric consultants and trainees spent longer looking at the defibrillator and algorithm (51 180 ms and 50 551 ms, respectively) than the PICU and paediatric emergency medicine consultants. This study is the first to describe differences in the gaze behaviour between experts and novices in a resuscitation. They mirror those described in aviation and surgery. Further research is needed to evaluate the potential use of eye tracking as an educational tool. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Systematic Review of Radiation Therapy Toxicity Reporting in Randomized Controlled Trials of Rectal Cancer: A Comparison of Patient-Reported Outcomes and Clinician Toxicity Reporting

Energy Technology Data Exchange (ETDEWEB)

Gilbert, Alexandra, E-mail: a.gilbert@leeds.ac.uk [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom); Ziegler, Lucy; Martland, Maisie [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom); Davidson, Susan [The Christie Hospital, Manchester (United Kingdom); Efficace, Fabio [Italian Group for Adult Hematologic Diseases, Rome (Italy); Sebag-Montefiore, David; Velikova, Galina [Leeds Institute of Cancer & Pathology, University of Leeds, Leeds (United Kingdom)

2015-07-01

The use of multimodal treatments for rectal cancer has improved cancer-related outcomes but makes monitoring toxicity challenging. Optimizing future radiation therapy regimens requires collection and publication of detailed toxicity data. This review evaluated the quality of toxicity information provided in randomized controlled trials (RCTs) of radiation therapy in rectal cancer and focused on the difference between clinician-reported and patient-reported toxicity. Medline, EMBASE, and the Cochrane Library were searched (January 1995-July 2013) for RCTs reporting late toxicity in patients treated with regimens including preoperative (chemo)radiation therapy. Data on toxicity measures and information on toxicity reported were extracted using Quantitative Analyses of Normal Tissue Effects in the Clinic recommendations. International Society for Quality of Life Research standards on patient-reported outcomes (PROs) were used to evaluate the quality of patient-reported toxicity. Twenty-one RCT publications met inclusion criteria out of 4144 articles screened. All PRO studies reported higher rates of toxicity symptoms than clinician-reported studies and reported on a wider range and milder symptoms. No clinician-reported study published data on sexual dysfunction. Of the clinician-reported studies, 55% grouped toxicity data related to an organ system together (eg “Bowel”), and 45% presented data only on more-severe (grade ≥3) toxicity. In comparison, all toxicity grades were reported in 79% of PRO publications, and all studies (100%) presented individual symptom toxicity data (eg bowel urgency). However, PRO reporting quality was variable. Only 43% of PRO studies presented baseline data, 28% did not use any psychometrically validated instruments, and only 29% of studies described statistical methods for managing missing data. Analysis of these trials highlights the lack of reporting standards for adverse events and reveals the differences between clinician and

Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors.

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Back, Anthony L; Steinhauser, Karen E; Kamal, Arif H; Jackson, Vicki A

2016-08-01

For palliative care (PC) clinicians, the work of caring for patients with serious illness can put their own well-being at risk. What they often do not learn in training, because of the relative paucity of evidence-based programs, are practical ways to mitigate this risk. Because a new study indicates that burnout in PC clinicians is increasing, we sought to design an acceptable, scalable, and testable intervention tailored to the needs of PC clinicians. In this article, we describe our paradigm for approaching clinician resilience, our conceptual model, and curriculum for a workplace resilience intervention for hospital-based PC teams. Our paradigm for approaching resilience is based on upstream, early intervention. Our conceptual model posits that clinician well-being is influenced by personal resources and work demands. Our curriculum for increasing clinician resilience is based on training in eight resilience skills that are useful for common challenges faced by clinicians. To address workplace issues, our intervention also includes material for the team leader and a clinician perception survey of work demands and workplace engagement factors. The intervention will focus on individual skill building and will be evaluated with measures of resilience, coping, and affect. For PC clinicians, resilience skills are likely as important as communication skills and symptom management as foundations of expertise. Future work to strengthen clinician resilience will likely need to address system issues more directly. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Mathematical model of statistical identification of information support of road transport

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V. G. Kozlov

2016-01-01

Full Text Available In this paper based on the statistical identification method using the theory of self-organizing systems, built multifactor model the relationship of road transport and training system. Background information for the model represented by a number of parameters of average annual road transport operations and information provision, including training complex system parameters (inputs, road management and output parameters. Ask two criteria: stability criterion model and test correlation. The program determines their minimum, and is the only model of optimal complexity. The predetermined number of parameters established mathematical relationship of each output parameter with the others. To improve the accuracy and regularity of the forecast of the interpolation nodes allocated in the test data sequence. Other data form the training sequence. Decision model based on the principle of selection. Running it with the gradual complication of the mathematical description and exhaustive search of all possible variants of the models on the specified criteria. Advantages of the proposed model: adequately reflects the actual process, allows you to enter any additional input parameters and determine their impact on the individual output parameters of the road transport, allows in turn change the values of key parameters in a certain ratio and to determine the appropriate changes the output parameters of the road transport, allows to predict the output parameters road transport operations.

Barriers and strategies for improving communication between inpatient and outpatient mental health clinicians.

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Stockdale, Susan E; Sherin, Jonathan E; Chan, Jeffrey A; Hermann, Richard C

2011-11-01

To explore hospital leaders' perceptions of organisational factors as barriers and/or facilitators in improving inpatient-outpatient (IP-OP) communication. Semistructured in-person interviews. Constant comparative method of qualitative data. Inpatient psychiatry units in 33 general medical/surgical and specialty psychiatric hospitals in California and Massachusetts (USA). Psychiatry chair/chief, service director or medical director. Importance to leadership, resources, organisational structure and culture. A majority of hospital leaders rated the IP-OP communication objective as highly or moderately important. Hospitals with good IP-OP communication had structures in place to support communication or had changed/implemented new procedures to enhance communication, and anticipated clinicians would 'buy in' to the goal of improved communication. Hospitals reporting no improvement efforts were less likely to have structures supporting IP-OP communication, anticipated resistance among clinicians and reported a need for technological resources such as electronic health records, integrated IT and secure online communication. Most leaders reported a need for additional staff time and information, knowledge or data. For many hospitals, successfully improving communication will require overcoming organisational barriers such as cultures not conducive to change and lack of resources and infrastructure. Creating a culture that values communication at discharge may help improve outcomes following hospitalisation, but changes in healthcare delivery in the past few decades may necessitate new strategies or changes at the systems level to address barriers to effective communication.

Educational Strategies to Enhance Reflexivity Among Clinicians and Health Professional Students: A Scoping Study

Directory of Open Access Journals (Sweden)

Rachel Landy

2016-09-01

Full Text Available Reflexivity involves the ability to understand how one's social locations and experiences of advantage or disadvantage have shaped the way one understands the world. The capacity for reflexivity is crucial because it informs clinical decisions, which can lead to improvements in service delivery and patient outcomes. In this article, we present a scoping study that explored educational strategies designed to enhance reflexivity among clinicians and/or health profession students. We reviewed articles and grey literature that address the question: What is known about strategies for enhancing reflexivity among clinicians and students in health professional training programs? We searched multiple databases using keywords including: reflexivity, reflective, allied health professionals, pedagogy, learning, and education. The search strategy was iterative and involved three reviews. Each abstract was independently reviewed by two team members. Sixty-eight texts met the inclusion criteria. There was great diversity among the educational strategies and among health professions. Commonalities across strategies were identified related to reflective writing, experiential learning, classroom-based activities, continuing education, and online learning. We also summarize the 19 texts that evaluated educational strategies to enhance reflexivity. Further research and education is urgently needed for more equitable and socially-just health care. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1603140

A teachable moment communication process for smoking cessation talk: description of a group randomized clinician-focused intervention

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Flocke Susan A

2012-05-01

Full Text Available Abstract Background Effective clinician-patient communication about health behavior change is one of the most important and most overlooked strategies to promote health and prevent disease. Existing guidelines for specific health behavior counseling have been created and promulgated, but not successfully adopted in primary care practice. Building on work focused on creating effective clinician strategies for prompting health behavior change in the primary care setting, we developed an intervention intended to enhance clinician communication skills to create and act on teachable moments for smoking cessation. In this manuscript, we describe the development and implementation of the Teachable Moment Communication Process (TMCP intervention and the baseline characteristics of a group randomized trial designed to evaluate its effectiveness. Methods/Design This group randomized trial includes thirty-one community-based primary care clinicians practicing in Northeast Ohio and 840 of their adult patients. Clinicians were randomly assigned to receive either the Teachable Moments Communication Process (TMCP intervention for smoking cessation, or the delayed intervention. The TMCP intervention consisted of two, 3-hour educational training sessions including didactic presentation, skill demonstration through video examples, skills practices with standardized patients, and feedback from peers and the trainers. For each clinician enrolled, 12 patients were recruited for two time points. Pre- and post-intervention data from the clinicians, patients and audio-recorded clinician‒patient interactions were collected. At baseline, the two groups of clinicians and their patients were similar with regard to all demographic and practice characteristics examined. Both physician and patient recruitment goals were met, and retention was 96% and 94% respectively. Discussion Findings support the feasibility of training clinicians to use the Teachable Moments

Strategies for research engagement of clinicians in allied health (STRETCH): a mixed methods research protocol.

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Mickan, Sharon; Wenke, Rachel; Weir, Kelly; Bialocerkowski, Andrea; Noble, Christy

2017-09-11

Allied health professionals (AHPs) report positive attitudes to using research evidence in clinical practice, yet often lack time, confidence and skills to use, participate in and conduct research. A range of multifaceted strategies including education, mentoring and guidance have been implemented to increase AHPs' use of and participation in research. Emerging evidence suggests that knowledge brokering activities have the potential to support research engagement, but it is not clear which knowledge brokering strategies are most effective and in what contexts they work best to support and maintain clinicians' research engagement. This protocol describes an exploratory concurrent mixed methods study that is designed to understand how allied health research fellows use knowledge brokering strategies within tailored evidence-based interventions, to facilitate research engagement by allied health clinicians. Simultaneously, a realist approach will guide a systematic process evaluation of the research fellows' pattern of use of knowledge brokering strategies within each case study to build a programme theory explaining which knowledge brokering strategies work best, in what contexts and why. Learning and behavioural theories will inform this critical explanation. An explanation of how locally tailored evidence-based interventions improve AHPs use of, participation in and leadership of research projects will be summarised and shared with all participating clinicians and within each case study. It is expected that local recommendations will be developed and shared with medical and nursing professionals in and beyond the health service, to facilitate building research capacity in a systematic and effective way. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mothers' and Clinicians' Priorities for Obesity Prevention Among Black, High-Risk Infants.

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Virudachalam, Senbagam; Gruver, Rachel S; Gerdes, Marsha; Power, Thomas J; Magge, Sheela N; Shults, Justine; Faerber, Jennifer A; Kalra, Gurpreet K; Bishop-Gilyard, Chanelle T; Suh, Andrew W; Berkowitz, Robert I; Fiks, Alexander G

2016-07-01

Despite many recommended strategies for obesity prevention during infancy, effectively delivering recommendations to parents in clinical settings is challenging, especially among high-risk populations. This study describes and compares mothers' and clinicians' priorities for obesity prevention during infancy, to facilitate more-effective obesity prevention messaging. A discrete choice experiment using maximum difference scaling was administered in 2013 and analyzed in 2013-2014. Twenty-nine low-income, obese mothers of infants and 30 pediatric clinicians from three urban primary care practices rated the relative importance of 16 items relevant to obesity prevention during infancy, in response to this question: Which topic would be most helpful [for new mothers] to learn about to prevent your [their] child from becoming overweight? Response options encompassed the domains of feeding, sleep, parenting (including physical activity and screen time), and maternal self-care. Mothers (all Medicaid-enrolled and black; mean age, 27 years; mean BMI, 35 kg/m(2)) and clinicians (97% female, 87% pediatricians, 13% nurse practitioners) both highly prioritized recognizing infant satiety and hunger cues, and appropriate feeding volume. Mothers rated infant physical activity and maintaining regular routines as 3.5 times more important than clinicians did (presponsive to these priorities. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Clinicians' perceptions of usefulness of the PubMed4Hh mobile device application for clinical decision making at the point of care: a pilot study.

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Gartrell, Kyungsook; Brennan, Caitlin W; Wallen, Gwenyth R; Liu, Fang; Smith, Karen G; Fontelo, Paul

2018-05-08

Although evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians' decision making at the point of care. Three iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.). Of the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts' usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or

Accuracy of Parent Identification of Stuttering Occurrence

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Einarsdottir, Johanna; Ingham, Roger

2009-01-01

Background: Clinicians rely on parents to provide information regarding the onset and development of stuttering in their own children. The accuracy and reliability of their judgments of stuttering is therefore important and is not well researched. Aim: To investigate the accuracy of parent judgements of stuttering in their own children's speech…

User-composable Electronic Health Record Improves Efficiency of Clinician Data Viewing for Patient Case Appraisal: A Mixed-Methods Study.

Science.gov (United States)

Senathirajah, Yalini; Kaufman, David; Bakken, Suzanne

2016-01-01

Challenges in the design of electronic health records (EHRs) include designing usable systems that must meet the complex, rapidly changing, and high-stakes information needs of clinicians. The ability to move and assemble elements together on the same page has significant human-computer interaction (HCI) and efficiency advantages, and can mitigate the problems of negotiating multiple fixed screens and the associated cognitive burdens. We compare MedWISE-a novel EHR that supports user-composable displays-with a conventional EHR in terms of the number of repeat views of data elements for patient case appraisal. The study used mixed-methods for examination of clinical data viewing in four patient cases. The study compared use of an experimental user-composable EHR with use of a conventional EHR, for case appraisal. Eleven clinicians used a user-composable EHR in a case appraisal task in the laboratory setting. This was compared with log file analysis of the same patient cases in the conventional EHR. We investigated the number of repeat views of the same clinical information during a session and across these two contexts, and compared them using Fisher's exact test. There was a significant difference (puser-composable EHR (14.6 percent) and conventional EHR (72.6 percent). Users of conventional EHRs repeatedly viewed the same information elements in the same session, as revealed by log files. Our findings are consistent with the hypothesis that conventional systems require that the user view many screens and remember information between screens, causing the user to forget information and to have to access the information a second time. Other mechanisms (such as reduction in navigation over a population of users due to interface sharing, and information selection) may also contribute to increased efficiency in the experimental system. Systems that allow a composable approach that enables the user to gather together on the same screen any desired information elements

Roles for Information professionals in patient education: Librarians' perspective

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Susan L. MacDonald

2010-07-01

Full Text Available Through an examination of librarians’ contributions to the PEPTalk research project, this article highlights roles for information professionals at various stages in the design and clinical implementation of an information system that delivers patient education. The Personal Education Plan (PEPTalk was a collaborative, multi-disciplinary research project (2005-2006 based at the University Health Network’s Princess Margaret Hospital that designed an information system to provide web-based health information resources to both patients and clinicians under a shared umbrella of patient education. This article provides an overview of the PEPTalk project methods and outcomes, and documents the contributions of librarians throughout the design and clinical implementation stages of the project. Librarians brought expertise about information seeking behaviours of both patients and clinicians to the project; liaised across institutional and professional boundaries; developed a classification system for online learning objects, and educated project team about information and health literacies. The contributions of librarians on the PEPTalk project illustrate the need for boundary spanners, information brokers, knowledge translators, and change champions in the design and implementation of patient education delivery systems. There are new roles emergent at the intersections of clinical practice and health information provision. There is a need for the traditional skills and expertise of librarians and other information professionals in tailoring health information. Yet the design and implementation of patient education systems also require the development of new skills and the application of advanced information literacy as it pertains to both clinicians and patients.

Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians.

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Nappi, Rossella E; Kaunitz, Andrew M; Bitzer, Johannes

2016-01-01

The clinical utility of extended regimen combined oral contraceptives (COCs) is increasingly being recognised. Our objective was to understand the attitudes of women and clinicians about the use of these regimens. We present the rationale for extended regimen COCs from a historical perspective, and trace their evolution and growing popularity in light of their clinical benefits. We conclude by offering potential strategies for counselling women about extended regimen COC options. We conducted a MEDLINE search to identify and summarise studies of extended regimen COCs, focusing on attitudes of women and clinicians regarding efficacy, safety/tolerability and fewer scheduled bleeding episodes and other potential benefits. The body of contemporary literature on extended regimen COCs suggests that their contraceptive efficacy is comparable to that of conventional 28-day (i.e., 21/7) regimens. For women seeking contraception that allows infrequent scheduled bleeding episodes, particularly those who suffer from hormone withdrawal symptoms and cyclical symptoms (e.g., headache, mood changes, dysmenorrhoea, heavy menstrual bleeding), extended regimen COCs are an effective and safe option. Although satisfaction with extended regimen COCs in clinical trials is high, misperceptions about continuous hormone use may still limit the widespread acceptance of this approach. Despite the widespread acceptance among clinicians of extended regimen COCs as an effective and safe contraceptive option, these regimens are underused, likely due to a lack of awareness about their availability and utility among women. Improved patient education and counselling regarding the safety and benefits of extended regimen COCs may help women make more informed contraceptive choices.

Factors involved in the identification of stuttering severity in a foreign language.

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Cosyns, Marjan; Einarsdóttir, Jóhanna T; Van Borsel, John

2015-01-01

Speech-language pathologists nowadays are more and more confronted with clients who speak a language different from their own mother tongue. The assessment of persons who speak a foreign language poses particular challenges. The present study investigated the possible role and interplay of factors involved in the identification of stuttering severity in a foreign language. Nineteen speech-language pathologists from five different countries (i.e. Iceland, Sweden, Norway, Finland, and Belgium) rated stuttering severity of speech samples featuring persons who stutter speaking Icelandic, Swedish, Norwegian, or Dutch. Additionally, they were asked to score how easy they found it to rate the samples. Accuracy of rating stuttering severity in another language appeared to be foremost determined by the client's stuttering severity, while experienced ease of rating stuttering severity was essentially related to closeness of the language of the clinician to that of the client and familiarity of the clinician with the client's language. Stuttering measurement training programmes in different languages are needed.

CHEST: Home of the Clinician-Educator.

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Kelly, William F; Niven, Alexander S

2018-03-01

Many hands can build a house; it takes trust to make that house a home. Trust has two main components: credibility (worthiness based on preparation and past performance) and empathy (the ability to understand and share another person's values). CHEST has maintained its credibility and empathy as the global leader in clinical pulmonary, critical care, and sleep medical education. It follows that the leader in chest clinical education would also be the home of the clinician-educator. You are that educator. Published by Elsevier Inc.

The laboratory information float, time-based competition, and point-of-care testing.

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Friedman, B A

1994-01-01

A new term, the laboratory information float, should be substituted for turnaround-time when evaluating the performance of the clinical laboratory because it includes the time necessary to make test results both available (ready to use) and accessible (easy to use) to clinicians ordering tests. The laboratory information float can be greatly reduced simply by telescoping the analytic phase of laboratory testing into the preanalytic phase. Significant costs are incurred by such a change, some of which can be reduced by developing a mobile clinical laboratory (sometimes referred to as a "lab-on-a-slab" or "rolling thunder") to transport the analytic devices directly to patient care units. The mobile clinical laboratory should be equipped with an integrated personal computer that can communicate continuously with the host laboratory information system and achieve some semblance of continuous flow processing despite test performance in point-of-care venues. Equipping clinicians with palmtop computers will allow the mobile clinician to access test results and order tests on the run. Such devices can be easily configured to operate in a passive mode, accessing relevant information automatically instead of forcing clinicians to query the laboratory information system periodically for the test results necessary to render care to their patients. The laboratory information float of the year 2,000 will surely be measured in minutes through the judicious deployment of relevant technology such as mobile clinical laboratories and palmtop computers.

Human babesiosis in Europe: what clinicians need to know.

Science.gov (United States)

Hildebrandt, A; Gray, J S; Hunfeld, K-P

2013-12-01

Although best known as an animal disease, human babesiosis is attracting increasing attention as a worldwide emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways of transmission are transplacental, perinatal and transfusion-associated. Infection of the human host can cause a very severe host-mediated pathology including fever, and hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure. In recent years, apparently owing to increased medical awareness and better diagnostic methods, the number of reported cases in humans is rising steadily worldwide. Hitherto unknown zoonotic Babesia spp. are now being reported from geographic areas where babesiosis was not previously known to occur and the growing numbers of travelers and immunocompromised individuals suggest that the frequency of cases in Europe will also continue to rise. Our review is intended to provide clinicians with practical information on the clinical management of this rare, but potentially life-threatening zoonotic disease. It covers epidemiology, phylogeny, diagnostics and treatment of human babesiosis and the potential risk of transfusion-transmitted disease with a special focus on the European situation.

Cultivating Future Radiology Educators: Development and Implementation of a Clinician-Educator Track for Residents.

Science.gov (United States)

Mendoza, Dexter; Peterson, Ryan; Ho, Christopher; Harri, Peter; Baumgarten, Deborah; Mullins, Mark E

2018-05-03

Effective and dedicated educators are critical to the preservation and advancement of the practice of radiology. The need for innovative and adaptable educators is increasingly being recognized, with several institutions granting academic promotions through clinician-educator tracks. The implementation of resident "clinician-educator tracks" or "teaching tracks" should better prepare residents aspiring to become academic radiologists focused on teaching. In this work, we describe our experience in the development and implementation of a clinician-educator track for diagnostic radiology residents at our institution. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

User-Centered Design for Developing Interventions to Improve Clinician Recommendation of Human Papillomavirus Vaccination.

Science.gov (United States)

Henninger, Michelle L; Mcmullen, Carmit K; Firemark, Alison J; Naleway, Allison L; Henrikson, Nora B; Turcotte, Joseph A

2017-01-01

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and is associated with multiple types of cancer. Although effective HPV vaccines have been available since 2006, coverage rates in the US remain much lower than with other adolescent vaccinations. Prior research has shown that a strong recommendation from a clinician is a critical determinant in HPV vaccine uptake and coverage. However, few published studies to date have specifically addressed the issue of helping clinicians communicate more effectively with their patients about the HPV vaccine. To develop one or more novel interventions for helping clinicians make strong and effective recommendations for HPV vaccination. Using principles of user-centered design, we conducted qualitative interviews, interviews with persons from analogous industries, and a data synthesis workshop with multiple stakeholders. Five potential intervention strategies targeted at health care clinicians, youth, and their parents were developed. The two most popular choices to pursue were a values-based communication strategy and a puberty education workbook. User-centered design is a useful strategy for developing potential interventions to improve the rate and success of clinicians recommending the HPV vaccine. Further research is needed to test the effectiveness and acceptability of these interventions in clinical settings.

The RCP Information Laboratory (iLab): breaking the cycle of poor data quality.

Science.gov (United States)

Croft, Giles P; Williams, John G

2005-01-01

A review of data quality in the NHS by the Audit Commission cited a lack of clinician involvement in the validation and use of centrally held activity data as one of the key issues to resolve. The perception that hospital episode statistics cannot support the needs of the individual clinician results in mistrust and disinterest. This in turn leads to under-development of such data from a clinical perspective, and the cycle continues. The RCP Information Laboratory (iLab) aims to address this problem by accessing, analysing and presenting information from these central repositories concerning the activity of visiting individual consultant physicians. With support from iLab staff--an information analyst and a clinician--local data quality issues are highlighted and local solutions sought. The information obtained can be used as an objective measure of activity to support the processes of appraisal and revalidation.

Identification of computer graphics objects

Directory of Open Access Journals (Sweden)

Rossinskyi Yu.M.

2016-04-01

Full Text Available The article is devoted to the use of computer graphics methods in problems of creating drawings, charts, drafting, etc. The widespread use of these methods requires the development of efficient algorithms for the identification of objects of drawings. The article analyzes the model-making algorithms for this problem and considered the possibility of reducing the time using graphics editing operations. Editing results in such operations as copying, moving and deleting objects specified images. These operations allow the use of a reliable identification of images of objects methods. For information on the composition of the image of the object along with information about the identity and the color should include information about the spatial location and other characteristics of the object (the thickness and style of contour lines, fill style, and so on. In order to enable the pixel image analysis to structure the information it is necessary to enable the initial code image objects color. The article shows the results of the implementation of the algorithm of encoding object identifiers. To simplify the process of building drawings of any kind, and reduce time-consuming, method of drawing objects identification is proposed based on the use as the ID information of the object color.

Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study).

Science.gov (United States)

Griffiths, Frances; Bryce, Carol; Cave, Jonathan; Dritsaki, Melina; Fraser, Joseph; Hamilton, Kathryn; Huxley, Caroline; Ignatowicz, Agnieszka; Kim, Sung Wook; Kimani, Peter K; Madan, Jason; Slowther, Anne-Marie; Sujan, Mark; Sturt, Jackie

2017-04-10

Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can

How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care.

Science.gov (United States)

Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W

2017-11-04

Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

Conflicts in the ICU: perspectives of administrators and clinicians.

Science.gov (United States)

Danjoux Meth, Nathalie; Lawless, Bernard; Hawryluck, Laura

2009-12-01

The purpose of this study is to understand conflicts in the ICU setting as experienced by clinicians and administrators and explore methods currently used to resolve such conflicts when there may be discordance between clinicians and families, caregivers or administration. Qualitative case study methodology using semi-structured interviews was used. The sample included community and academic health science centres in 16 hospitals from across the province of Ontario, Canada. A total of 42 participants including hospital administrators and ICU clinicians were interviewed. Participants were sampled purposively to ensure representation. The most common source of conflict in the ICU is a result of disagreement about the goals of treatment. Such conflicts arise between the ICU and referring teams (inter-team), among members of the ICU team (intra-team), and between the ICU team and patients' family/substitute decision-maker (SDM). Inter- and intra-team conflicts often contribute to conflicts between the ICU team and families. Various themes were identified as contributing factors that may influence conflict resolution practices as well as the various consequences and challenges of conflict situations. Limitations of current conflict resolution policies were revealed as well as suggested strategies to improve practice. There is considerable variability in dealing with conflicts in the ICU. Greater attention is needed at a systems level to support a culture aimed at prevention and resolution of conflicts to avoid increased sources of anxiety, stress and burnout.

Clinicians' Judgments of the Clinical Utility of Personality Disorder Trait Descriptions.

Science.gov (United States)

Crego, Cristina; Sleep, Chelsea E; Widiger, Thomas A

2016-01-01

Proposed for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was a five-domain, 25-dimensional trait model that would have constituted a significant part of the diagnostic criteria for each personality disorder. A primary concern with respect to the proposal was that clinicians might find such an approach to be unacceptable. This study provides results from three independent data collections that compared clinicians' clinical utility ratings for each iteration of the DSM-5 dimensional trait assignments, along with an alternative list of traits derived from the Five Factor Form (FFF). The clinicians considered the final trait assignments that were posted for the avoidant, narcissistic, obsessive-compulsive, and schizoid personality disorders to be significantly less acceptable than the original assignments. They also considered the FFF trait assignments to be preferable to the DSM-5 final postings with respect to the avoidant, narcissistic, obsessive-compulsive, dependent, and histrionic personality disorders. The implications of these results for future editions of the diagnostic manual are discussed.

Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance.

Science.gov (United States)

Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

2010-06-03

Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (ptechnician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for GAD. This form of treatment has potential to increase the

Biofilms and Wounds: An Identification Algorithm and Potential Treatment Options

Science.gov (United States)

Percival, Steven L.; Vuotto, Claudia; Donelli, Gianfranco; Lipsky, Benjamin A.

2015-01-01

Significance: The presence of a “pathogenic” or “highly virulent” biofilm is a fundamental risk factor that prevents a chronic wound from healing and increases the risk of the wound becoming clinically infected. There is presently no unequivocal gold standard method available for clinicians to confirm the presence of biofilms in a wound. Thus, to help support clinician practice, we devised an algorithm intended to demonstrate evidence of the presence of a biofilm in a wound to assist with wound management. Recent Advances: A variety of histological and microscopic methods applied to tissue biopsies are currently the most informative techniques available for demonstrating the presence of generic (not classified as pathogenic or commensal) biofilms and the effect they are having in promoting inflammation and downregulating cellular functions. Critical Issues: Even as we rely on microscopic techniques to visualize biofilms, they are entities which are patchy and dispersed rather than confluent, particularly on biotic surfaces. Consequently, detection of biofilms by microscopic techniques alone can lead to frequent false-negative results. Furthermore, visual identification using the naked eye of a pathogenic biofilm on a macroscopic level on the wound will not be possible, unlike with biofilms on abiotic surfaces. Future Direction: Lacking specific biomarkers to demonstrate microscopic, nonconfluent, virulent biofilms in wounds, the present focus on biofilm research should be placed on changing clinical practice. This is best done by utilizing an anti-biofilm toolbox approach, rather than speculating on unscientific approaches to identifying biofilms, with or without staining, in wounds with the naked eye. The approach to controlling biofilm should include initial wound cleansing, periodic debridement, followed by the application of appropriate antimicrobial wound dressings. This approach appears to be effective in removing pathogenic biofilms. PMID:26155381

Accuracy of Clinicians in Predicting the Bacterial Cause of Clinical Bovine Mastitis

OpenAIRE

White, Maurice E.; Glickman, Lawrence T.; Barnes-Pallesen, Frances D.; Stem, Edgar S.; Dinsmore, Page; Powers, Michael S.; Powers, Pamela; Smith, Mary C.; Jasko, David

1986-01-01

We examined the ability of clinicians to predict the causative organism of bovine mastitis in our practice. We obtained 118 milk culture results from 112 mastitic cows and compared the culture results to the predictions of clinicians at the time of milk sample collection. Sixty of 118 culture results were accurately predicted. The positive predictive value for coliform mastitis was 42% and the negative predictive value was 79% in a study population with a 31% prevalence of coliform mastitis. ...

Effect of Physical Therapy Students' Clinical Experiences on Clinician Productivity.

Science.gov (United States)

Pivko, Susan E; Abbruzzese, Laurel D; Duttaroy, Pragati; Hansen, Ruth L; Ryans, Kathryn

2016-01-01

Physical therapy clinical education experiences (CEEs) are difficult to secure, particularly first-level CEEs. Our purpose was to determine 1) what impact student full-time CEEs have on PT clinician productivity and 2) whether there is a productivity difference between first vs final CEEs. Productivity logs, including possible factors impacting productivity, were distributed to clinician-student pairings on first and final CEEs. Two-week baseline data (without a student) were compared to weeks 1 and 6 (with a student) for 31 logs using a 2x4 repeated-measures ANOVA. In a subset of 17 logs for CEEs 8 weeks or longer, a 2x5 repeated-measures ANOVA was performed. There was a significant increase in the number of patients seen and CPT units billed by both levels of CEEs comparing weeks 1 and 6. In the subset of CEEs, 8 weeks or longer, there was a significant increase in the number of patients treated per hour at week 6 and a trend toward a change at week 8 when compared to baseline week A. The factors selected as impacting productivity were census (59%) and staffing (32%). Physical therapy clinician-student pairings showed an overall increase in productivity during both full-time first and final level CEEs.

Study of identification of geometrically shaped solids using colour and range information

International Nuclear Information System (INIS)

Ebihara, Kenichi

1997-05-01

This report is the revision of the Technical Report (MECSE 1996-7) of Monash University in Melbourne, Australia which has been distributed to the Department Library in this University. The main work which is described in this report was carried out at Intelligent Robotics Research Center (IRRC) in the Department of Electrical and Computer Systems Engineering of Monash University from March in 1995 to March in 1996 and was be supported by a grant from Research Development Corporation of Japan (JRDC). This report describes the study of identification of geometrically shaped solids with unique colour using colour and range information. This study aims at recognition of equipment in nuclear plants. For this purpose, it is hypothesized that equipment in nuclear plants can be represented by combination of geometrically shaped solids with unique colour, such as a sphere, an ellipsoid, a cone, a cylinder, a rectangular solid and a pyramid. In this report, the colour image of geometrically shaped solids could be segmented comparatively easily and effectively into regions of each solid by using colour and range information. The range data of each solid was extracted using the segmented colour image. Thus the extracted range data could be classified into a plane surface or a curved surface by checking its spatial distribution. (author)

An Automated Approach for Ranking Journals to Help in Clinician Decision Support

Science.gov (United States)

Jonnalagadda, Siddhartha R.; Moosavinasab, Soheil; Nath, Chinmoy; Li, Dingcheng; Chute, Christopher G.; Liu, Hongfang

2014-01-01

Point of care access to knowledge from full text journal articles supports decision-making and decreases medical errors. However, it is an overwhelming task to search through full text journal articles and find quality information needed by clinicians. We developed a method to rate journals for a given clinical topic, Congestive Heart Failure (CHF). Our method enables filtering of journals and ranking of journal articles based on source journal in relation to CHF. We also obtained a journal priority score, which automatically rates any journal based on its importance to CHF. Comparing our ranking with data gathered by surveying 169 cardiologists, who publish on CHF, our best Multiple Linear Regression model showed a correlation of 0.880, based on five-fold cross validation. Our ranking system can be extended to other clinical topics. PMID:25954382

Obesity perceptions and documentation among primary care clinicians at a rural academic health center.

Science.gov (United States)

Aleem, Sohaib; Lasky, Rosalind; Brooks, W Blair; Batsis, John A

2015-01-01

Obesity recognition in primary care is important to address the epidemic. We aimed to evaluate primary care clinician-reported documentation, management practices, beliefs and attitudes toward obesity compared to body mass index (BMI) calculation, obesity prevalence and actual documentation of obesity as an active problem in electronic health record in a rural academic center. Our target population for previously validated clinician survey was 56 primary care providers working at 3 sites. We used calendar year 2012 data for assessment of baseline system performance for metrics of documentation of BMI in primary care visits, and proportion of visits in patients with obesity with obesity as a problem. Standard statistical methods assessed the data. Survey response rate was 91%. Average age of respondents was 48.9 years and 62.7% were females. 72.5% clinicians reported having normal BMI. The majority of clinicians reported regularly documenting obesity as an active problem, and utilized motivational interviewing and basic good nutrition and healthy exercise. Clinicians identified lack of discipline and exercise time, access to unhealthy food and psychosocial issues as major barriers. Most denied disliking weight loss discussion or patients taking up too much time. In 21,945 clinic visits and 11,208 annual preventive care visits in calendar year 2012, BMI was calculated in 93% visits but obesity documentation as an active problem only 27% of patients meeting BMI criteria for obesity. Despite high clinician-reported documentation of obesity as an active problem, actual obesity documentation rates remained low in a rural academic medical center. Copyright © 2015 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder.

Science.gov (United States)

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2017-11-01

This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.

Vulnerability Identification Errors in Security Risk Assessments

OpenAIRE

Taubenberger, Stefan

2014-01-01

At present, companies rely on information technology systems to achieve their business objectives, making them vulnerable to cybersecurity threats. Information security risk assessments help organisations to identify their risks and vulnerabilities. An accurate identification of risks and vulnerabilities is a challenge, because the input data is uncertain. So-called ’vulnerability identification errors‘ can occur if false positive vulnerabilities are identified, or if vulnerabilities remain u...

Self vs. other: neural correlates underlying agent identification based on unimodal auditory information as revealed by electrotomography (sLORETA).

Science.gov (United States)

Justen, C; Herbert, C; Werner, K; Raab, M

2014-02-14

Recent neuroscientific studies have identified activity changes in an extensive cerebral network consisting of medial prefrontal cortex, precuneus, temporo-parietal junction, and temporal pole during the perception and identification of self- and other-generated stimuli. Because this network is supposed to be engaged in tasks which require agent identification, it has been labeled the evaluation network (e-network). The present study used self- versus other-generated movement sounds (long jumps) and electroencephalography (EEG) in order to unravel the neural dynamics of agent identification for complex auditory information. Participants (N=14) performed an auditory self-other identification task with EEG. Data was then subjected to a subsequent standardized low-resolution brain electromagnetic tomography (sLORETA) analysis (source localization analysis). Differences between conditions were assessed using t-statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. Three-dimensional sLORETA source localization analysis revealed cortical activations in brain regions mostly associated with the e-network, especially in the medial prefrontal cortex (bilaterally in the alpha-1-band and right-lateralized in the gamma-band) and the temporo-parietal junction (right hemisphere in the alpha-1-band). Taken together, the findings are partly consistent with previous functional neuroimaging studies investigating unimodal visual or multimodal agent identification tasks (cf. e-network) and extent them to the auditory domain. Cortical activations in brain regions of the e-network seem to have functional relevance, especially the significantly higher cortical activation in the right medial prefrontal cortex. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Feature-Augmented Neural Networks for Patient Note De-identification

OpenAIRE

Lee, Ji Young; Dernoncourt, Franck; Uzuner, Ozlem; Szolovits, Peter

2016-01-01

Patient notes contain a wealth of information of potentially great interest to medical investigators. However, to protect patients' privacy, Protected Health Information (PHI) must be removed from the patient notes before they can be legally released, a process known as patient note de-identification. The main objective for a de-identification system is to have the highest possible recall. Recently, the first neural-network-based de-identification system has been proposed, yielding state-of-t...

Patient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers.

Science.gov (United States)

Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David H

2015-01-01

With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient-clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Mobile texting messaging has the potential to play an important role in patient-clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication.

Fieldable Nuclear Material Identification System

International Nuclear Information System (INIS)

Radle, James E.; Archer, Daniel E.; Carter, Robert J.; Mullens, James Allen; Mihalczo, John T.; Britton, Charles L. Jr.; Lind, Randall F.; Wright, Michael C.

2010-01-01

The Fieldable Nuclear Material Identification System (FNMIS), funded by the NA-241 Office of Dismantlement and Transparency, provides information to determine the material attributes and identity of heavily shielded nuclear objects. This information will provide future treaty participants with verifiable information required by the treaty regime. The neutron interrogation technology uses a combination of information from induced fission neutron radiation and transmitted neutron imaging information to provide high confidence that the shielded item is consistent with the host's declaration. The combination of material identification information and the shape and configuration of the item are very difficult to spoof. When used at various points in the warhead dismantlement sequence, the information complimented by tags and seals can be used to track subassembly and piece part information as the disassembly occurs. The neutron transmission imaging has been developed during the last seven years and the signature analysis over the last several decades. The FNMIS is the culmination of the effort to put the technology in a usable configuration for potential treaty verification purposes.

Knowledge of cardiopulmonary resuscitation of clinicians at a South ...

African Journals Online (AJOL)

2011-11-28

Nov 28, 2011 ... patients and recognising cardiac arrest, to assess clinicians' ... programmes that are accessible, innovative and inexpensive. .... well as, and sometimes better than, traditional CPR.16 In ... resuscitation training programme resulted in a noticeable ... 31 physicians in Canada whose resuscitation skills were.

An online spaced-education game among clinicians improves their patients' time to blood pressure control: a randomized controlled trial.

Science.gov (United States)

Kerfoot, B Price; Turchin, Alexander; Breydo, Eugene; Gagnon, David; Conlin, Paul R

2014-05-01

Many patients with high blood pressure (BP) do not have antihypertensive medications appropriately intensified at clinician visits. We investigated whether an online spaced-education (SE) game among primary care clinicians can decrease time to BP target among their hypertensive patients. A 2-arm randomized trial was conducted over 52 weeks among primary care clinicians at 8 hospitals. Educational content consisted of 32 validated multiple-choice questions with explanations on hypertension management. Providers were randomized into 2 groups: SE clinicians were enrolled in the game, whereas control clinicians received identical educational content in an online posting. SE game clinicians were e-mailed 1 question every 3 days. Adaptive game mechanics resent questions in 12 or 24 days if answered incorrectly or correctly, respectively. Clinicians retired questions by answering each correctly twice consecutively. Posting of relative performance among peers fostered competition. Primary outcome measure was time to BP target (game was completed by 87% of clinicians (48/55), whereas 84% of control clinicians (47/56) read the online posting. In multivariable analysis of 17 866 hypertensive periods among 14 336 patients, the hazard ratio for time to BP target in the SE game cohort was 1.043 (95% confidence interval, 1.007-1.081; P=0.018). The number of hypertensive episodes needed to treat to normalize one additional patient's BP was 67.8. The number of clinicians needed to teach to achieve this was 0.43. An online SE game among clinicians generated a modest but significant reduction in the time to BP target among their hypertensive patients. http://www.clinicaltrials.gov. Unique identifier: NCT00904007. © 2014 American Heart Association, Inc.

Survey of the UK veterinary profession 2: sources of information used by veterinarians

Science.gov (United States)

Nielsen, T. D.; Dean, R. S.; Massey, A.; Brennan, M. L.

2015-01-01

Access to the most up-to-date evidence is an important cornerstone for veterinarians attempting to practice in an evidence-based manner; therefore, an understanding of what and how information is accessed is vital. The aim of this study was to identify what resources the UK veterinary profession access and regard as most useful. Based on questionnaires received from veterinarians, the Veterinary Times was nominated as most often read journal or magazine by respondents (n=3572, 79 per cent). In Practice (n=3224, 82 per cent) and the Veterinary Record (n=165, 34 per cent) were seen as most useful by clinicians, and non-clinicians, respectively. Google was the most often nominated electronic resource by all respondents (n=3076, 71 per cent), with Google (n=459, 23 per cent) and PubMed (n=60, 17 per cent) seen as most useful by clinicians and non-clinicians, respectively. The abstract and conclusion sections were the most read parts of scientific manuscripts nominated by all respondents. When looking for assistance with difficult cases, colleagues were the common information choice for clinicians. Different sections of the veterinary profession access information, and deem resources useful, in different ways. Access to good quality evidence is important for the practice of evidence-based veterinary medicine, and therefore, researchers should think about disseminating their findings in a targeted way for optimal use by the profession. PMID:26246397

Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?

Science.gov (United States)

McDougall, Rosalind J; Gillam, Lynn; Delany, Clare; Jayasinghe, Yasmin

2018-01-01

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such 'experimental' procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents' decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children's Hospital in Melbourne, Australia. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost Optimal System Identification Experiment Design

DEFF Research Database (Denmark)

Kirkegaard, Poul Henning

A structural system identification experiment design method is formulated in the light of decision theory, structural reliability theory and optimization theory. The experiment design is based on a preposterior analysis, well-known from the classical decision theory. I.e. the decisions concerning...... reflecting the cost of the experiment and the value of obtained additional information. An example concerning design of an experiment for parametric identification of a single degree of freedom structural system shows the applicability of the experiment design method....... the experiment design are not based on obtained experimental data. Instead the decisions are based on the expected experimental data assumed to be obtained from the measurements, estimated based on prior information and engineering judgement. The design method provides a system identification experiment design...

Determinants of patient-rated and clinician-rated illness severity in schizophrenia.

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Fervaha, Gagan; Takeuchi, Hiroyoshi; Agid, Ofer; Lee, Jimmy; Foussias, George; Remington, Gary

2015-07-01

The contribution of specific symptoms on ratings of global illness severity in patients with schizophrenia is not well understood. The present study examined the clinical determinants of clinician and patient ratings of overall illness severity. This study included 1,010 patients with a DSM-IV diagnosis of schizophrenia who participated in the baseline visit of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study conducted between January 2001 and December 2004 and who had available symptom severity, side effect burden, cognition, and community functioning data. Both clinicians and patients completed the 7-point Clinical Global Impressions-Severity of Illness scale (CGI-S), the primary measure of interest in the present study. Symptoms were rated using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia, and functional status with the Quality of Life Scale. Neurocognition, insight, and medication-related side effects were also evaluated. Clinicians rated illness severity significantly higher than patients (P negative, disorganized, and depressive symptoms, as well as functional outcome (all P values enhance patient engagement in care and improve outcomes. ClinicalTrials.gov identifier: NCT00014001. © Copyright 2014 Physicians Postgraduate Press, Inc.

Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.

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Catling, C; Petrovska, K; Watts, N; Bisits, A; Homer, C S E

2016-04-01

Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth. A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically. Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper. In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Learning Curve Characteristics for Caesarean Section Among Associate Clinicians : A Prospective Study from Sierra Leone

NARCIS (Netherlands)

Waalewijn, B.P.; van Duinen, A.; Koroma, A. P.; Rijken, M. J.; Elhassein, M.; Bolkan, H. A.

2017-01-01

Background: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to

Moderate efficiency of clinicians' predictions decreased for blurred clinical conditions and benefits from the use of BRASS index. A longitudinal study on geriatric patients' outcomes.

Science.gov (United States)

Signorini, Giulia; Dagani, Jessica; Bulgari, Viola; Ferrari, Clarissa; de Girolamo, Giovanni

2016-01-01

Accurate prognosis is an essential aspect of good clinical practice and efficient health services, particularly for chronic and disabling diseases, as in geriatric populations. This study aims to examine the accuracy of clinical prognostic predictions and to devise prediction models combining clinical variables and clinicians' prognosis for a geriatric patient sample. In a sample of 329 consecutive older patients admitted to 10 geriatric units, we evaluated the accuracy of clinicians' prognosis regarding three outcomes at discharge: global functioning, length of stay (LoS) in hospital, and destination at discharge (DD). A comprehensive set of sociodemographic, clinical, and treatment-related information were also collected. Moderate predictive performance was found for all three outcomes: area under receiver operating characteristic curve of 0.79 and 0.78 for functioning and LoS, respectively, and moderate concordance, Cohen's K = 0.45, between predicted and observed DD. Predictive models found the Blaylock Risk Assessment Screening Score together with clinicians' judgment relevant to improve predictions for all outcomes (absolute improvement in adjusted and pseudo-R(2) up to 19%). Although the clinicians' estimates were important factors in predicting global functioning, LoS, and DD, more research is needed regarding both methodological aspects and clinical measurements, to improve prognostic clinical indices. Copyright © 2016 Elsevier Inc. All rights reserved.

Normal tissue complication probability (NTCP), the clinician,s perspective

International Nuclear Information System (INIS)

Yeoh, E.K.

2011-01-01

Full text: 3D radiation treatment planning has enabled dose distributions to be related to the volume of normal tissues irradiated. The dose volume histograms thus derived have been utilized to set NTCP dose constraints to facilitate optimization of treatment planning. However, it is not widely appreciated that a number of important variables other than DYH's which determine NTCP in the individual patient. These variables will be discussed under the headings of patient and treatment related as well as tumour related factors. Patient related factors include age, co-morbidities such as connective tissue disease and diabetes mellitus, previous tissue/organ damage, tissue architectural organization (parallel or serial), regional tissue/organ and individual tissue/organ radiosensitivities as well as the development of severe acute toxicity. Treatment related variables which need to be considered include dose per fraction (if not the conventional 1.8012.00 Gy/fraction, particularly for IMRT), number of fractions and total dose, dose rate (particularly if combined with brachytherapy) and concurrent chemotherapy or other biological dose modifiers. Tumour related factors which impact on NTCP include infiltration of normal tissue/organ usually at presentation leading to compromised function but also with recurrent disease after radiation therapy as well as variable tumour radiosensitivities between and within tumour types. Whilst evaluation of DYH data is a useful guide in the choice of treatment plan, the current state of knowledge requires the clinician to make an educated judgement based on a consideration of the other factors.

Perceptions of shared decision making and decision aids among rural primary care clinicians.

Science.gov (United States)

King, Valerie J; Davis, Melinda M; Gorman, Paul N; Rugge, J Bruin; Fagnan, L J

2012-01-01

Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs. To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs. Cross-sectional survey. Setting and Participants Primary care clinicians affiliated with the Oregon Rural Practice-based Research Network. Surveys were returned by 181 of 231 eligible participants (78%); 174 could be analyzed. Two-thirds of participants were physicians, 84% practiced family medicine, and 55% were male. Sixty-five percent of respondents were unfamiliar with the term shared decision making, but following definition, 97% reported that they found the approach useful for conditions with multiple treatment options. Over 90% of clinicians perceived helping patients make decisions regarding chronic pain and health behavior change as moderate/hard in difficulty. Although 69% of respondents preferred that patients play an equal role in making decisions, they estimate that this happens only 35% of the time. Time was reported as the largest barrier to engaging in SDM (63%). Respondents were receptive to using DAs to facilitate SDM in print- (95%) or web-based formats (72%), and topic preference varied by clinician specialty and decision difficulty. Rural clinicians recognized the value of SDM and were receptive to using DAs in multiple formats. Integration of DAs to facilitate SDM in routine patient care may require addressing practice operation and reimbursement.

Motivational interviewing in respiratory therapy: What do clinicians need to make it part of routine care? A qualitative study.

Directory of Open Access Journals (Sweden)

Robert Shannon

Full Text Available Motivational interviewing (MI is a method for building motivation for behaviour change that has potential for use in respiratory contexts. There is a paucity of published research exploring the feasibility of this intervention from the clinicians' perspective. This study aimed to explore respiratory clinicians' views of MI: Is it perceived as useful? Could it be integrated into practice? What training would be required to make it part of routine care? Nine respiratory clinicians attended a one-day MI workshop and a semi-structured face-to-face interview two weeks later. All interviews were audio-recorded, transcribed verbatim and analysed with thematic analysis. Four main themes are presented-1 MI's suitability for use in respiratory contexts: participants saw potential in using MI to motivate their patients to engage with prescribed respiratory interventions, such as increased physical activity. Those who experimented with new skills post-workshop were encouraged by patient responsiveness and outcomes. 2 MI's relationship with routine clinical practice: some believed they already used elements of MI, but most participants felt MI was fundamentally 'different' to their normal style of working. 3 Implementation issues: additional time would need to be made available to enable an appropriate depth of conversation. 4 Training issues: Participants sensed the complexity of MI could make it difficult to learn and that it would take them time to become competent. On-going supervision was perceived as necessary. One key challenge identified was how to suppress behaviours that are antithetical to MI. These findings lend support to the feasibility of using MI in respiratory contexts such as pulmonary rehabilitation programmes, but highlight implementation and training issues that would need to be overcome. The insights have informed the development of another study, testing the effect of a tailored training package on MI skill, specifically for

Effect of provider experience on clinician-performed ultrasonography for hydronephrosis in patients with suspected renal colic.

Science.gov (United States)

Herbst, Meghan K; Rosenberg, Graeme; Daniels, Brock; Gross, Cary P; Singh, Dinesh; Molinaro, Annette M; Luty, Seth; Moore, Christopher L

2014-09-01

Hydronephrosis is readily visible on ultrasonography and is a strong predictor of ureteral stones, but ultrasonography is a user-dependent technology and the test characteristics of clinician-performed ultrasonography for hydronephrosis are incompletely characterized, as is the effect of ultrasound fellowship training on predictive accuracy. We seek to determine the test characteristics of ultrasonography for detecting hydronephrosis when performed by clinicians with a wide range of experience under conditions of direct patient care. This was a prospective study of patients presenting to an academic medical center emergency department with suspected renal colic. Before computed tomography (CT) results, an emergency clinician performed bedside ultrasonography, recording the presence and degree of hydronephrosis. CT data were abstracted from the dictated radiology report by an investigator blinded to the bedside ultrasonographic results. Test characteristics of bedside ultrasonography for hydronephrosis were calculated with the CT scan as the reference standard, with test characteristics compared by clinician experience stratified into 4 levels: attending physicians with emergency ultrasound fellowship training, attending physicians without emergency ultrasound fellowship training, ultrasound experienced non-attending physician clinicians (at least 2 weeks of ultrasound training), and ultrasound inexperienced non-attending physician clinicians (physician assistants, nurse practitioners, off-service rotators, and first-year emergency medicine residents with fewer than 2 weeks of ultrasound training). There were 670 interpretable bedside ultrasonographic tests performed by 144 unique clinicians, 80.9% of which were performed by clinicians directly involved in the care of the patient. On CT, 47.5% of all subjects had hydronephrosis and 47.0% had a ureteral stone. Among all clinicians, ultrasonography had a sensitivity of 72.6% (95% confidence interval [CI] 65.4% to 78

Patient–Clinician Mobile Communication: Analyzing Text Messaging Between Adolescents with Asthma and Nurse Case Managers

Science.gov (United States)

Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V.; Gustafson, David H.

2015-01-01

Abstract Background: With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient–clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. Materials and Methods: We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Results: Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Conclusions: Mobile texting messaging has the potential to play an important role in patient–clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication. PMID:25401324

Odour discrimination and identification are improved in early blindness.

Science.gov (United States)

Cuevas, Isabel; Plaza, Paula; Rombaux, Philippe; De Volder, Anne G; Renier, Laurent

2009-12-01

Previous studies showed that early blind humans develop superior abilities in the use of their remaining senses, hypothetically due to a functional reorganization of the deprived visual brain areas. While auditory and tactile functions have been investigated for long, little is known about the effects of early visual deprivation on olfactory processing. However, blind humans make an extensive use of olfactory information in their daily life. Here we investigated olfactory discrimination and identification abilities in early blind subjects and age-matched sighted controls. Three levels of cuing were used in the identification task, i.e., free-identification (no cue), categorization (semantic cues) and multiple choice (semantic and phonological cues). Early blind subjects significantly outperformed the controls in odour discrimination, free-identification and categorization. In addition, the larger group difference was observed in the free-identification as compared to the categorization and the multiple choice conditions. This indicated that a better access to the semantic information from odour perception accounted for part of the improved olfactory performances in odour identification in the blind. We concluded that early blind subjects have both improved perceptual abilities and a better access to the information stored in semantic memory than sighted subjects.