Sample records for include clinicians consumers

  1. Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems. (United States)

    Woods, Susan Swartz; Jaén, Carlos Roberto


    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.

  2. 75 FR 34169 - Hewlett-Packard Company, Inkjet Consumer Solutions, HP Consumer Hardware Inkjet Lab, Including... (United States)


    ... Hardware Inkjet Lab, Including Leased Workers From Hightower Technology Capital, Inc., Syncro Design, VMC, PDG Oncore, K Force, Supply Source, Sigma Design, Novo Engineering, Act, Stilwell Baker, and... Company, Inkjet Consumer Solutions, HP Consumer Hardware Inkjet Lab, Vancouver, Washington. The notice was...

  3. Comparing consumer and clinician values for alternative functional states: application of a new feature trade-off consensus building tool. (United States)

    Stineman, M G; Maislin, G; Nosek, M; Fiedler, R; Granger, C V


    To present the Features-Resource Trade-Off Game (Features Game) as a new method for comparing preferences for alternative outcomes among different groups of people. The Features Game is illustrated by comparing preferences for recovery among the 18 functional status items making up the Functional Independence Measure. Methods involved trading levels of independence (resources) across the different items (features). Ten community-dwelling consumers with physical disabilities and 10 rehabilitation clinicians participated in four separate expert panels-two in Houston and two in Philadelphia. Five sets of hierarchical stages defined by the four separate panels specifying the profiles of function believed to most foster independent living. Cognitive and communication skills were selected preferentially over the recovery of physical tasks by all panels, but, in comparison to clinicians, consumers were more willing to accept mild deficits in cognitive skills as trade for realizing earlier recovery of physical abilities. The overwhelming choice of cognitive and communication abilities over physical abilities suggests a need to enhance therapeutic efforts in those areas. More subtle differences in consumer and clinician preferences emphasize the importance of establishing consumer-oriented goals.

  4. Tensions of difference: reconciling organisational imperatives for risk management with consumer-focused care from the perspectives of clinicians and managers. (United States)

    Clancy, Leonie; Happell, Brenda


    To understand the impact of risk management and assessment on the delivery of mental health care from the perspectives of managers and clinicians. The concept of risk is now embedded in contemporary mental health services. A focus on risk has been identified as a barrier to the provision of consumer-focused care; however, there is a paucity of research in this area, particularly being drawn from key stakeholders in the field. Qualitative exploratory methods. In-depth interviews were conducted with managers and clinicians from a large metropolitan aged-care mental health service in Australia. The participants represented a range of disciplines and expertise across practice settings (community, inpatient and residential). The theme tensions of difference emerged from this research. This theme referred to the tensions between accountability and attending to risk issues and consumer-centred care, with concerns being raised that procedural and bureaucratic accountability influence (often negatively) the provision of care. Differences in the perspectives of clinicians and managers were also evident in the perceived contribution of evidence-based practice in relation to risk. Prioritising risk management may be interfering with the capacity of clinicians and managers to provide quality and consumer-focused mental health care. A deeper examination and reconceptualisation of the role and importance of risk in mental health care are needed to ensure the focus of service delivery remains consumer-focused.

  5. Factors associated with a clinician's offer of screening HIV-positive patients for sexually transmitted infections, including syphilis. (United States)

    Heller, R; Fernando, I; MacDougall, M


    This retrospective study assessed whether Quality Improvement Scotland national standards for the sexual health care offered to HIV-positive individuals are being met by the Edinburgh genitourinary (GU) medicine clinic; specifically whether HIV-positive patients are offered: (a) sexually transmitted infection (STI) screening annually and (b) syphilis testing six-monthly. The study also reviewed what factors were associated with a clinician's offer of STI screening and syphilis testing. Of the 509 patients seen within the study period, case notes documented that 64% were offered STI screens, and 69% were offered syphilis testing, results consistent with audits of services elsewhere. Sexual orientation (P offer of STI screening, while gender (P offer of syphilis testing. Our results suggest that one explanation for clinicians failing to offer STI screens and syphilis serology testing is their (implicit) risk assessment that STI testing is not required in individual patients.

  6. Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices. (United States)

    Sage, Adam; Blalock, Susan J; Carpenter, Delesha

    This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Fresh meat packaging: consumer acceptance of modified atmosphere packaging including carbon monoxide. (United States)

    Grebitus, Carola; Jensen, Helen H; Roosen, Jutta; Sebranek, Joseph G


    Consumers' perceptions and evaluations of meat quality attributes such as color and shelf life influence purchasing decisions, and these product attributes can be affected by the type of fresh meat packaging system. Modified atmosphere packaging (MAP) extends the shelf life of fresh meat and, with the inclusion of carbon monoxide (CO-MAP), achieves significant color stabilization. The objective of this study was to assess whether consumers would accept specific packaging technologies and what value consumers place on ground beef packaged under various atmospheres when their choices involved the attributes of color and shelf life. The study used nonhypothetical consumer choice experiments to determine the premiums that consumers are willing to pay for extended shelf life resulting from MAP and for the "cherry red" color in meat resulting from CO-MAP. The experimental design allowed determination of whether consumers would discount foods with MAP or CO-MAP when (i) they are given more detailed information about the technologies and (ii) they have different levels of individual knowledge and media exposure. The empirical analysis was conducted using multinomial logit models. Results indicate that consumers prefer an extension of shelf life as long as the applied technology is known and understood. Consumers had clear preferences for brighter (aerobic and CO) red color and were willing to pay $0.16/lb ($0.35/kg) for each level of change to the preferred color. More information on MAP for extending the shelf life and on CO-MAP for stabilizing color decreased consumers' willingness to pay. An increase in personal knowledge and media exposure influenced acceptance of CO-MAP negatively. The results provide quantitative measures of how packaging affects consumers' acceptance and willingness to pay for products. Such information can benefit food producers and retailers who make decisions about investing in new packaging methods.

  8. consumers

    African Journals Online (AJOL)

    Results: It was found that the haemoglobin, packed sell volume, red blood cell count and the white blood cell count were within the reference ... alcohol}. One bottle of beer and one medium calabash of. BURUKUTU contain about 2 units of alcohols. Like the palm wine of Southem Nigeria, BURUKUTU is consumed by the.

  9. Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients' and clinicians' perspectives on communication about distress. (United States)

    Zwahlen, Diana; Tondorf, Theresa; Rothschild, Sacha; Koller, Michael T; Rochlitz, Christoph; Kiss, Alexander


    International standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument. We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer. This is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients' reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry. The study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients' and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services

  10. Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practice. (United States)

    Fortuna, Robert J; Ross-Degnan, Dennis; Finkelstein, Jonathan; Zhang, Fang; Campion, Francis X; Simon, Steven R


    Prescribing decisions are subject to a myriad of external forces, including patient requests for advertised medications. Although numerous factors influence prescribing, resources to support unbiased evidence-based prescribing are not widely available. To guide future interventions, we surveyed clinicians about influences on prescribing, awareness of pharmaceutical costs and attitudes towards computerized decision support. A 21-item survey was sent to 604 prescribing clinicians in a large multi-specialty group practice that employs a robust electronic medical record. Surveys were returned from 405 clinicians (67%). Most respondents (87%) felt that direct-to-consumer (DTC) advertising prompts patients to request inappropriate medications, and more than one in five clinicians (22%) reported difficulty declining patients' requests for advertised medications. Providers with more clinical sessions per week reported greater difficulty. Although 93% of clinicians felt they have access to the information needed to guide prescribing, only about half (54%) reported they are aware of how much patients pay for prescription medications. Clinicians' awareness of medication costs varied considerably by specialty, with behavioural health clinicians being the most aware. The majority of providers (79%) stated that computerized prescribing alerts are a clinically useful source of information. Although the majority of clinicians reported that DTC advertising leads many patients to request medications that are inappropriate for their condition, a sizable proportion of clinicians reported difficulty declining these requests, and many are unaware of medication costs. Interventions to support prescribing decisions should provide the busiest clinicians with up-to-date, specialty-specific evidence and cost information.

  11. Transthoracic Ultrasonography for Clinicians

    Directory of Open Access Journals (Sweden)

    Morné Johan Vorster


    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

  12. Technical support document: Energy efficiency standards for consumer products: Refrigerators, refrigerator-freezers, and freezers including draft environmental assessment, regulatory impact analysis

    Energy Technology Data Exchange (ETDEWEB)



    The Energy Policy and Conservation Act (P.L. 94-163), as amended by the National Appliance Energy Conservation Act of 1987 (P.L. 100-12) and by the National Appliance Energy Conservation Amendments of 1988 (P.L. 100-357), and by the Energy Policy Act of 1992 (P.L. 102-486), provides energy conservation standards for 12 of the 13 types of consumer products` covered by the Act, and authorizes the Secretary of Energy to prescribe amended or new energy standards for each type (or class) of covered product. The assessment of the proposed standards for refrigerators, refrigerator-freezers, and freezers presented in this document is designed to evaluate their economic impacts according to the criteria in the Act. It includes an engineering analysis of the cost and performance of design options to improve the efficiency of the products; forecasts of the number and average efficiency of products sold, the amount of energy the products will consume, and their prices and operating expenses; a determination of change in investment, revenues, and costs to manufacturers of the products; a calculation of the costs and benefits to consumers, electric utilities, and the nation as a whole; and an assessment of the environmental impacts of the proposed standards.

  13. Proposta de um quadro de referência para integrar o consumidor nos conceitos de redes [Proposed Reference Table to Include the Consumer in Network Concepts

    Directory of Open Access Journals (Sweden)

    Ernesto Michelangelo Giglio


    Full Text Available O artigo apresenta uma proposta e defesa da inclusão do ator consumidor nos raciocínios e pesquisas sobre redes, a partir da teoria das redes sociais. A proposta decorre da análise e reflexão sobre 82 artigos de redes selecionados, cujos objetivos incluíam o consumidor. Esta análise mostrou que o consumidor está ausente como ator, tanto teoricamente, quanto nas sugestões gerenciais. Seu papel na rede é secundário e são raros os estudos sobre a gestão de sua participação. Entre as causas dessa ausência, destacam-se a dominância de modelos sócio técnicos de redes na bibliografia e o uso de teorias da psicologia do indivíduo, quando se aborda o consumidor, o que se entende como inadequado num raciocínio de redes a partir das redes sociais. Nas conclusões, propõe-se um conjunto de princípios que inclui o consumidor como ator da rede, ampliando o campo de reflexões e de pesquisas da área. --- Proposed Reference Table to Include the Consumer in Network Concepts --- Abstract --- The article presents a model that includes the consumer in the principles and research on networks, using the concepts of social networks. The model arises from the analysis and reflections of 82 articles about networks, whose objectives included the consumer. It showed that he/she is absent as an actor in both theoretically and management proposals. His/her role in the network is secondary and there are few studies into the management of his/her participation. Among the causes of this absence we identify the dominance of socio-technical models in the bibliography and the use of theories of individual psychology, which are inadequate in a reasoning of social networks. Finally we propose a set of principles that includes the consumer as an actor in a network, widening the reflections and research in this area.

  14. [Cooperation between clinicians and pathologists]. (United States)

    Lerch, M M


    To the disadvantage of physician in training and quality control the number of post mortem examinations has declined in many Western countries including Germany. The frequency at which surgical or biopsy specimens are investigated by pathologist, on the other hand, appears to increase and clinicians have become increasingly more reliant on a pathologists assessment in terms of diagnosis and treatment strategy. There are some areas where communication between clinician and pathologist could be improved. The first regards the classification of malignancies which should, wherever possible, follow international guidelines such the WHO's. From a clinicians perspective assessment of tumour staging and grading should be based on the patient's prognosis rather than morphological criteria alone. In the case of rare tumours, for which the clinician can be assumed to be ignorant, reference to the literature is helpful. If the surgical or biopsy specimen reveals a malignancy that cannot be classified suggestions for a differential diagnosis can be still helpful. Frequently, at least in my field of speciality, the only tissue accessible is a hepatic or lymphatic metastasis. Determination of the tumour of origin is often essential in deciding on treatment options and every effort including immonocytochemical methods should be made to help to determine the tumour's original site. It spares enormous cost and makes many unpleasant interventional procedures redundant. Further areas where clinicians increasingly need help from pathologists are the diagnosis of inflammatory and infectious diseases and in the usage of molecular genetic methods.

  15. Technical support document: Energy conservation standards for consumer products: Dishwashers, clothes washers, and clothes dryers including: Environmental impacts; regulatory impact analysis

    Energy Technology Data Exchange (ETDEWEB)


    The Energy Policy and Conservation Act as amended (P.L. 94-163), establishes energy conservation standards for 12 of the 13 types of consumer products specifically covered by the Act. The legislation requires the Department of Energy (DOE) to consider new or amended standards for these and other types of products at specified times. This Technical Support Document presents the methodology, data and results from the analysis of the energy and economic impacts of standards on dishwashers, clothes washers, and clothes dryers. The economic impact analysis is performed in five major areas: An Engineering Analysis, which establishes technical feasibility and product attributes including costs of design options to improve appliance efficiency. A Consumer Analysis at two levels: national aggregate impacts, and impacts on individuals. The national aggregate impacts include forecasts of appliance sales, efficiencies, energy use, and consumer expenditures. The individual impacts are analyzed by Life-Cycle Cost (LCC), Payback Periods, and Cost of Conserved Energy (CCE), which evaluate the savings in operating expenses relative to increases in purchase price; A Manufacturer Analysis, which provides an estimate of manufacturers' response to the proposed standards. Their response is quantified by changes in several measures of financial performance for a firm. An Industry Impact Analysis shows financial and competitive impacts on the appliance industry. A Utility Analysis that measures the impacts of the altered energy-consumption patterns on electric utilities. A Environmental Effects analysis, which estimates changes in emissions of carbon dioxide, sulfur oxides, and nitrogen oxides, due to reduced energy consumption in the home and at the power plant. A Regulatory Impact Analysis collects the results of all the analyses into the net benefits and costs from a national perspective. 47 figs., 171 tabs. (JF)

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

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


    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.

  17. Supporting clinicians in infrastructuring

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten; Karasti, Helena


    the notion of infrastructuring, we carry out an infrastructural analysis of eWBs and approach our joint efforts as unfolding and continuing the con-figuration of participatory design activities. We identify a need for local support and novel competences among the clinicians in order for them to engage...

  18. The use of technology for urgent clinician to clinician communications: a systematic review of the literature. (United States)

    Nguyen, Cristina; McElroy, Lisa M; Abecassis, Michael M; Holl, Jane L; Ladner, Daniela P


    Urgent clinician-clinician communications require routes of contact that are fast and dependable, and allow for the exchange of complex information. Despite the increasing focus on improving healthcare delivery systems over the past decade, few studies have examined the role of technology in clinician-clinician communication. The aim of this study was to review the literature examining the role of devices and technology in facilitating urgent clinician-clinician communication to identify critical areas for future research. A search of Pub Med was performed using the terms (((("Critical Care"[Mesh] OR "urgent")))) AND (((hospital communication systems[MeSH Terms]) OR health communication[MeSH Terms]) OR interdisciplinary communication[MeSH Terms]). Commentaries and editorials were excluded. The initial search returned 272 articles, which were reviewed to identify articles describing: (1) the role of technological support or devices in clinician-clinician communication, (2) technology-based interventions that improved clinician-to-clinician communication in hospitals or acute care facilities related to critically ill patients, or (3) critical information exchange. A total of 16 articles were included in the final review. These were grouped into three categories: alphanumeric pagers, cellular and smart telephones, and novel uses of technology. Breakdowns in clinician-clinician communication are complex and cannot be solved through the implementation of devices or technologically advanced systems alone. It is essential to understand the correlation between emerging technologies, a demanding workload, and clinician-clinician interaction. Enhanced communication of clinical ideas, opportunities for team discussion, and a sense of partnership and support require not just increased information, but enhanced delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Feedback control for clinicians. (United States)

    Dumont, Guy A


    Although feedback control and automation has revolutionized many fields of human activity, it has yet to have a significant impact on healthcare, particularly when a patient is in the loop. Although there have been a number of studies concerned with closed-loop control of anesthesia, they have yet to have an impact on clinical practice. For such systems to be successful, engineers and clinicians have to work hand in hand, for this they have to have a basic understanding of each other's fields. The goal of this paper is to introduce clinicians to basic concepts in control engineering, with an emphasis on the properties of feedback control. Concepts such as modelling for control, feedback and uncertainty, robustness, feedback controller such as proportional-integral-derivative control, predictive control and adaptive control are briefly reviewed. Finally we discuss the safety issues around closed-loop control and discuss ways by which safe control can be guaranteed.

  20. Essential and toxic element concentrations in blood and urine and their associations with diet: Results from a Norwegian population study including high-consumers of seafood and game

    Energy Technology Data Exchange (ETDEWEB)

    Birgisdottir, B.E.; Knutsen, H.K.; Haugen, M.; Gjelstad, I.M. [Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo (Norway); Jenssen, M.T.S. [Norwegian Institute for Water Research, Oslo (Norway); Ellingsen, D.G.; Thomassen, Y. [National Institute of Occupational Health, Oslo (Norway); Alexander, J. [Office of the Director-General, Norwegian Institute of Public Health, Oslo (Norway); Meltzer, H.M. [Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo (Norway); Brantsæter, A.L., E-mail: [Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo (Norway)


    The first aim of the study was to evaluate calculated dietary intake and concentrations measured in blood or urine of essential and toxic elements in relation to nutritional and toxicological reference values. The second aim was to identify patterns of the element concentrations in blood and urine and to identify possible dietary determinants of the concentrations of these elements. Adults with a known high consumption of environmental contaminants (n = 111), and a random sample of controls (n = 76) answered a validated food frequency questionnaire (FFQ). Complete data on biological measures were available for 179 individuals. Blood and urine samples were analyzed for selenium, iodine, arsenic, mercury, cadmium and lead. Principal component analysis was used to identify underlying patterns of correlated blood and urine concentrations. The calculated intakes of selenium, iodine, inorganic arsenic and mercury were within guideline levels. For cadmium 24% of the high consumer group and 8% of the control group had intakes above the tolerable weekly intake. Concentrations of lead in blood exceeded the bench-mark dose lower confidence limits for some participants. However, overall, the examined exposures did not give rise to nutritional or toxicological concerns. Game consumption was associated with lead in blood (B{sub ln} 0.021; 95%CI:0.010, 0.031) and wine consumption. Seafood consumption was associated with urinary cadmium in non-smokers (B{sub ln} 0.009; 95%CI:0.003, 0.015). A novel finding was a distinct pattern of positively associated biological markers, comprising iodine, selenium, arsenic and mercury (eigenvalue 3.8), reflecting seafood intake (B 0.007; 95%CI:0.004, 0.010). The study clearly demonstrates the significance of seafood as a source of both essential nutrients and toxic elements simultaneously and shows that exposure to various essential and toxic elements can be intertwined. - Highlights: • A study on interplay and sources of six different

  1. Essential and toxic element concentrations in blood and urine and their associations with diet: Results from a Norwegian population study including high-consumers of seafood and game

    International Nuclear Information System (INIS)

    Birgisdottir, B.E.; Knutsen, H.K.; Haugen, M.; Gjelstad, I.M.; Jenssen, M.T.S.; Ellingsen, D.G.; Thomassen, Y.; Alexander, J.; Meltzer, H.M.; Brantsæter, A.L.


    The first aim of the study was to evaluate calculated dietary intake and concentrations measured in blood or urine of essential and toxic elements in relation to nutritional and toxicological reference values. The second aim was to identify patterns of the element concentrations in blood and urine and to identify possible dietary determinants of the concentrations of these elements. Adults with a known high consumption of environmental contaminants (n = 111), and a random sample of controls (n = 76) answered a validated food frequency questionnaire (FFQ). Complete data on biological measures were available for 179 individuals. Blood and urine samples were analyzed for selenium, iodine, arsenic, mercury, cadmium and lead. Principal component analysis was used to identify underlying patterns of correlated blood and urine concentrations. The calculated intakes of selenium, iodine, inorganic arsenic and mercury were within guideline levels. For cadmium 24% of the high consumer group and 8% of the control group had intakes above the tolerable weekly intake. Concentrations of lead in blood exceeded the bench-mark dose lower confidence limits for some participants. However, overall, the examined exposures did not give rise to nutritional or toxicological concerns. Game consumption was associated with lead in blood (B ln 0.021; 95%CI:0.010, 0.031) and wine consumption. Seafood consumption was associated with urinary cadmium in non-smokers (B ln 0.009; 95%CI:0.003, 0.015). A novel finding was a distinct pattern of positively associated biological markers, comprising iodine, selenium, arsenic and mercury (eigenvalue 3.8), reflecting seafood intake (B 0.007; 95%CI:0.004, 0.010). The study clearly demonstrates the significance of seafood as a source of both essential nutrients and toxic elements simultaneously and shows that exposure to various essential and toxic elements can be intertwined. - Highlights: • A study on interplay and sources of six different elements • The

  2. Clinician stress and patient-clinician communication in HIV care. (United States)

    Ratanawongsa, Neda; Korthuis, P Todd; Saha, Somnath; Roter, Debra; Moore, Richard D; Sharp, Victoria L; Beach, Mary Catherine


    Clinician stress is common, but few studies have examined its relationship with communication behaviors. To investigate associations between clinician stress and patient-clinician communication in primary HIV care. Observational study. Thirty-three primary HIV clinicians and 350 HIV-infected adult, English-speaking patients at three U.S. HIV specialty clinic sites. Clinicians completed the Perceived Stress Scale, and we categorized scores in tertiles. Audio-recordings of patient-clinician encounters were coded using the Roter Interaction Analysis System. Patients rated the quality of their clinician's communication and overall quality of medical care. We used regression with generalized estimating equations to examine associations between clinician stress and communication outcomes, controlling for clinician gender, clinic site, and visit length. Among the 33 clinicians, 70 % were physicians, 64 % were women, 67 % were non-Hispanic white, and the mean stress score was 3.9 (SD 2.4, range 0-8). Among the 350 patients, 34 % were women, 55 % were African American, 23 % were non-Hispanic white, 16 % were Hispanic, and 30 % had been with their clinicians >5 years. Verbal dominance was higher for moderate-stress clinicians (ratio=1.93, pstress clinicians (ratio=1.76, p=0.01), compared with low-stress clinicians (ratio 1.45). More medical information was offered by moderate-stress clinicians (145.5 statements, p stress clinicians (125.9 statements, p=0.02), compared with low-stress clinicians (97.8 statements). High-stress clinicians offered less psychosocial information (17.1 vs. 19.3, p=0.02), and patients of high-stress clinicians rated their quality of care as excellent less frequently than patients of low-stress clinicians (49.5 % vs. 66.9 %, pstress clinicians offered more partnering statements (27.7 vs. 18.2, p=0.04) and positive affect (3.88 vs. 3.78 score, p=0.02) than low-stress clinicians, and their patients' ratings did not differ. Although higher stress was

  3. Ethical issues faced by clinician/managers in resource-allocation decisions. (United States)

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


    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.

  4. Marketing strategies - consumers

    International Nuclear Information System (INIS)

    Campbell, C.


    As Australia's largest consumer organisation, the Australian Consumers' Association (ACA) has a vital role in providing information, so consumers can make an informed choice, as well as participating in formulation of standards to increase the quality of products, including foods. The consumer movement is marketing the process of irradiation and will continue to give consumers information that allows them to make an informed choice

  5. 'Learning Organizations': a clinician's primer. (United States)

    O'Connor, Nick; Kotze, Beth


    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.

  6. Data Science Meets the Clinician: Challenges and Future Directions. (United States)

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


    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.

  7. A clinician-driven home care delivery system. (United States)

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


    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.

  8. How can clinician-educator training programs be optimized to match clinician motivations and concerns? (United States)

    McCullough, Brendan; Marton, Gregory E; Ramnanan, Christopher J


    Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Review of medical education literature using the terms "attitudes", "motivations", "physicians", "teaching", and "undergraduate medical education" resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education.

  9. Supervision of Occupational Therapy Level II Fieldwork Students: Impact on and Predictors of Clinician Productivity. (United States)

    Ozelie, Rebecca; Janow, Janet; Kreutz, Corinne; Mulry, Mary Kate; Penkala, Ashley


    This study aimed to determine whether a difference in productivity exists between clinicians supervising and not supervising a Level II occupational therapy student and whether factors including clinician years of experience, practice setting, and clinician productivity without a student could predict clinician productivity while supervising a student. We used paired-sample t tests to examine clinician productivity with and without a student in 109 clinician-student encounters and regression analysis to determine factors predictive of clinician productivity with a student. Results indicated no difference in clinician productivity with or without a student. Clinician years of experience, practice area, and productivity without a student were significant predictors of clinician productivity while supervising a student. Study results contradict the belief that supervising Level II fieldwork students lowers clinicians' productivity. Findings suggest that practice area and productivity without a student are important factors influencing the productivity of clinicians supervising a fieldwork student. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  10. Clinicians and journalists responding to disasters. (United States)

    Newman, Elana; Shapiro, Bruce


    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.

  11. Clinician compliance with laboratory monitoring and prescribing ...

    African Journals Online (AJOL)

    urban SA ART sites to describe clinician compliance with tenofovir prescribing and monitoring guidelines in HIVinfected adults on firstline ART. Methods. We included treatmentnaive patients aged ≥16 years who started firstline tenofovirbased ART between 2010 and 2012 at Khayelitsha and Themba Lethu clinics in Cape ...

  12. Understanding Economic Evaluation: A Policy Perspective for Clinicians

    Directory of Open Access Journals (Sweden)

    M Giacomini


    Full Text Available The rhetoric of ‘efficiency’ frames much current debate about how limited health care resources should be used. Clinicians increasingly turn to economic evaluation literature to discern evidence-based claims of ‘efficiency’ or ‘cost effectiveness’ from empty ones. Economic evaluation research is designed to compare health services on the basis of their efficiency (eg, how well they produce health benefits relative to resource costs. Although economic studies appear throughout the respirology literature, relatively few are complete economic evaluations. Economic evaluation studies serve various purposes, including critical evaluation and persuasive marketing, which produce studies that vary in research agendas and scientific rigour. This paper is intended to serve clinicians and consumers of economic evaluation studies by: introducing economic evaluation research information as a policy making tool; describing the three basic elements and three basic types of economic evaluation (cost-benefit, cost-effectiveness, and cost-utility analyses; and reviewing some limitations of economic evaluation information for policy decision making. The usefulness of economic evaluation research for policy making depends not only on the scientific merit of the analysis but also crucially on whose specific concerns the research questions address.

  13. Help wanted: developing clinician leaders. (United States)

    Stoller, James K


    Because healthcare faces challenges, such as ensuring quality and access and controlling cost, effective leadership is needed at every level of healthcare organizations. Yet, physicians are trained in clinical and scientific skills but not in leadership competencies. Furthermore, clinicians often feel ill-prepared to assume managerial and leadership roles. To close this gap, training in leadership competencies, such as emotional intelligence, communication, teamwork, and change management, is urgently needed for physicians and clinicians of all disciplines. Leadership training should be multidisciplinary and should begin early in clinicians' careers.

  14. Consumer Identity


    Young, Melissa Marie


    The purpose of this thesis is to prove that despite consumers' impression that they are alone in deciding their consumption decision they are wrong. Consumers are manipulated on various levels by marketers. It is the marketer who decides what consumer identities should be created. Consumers are persuaded by marketers on different levels beginning with consumers' needs. Marketers begin by appealing to consumer drives, motivations and emotions to persuade their consumers to purchase their brand...

  15. Assessment Practices of Child Clinicians. (United States)

    Cook, Jonathan R; Hausman, Estee M; Jensen-Doss, Amanda; Hawley, Kristin M


    Assessment is an integral component of treatment. However, prior surveys indicate clinicians may not use standardized assessment strategies. We surveyed 1,510 clinicians and used multivariate analysis of variance to explore group differences in specific measure use. Clinicians used unstandardized measures more frequently than standardized measures, although psychologists used standardized measures more frequently than nonpsychologists. We also used latent profile analysis to classify clinicians based on their overall approach to assessment and examined associations between clinician-level variables and assessment class or profile membership. A four-profile model best fit the data. The largest profile consisted of clinicians who primarily used unstandardized assessments (76.7%), followed by broad-spectrum assessors who regularly use both standardized and unstandardized assessment (11.9%), and two smaller profiles of minimal (6.0%) and selective assessors (5.5%). Compared with broad-spectrum assessors, unstandardized and minimal assessors were less likely to report having adequate standardized measures training. Implications for clinical practice and training are discussed.

  16. How can clinician-educator training programs be optimized to match clinician motivations and concerns?

    Directory of Open Access Journals (Sweden)

    McCullough B


    Full Text Available Brendan McCullough, Gregory E Marton, Christopher J Ramnanan Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Background: Several medical schools have implemented programs aimed at supporting clinician-educators with formal mentoring, training, and experience in undergraduate medical teaching. However, consensus program design has yet to be established, and the effectiveness of these programs in terms of producing quality clinician-educator teaching remains unclear. The goal of this study was to review the literature to identify motivations and perceived barriers to clinician-educators, which in turn will improve clinician-educator training programs to better align with clinician-educator needs and concerns. Methods: Review of medical education literature using the terms “attitudes”, “motivations”, “physicians”, “teaching”, and “undergraduate medical education” resulted in identification of key themes revealing the primary motivations and barriers involved in physicians teaching undergraduate medical students. Results: A synthesis of articles revealed that physicians are primarily motivated to teach undergraduate students for intrinsic reasons. To a lesser extent, physicians are motivated to teach for extrinsic reasons, such as rewards or recognition. The key barriers deterring physicians from teaching medical students included: decreased productivity, lack of compensation, increased length of the working day, patient concerns/ethical issues, and lack of confidence in their own ability. Conclusion: Our findings suggest that optimization of clinician-educator training programs should address, amongst other factors, time management concerns, appropriate academic recognition for teaching service, and confidence in teaching ability. Addressing these issues may increase the retention of clinicians who are active and proficient in medical education. Keywords: clinician-educators, teaching, undergraduate medical

  17. The clinician and the thyroid

    International Nuclear Information System (INIS)

    Biersack, H.J.; Hotze, A.


    The goiter prevalence in iodine-deficient regions is up to 25%-54%. The most frequent disease in these endemic areas is non-toxic goiter, which is, however, oftentimes connected with autonomously functioning thyroid tissue leading to borderline or overt hyperthyroidism. Other thyroid diseases like cancer, thyroiditis and hypothyroidism play only a miner role in a thyroid clinic, while cases of Graves' disease may be observed more frequently. The most cost-effective tools to evaluate thyroid patients are the hand, ear and mouth of the thyroid clinician. The differential diagnosis of thyroid disorders may be evaluated by a battery of diagnostic tools like in-vitro tests and high performance imaging modalities. Once the diagnosis is established, the appropriate therapeutic procedures (drugs, radioiodine, surgery) have to be chosen. This review should be considered as a guideline for the diagnosis and treatment of thyroid diseases. In addition, special problems concerning elderly patients and pregnant women are discussed, including the differential diagnosis of thyroid diseases. (orig.)


    Directory of Open Access Journals (Sweden)

    Ilie BUDICA


    Full Text Available The study of consumers helps firms and organizations improve their marketing strategies by understanding issues such as: the psychology of how consumers think, feel, reason, and select between different alternatives; the psychology of how the consumer is influenced by his or her environment; the behavior of consumers while shopping or making other marketing decisions; limitations in consumer knowledge or information processing abilities influence decisions and marketing outcome; how consumer motivation and decision strategies differ between products that differ in their level of importance or interest that they entail for the consumer; and how marketers can adapt and improve their marketing campaigns and marketing strategies to more effectively reach the consumer.

  19. Clinicians' Knowledge and Perception of Telemedicine Technology. (United States)

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


    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.

  20. Rising to the challenge: Training the next generation of clinician ...

    African Journals Online (AJOL)

    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 ...

  1. Veterinary dentistry: a clinician's viewpoint. (United States)

    Baxter, Colin


    This is a clinician's view of the current state of veterinary dentistry at the level of the general practitioner across the different species. An indication of the work done and the hazards commonly encountered are covered. To increase awareness within the dental profession of the current state of veterinary dentistry.

  2. Senior Clinician | Center for Cancer Research (United States)

    The Center for Cancer Research (CCR), NCI, NIH, HHS is seeking to fill several Senior Clinician positions with outstanding oncologists with research experience and expertise in one of the following areas:  1) genitourinary malignancies, 2) thoracic malignancies; 3) gastrointestinal malignancies; 4) lymphomas; 5) pediatric cancers; or 6) genetic tumor predisposition syndromes. These positions are located at the NIH campus in Bethesda, Maryland. The NIH Clinical Center is the world’s largest research hospital which offers state-of-the-art facilities, collaborative opportunities, and core facilities for advanced technologies.  The Senior Clinician will have available resources including funding for clinical trials, nurse practitioners, research nurses, and patient care coordinators.  In addition, the senior clinician will have access to a robust clinical trials infrastructure including data management, training, protocol support office, regulatory support, information systems and technology, and data safety monitoring.  The CCR’s collaborative culture also offers research staff access to a wide array of intellectual and technological assets, including high-quality technology cores dedicated to pharmacokinetics/pharmacodynamics, protein chemistry, natural products chemistry, biophysics, mass spectrometry, imaging, microscopy, proteomics and genomics, bioinformatics/biostatistics, and flow cytometry.  For an overview of CCR, please visit  For more information contact Lori Holliday at

  3. The role of technology in clinician-to-clinician communication. (United States)

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


    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.

  4. Clinical Photography: A Guide for the Clinician

    Directory of Open Access Journals (Sweden)

    Nayler J


    Full Text Available Clinicians might not always have available the services of a professional medical photographer, but if a standardised approach is followed those who take their own clinical photographs can achieve acceptable results. This article offers guidance to the clinician on consistent lighting, exposure, patient positioning, linear scale, perspective, depth of field, and background. Advice is given on equipment and materials, including digital and conventional cameras, flash (strobe, films, and processing choices. Consistency of approach is emphasised - it is not acceptable to use photographic tricks to enhance the appearance of clinical outcomes. Rather, care should be taken to ensure that the only changes among clinical photographs taken over time are in the patient. Photographs should be stored and presented appropriately for their use and images for publication should be prepared according to the instructions to authors. Digital images for publication should be sized appropriately for the final reproduction size.

  5. Consumer entrepreneurship

    NARCIS (Netherlands)

    Dentoni, Domenico; Poldner, Kim; Pascucci, Stefano; Gartner, William B.


    The objective of this chapter is to understand innovative processes of resource redeployment taking place during consumption. We label this as consumer entrepreneurship. We define consumer entrepreneurship as the process of sharing and recombining resources innovatively to seek opportunities for

  6. Consumer Health. (United States)

    Cornacchia, Harold J.

    Consumer health refers to the potential or actual impact upon the consumer, individually or collectively, of any substances, devices, services, or systems that are offered for the supposed purpose of protecting, preserving, or restoring physical or mental health. This book is an effort to help the consumer to choose intelligently in spending for…

  7. Social norms of "good" design: Interdisciplinary perspectives from a survey of engineers and clinicians in bioengineering. (United States)

    Johnson, Angela N


    In bioengineering training for new researchers and engineers, a great deal of time is spent discussing what constitutes "good" design. Conceptualization of good design, however, varies widely across interdisciplinary team members, with potential to both foster innovation or lead to unproductive conflict. To explore how groups central to bioengineering teams (physicians/clinicians and engineers/physicists) conceptualize good design, we asked 176 professionals in bioengineering to complete a comprehensive online survey including items designed to assess cognitive and moral foundations (validated MFQ30 tool) and custom items assessing perceptions on good design in three areas (good design characteristics, reputation of design approvers, and perceived design patient/consumer suitability). Of those that responded, 82 completed all quantitative survey sections and were included in this preliminary analysis. Correlations between response areas were examined to explore the possible links between cognitive and moral biases and perspectives on good design. The survey results indicated that both groups were more conservative than average Americans based on previous reports, and clinicians scored higher on average for all MFQ30 domains. Numerous significant correlations with good design were observed among clinicians, while engineers/physicists most closely correlated good design with prescriber approval and scientific/technical literature. The exploratory analysis demonstrated the potential utility of sociological frameworks to explore relationships in design thinking with potential utility to stimulate thriving conversation on team-based design thinking in bioengineering education and practice.

  8. Consumer Finance


    Peter Tufano


    Although consumer finance is a substantial element of the economy, it has had a smaller footprint within financial economics. In this review, I suggest a functional definition of the subfield of consumer finance, focusing on four key functions: payments, risk management, moving funds from today to tomorrow (saving/investing), and from tomorrow to today (borrowing). I provide data showing the economic importance of consumer finance in the American economy. I propose a historical explanation fo...

  9. Accuracy of rapid disposition by emergency clinicians. (United States)

    Backay, Andrew; Bystrzycki, Adam; Smit, De Villiers; Keogh, Martin; O'Reilly, Gerard; Mitra, Biswadev


    Objectives Rapid disposition protocols are increasingly being considered for implementation in emergency departments (EDs). Among patients presenting to an adult tertiary referral hospital, this study aimed to compare prediction accuracy of a rapid disposition decision at the conclusion of history and examination, compared with disposition following standard assessment. Methods Prospective observational data were collected for 1 month between October and November 2012. Emergency clinicians (including physicians, registrars, hospital medical officers, interns and nurse practitioners) filled out a questionnaire within 5min of obtaining a history and clinical examination for eligible patients. Predicted patient disposition (representing 'rapid disposition') was compared with final disposition (determined by 'standard assessment'). Results There were 301 patient episodes included in the study. Predicted disposition was correct in 249 (82.7%, 95% confidence interval (CI) 78.0-86.8) cases. Accuracy of predicting discharge to home appeared highest among emergency physicians at 95.8% (95% CI 78.9-99.9). Overall accuracy at predicting admission was 79.7% (95% CI 67.2-89.0). The remaining 20.3% (95% CI 11.0-32.8) were not admitted following standard assessment. Conclusion Rapid disposition by ED clinicians can predict patient destination accurately but was associated with a potential increase in admission rates. Any model of care using rapid disposition decision making should involve establishment of inpatient systems for further assessment, and a culture of timely inpatient team transfer of patients to the most appropriate treating team for ongoing patient management. What is known about the topic? In response to the National Emergency Access Targets, there has been widespread adoption of rapid-disposition-themed care models across Australia. Although there is emerging data that clinicians can predict disposition accurately, this data is currently limited. What does this

  10. Clinical Prediction Making: Examining Influential Factors Related to Clinician Predictions of Recidivism among Juvenile Offenders (United States)

    Calley, Nancy G.; Richardson, Emily M.


    This study examined factors influencing clinician predictions of recidivism for juvenile offenders, including youth age at initial juvenile justice system involvement, youth age at discharge, program completion status, clinician perception of strength of the therapeutic relationship, and clinician perception of youth commitment to treatment.…

  11. Clinicians' Choices in Selecting Orthodontic Archwires

    Directory of Open Access Journals (Sweden)

    Silvia-Izabella Pop


    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

  12. Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives. (United States)

    Rothenfluh, Fabia; Schulz, Peter J


    Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes

  13. Clinician perspectives of an intensive comprehensive aphasia program. (United States)

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


    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.

  14. Clinicians' perceptions of pharmacogenomics use in psychiatry. (United States)

    Chan, Christopher Yi Wen; Chua, Boon Yiang; Subramaniam, Mythily; Suen, Emily Liew Kai; Lee, Jimmy


    This study aims to assess the attitudes and opinions of clinicians practicing in psychiatry toward pharmacogenomic testing, and in so doing elicits possible barriers and risks to employ this technology in patient care. Doctors and pharmacists presently practicing in psychiatry were invited to participate in an anonymous web-based survey. Besides information on participant characteristics and experience in psychiatry, specific themes on pharmacogenomics including self-assessed competency, perceived usefulness in clinical situations, perceived risks and preferred mode of education were evaluated. A total of 81% of respondents believed that pharmacogenomic testing would be useful for identifying suitable treatments and 71% believed that pharmacogenomic testing would be useful for medication intolerance. However, only 46.4% felt competent to order these tests. There were significant differences in responses for gender, doctors versus pharmacists and seniority in position. A total of 94.3% of respondents were concerned about costs and 84.5% were concerned about the lack of clear guidelines on its use. A total of 98.5% of respondents were keen on learning more about the applicability of pharmacogenomics, and the most preferred format of education was a lecture (44.5%). Most clinicians acknowledge the potential of pharmacogenomic testing in clinical practice. However, concerns with regard to its cost-effectiveness and the lack of clear guidelines are possible barriers to its clinical implementation.

  15. Consumer Neoteny

    Directory of Open Access Journals (Sweden)

    Mathieu Alemany Oliver


    Full Text Available This research explores childlike consumer behavior from an evolutionary perspective. More specifically, it uses the concept of neoteny to show that the retention of ancestors’ juvenile characteristics is related to specific behaviors. The results of factor analyses conducted on a UK sample (n = 499 and a French sample (n = 292 7 years later indicate four dimensions of childlike consumer behavior, namely, stimulus seeking, reality conflict, escapism, and control of aggression.

  16. The clinician's guide to autism. (United States)

    Harrington, John W; Allen, Korrie


    On the basis of the most recent epidemiologic research, Autism Spectrum Disorder (ASD) affects approximately 1% to 2% of all children. (1)(2) On the basis of some research evidence and consensus, the Modified Checklist for Autism in Toddlers isa helpful tool to screen for autism in children between ages 16 and 30 months. (11) The Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, changes to a 2-symptom category from a 3-symptom category in the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition(DSM-5): deficits in social communication and social interaction are combined with repetitive and restrictive behaviors, and more criteria are required per category. The DSM-5 subsumes all the previous diagnoses of autism (classic autism, Asperger syndrome, and pervasive developmental disorder not otherwise specified) into just ASDs. On the basis of moderate to strong evidence, the use of applied behavioral analysis and intensive behavioral programs has a beneficial effect on language and the core deficits of children with autism. (16) Currently, minimal or no evidence is available to endorse most complementary and alternative medicine therapies used by parents, such as dietary changes (gluten free), vitamins, chelation, and hyperbaric oxygen. (16) On the basis of consensus and some studies, pediatric clinicians should improve their capacity to provide children with ASD a medical home that is accessible and provides family-centered, continuous, comprehensive and coordinated, compassionate, and culturally sensitive care. (20)

  17. Gender and international clinician educators. (United States)

    Stadler, Dora J; Archuleta, Sophia; Ibrahim, Halah; Shah, Nina G; Al-Mohammed, Ahmed Ali; Cofrancesco, Joseph


    To describe gender differences of international clinician educators (CEs) and leaders, and CEs' perceptions by gender of preparation, roles, rewards and factors affecting job satisfaction and retention in emerging international competency-based residency programmes. Cross-sectional surveys of CEs and leadership were conductedJune 2013-June 2014 at institutions that had adopted competency-based graduate medical education and were accredited by the Accreditation Council for Graduate Medical Education-International. 274 (76.3%) of 359 eligible participants responded; 69 (25.2%) were female. Two (18%) of 11 chief executive officers and 1 (9%) of 11 chief medical officers were women. Female CEs were younger, more likely to be single and childless. They were less likely to hold academic appointments, despite no gender differences in length of time at current institution or in current position. A greater proportion of female CEs felt they were 'never' rewarded by academic promotion. Satisfaction rates were similar between the genders. Single female CEs were five times as likely to report being 'extremely likely' to stay in the country. Female CEs with children gender gap in appointment and advancement. Stakeholders at international programmes need to develop contextualised strategies to expand entry and decrease attrition of women into CE tracks, and promote gender equity. © 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.

  18. Entering and navigating academic medicine: academic clinician-educators' experiences. (United States)

    Kumar, Koshila; Roberts, Chris; Thistlethwaite, Jill


    Despite a recognised need for richer narratives about academic medicine, much of the literature is limited to an analysis of the enablers and barriers associated with recruitment and retention, and focuses on analysing the development of research career pathways. We explored academic clinician-educators' experiences of entering into and navigating academic medicine, with a particular focus on those who privilege teaching above research. Data were collected through interviews and focus groups conducted across a medical school at one Australian university. We used socio-cognitive career theory to provide theoretical insight into the factors that influence academic clinician-educators' interests, choice and motivations regarding entering and pursuing a teaching pathway within academic medicine. Framework analysis was used to illustrate key themes in the data. We identified a number of themes related to academic clinician-educators' engagement and performance within an academic medicine career focused on teaching. These include contextual factors associated with how academic medicine is structured as a discipline, cultural perceptions regarding what constitutes legitimate practice in academia, experiential factors associated with the opportunity to develop a professional identity commensurate with being an educator, and socialisation practices. The emphasis on research in academia can engender feelings of marginalisation and lack of credibility for those clinicians who favour teaching over research. The prevailing focus on supporting and socialising clinicians in research will need to change substantially to facilitate the rise of the academic clinician-educator. © Blackwell Publishing Ltd 2011.

  19. How is health economics relevant to transplant clinicians? (United States)

    Wong, Germaine; Howard, Kirsten; Webster, Angela C; Morton, Rachael L; Chapman, Jeremy R; Craig, Jonathan C


    Decision making is complex and difficult in clinical practice. Clinicians are often faced with a large range of possible alternative decision options, each with their own consequences and trade-offs. Health economics methods enable informed decision making on how best to allocate limited resources that could lead to most health gains. Economic evaluation in particular is highly relevant in transplantation medicine. Transplantation is an expensive intervention, but it improves the quality of life and survival of people with chronic diseases. The balance between health care resource use and the optimal health gains is useful not only to decision-makers, but also to consumers, clinicians, and researchers. This article is an overview of the concepts of economic evaluation in the setting of transplantation and highlights the applicability of these concepts in clinical transplantation.

  20. Engaging clinicians in health informatics projects. (United States)

    Caballero Muñoz, Erika; Hullin Lucay Cossio, Carola M


    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.

  1. Consumer Fetish

    DEFF Research Database (Denmark)

    Arnould, Eric; Cayla, Julien


    What is the sovereign consumer that occupies such a central role in organizational discourse whose satisfaction has become an organizational imperative? Our research draws from extended fieldwork in the world of commercial ethnography. Our analysis shows how ethnography is implicated in the organ......What is the sovereign consumer that occupies such a central role in organizational discourse whose satisfaction has become an organizational imperative? Our research draws from extended fieldwork in the world of commercial ethnography. Our analysis shows how ethnography is implicated...... in the organizational fetishization of consumers, that is, how in the process of understanding and managing markets, a quasimagical fascination with amalgams of consumer voices, images, and artefacts comes about. We offer several contributions. First, we demonstrate the pertinence of (primarily anthropological......) theories of the fetish to organizational sensemaking. Second, we describe a distinctive process of organizational market sensemaking that is sensuous, magical, and analogical. Third, we offer a subtle critique of commercial ethnography, a popular research practice that aims to bring ‘real’ consumers...

  2. Can images of pain enhance patient-clinician rapport in pain consultations? (United States)

    Ashton-James, Claire E; Dekker, Peter H; Addai-Davis, Judy; Chadwick, Tom; Zakrzewska, Joanna M; Padfield, Deborah; Williams, Amanda C de C


    A variety of treatment outcomes in chronic pain are influenced by patient-clinician rapport. Patients often report finding it difficult to explain their pain, and this potential obstacle to mutual understanding may impede patient-clinician rapport. Previous research has argued that the communication of both patients and clinicians is facilitated by the use of pain-related images in pain assessments. This study investigated whether introducing pain-related images into pain assessments would strengthen various components of patient-clinician rapport, including relative levels of affiliation and dominance, and interpersonal coordination between patient and clinician behaviour. Videos of 35 pain assessments in which pain images were present or absent were used to code behavioural displays of patient and clinician rapport at fixed intervals across the course of the assessment. Mixed modelling was used to examine patterns of patient and clinician affiliation and dominance with consultation type (Image vs Control) as a moderator. When pain images were present, clinicians showed more affiliation behaviour over the course of the consultation and there was greater correspondence between the affiliation behaviour of patient and clinician. However, relative levels of patient and clinician dominance were unaffected by the presence of pain images in consultations. Additional analyses revealed that clinicians responded directly to patients' use of pain images with displays of affiliation. Based on the results of this study, we recommend further investigation into the utility and feasibility of incorporating pain images into pain assessments to enhance patient-clinician communication.

  3. Consumer perceptions

    DEFF Research Database (Denmark)

    Ngapo, T. M.; Dransfield, E.; Martin, J. F.


    that there was no link between the negative images of production methods and their purchase behaviour. The groups were clearly confused and mistrusted the limited information available at the point of purchase. Careful consideration should be given to meat labelling, in particular taking account of the evident consumer......Consumer focus groups in France, England, Sweden and Denmark were used to obtain insights into the decision-making involved in the choice of fresh pork and attitudes towards today's pig production systems. Many positive perceptions of pork meat were evoked. Negative images of the production systems...... in use today were expressed, but rationalised in terms of consumer demands, market competition and by comparisons to previous systems of production. Knowledge of production systems appeared of little consequence in terms of any meat market potential as several groups freely remarked...

  4. Consumer Behavior Research

    Directory of Open Access Journals (Sweden)

    Kaveh Peighambari


    Full Text Available This article analyzes 12 years of recent scholarly research on consumer behavior published in the five leading international journals in this field. Analyzing academic contributions to a specific area of research provides valuable insights into how it has evolved over a defined period. The approach was to briefly discuss content analysis and its application in scholarly literature review studies. The methodology used here involves the classification of topics to evaluate key trends in consumer behavior literature. It includes a ranking of topics published, typology of the published articles, the research classification in terms of methodologies, and analysis techniques. The most cited articles in the field and within each journal are also examined. The comprehensive literature review of consumer behavior research undertaken in this article could advance the discipline of consumer behavior research by elucidating the evolution of consumer behavior literature in the studied period.

  5. Clinicians' recognition and management of emotions during difficult healthcare conversations. (United States)

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


    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.

  6. [Leadership and management courses for clinicians]. (United States)

    Wichelhaus, Daniel; Fischer, Peter


    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

  7. Consumer Behavior

    NARCIS (Netherlands)

    Hoyer, W.D.; MacInnis, D.J.; Pieters, R.


    CONSUMER BEHAVIOR combines a foundation in key concepts from marketing, psychology, sociology, and anthropology with a highly practical focus on real-world applications for today's business environment. The new edition of this popular, pioneering text incorporates the latest cutting-edge research

  8. Impact of alert specifications on clinicians' adherence

    NARCIS (Netherlands)

    Langemeijer, M. M.; Peute, L. W.; Jaspers, M. W. M.


    Computerized alerts provided by health care information systems have been shown to enhance clinical practice. However, clinicians still override more than half of the alerts. This indicates that certain aspects of alerts need improvement to fulfill their purpose of supporting clinicians in decision

  9. Behavioural Economics, Consumer Behaviour, and Consumer Policy

    DEFF Research Database (Denmark)

    Reisch, Lucia A.; Zhao, Min


    . In particular, we discuss the impacts of key principles such as status quo bias, the endowment effect, mental accounting and the sunkcost effect, other heuristics and biases related to availability, salience, the anchoring effect and simplicity rules, as well as the effects of other supposedly irrelevant...... factors such as music, temperature and physical markers on consumers’ decisions. These principles not only add significantly to research on consumer behaviour – they also offer readily available practical implications for consumer policy to nudge behaviour in beneficial directions in consumption domains...... including financial decision making, product choice, healthy eating and sustainable consumption....

  10. Examining clinicians' perceptions of head and neck cancer (HNC) information. (United States)

    Jabbour, Joe; Wykes, James; Milross, Chris; Sundaresan, Puma; Ebrahimi, Ardalan; Shepherd, Heather L; Dhillon, Haryana M; Clark, Jonathan R


    Providing appropriate educational resources to patients with head and neck cancer (HNC) is important but challenging. The aim of this study was to determine Australian clinicians' perceptions of currently used HNC information resources. A purpose-designed questionnaire was disseminated electronically to clinician members of the Australian and New Zealand Head and Neck Cancer Society (ANZHNCS) and The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS). Of the 648 clinicians invited, 112 responded to the survey (17.3% response rate). Overall, 85% utilized written information as their primary mode of patient education and 49% received information on treatment details. Areas for improvement include information provision, pain management, emerging risk factors, survivorship and side effects. The majority (66%) of clinicians had a preference for internet patient education materials. Clinicians predominantly utilized written HNC information rather than multimedia or interactive resources. However, they expressed the desire to be able to deliver HNC information resources via an internet-based platform covering the psychosocial effects of treatment. © 2018 John Wiley & Sons Australia, Ltd.

  11. Consumer choice behaviour

    DEFF Research Database (Denmark)

    Hansen, Flemming; Percy, Larry; Hallum Hansen, Morten


    The paper is concerned with the measurement of emotions and the study of the role ofemotions in consumer choice. Contemporary neurological findings suggest that emotionsmay play a role in its own right, quite different from the way in which they have beenconsidered in traditional consumer choice...... behaviour theory. A large-scale study including800 respondents, covering 64 brands, provide findings on emotional response tendenciesfor the brands, and relate these to involvement, type of need gratification, purchasingbehaviour, etc....

  12. Consumer choice behaviour

    DEFF Research Database (Denmark)

    Hansen, Flemming; Percy, Larry; Hallum Hansen, Morten


    The paper is concerned with the measurement of emotions and the study of the role ofemotions in consumer choice. Contemporary neurological findings suggest that emotionsmay play a role in its own right, quite different from the way in which they have beenconsidered in traditional consumer choice ...... behaviour theory. A large-scale study including800 respondents, covering 64 brands, provide findings on emotional response tendenciesfor the brands, and relate these to involvement, type of need gratification, purchasingbehaviour, etc....

  13. Consumer choice behaviour


    Hansen, Flemming; Percy, Larry; Hallum Hansen, Morten


    The paper is concerned with the measurement of emotions and the study of the role of emotions in consumer choice. Contemporary neurological findings suggest that emotions may play a role in its own right, quite different from the way in which they have been considered in traditional consumer choice behaviour theory. A large-scale study including 800 respondents, covering 64 brands, provide findings on emotional response tendencies for the brands, and relate these to involvement...

  14. Are Clinicians' Assessments of Improvements in Children's Functioning "Global"? (United States)

    De Los Reyes, Andres; Alfano, Candice A.; Beidel, Deborah C.


    In this study, the authors examined the relations among clinician ratings of treatment improvement and discrepancies between parent and blinded laboratory rater reports of child social functioning administered before and after treatment for social anxiety disorder. Participants included a clinic sample of 101 children (7-16 years old; M = 11.67,…

  15. Exploring dialectical behaviour therapy clinicians' experiences of team consultation meetings. (United States)

    Walsh, Cian; Ryan, Patrick; Flynn, Daniel


    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.

  16. Improving clinicians' access to cost data. (United States)

    Kenagy, John; Shah, Ben


    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.

  17. A survey of drug information references emergency medicine clinicians utilize for prescribing in pregnant patients. (United States)

    Jellinek, Samantha P; Cohen, Victor; Stansfield, Lindsay; Likourezos, Antonios; Sable, Kenneth N


    Clinicians practicing in Emergency Departments (EDs) using outdated pocket guides and other non-pregnancy-specific references when prescribing in pregnancy may place the pregnancy or fetus at risk. To identify the references that emergency medicine (EM) clinicians use for prescribing in pregnant patients, the prescribing trends when clinicians are given the pregnancy category information, and clinician awareness of access to drug information references. This cross-sectional survey was administered to EM clinicians. In part I, clinicians listed the top 3 drug information references that they routinely use in clinical practice. In part II, clinicians ranked their willingness to prescribe a Category A, B, C, D, or X drug using a 5-point Likert scale. In part III, clinicians selected from a list of electronic and print resources those that they consider available to them in the ED to find pregnancy-related drug prescribing information. Statistical analyses included frequency distribution and bivariate analysis. Fifty-five clinicians with an average of 5.71 +/- 7.95 years (+/- SD) in the profession completed the survey. The most commonly used references included Micromedex, Tarascon Pocket Pharmacopoeia, and Epocrates (29%, 18%, and 14%, respectively). Ten (18%) respondents stated that they would be willing to prescribe Category C drugs. Among the 5 pregnancy-specific drug information references that are available in our ED, only 20% of EM clinicians stated that these references were available to them. EM clinicians rely on general references to make prescribing decisions for pregnant patients and are willing to prescribe medications that have data to support safe use in pregnancy. A minority of EM clinicians acknowledged the availability of pregnancy-specific references in the ED. Increased awareness of references that incorporate human data into their pharmacotherapy recommendations is warranted to assist EM clinicians in achieving their goal of prescribing safely in

  18. [Barriers to communication between clinicians and immigrants]. (United States)

    Sodemann, Morten; Kristensen, Trine Rønde; Sångren, Henrik; Nielsen, Dorthe


    Clinicians lack cultural competencies and communication skills relevant to clinical decision-making in cases of language and cultural barriers. Life course perspectives and basic understanding of life in exile are not integrated in diagnostics, treatment or follow-up resulting in low patient compliance, mistrust, complications, diagnostic errors and delays. Stereotyping and generalizations put patients in a position where they are forced to protect themselves by withholding important information. When in doubt clinicians should ask, listen and avoid guessing.

  19. Turning attention to clinician engagement in Victoria. (United States)

    Jorm, Christine; Hudson, Robyn; Wallace, Euan


    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.

  20. A framework for understanding moral distress among palliative care clinicians. (United States)

    Rushton, Cynda H; Kaszniak, Alfred W; Halifax, Joan S


    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.

  1. Clinician knowledge, clinician barriers, and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates. (United States)

    Rutten, Lila J Finney; St Sauver, Jennifer L; Beebe, Timothy J; Wilson, Patrick M; Jacobson, Debra J; Fan, Chun; Breitkopf, Carmen Radecki; Vadaparampil, Susan T; Jacobson, Robert M


    We tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level. We conducted a survey from October 2015 through January 2016 among primary care clinicians (n=280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9-18year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9-18years (n=68,272). Consistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR]=1.05) and completion of three doses (IRR=1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR=0.94) and completion (IRR=0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9-13, and percent with government insurance or self-pay at each site. Clinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates-initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences

  2. Bioethics for clinicians: 27. Catholic bioethics (United States)

    Markwell, Hazel J.; Brown, Barry F.


    THERE IS A LONG TRADITION OF BIOETHICAL REASONING within the Roman Catholic faith, a tradition expressed in scripture, the writings of the Doctors of the Church, papal encyclical documents and reflections by contemporary Catholic theologians. Catholic bioethics is concerned with a broad range of issues, including social justice and the right to health care, the duty to preserve life and the limits of that duty, the ethics of human reproduction and end-of-life decisions. Fundamental to Catholic bioethics is a belief in the sanctity of life and a metaphysical conception of the person as a composite of body and soul. Although there is considerable consensus among Catholic thinkers, differences in philosophical approach have given rise to some diversity of opinion with respect to specific issues. Given the influential history of Catholic reflection on ethical matters, the number of people in Canada who profess to be Catholic, and the continuing presence of Catholic health care institutions, it is helpful for clinicians to be familiar with the central tenets of this tradition while respecting the differing perspectives of patients who identify themselves as Catholic. PMID:11501460

  3. Evidence-based Practice. Findings from the Section on Education and Consumer Health Informatics. (United States)

    Staccini, P; Douali, N


    To provide an overview of outstanding current research conducted in Education and Consumer Informatics. Synopsis of the articles on education and consumer health informatics published in 2012 and selected for the IMIA Yearbook of Medical Informatics 2013. Architecture of monitoring or telehealth information systems for patients with chronic disease must include wireless devices to aid in the collection of personal data. Data acquisition technologies have an impact on patients' willingness to participate in telehealth programmes. Patients are more likely to prefer mobile applications over web-based applications. Social media is widely used by clinicians. Especially younger clinicians use it for personal purposes and for reference materials retrieval. Questions remain on optimal training requirements and on the effects on clinician behavior and on patient outcomes. A high level of e-Health literacy by patients will promote increased adoption and utilization of personal health records. The selected articles highlight the need for training of clinicians to become aware of existing telehealth systems, in order to correctly inform and guide patients to take part in telehealth systems and adopt personal healthcare records (PHR).

  4. The repeatability of automated and clinician refraction. (United States)

    Bullimore, M A; Fusaro, R E; Adams, C W


    Auto-refractors are used as a starting point for clinicians' refractions and in studies of refractive error. We investigated the repeatability of the Hoya AR-570 and clinician refraction. Eighty-six subjects, aged 11 to 60 years, were recruited by mailing inquiries to 500 randomly selected patients who had received recent examinations at the University of California Optometric Eye Center. Contact lens wearers, patients with best corrected visual acuity worse than 20/30 in either eye, and patients with a history of diabetes were excluded. Each subject was examined by two clinicians during one visit. The first clinician obtained five auto-refractor readings for each eye (which were later averaged), performed a balanced subjective refraction (with spherical masking lenses in the phoropter), and repeated the automated refractor measurements. This protocol was then repeated by the second clinician. Clinicians were randomized with regard to testing order and masked to automated refractor results, each other's refractions, and previous spectacle prescriptions. To quantify repeatability, we used mixed model analyses of variance to estimate the appropriate variance components while accounting for the correlation among, for example, repeated measurements of the same eye. Astigmatic data were analyzed by converting into Fourier form: two cross-cylinders at axis 0 degrees (J0) and axis 45 degrees (J45). For mean spherical equivalent, the average difference between five averaged automated refractor readings, taken by two different optometrists, was +0.02 D (95% limits of agreement = -0.36 to +0.40 D). The average difference between the two optometrists' subjective refractions was -0.12 D (95% limits of agreement = -0.90 to +0.65 D). The 95% limits of agreement for the automated refractor were about half those of the clinician for both astigmatic terms (J0 and J45) and for all comparisons. Automated refraction is more repeatable than subjective refraction and therefore more

  5. Clinicians' perspectives on decision making in lower limb amputee rehabilitation. (United States)

    Sansam, Kate; O'Connor, Rory J; Neumann, Vera; Bhakta, Bipin


    Decision making within amputee rehabilitation includes the assessment of whether a patient is suitable for a prosthesis and if so, what components to provide. This study seeks to increase understanding about clinicians' perspectives on what factors influence these decisions. One-to-one semi-structured interviews were completed with 23 experienced clinicians at their place of work at 4 UK amputee rehabilitation centres. Thematic analysis using a theoretical, semantic approach was used to identify key themes from the data. Four key themes were identified: estimating outcome; difficulties predicting outcome; patient choice and barriers to prescribing. There was variation in the importance placed on each theme between individual clinicians and services, with factors such as budget and risk aversion acting as barriers to prescribing. Only one of the 4 centres used formal prescribing guidelines. The results highlight the difficulties clinicians experience in estimating outcome and suggest inequity of prosthetic provision in the UK, with variation in the provision of high cost items. The development of national prescription guidelines is suggested to improve equality of prosthetic provision.

  6. Exploring Consumer Literacy (United States)

    Moore, Virginia; Sumrall, William; Mott, Michael; Mitchell, Elizabeth; Theobald, Becky


    Methods for facilitating students' standards-based consumer literacy are addressed via the use of problem solving with food and product labels. Fifth graders will be able to: (1) provide detailed analysis of food and product labels; (2) understand large themes, including production, distribution, and consumption; and (3) explore consumer…

  7. What motivates senior clinicians to teach medical students?

    Directory of Open Access Journals (Sweden)

    Owen Cathy


    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.

  8. Advanced Practice Clinician Training for Neurology (United States)

    Cox, Lori; Ahmed, Aiesha


    Background The specialty of Neurology is faced with a fundamental problem of economics: supply and demand. The projected increase in provider supply is unlikely to keep up with projected increases in patient-care demand. Many large academic centers have used residents to meet this patient-care demand. However, the conflict between education of residents and patient-care needs has created a hindrance to both of those missions. Many specialties have been using advanced practice clinicians (APCs) to help address the need for patient care. In the setting of a residency program, this availability of APCs can help to alleviate patient-care demands for the resident and allow for better allocated educational time. Neurology has not historically been a popular choice for APCs and a standardized educational curriculum for a Neurology APC has not been established. Methods The authors share an example curriculum recently implemented for training new inpatient Neurology APCs. This curriculum includes a 12-week program complete with rotations through various subspecialties and proposes fundamental lecture topics for use in education. The authors share their expectations for clinical duties that evolve over the course of the 12-week program in conjunction with expectations for increasing clinical knowledge as well as efficiency in system utilization. Conclusion The addition of APCs to support a busy inpatient Neurology practice has obvious beneficial implications but the integration and education of this new staff must be structured and well-designed to support the confidence of the APC in both their knowledge and their role as an indispensable member of the care team. PMID:28560122

  9. Consumer Energy Atlas

    Energy Technology Data Exchange (ETDEWEB)


    This first edition of the Atlas provides, in reference form, a central source of information to consumers on key contacts concerned with energy in the US. Energy consumers need information appropriate to local climates and characteristics - best provided by state and local governments. The Department of Energy recognizes the authority of state and local governments to manage energy programs on their own. Therefore, emphasis has been given to government organizations on both the national and state level that influence, formulate, or administer policies affecting energy production, distribution, and use, or that provide information of interest to consumers and non-specialists. In addition, hundreds of non-government energy-related membership organizations, industry trade associations, and energy publications are included.

  10. THE ROLE OF FARMERS IN MANAGING WATER Dr Tony Colman Professor Tony Allan Farmers manage about 92% of the water consumed by society which needs to recognise that farming practices and the decisions made by those who operate food supply chains - including corporates and those making public policy - determine how water is stewarded. (United States)

    Colman, A. J.


    Title Food-water and society Dr. Tony Colman and Professor Tony Allan Abstract The purpose of the paper is to highlight some key relationships between water resources and society. First, water is an very important resource for society in that it provides an essential input to society's food supply chains. Secondly, it is an essential input to farmer livelihoods. About half of the families of the world still work in agriculture - albeit a declining proportion. Thirdly, farmers manage about 92% of the water consumed by society - including the blue water (surface and groundwater) for irrigation and the green water (effective rainfall) consumed on rainfed farms. They also account for about 66% of society's impacts on biodiversity and about 25% of emissions. Finally it will be argued that those who analyse allocation and management of water must recognise that farming practices and the decisions made by those who operate food supply chains - including corporates and those making public policy - must recognise that it is farmers and food consumers who determine how water is stewarded. It will be suggested that we need to understand that well informed consumers could be the regulators.

  11. Disseminating effective clinician communication techniques: Engaging clinicians to want to learn how to engage patients. (United States)

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


    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.

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

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


    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

  13. Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction. (United States)

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


    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

  14. Results of the Clinician Apps Survey, How Clinicians Working With Patients With Diabetes and Obesity Use Mobile Health Apps. (United States)

    Karduck, Justine; Chapman-Novakofski, Karen


    To develop and administer a questionnaire to determine what factors may be associated with app use (including frequency of use, reasons to recommend to clients/patients, perceived effectiveness on health, health aspects used, features, and types of apps) by clinicians working in diabetes and weight management patient care settings. The Clinician Apps Survey was developed and contained 3 question domains (smartphone apps use, behavior theory in counseling sessions, and demographics) to explore frequency, types, preferred features, benefits/barriers of using apps, counseling techniques used, and clinician demographics. Clinicians (n = 719) were recruited to complete the online survey through 4 dietetics and diabetes professional groups. Clinician use and preferences for health-related apps for personal reasons and in patient care settings were determined, and comparisons were made between high and non-app users. Descriptive statistics were used with current practices and attitudes about apps. Chi-square test of independence compared those using apps both personally and professionally (app enthusiasts) vs those with no app use. There were more app enthusiasts (53%; n = 380) than non-app users (20%; n = 145). Whereas 68% recommended pen/paper methods for diet and physical activity monitoring, 62% recommended apps. Most agreed that apps were superior to traditional methods for patients to track dietary intake (62%) and physical activity (58%), make better food choices (34%), lose weight (45%), and track blood glucose (43%). App enthusiasts used the American Association of Diabetes Educators self-care guidelines (P = .001) and advanced counseling techniques (eg, motivational interviewing) more often than did non-app users (P Apps most frequently recommended to clients were MyFitnessPal (n = 425), CalorieKing (n = 356), and Fitbit (n = 312). Health-related smartphone apps are being widely used and recommended to patients with diabetes and obesity by

  15. [The agony of rubbish to clinicians]. (United States)

    Xhauflaire-Uhoda, E; Quatresooz, P; Piérard-Franchimont, C; Piérard, G E


    The clinician is at the crossroad between scientific information and some rubbish presentations of low level communication. In this background, searching for objectivity is mandatory in clinical trials. We summarize the main aspects of assessment on nominal scale, ordinal scale, interval scale as well as on structured and non structured scales.

  16. A letter to the Master Clinician


    Jhaveri, Kenar D.


    In this commentary, the author writes a letter to the Master Clinician about his concerns regarding the teaching responsibilities of current faculty members during ward rounds. This short essay highlights the transition that has been noticed in medical training in the last decade.

  17. A letter to the Master Clinician. (United States)

    Jhaveri, Kenar D


    In this commentary, the author writes a letter to the Master Clinician about his concerns regarding the teaching responsibilities of current faculty members during ward rounds. This short essay highlights the transition that has been noticed in medical training in the last decade.

  18. Balancing treatment allocations by clinician or center in randomized trials allows unacceptable levels of treatment prediction. (United States)

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


    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

  19. Conflicts in the ICU: perspectives of administrators and clinicians. (United States)

    Danjoux Meth, Nathalie; Lawless, Bernard; Hawryluck, Laura


    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.

  20. Consumer Demands

    DEFF Research Database (Denmark)

    Holm-Nielsen, Jens Bo


    to farms that supply fresh manure to the digestion process, partly to crop farms in need of organic fertilizers. Environmental and agricultural benefits include savings for farmers as a consequence of improved fertilizer efficiency and thereby reduction  of needs of chemical fertilizers. A side effect...

  1. Consumer Concerns: Newcomer's Guide. 4. (United States)

    Michael, Jean

    A bilingual pamphlet containing practical law-related information for recent Russian Jewish immigrants to New York City, this document addresses consumer concerns. Following a brief description of the Newcomer series, 15 questions are listed, each followed by an answer. Questions asked include the meaning of the terms consumer and contract;…

  2. Predictive models in cancer management: A guide for clinicians. (United States)

    Kazem, Mohammed Ali


    Predictive tools in cancer management are used to predict different outcomes including survival probability or risk of recurrence. The uptake of these tools by clinicians involved in cancer management has not been as common as other clinical tools, which may be due to the complexity of some of these tools or a lack of understanding of how they can aid decision-making in particular clinical situations. The aim of this article is to improve clinicians' knowledge and understanding of predictive tools used in cancer management, including how they are built, how they can be applied to medical practice, and what their limitations may be. Literature review was conducted to investigate the role of predictive tools in cancer management. All predictive models share similar characteristics, but depending on the type of the tool its ability to predict an outcome will differ. Each type has its own pros and cons, and its generalisability will depend on the cohort used to build the tool. These factors will affect the clinician's decision whether to apply the model to their cohort or not. Before a model is used in clinical practice, it is important to appreciate how the model is constructed, what its use may add over and above traditional decision-making tools, and what problems or limitations may be associated with it. Understanding all the above is an important step for any clinician who wants to decide whether or not use predictive tools in their practice. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  3. Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter. (United States)

    Anazodo, Antoinette C; Gerstl, Brigitte; Stern, Catharyn J; McLachlan, Robert I; Agresta, Franca; Jayasinghe, Yasmin; Cohn, Richard J; Wakefield, Claire E; Chapman, Michael; Ledger, William; Sullivan, Elizabeth A


    In Australia and New Zealand, there has not been a national systematic development of oncofertility services for cancer patients of reproductive age although many cancer and fertility centers have independently developed services. A number of barriers exist to the development of these services, including a lack of clear referral pathways, a lack of communication between clinicians and patients about fertility preservation, differences in the knowledge base of clinicians about the risk of cancer treatment causing infertility and fertility preservation options, a lack of national health insurance funding covering all aspects of fertility preservation, and storage costs and cultural, religious, and ethical barriers. The development of strategies to overcome these barriers is a high priority for oncofertility care to ensure that equitable access to the best standard of care is available for all patients. The FUTuRE Fertility Research Group led a collaborative consultation process with the Australasian Oncofertility Consumer group and oncofertility specialists to explore consumers' experiences of oncofertility care. Consumers participated in qualitative focus group meetings to define and develop a model of consumer driven or informed "gold standard oncofertility care" with the aim of putting together a Charter that specifically described this. The finalized Australasian Oncofertility Consortium Charter documents eight key elements of gold standard oncofertility care that will be used to monitor the implementation of oncofertility services nationally, to ensure that these key elements are incorporated into standard practice over time.

  4. Moving beyond 'not enough time': factors influencing paediatric clinicians' participation in research. (United States)

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


    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.

  5. Integrative medicine at academic health centers: a survey of clinicians' educational backgrounds and practices. (United States)

    Ehrlich, Gillian; Callender, Travis; Gaster, Barak


    Integrative medicine is a relatively new field that seeks to combine conventional and nonconventional approaches to patient care. Many academic health centers have now established integrative medicine clinics, yet little is known about the clinicians who practice at them. We used a nationwide survey to characterize the backgrounds, clinical practices, and involvement in research and education of clinicians who practice integrative medicine at academic health centers. Participants included clinicians (MDs, DOs, PAs, and nurse practitioners) who practice at 30 different integrative medicine clinics that are affiliated with academic health centers. Completed surveys from 136 of 162 clinicians were received (84% response rate). The integrative therapies that clinicians most often reported providing themselves were breathing exercises (66%), herbal medicine prescribing (61%), meditation (44%), and functional medicine (34%). The integrative therapies that clinicians most often referred their patients for were acupuncture (96%), massage (92%), yoga (85%), and meditation (79%). Respondents reported spending a mean of 20% of their time training medical students, and 63% had participated in research in the past year. This survey provides the first national assessment of clinicians practicing integrative medicine at academic health centers. These clinicians use a wide variety of complementary and alternative therapies and appear involved in the research and education missions of their academic health centers.

  6. Reflections on the current and future roles of clinician-scientists. (United States)

    Baumal, Reuben; Benbassat, Jochanan; Van, Julie A D


    "Clinician-scientists" is an all-inclusive term for board-certified specialists who engage in patient care and laboratory-based (biomedical) research, patient-based (clinical) research, or population-based (epidemiological) research. In recent years, the number of medical graduates who choose to combine patient care and research has declined, generating concerns about the future of medical research. This paper reviews: a) the various current categories of clinician-scientists, b) the reasons proposed for the declining number of medical graduates who opt for a career as clinician-scientists, c) the various interventions aimed at reversing this trend, and d) the projections for the future role of clinician-scientists. Efforts to encourage students to combine patient care and research include providing financial and institutional support, and reducing the duration of the training of clinician-scientists. However, recent advances in clinical and biomedical knowledge have increased the difficulties in maintaining the dual role of care-providers and scientists. It was therefore suggested that rather than expecting clinician-scientists to compete with full-time clinicians in providing patient care, and with full-time investigators in performing research, clinician-scientists will increasingly assume the role of leading/coordinating interdisciplinary teams. Such teams would focus either on patient-based research or on the clinical, biomedical and epidemiological aspects of specific clinical disorders, such as hypertension and diabetes.

  7. 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

  8. Online Consumer Ethnocentrism of Danish Consumers

    DEFF Research Database (Denmark)

    Bujac, Andreea Ioana


    No doubt that consumer ethnocentrism is an important phenomenon in international marketing. However, not much attention has been paid to consumer ethnocentrism in an online context. The current study aims to fill in this gap. Specifically, the ethnocentric tendency of Danish online consumers...

  9. The Last Mile: Using Fax Machines to Exchange Data between Clinicians and Public Health. (United States)

    Downs, Stephen M; Anand, Vibha; Sheley, Meena; Grannis, Shaun J


    There is overlap in a wide range of activities to support both public health and clinical care. Examples include immunization registries (IR), newborn screening (NBS), disease reporting, lead screening programs, and more. Health information exchanges create an opportunity to share data between the clinical and public health environments, providing decision support to clinicians and surveillance and tracking information to public health. We developed mechanisms to support two-way communication between clinicians in the Indiana Health information Exchange (IHIE) and the Indiana State Department of Health (ISDH). This paper describes challenges we faced and design decisions made to overcome them. We developed systems to help clinicians communicate with the ISDH IR and with the NBS program. Challenges included (1) a minority of clinicians who use electronic health records (EHR), (2) lack of universal patient identifiers, (3) identifying physicians responsible for newborns, and (4) designing around complex security policies and firewalls. To communicate electronically with clinicians without EHRs, we utilize their fax machines. Our rule-based decision support system generates tailored forms that are automatically faxed to clinicians. The forms include coded input fields that capture data for automatic transfer into the IHIE when they are faxed back. Because the same individuals have different identifiers, and newborns' names change, it is challenging to match patients across systems. We use a stochastic matching algorithm to link records. We scan electronic clinical messages (HL7 format) coming into IHIE to find clinicians responsible for newborns. We have designed an architecture to link IHIE, ISDH, and our systems.

  10. Corporate Consumer Contact API (United States)

    General Services Administration — The data in the Corporate Consumer Contact API is based on the content you can find in the Corporate Consumer Contact listing in the Consumer Action Handbook (PDF)....

  11. Radiology reporting of obesity: a survey of patient and clinician attitudes. (United States)

    Murray, T E; Ma, S D; Doyle, F; Lee, M J


    To determine whether obesity information obtained via imaging techniques is desirable for clinicians and patients, and to investigate whether it impacts clinical decision-making. Parallel surveys were designed to assess patient and clinician attitudes to the medical utility and social stigma of reporting obesity on radiology reports performed for other reasons. Where obesity was noted at medical imaging performed for any reason, clinicians and patients strongly agreed that it should be included in the radiology report (5.9 and 5.8, respectively, on a seven-point preference score ranging from strongly disagree [1] to strongly agree [7]). Clinicians and patients indicated a preference for a quantitative report. Clinicians somewhat disagreed and patients disagreed that a radiology report describing obesity would be considered insulting (3 and 2.1, respectively). Clinicians and patients agreed that they would be more likely to discuss overweight/obesity if it was described in a radiology report (5.3 and 6.1 respectively). Clinicians and patients agreed that radiology reports describing obesity would influence future management/behaviour (4.5 and 6.2, respectively). Clinicians strongly disagreed that they would avoid sending patients for scans if obesity was reported (1.3). Patients also disagreed that including such information on a report would result in imaging avoidance (1.9). Both clinicians and patients indicate a clear preference for obesity-related information on radiology reports for examinations performed for any reason. Surveyed attitudes suggest including such information is not considered insulting, and is unlikely to result in avoidance of imaging. Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Facilitators and Barriers to International Collaboration in Spinal Cord Injury: Results from a Survey of Clinicians and Researchers. (United States)

    Noonan, Vanessa K; Chan, Elaine; Bassett-Spiers, Kent; Berlowitz, David J; Biering-Sørensen, Fin; Charlifue, Susan; Graco, Marnie; Hayes, Keith C; Horsewell, Jane; Joshi, Phalgun; Markelis, Debora; Smith, Verna; Waheed, Zeina; Brown, Douglas J


    International collaboration in spinal cord injury (SCI) research is necessary to overcome the challenges often encountered by clinicians and researchers, including participant recruitment, high cost, and the need for specialized expertise. However, international collaboration poses its own obstacles. The objective of this study was to conduct an international online survey to assess barriers and facilitators to international SCI clinical research, potential initiatives to facilitate future collaborations, and the use of SCI-specific data sets and standards. Results were analyzed using descriptive statistics. Of 364 total respondents, 213 completed the survey, with the majority of these participants based in North America (38%), Asia (22%), Europe (18%), and Oceania (16%). Over half had more than 10 years of experience in SCI research or clinical practice (57%) and 60% had previous experience with international collaborations. Funding was identified as a top barrier (82%), a facilitator (93%), and a proposed future initiative (97%). Communication and technology were also identified as strong facilitators and proposed future initiatives. The International Standards for Neurological Classification of SCI were used by 69% of participants, the International Standards to document remaining Autonomic Function after SCI by 13% of participants, and the International SCI Data Sets by 45% of participants. As the need for international collaborations in SCI research increases, it is important to identify how clinicians and researchers can be supported by SCI consumer and professional organizations, funders, and networks. Furthermore, unique solutions to overcome modifiable barriers and creation of new facilitators are also needed.

  13. CGB - Consumer Complaints Data (United States)

    Federal Communications Commission — Individual informal consumer complaint data detailing complaints filed with the Consumer Help Center beginning October 31, 2014. This data represents information...

  14. Profile of organic food consumers

    Directory of Open Access Journals (Sweden)

    Kranjac Mirjana


    Full Text Available The aim of this study is to prove that profile of organic food consumers is dependent on their socio-demographic characteristics as well as to shape universal organic food consumer profile. The survey included 398 consumers in Serbia. Results indicate existence of typical consumer's profile. The findings could be generalized proving that socio-demographic profiles in a larger population are strictly related to the decision to utilize organic food. The study finally contributes to the stakeholders in general, since the knowledge of the attributes can help all of them to play more active role in this supply chain. It should stimulate the personalized approach to the particular groups of consumers based on socio-demographic characteristics in order to intensify consumption of organic food and to create different marketing plans dependent on the particular countries or areas.

  15. European consumers and beef safety

    DEFF Research Database (Denmark)

    Van Wezemael, Lynn; Verbeke, Wim; Kügler, Jens Oliver


    European beef consumption has been gradually declining during the past decades, while consumers' concerns about beef safety have increased. This paper explores consumer perceptions of and interest in beef safety and beef safety information, and their role in beef safety assessment and the beef...... consumption decision making process. Eight focus group discussions were performed with a total of 65 beef consumers in four European countries. Content analysis revealed that European consumers experienced difficulties in the assessment of the safety of beef and beef products and adopted diverging uncertainty...... reduction strategies. These include the use of colour, labels, brands and indications of origin as cues signalling beef safety. In general, consumer trust in beef safety was relatively high, despite distrust in particular actors....

  16. Inequities in access to rehabilitation: exploring how acute stroke unit clinicians decide who to refer to rehabilitation. (United States)

    Lynch, Elizabeth A; Luker, Julie A; Cadilhac, Dominique A; Hillier, Susan L


    Less than half of the patients with stroke in Australian hospitals are assessed by rehabilitation specialists. We sought to explore how clinicians working in acute stroke units (ASUs) determine which patients to refer to rehabilitation services. Qualitative descriptive study. Team meetings were observed and medical records were reviewed over four weeks at two ASUs. Focus groups were conducted with staff from eight ASUs in two states of Australia. Rehabilitation was mentioned in team meetings for 50/64 patients (78%) during the observation period. Rehabilitation referrals were organised for 47 patients (94%) for whom rehabilitation was discussed (74% of the sample); and for no patients when rehabilitation was not discussed. Factors identified that influenced whether referrals were organised included the anticipated discharge destination; severity of stroke; staff expectations of the patient's recovery; and if there was advocacy by families about rehabilitation. Clinicians tended to refer the patients they considered would be accepted by the rehabilitation service. Staff at two ASUs expressed concern that referring all patients with stroke-related deficits to rehabilitation would be unfavourable with rehabilitation providers. Decisions made by ASU staff regarding who to refer to stroke rehabilitation are often not solely based on patients' rehabilitation requirements. Implications for Rehabilitation Not all patients on acute stroke units (ASUs) who may have benefited from rehabilitation were offered rehabilitation referrals. Criteria for rehabilitation referrals need to be made explicit and discussed openly with consumers, ASU clinicians and rehabilitation specialists. A change in rehabilitation assessment practices is required to provide data regarding the unmet rehabilitation needs of patients with stroke. New models of rehabilitation service delivery or increased rehabilitation services may be required to meet the rehabilitation needs of all patients with stroke.

  17. Supporting clinician educators to achieve “work-work balance”

    Directory of Open Access Journals (Sweden)

    Jerry M Maniate


    Full Text Available Clinician Educators (CE have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve “work-work balance.” Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE’s “Four Ps”; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance.

  18. Molecular Genetics of Epilepsy: A Clinician's Perspective. (United States)

    Dhiman, Vikas


    Epilepsy is a common neurological problem, and there is a genetic basis in almost 50% of people with epilepsy. The diagnosis of genetic epilepsies makes the patient assured of the reasons of his/her seizures and avoids unnecessary, expensive, and invasive investigations. Last decade has shown tremendous growth in gene sequencing technologies, which have made genetic tests available at the bedside. Whole exome sequencing is now being routinely used in the clinical setting for making a genetic diagnosis. Genetic testing not only makes the diagnosis but also has an effect on the management of the patients, for example, the role of sodium channels blockers in SCN1A + Dravet syndrome patients and usefulness of ketogenic diet therapy in SLC2A1 + generalized epilepsy patients. Many clinicians in our country have no or limited knowledge about the molecular genetics of epilepsies, types of genetic tests available, how to access them and how to interpret the results. The purpose of this review is to give an overview in this direction and encourage the clinicians to start considering genetic testing as an important investigation along with electroencephalogram and magnetic resonance imaging for better understanding and management of epilepsy in their patients.

  19. Molecular genetics of epilepsy: A clinician's perspective

    Directory of Open Access Journals (Sweden)

    Vikas Dhiman


    Full Text Available Epilepsy is a common neurological problem, and there is a genetic basis in almost 50% of people with epilepsy. The diagnosis of genetic epilepsies makes the patient assured of the reasons of his/her seizures and avoids unnecessary, expensive, and invasive investigations. Last decade has shown tremendous growth in gene sequencing technologies, which have made genetic tests available at the bedside. Whole exome sequencing is now being routinely used in the clinical setting for making a genetic diagnosis. Genetic testing not only makes the diagnosis but also has an effect on the management of the patients, for example, the role of sodium channels blockers in SCN1A+ Dravet syndrome patients and usefulness of ketogenic diet therapy in SLC2A1+ generalized epilepsy patients. Many clinicians in our country have no or limited knowledge about the molecular genetics of epilepsies, types of genetic tests available, how to access them and how to interpret the results. The purpose of this review is to give an overview in this direction and encourage the clinicians to start considering genetic testing as an important investigation along with electroencephalogram and magnetic resonance imaging for better understanding and management of epilepsy in their patients.

  20. Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary (United States)

    Haggerty, Jeannie L.; Roberge, Danièle; Freeman, George K.; Beaulieu, Christine


    PURPOSE Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients’ experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity. METHODS From an initial list of 514 potential studies (1997–2007), 33 met our criteria of using qualitative methods and exploring patients’ experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes. RESULTS For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians. CONCLUSION Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity. PMID:23690327

  1. Aspiration Abortion With Immediate Intrauterine Device Insertion: Comparing Outcomes of Advanced Practice Clinicians and Physicians. (United States)

    Patil, Eva; Darney, Blair; Orme-Evans, Kaebah; Beckley, Ethan H; Bergander, Linn; Nichols, Mark; Bednarek, Paula H


    Immediate postabortion intrauterine device (IUD) insertion is a safe, effective strategy to prevent subsequent unplanned pregnancy. Oregon is one of 5 US states where advanced practice clinicians perform aspiration abortions. This study compares outcomes of first-trimester aspiration abortion with immediate IUD insertion between advanced practice clinicians and physicians. We conducted a historical cohort study of first-trimester aspiration abortions with immediate IUD insertion performed at our center from 2009 to 2011. We extracted demographic and clinical data from patient charts. Immediate complications including excessive blood loss, perforation, and reaspirations were recorded at the time of procedure. We used descriptive statistics and multivariable logistic regression to test for differences in outcomes by clinician type. Data were available on 669 of the 1134 combined procedures. Advanced practice clinicians performed 224 of these. There were no significant differences in immediate outcomes. The only immediate complications were reaspirations; 1.8% (4/224) in the advanced practice clinician group, and 2.0% (9/445) in the physician group (P = .83). We found no differences in outcomes between provider type for immediate IUD insertion after first-trimester aspiration abortion. This study helps reinforce that advanced practice clinicians can provide immediate postaspiration abortion IUD insertions with similar outcomes to those of physicians. Many countries do not allow advanced practice clinicians to perform this service, but a change in policy could help address family planning provider shortages. © 2016 by the American College of Nurse-Midwives.

  2. Clinician adherence to guidelines in the delivery of family-based therapy for eating disorders. (United States)

    Kosmerly, Stacey; Waller, Glenn; Lafrance Robinson, Adele


    Clinicians have been shown to drift away from protocol in their delivery of evidence-based treatments. This study explores this phenomenon in the delivery of family-based therapy (FBT) for eating disorders, and the clinician characteristics that might explain such therapist drift. The participants were 117 clinicians who reported using FBT for eating disorders. They completed an online survey, which included questions relating to clinician characteristics, caseload, and reported use of FBT manuals and core therapeutic tasks, as well as a measure of anxiety. The use of core FBT tasks was higher than for other therapies, but there were still noteworthy gaps between recommended and reported practice. Approximately a third of clinicians reported delivering "FBT" that deviated very substantially from evidence-based protocols, often appearing to be on an individual therapy basis. Using an FBT manual to guide treatment delivery was associated with greater adherence to recommended techniques. Clinician caseload and anxiety were associated with differences in the use of specific FBT tasks. Consistent with previous research regarding clinicians' use of other therapies, the delivery of FBT for the eating disorders is not homogeneous. Further investigation of this phenomenon is needed to determine the impact of deviating from treatment protocols on the effectiveness of FBT for the eating disorders. © 2014 Wiley Periodicals, Inc.

  3. Collaboration in a competitive healthcare system: negotiation 101 for clinicians. (United States)

    Clay-Williams, Robyn; Johnson, Andrew; Lane, Paul; Li, Zhicheng; Camilleri, Lauren; Winata, Teresa; Klug, Michael


    Purpose The purpose of this paper is to evaluate the effectiveness of negotiation training delivered to senior clinicians, managers and executives, by exploring whether staff members implemented negotiation skills in their workplace following the training, and if so, how and when. Design/methodology/approach This is a qualitative study involving face-to-face interviews with 18 senior clinicians, managers and executives who completed a two-day intensive negotiation skills training course. Interviews were transcribed verbatim, and inductive interpretive analysis techniques were used to identify common themes. Research setting was a large tertiary care hospital and health service in regional Australia. Findings Participants generally reported positive affective and utility reactions to the training, and attempted to implement at least some of the skills in the workplace. The main enabler was provision of a Negotiation Toolkit to assist in preparing and conducting negotiations. The main barrier was lack of time to reflect on the principles and prepare for upcoming negotiations. Participants reported that ongoing skill development and retention were not adequately addressed; suggestions for improving sustainability included provision of refresher training and mentoring. Research limitations/implications Limitations include self-reported data, and interview questions positively elicited examples of training translation. Practical implications The training was well matched to participant needs, with negotiation a common and daily activity for most healthcare professionals. Implementation of the skills showed potential for improving collaboration and problem solving in the workplace. Practical examples of how the skills were used in the workplace are provided. Originality/value To the authors' knowledge, this is the first international study aimed at evaluating the effectiveness of an integrative bargaining negotiation training program targeting executives, senior

  4. Improving therapeutic use of homework: suggestions from mental health clinicians. (United States)

    Kelly, Peter J; Deane, Frank P


    The majority of mental health clinicians report the use of homework to support their case management, but practitioner surveys indicate that homework is not routinely used. To examine barriers that mental health case managers experience in implementing homework and to identify strategies to promote successful homework administration. One hundred thirty-four surveys were completed by mental health case managers. The survey examined their use of homework for individuals diagnosed with a severe mental health problem. It also asked them to identify barriers to regularly implement homework and describe strategies to promote more regular use of homework. On average, homework was used at 50% of clinical contacts. The primary reasons for not using homework included allocating insufficient time at appointments, perceived client resistance for using homework and concerns that the client was too unwell. Strategies used to overcome these difficulties included prioritising the use of homework and ensuring that homework assignments were achievable. Clinicians are able to identify a range of practical strategies to promote the use of homework. Discussion focuses on the application of the suggested strategies to promote regular use of homework. This includes discussion of possible training approaches to enhance systematic homework administration.

  5. Journal of Consumer Sciences

    African Journals Online (AJOL)

    The Journal of Consumer Sciences is an official publication of the South African Association of Family Ecology and Consumer Sciences (SAAFECS). The Journal of Consumer Sciences (JCS) publishes articles that focus on consumer experiences in different places and from different perspectives and methodological ...

  6. The effect of core clinician interpersonal behaviours on depression. (United States)

    Barnicot, K; Wampold, B; Priebe, S


    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.

  7. Clinician preferences and the estimation of causal treatment differences


    Korn, Edward L.; Baumrind, Sheldon


    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 ...

  8. Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors. (United States)

    Back, Anthony L; Steinhauser, Karen E; Kamal, Arif H; Jackson, Vicki A


    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.

  9. 45 CFR 98.33 - Consumer education. (United States)


    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Consumer education. 98.33 Section 98.33 Public... Program Operations (Child Care Services)-Parental Rights and Responsibilities § 98.33 Consumer education... public consumer education information that will promote informed child care choices including, at a...

  10. "She's on her own": a thematic analysis of clinicians' comments on abortion referral. (United States)

    Homaifar, Nazeneen; Freedman, Lori; French, Valerie


    The objective was to understand the motivations around and practices of abortion referral among women's health providers. We analyzed the written comments from a survey of Nebraska physicians and advanced-practice clinicians in family medicine and obstetrics-gynecology about their referral practices and opinions for a woman seeking an abortion. We analyzed clinician's responses to open-ended questions on abortion referral thematically. Of the 496 completed surveys, 431 had comments available for analysis. We found four approaches to abortion referral: (a) facilitating a transfer of care, (b) providing the abortion clinic name or phone number, (c) no referral and (4) misleading referrals to clinicians or facilities that do not provide abortion care. Clinicians described many motivations for their manner of referral, including a fiduciary obligation to refer, empathy for the patient, respect for patient autonomy and the lack of need for referral. We found that abortion stigma impacts referral as clinicians explained that patients often desire additional privacy and clinicians themselves seek to avoid tension among their staff. Other clinicians would not provide an abortion referral, citing moral or religious objections or stating they did not know where to refer women seeking abortion. Some respondents would refer women to other providers for additional evaluation or counseling before an abortion, while others sought to dissuade the woman from obtaining an abortion. While practices and motivations varied, few clinicians facilitated referral for abortion beyond verbally naming a clinic if an abortion referral was made at all. Interprofessional leadership, enhanced clinician training and public policy that addresses conscientious refusal of abortion referral are needed to reduce abortion stigma and ensure that women can access safe care. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Clinician-patient E-mail communication: challenges for reimbursement. (United States)

    Komives, Eugenie M


    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

  12. The making of expert clinicians: reflective practice. (United States)

    Maestre, J M; Szyld, D; Del Moral, I; Ortiz, G; Rudolph, J W


    Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice". Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Hormonal anticonception anno 2013: a clinician's view. (United States)

    Dhont, M; Verhaeghe, V


    Hormonal contraception has recently drawn the attention of both national and international Health Organizations mainly because of new data on the risk of venous and arterial thrombosis. This has, fortunately, not led to a 'pill scare' as happened in 1996 when controversy arose with respect to the thrombotic risk of third versus second -generation pills. This time, evidence on the thrombotic risk of pills with the newer progestogens is gathering, -leading to a re-evaluation of guidelines. In this paper, we summarize this evidence and try to present a clinician's view of the indications and contraindications of hormonal contraception and situate them in the perspective of the numerous non-contraceptive health benefits of hormonal contraception.

  14. Bayes’ Rule for Clinicians: An Introduction

    Directory of Open Access Journals (Sweden)

    Chris F Westbury


    Full Text Available Bayes’ Rule is a way of calculating conditional probabilities. It is difficult to find an explanation of its relevance that is both mathematically comprehensive and easily accessible to all readers. This article tries to fill that void, by laying out the nature of Bayes’ Rule and its implications for clinicians in a way that assumes little or no background in probability theory. It builds on Meehl & Rosen’s (1955 classic paper, by laying out algebraic proofs that they simply allude to, and by providing extremely simple and intuitively accessible examples of the concepts that they assumed their reader understood, and provides examples of how the rule applies in a variety of clinical settings.

  15. Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability (United States)

    Holloway, Kristi; Riley, Geoffrey; Auret, Kirsten


    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

  16. Mental Health Clinicians' Participation in Web-Based Training for an Evidence Supported Intervention: Signs of Encouragement and Trouble Ahead. (United States)

    McMillen, J Curtis; Hawley, Kristin M; Proctor, Enola K


    Comprehensive scalable clinician training is needed to increase the impact of evidence-supported psychotherapies. This study was designed to ascertain clinician participation in different low-cost training activities, what predicts their training participation, and how participation can be increased. The study enrolled 163 clinicians. Of these, 105 completed a follow-up survey and 20 completed a more in-depth qualitative interview. Some activities (web training) attracted greater participation than others (e.g., discussion boards, role playing). Key findings include the desirability of self-paced learning and the flexibility it afforded practicing clinicians. However, some found the lack of accountability insurmountable. Many desired in-person training as a way to introduce accountability and motivation. While low-cost, relevant, self-paced learning appeals to practicing clinicians, it may need to be combined with opportunities for in-person training and accountability mechanisms in order to encourage large numbers of clinicians to complete training.

  17. Patient- and clinician- reported outcome in eating disorders

    DEFF Research Database (Denmark)

    Winkler, Laura Vad; Frølich, Jacob Stampe; Gudex, Claire


    Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross......-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs. We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark. Patient-reported measures included the Eating Disorder Inventory-2 (EDI-2) and the Short...... Form 36 (SF-36), and clinical data included remission status and body mass index (BMI). We found a positive association between BMI and EDI-2 scores for anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS), reflecting increasing ED symptomatology with increasing BMI...

  18. When professional kindness is misunderstood: boundaries and stalking issues: a case study for the home health clinician. (United States)

    Holz, Cheryl L


    There is the potential for home health nurses and other home care clinicians to be subjected to intrusive and possibly stalking behavior by current and former clients. Most healthcare clinicians do not receive training on the risk of intrusive interactions or stalking, nor on strategies to manage this objectionable client behavior. This article informs nurses and other home health clinicians about the potential risk of stalking. Included is a true case vignette, the legal definition of stalking, incidence occurrence among clinicians, the basic profile and behaviors of a stalker, the victimology and psychological consequences, and implications for policy and procedures and prevention techniques.

  19. Consumer concerns: motivating to action. (United States)

    Bruhn, C M


    Microbiologic safety is consumers' most frequently volunteered food safety concern. An increase in the level of concern in recent years suggests that consumers are more receptive to educational information. However, changing lifestyles have lessened the awareness of foodborne illness, especially among younger consumers. Failure to fully recognize the symptoms or sources of foodborne disease prevents consumers from taking corrective action. Consumer education messages should include the ubiquity of microorganisms, a comprehensive description of foodborne illnesses, and prevention strategies. Product labels should contain food-handling information and warnings for special populations, and foods processed by newer safety-enhancing technologies should be more widely available. Knowledge of the consequences of unsafe practices can enhance motivation and adherence to safety guidelines. When consumers mishandle food during preparation, the health community, food industry, regulators, and the media are ultimately responsible. Whether inappropriate temperature control, poor hygiene, or another factor, the error occurs because consumers have not been informed about how to handle food and protect themselves. The food safety message has not been delivered effectively.

  20. Consumers' various and surprising responses to direct-to-consumer advertisements in magazine print. (United States)

    Arney, Jennifer; Street, Richard L; Naik, Aanand D


    Direct-to-consumer advertising (DTCA) is ubiquitous in media outlets, but little is known about the ways in which consumers' values, needs, beliefs, and biases influence the perceived meaning and value of DTCA. This article aims to identify the taxonomy of readership categories that reflect the complexity of how health care consumers interact with DTCA, with particular focus on individuals' perceptions of print DTCA in popular magazines. Respondent-driven sampling was used to recruit 18 male and female magazine readers and 18 male and female prescription medication users aged 18-71 years. Semi-structured, in-depth interviews with consumers about their attentiveness, motivations, perceived value, and behavioral responses to DTCA were conducted. The analyses were guided by principles of grounded theory analysis; four categories that vary in consumers' attentiveness, motivations, perceived value, and behavioral responses to DTCA were identified. Two categories - the lay physician and the informed shopper - see value in information from DTCA and are likely to seek medical care based on the information. One category - the voyeur - reads DTCA, but is not likely to approach a clinician regarding advertised information. The fourth category - the evader - ignores DTCA and is not likely to approach a clinician with DTCA information. Responses to DTCA vary considerably among consumers, and physicians should view patients' understanding and response to DTCA within the context of their health-related needs. Patients' comments related to DTCA may be used as an opportunity to engage and understand patients' perspectives about illness and medication use. Clinicians may use information about these categories to facilitate shared understanding and improve communication within the doctor-patient relationship.

  1. Promoting evidence-based practice through a research training program for point-of-care clinicians. (United States)

    Black, Agnes T; Balneaves, Lynda G; Garossino, Candy; Puyat, Joseph H; Qian, Hong


    The purpose of this study was to evaluate the effect of a research training program on clinicians' knowledge, attitudes, and practices related to research and evidence-based practice (EBP). EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP. Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted. Statistically significant improvement in research knowledge and ability was demonstrated. Participants and administrators identified benefits of the training program, including the impact on EBP. Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research.

  2. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis. (United States)

    Chapman, Nicola H; Lazar, Steven P; Fry, Margaret; Lassere, Marissa N; Chong, Beng H


    Venous Thromboembolism (VTE) is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Analysis of interviews revealed that barriers to evidence based practice include i) the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii) the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.

  3. Enhancing health-care workers' understanding and thinking about people living with co-occurring mental health and substance use issues through consumer-led training. (United States)

    Roussy, Véronique; Thomacos, Nikos; Rudd, Annette; Crockett, Belinda


    Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co-occurring mental health and substance use issues (dual diagnosis). To evaluate the effectiveness of consumer-led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group. A controlled before-and-after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4-h clinician-led training session. The intervention consisted of a 3-h consumer-led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance. Consumer-led training was associated with a significant increase in understanding. The combination of clinician-led and consumer-led training was associated with a positive change in role adequacy. Consumer-led training is a promising approach to enhance primary health-care workers' understanding of the issues faced by dual-diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer-led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group. © 2013 John Wiley & Sons Ltd.

  4. Latinos and violence: mental health implications and strategies for clinicians. (United States)

    Vasquez, M J


    This article seeks to identify mental health issues in regard to violence among Hispanics and Latinos relative to other groups in the United States. A review of the literature provides prevalence and incidence rates, population and demographic information, and unique issues in regard to violence for Latinos and Latinas, including in the areas of battering and wife abuse, child and sexual abuse, sexual harassment, and the complicating effects of racial-ethnic discrimination. Aspects of cultural ideology, including the social construction of gender and its relevance to violence, are discussed, as are theoretical explorations of the impact of violence on familism, a major Hispanic cultural value. Finally, therapeutic implications for clinicians are explored, structured by the American Psychological Association (1993).

  5. Consumer Empowerment in Dermatology (United States)

    Hoch, Heather E.; Busse, Kristine L.; Dellavalle, Robert P.


    Summary Health care consumers increasingly confront and collaborate with their medical providers. We describe consumer success in other medical fields and in dermatology, especially dermatologic disease advocacy and improving dermatologist-patient interactions. PMID:19254661

  6. Essays on consumer welfare


    Lin, P.


    The fast-changing retail industry (with its numerous new product developments and new marketing channels) has policy makers worried about possible detrimental effects of these changes for consumer welfare. Despite the interest of policy makers, only few marketing studies have considered the impact of retailing on consumer welfare. This dissertation contributes to the consumer welfare research from a marketing/retailing perspective. In contrast to the marketing literature, where consumer welfa...

  7. Constructive Consumer Choice Processes.


    Bettman, James R; Luce, Mary Frances; Payne, John W


    Consumer decision making has been a focal interest in consumer research, and consideration of current marketplace trends ( e.g., technological change, an information explosion) indicates that this topic will continue to be critically important. We argue that consumer choice is inherently constructive. Due to limited processing capacity, consumers often do not have well-defined existing preferences, but construct them using a variety of strategies contingent on task demands. After describing c...

  8. Defining Consumer Ombudsmen


    Gill, Chris; Hirst, Carolyn


    This report seeks to describe consumer ombudsmen as they have developed in the United Kingdom. The recent European Union Directive on Consumer Alternative Dispute Resolution (2013/11/EU) defines consumer dispute resolution mechanisms in general, but does not distinguish between them individually. It does not, for instance, distinguish between consumer ombudsmen, arbitrators and adjudication schemes. Other existing approaches to definition, such as the Ombudsman Association’s criteria for ‘omb...

  9. Contending With Preplanned Death: Questions for Clinicians. (United States)

    Yager, Joel


    The goal of this column is to assist readers in reflecting on their attitudes and responses toward clinical and nonclinical situations involving preplanned deaths by decisionally capable individuals. Such circumstances range from encountering individuals in one's personal and professional lives who desire and intend to end their lives under their own terms, to having such individuals request assistance with predeath and postdeath arrangements. Attending to pertinent literature, this essay uses Socratic inquiry to question conventional assumptions and attitudes, push readers' thoughts beyond typical comfort zones, and consider alternative modes of responding to challenges posed by preplanned death. Studies indicate that, for their own end-of-life circumstances, physicians would prefer a briefer, higher quality life to prolonged low-quality life, dignity in infirmity and death, and avoidance of terminal suffering. Lay people generally endorse similar preferences. Although contemporary society generally shuns contemplating preplanned death, cultural attitudes regarding preplanned death are rapidly evolving, and variations of "Death with Dignity" legislation have gained traction in increasing numbers of US states as well as internationally. As yet, no broad consensus exists as to how clinicians should manage circumstances involving preplanned death. Considerations regarding preplanned deaths merit greater professional and public discussion. Many options exist for improving how professionals address the quality of human experiences surrounding death.

  10. Myeloid Sarcoma: The Clinician's Point of View

    Directory of Open Access Journals (Sweden)

    M. Malagola


    Full Text Available Myeloid Sarcoma may occur in patients with an acute or chronic myeloproliferative disorder as well as de novo, with no apparent sign or symptom of concomitant haematological disease. The patients are preferentially young male and the site of disease localization may vary from central nervous system to pleura and thorax, with a common involvement of the reticuloendothelial system. The disease often shows chromosomal rearrangements, involving chromosomes 7, 8 and 3 and sometimes a complex karyotype (more than 3 abnormalities is detected at diagnosis. The prognosis of this disease is dismal and only high-dose chemotherapy with autologous or allogeneic stem cells transplantation (auto or allo-SCT may be potentially curative. In the absence of definitive elements that can define the prognosis of extra-medullary localization of “standard risk” AML, Clinicians should pursue the collection of data from different Centres and design of homogeneous treatment strategies, that could integrate standard chemotherapy with specific approaches, such as radiotherapy, transplant procedures or, in selected cases (such as those displaying molecular abnormalities involving protein tyrosine-kinases, molecularly targeted therapies.

  11. Childhood agricultural injuries: an update for clinicians. (United States)

    Wright, Suzanne; Marlenga, Barbara; Lee, Barbara C


    Every three days a child dies in an agriculture-related incident, and every day 45 children are injured in the United States. These tragedies should not be regarded as "accidents," as they often follow predictable and preventable patterns. Prevention is not only possible, but vital, since many of these injuries are almost immediately fatal. Major sources of fatal injuries are machinery, motor vehicles, and drowning. Tractor injuries alone account for one-third of all deaths. The leading sources of nonfatal injuries are structures and surfaces, animals (primarily horses), and vehicles (primarily all-terrain vehicles [ATVs]). Children living on farms are at a higher risk than hired workers, and are unprotected by child labor laws. Preschool children and older male youth are at the highest risk for fatal injury, while nonfatal injury was most common among boys aged 10-15 years. Multiple prevention strategies have been developed, yet economic and cultural barriers often impede their implementation. Educational campaigns alone are often ineffective, and must be coupled with re-engineering of machines and safety devices to reduce fatalities. Legislation has the potential to improve child safety, yet political and economic pressures often prohibit changes in child labor laws and mandated safety requirements. Clinicians play a pivotal role in injury prevention, and should actively address common rural risk-taking behaviors as part of the routine office visit in order to help prevent these tragedies. Copyright © 2013 Mosby, Inc. All rights reserved.

  12. Secondary traumatic stress in emergency medicine clinicians. (United States)

    Roden-Foreman, Jacob W; Bennett, Monica M; Rainey, Evan E; Garrett, John S; Powers, Mark B; Warren, Ann Marie


    Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending ≥10% of one's time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.

  13. Interpretation of data by the clinician. (United States)

    Goldzieher, J W

    The cardinal challenges to every practicing physician are to interpret clinical data correctly and to place them in proper perspective. Clinical investigations frequently lack the rigidly controlled conditions and the careful experimental designs usually found in preclinical animal studies, and this deficiency is partially attributable to the inherent complexities of clinical medicine. Consequently, a great deal of controversy results from conflicting interpretations, extrapolations and overextension of limited data that are often equivocal. More careful appraisal of data and increased awareness of the well-known pitfalls found in retrospective and prospective studies, in which biostatistical design and clinical relevance are often incompatible, are emphasized, and personal biases and the flagrant sensationalism expounded by the media are condemned. The clinician is cautioned to sift through the data, consider the benefit/risk ratio for each patient and then to subordinate the role of critical scientist and assume the role of physician, exercising good judgment in light of the existing evidence and the immediate problems at hand.

  14. Pastoral power and gynaecological examinations: a Foucauldian critique of clinician accounts of patient-centred consent. (United States)

    Cook, Catherine; Brunton, Margaret


    Invasive non-sedated clinical procedures such as gynaecological examinations are normalised; however, there is limited research highlighting the relational and technical skills required for clinicians to ensure patients' continued consent. A considerable body of research emphasises that women dislike examinations, leading to their non-compliance or a delayed follow up for gynaecological and sexual health problems. However, medical research focuses on 'problem' women; the role of clinicians receives limited appraisal. This article draws on interviews with sexual health clinicians in New Zealand, from metropolitan and provincial locations. The gynaecological care of women in New Zealand attained international notoriety with the 1988 publication of Judge Cartwright's inquiry into ethical shortcomings in cervical cancer research at the National Women's Hospital. Judge Cartwright's recommendations included patient-centred care in order to ensure informed consent had been received for clinical procedures and research participation. This article's critical analysis is that, although clinicians' language draws on humanistic notions of patient-centredness, Foucault's notion of secularised pastoral power enables a more nuanced appreciation of the ethical work undertaken by clinicians when carrying out speculum examinations. The analysis highlights both the web of power relations present during examination practices and the strategies clinicians use to negotiate women's continued consent; which is significant because consent is usually conceptualised as an event, rather than an unfolding, unstable process. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

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

    Directory of Open Access Journals (Sweden)

    Keogh Louise A


    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.

  16. Clinician Perceptions Related to the Use of the CBT-I Coach Mobile App. (United States)

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


    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.

  17. Factors related to clinician attitudes toward prolonged exposure therapy for PTSD. (United States)

    Ruzek, Josef I; Eftekhari, Afsoon; Rosen, Craig S; Crowley, Jill J; Kuhn, Eric; Foa, Edna B; Hembree, Elizabeth A; Karlin, Bradley E


    This study examines pretraining attitudes toward prolonged exposure (PE) therapy in a sample of 1,275 mental health clinicians enrolled in a national PE training program sponsored by the U.S. Department of Veterans Affairs. Attitudes assessed via survey included values placed on outcomes targeted by PE, outcome expectancies (positive expectancies for patient improvement and negative expectancies related to patient deterioration, clinician time burden, and clinician emotional burden), and self-efficacy for delivering PE. Results indicated that clinicians were receptive to learning PE and had positive expectations about the treatment, but expressed concerns that PE might increase patient distress. Responses varied by clinician characteristics with psychologists, clinicians working in specialty PTSD treatment settings (as opposed to those in mental health clinics and other clinic types), and those with a primarily cognitive-behavioral orientation expressing attitudes that were most supportive of learning and implementing PE across various indicators. Implications for addressing attitudinal barriers to implementation of PE therapy are discussed. Published 2014. This article is a US Government work and is in the public domain in the USA.

  18. Radurization : the consumer perspective

    International Nuclear Information System (INIS)

    Foster, J.W.


    A three part study in which a number of consumer groups were involved was conducted. The study examined the views of South African consumers concerning radurization. The results of the study are discussed and recommendations are made with regard to possible greater consumer acceptance of radurization in South Africa. 2 figs

  19. Self-consuming materials

    Energy Technology Data Exchange (ETDEWEB)

    Thoma, Steven G.; Grubelich, Mark C; Celina, Mathias C.; Vaughn, Mark R.; Knudsen, Steven D.


    A self-consuming structure is disclosed that is formed from a self-consuming composition based on an epoxy or polyurethane having fuel and/or oxidizer molecularly dispersed and/or as particulates in the epoxy or polyurethane. The composition may be used to form self-consuming structural components.

  20. Consumer Behavior Research Methods

    DEFF Research Database (Denmark)

    Chrysochou, Polymeros


    This chapter starts by distinguishing consumer behavior research methods based on the type of data used, being either secondary or primary. Most consumer behavior research studies phenomena that require researchers to enter the field and collect data on their own, and therefore the chapter...... of the methods and how to improve quality in consumer behavior research methods....

  1. Complexities of emergency communication: clinicians' perceptions of communication challenges in a trilingual emergency department. (United States)

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


    consultation. The findings reveal that the quality of communication in this Hong Kong emergency department is compromised by specific factors inherent in the linguistic complexity of Hong Kong emergency departments. These factors include the constant translation of medical information, inadequate documentation of medical information and significant professional and cultural pressures. Each of these issues increases the likelihood that healthcare communication will be difficult, incomplete or incorrect. This research provides empirical evidence for, and justifies the development of, an effective framework to enable clinicians to overcome communication challenges. The findings of this study may shed light on the unique conditions faced by clinicians, particularly in relation to communication, in the complex trilingual healthcare context of an emergency department similar to those in Hong Kong, and provide potential policy solutions for barriers to improve communication in such settings. © 2016 John Wiley & Sons Ltd.

  2. Consumer loyalty in retailing

    Directory of Open Access Journals (Sweden)

    Drinić Dragana


    Full Text Available Loyal consumers are partner enterprises and they represent stable source of income. Companies are more interested in maintaining the existing consumers, rather than attracting the newones, because loyal consumers are the most valuable asset. The aim of this article is to develop an integrative conceptual framework for creating and maintaining consumer loyalty, and ,at the same time, to be based on a thorough review of the relevant literature and the current market situation . In this context, empirical research was carried out by using the survey method on a random sample of 165 respondents. Based on the research conducted, important factors that influence consumer loyalty were identified.

  3. Bioethics for clinicians: 25. Teaching bioethics in the clinical setting (United States)

    McKneally, Martin F.; Singer, Peter A.


    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

  4. Action and resistance mechanisms of antibiotics: A guide for clinicians

    Directory of Open Access Journals (Sweden)

    Garima Kapoor


    Full Text Available Infections account for a major cause of death throughout the developing world. This is mainly due to the emergence of newer infectious agents and more specifically due to the appearance of antimicrobial resistance. With time, the bacteria have become smarter and along with it, massive imprudent usage of antibiotics in clinical practice has resulted in resistance of bacteria to antimicrobial agents. The antimicrobial resistance is recognized as a major problem in the treatment of microbial infections. The biochemical resistance mechanisms used by bacteria include the following: antibiotic inactivation, target modification, altered permeability, and “bypass” of metabolic pathway. Determination of bacterial resistance to antibiotics of all classes (phenotypes and mutations that are responsible for bacterial resistance to antibiotics (genetic analysis are helpful. Better understanding of the mechanisms of antibiotic resistance will help clinicians regarding usage of antibiotics in different situations. This review discusses the mechanism of action and resistance development in commonly used antimicrobials.

  5. Patient-Clinician Communication: The Roadmap for HCI. (United States)

    Wilcox, Lauren; Patel, Rupa; Back, Anthony; Czerwinski, Mary; Gorman, Paul; Horvitz, Eric; Pratt, Wanda


    Effective communication between patients and their clinicians during clinical encounters has a positive impact on health outcomes. Technology has the potential to help transform this synchronous interaction, but researchers are still at early stages of developing interventions to assess and improve patient-clinician communication. In this workshop, we envision opening up a dialogue among researchers and clinicians who wish to discuss directions for future research in this domain. In particular, the workshop will focus on exploring how technologies available today, as well as projected for the future, can support the communication needs of clinicians and patients.

  6. Treatment of adult ADHD: Is current knowledge useful to clinicians?

    Directory of Open Access Journals (Sweden)

    Terje Torgersen


    Full Text Available Terje Torgersen1,2, Bjørn Gjervan1,3, Kirsten Rasmussen31Department of Psychiatry, Sykehuset Levanger, Helse Nord-Troendelag HF, Levanger, Norway; 2Faculty of Medicine and 3Department of Psychology, Norwegian University of Science and Technology, Trondheim, NorwayAbstract: Psychostimulant drugs have for decades been considered the cornerstone of ADHD treatment. Non-stimulant drugs have also been reported successful. However, many controlled studies exclude patients with comorbidities typical for patients seen in clinical setting. Many patients are also considered non-responders to medication. Current knowledge might not be directly useful to clinicians. The present article reviews the literature on pharmacological and psychotherapeutic treatment in adult ADHD emphasizing comorbidity and other clinically important factors, as well as ADHD specific outcomes. Thirty-three relevant studies of pharmacotherapy and three studies of psychotherapy were included. Most subjects had little current comorbidity, but some studies included subjects with substance use disorder. Significant effect of treatment on ADHD symptoms was found in most studies using pharmacotherapy and all studies of psychotherapy. Both positive and negative effects on comorbid anxiety and depression measures were reported. Pharmacotherapy did not seem to have effect on substance use disorder. Few pharmacotherapy studies conducted any long-term follow-up; two studies that did, found that most subjects had discontinued medication. A clear-cut dose-respons relationship was not substanciated. In conclusion, clinicians have good support for both pharmacological and psychotherapeutic treatment of ADHD in adults, but should take additional measures to deal with comorbidities as well as treatment adherence.Keywords: ADHD, adults, treatment, stimulants, psychotherapy, comorbidity

  7. Risk communication in the hyperacute setting of stroke thrombolysis: an interview study of clinicians. (United States)

    Lie, M L S; Murtagh, M J; Watson, D Burges; Jenkings, K N; Mackintosh, J; Ford, G A; Thomson, R G


    Communicating treatment risks and benefits to patients and their carers is central to clinical practice in modern healthcare. We investigated the challenges of risk communication by clinicians offering thrombolytic therapy for hyperacute stroke where treatment must be administered rapidly to maximise benefit. Semistructured interviews with 13 clinicians from three acute stroke units involved in decision making and/or information provision about thrombolysis. We report on clinicians' accounts of communicating risks and benefits to patients and carers. Framework analysis was employed. We identified the major challenges facing clinicians in communicating risk in this context that is, disease complexity, patients' capacity and time constraints, and communicating quality of life after stroke. We found significant variation in the data on risks and benefits that clinicians provide, and ways these were communicated to patients. Clinicians' communication strategies varied and included practices such as: a phased approach to communicating information, being responsive to the patient and family and documenting information they gave to patients. Risk communication about thrombolysis involves complex uncertainties. We elucidate the challenges of effective risk communication in a hyperacute setting and identify the issues regarding variation in risk communication and the use of less effective formats for the communication of numerical risks and benefits. The paper identifies good practice, such as the phased transfer of information over the care pathway, and ways in which clinicians might be supported to overcome challenges. This includes standardised risk and benefit information alongside appropriate personalisation of risk communication. Effective risk communication in emergency settings requires presentation of high-quality data which is amenable to tailoring to individual patients' circumstances. It necessitates clinical skills development supported by personalised risk

  8. Consumer Health Informatics: The Application of ICT in Improving Patient-Provider Partnership for a Better Health Care. (United States)

    Abaidoo, Benjamin; Larweh, Benjamin Teye


    There is a growing interest concerning the potential of ICT solutions that are customized to consumers. This emerging discipline referred to as consumer health informatics (CHI) plays a major role in providing information to patients and the public, and facilitates the promotion of self-management. The concept of CHI has emerged out of the desire of most patients to shoulder responsibilities regarding their health and a growing desire of health practitioners to fully appreciate the potential of the patient. To describe the role of ICT in improving the patient-provider partnership in consumer health informatics. Systematic reviewing of literature, identification of reference sources and formulation of search strategies and manual search regarding the significance of developed CHI applications in healthcare delivery. New consumer health IT applications have been developed to be used on a variety of different platforms, including the Web, messaging systems, PDAs, and cell phones. These applications assists patients with self-management through reminders and prompts, delivery of real-time data on a patient's health condition to patients and providers, web-based communication and personal electronic health information. New tools are being developed for the purposes of providing information to patients and the public which has enhanced decision making in health matters and an avenue for clinicians and consumers to exchange health information for personal and public use. This calls for corroboration among healthcare organizations, governments and the ICT industry to develop new research and IT innovations which are tailored to the health needs of the consumer.

  9. Informing consumers: Protection from deceptive advertising

    Directory of Open Access Journals (Sweden)

    Stanković Ljiljana


    Full Text Available It is widely accepted that only informed consumers are protected from potential violation of their consumer rights. Advertising represents one of the main ways of informing consumers, so it is of crutial importance for it to include adequate information that can facilitate decision making proces regarding the purchase. With aim of preventing violation of basic consumer rights, advertising is regulated by legislation, both on EU level and on national level in Republic of Serbia, and while so special attention is dedicated to defining advertising that can possibly lead to deception of consumers. Authors of this paper are focused on analysing legislation and theoretical explanations of deceptive advertising. Results of the research regarding advertising in Serbia and ability of consumers to protect themselves from deceptive advertising are presented. The main aim of the authors is to contribute to increasing level of consumers' self-protection through increasing level of their counciousness on deceptive advertising and its concequences.



    Baker, Gregory A.


    Past research has yielded conflicting results on consumer valuation of food safety characteristics. In this study, conjoint analysis is used to evaluate consumer responses to hypothetical apple products in a nationwide survey. Product characteristics include price, quality, pesticide use levels and the corresponding cancer risk, and type of government inspection. Consumers expressed a broad preference for reduced pesticide usage. Four market segments were identified corresponding to consumers...

  11. State and Local Consumer Publications. A Bibliography. (United States)

    Office of Consumer Affairs, Washington, DC.

    This bibliography, designed primarily for state and local consumer offices, includes 650 publications on a wide range of consumer affairs subjects. Topics include advertising, appliance purchase and repair, automobiles, how and where to complain, contracts, credit and banking, fraud, door-to-door sales, energy and utilities, financial planning and…

  12. Assessment of Resident Physicians' Communicator and Collaborator Competencies by Interprofessional Clinicians: A Mixed-Methods Study. (United States)

    Sonnenberg, Lyn K; Pritchard-Wiart, Lesley; Hodgson, Carol S; Yu, YongQiang; King, Sharla


    Phenomenon: As we move toward competency-based medical education, greater emphasis is being placed on assessing a more comprehensive skill set, including the ability to communicate and collaborate effectively in the workplace. Nonphysician members on interprofessional (IP) teams have valuable perspectives on actual resident performance and are often not adequately engaged in the provision of feedback to residents. Based on the educational theories of collaborative evaluation and social constructivism, this research examined the ability of IP clinicians to provide feedback to residents. The aim of this study was to examine IP clinicians' perceptions of their ability to provide formative feedback, through their observations and assessments of developmental pediatric residents, compared to physician supervisors on the rotation, and to qualitatively explore potential barriers to the feedback process from their perspective. This explanatory, sequential mixed-methods design study first examined which and how many of the CanMEDS Communicator and Collaborator training objectives (N = 40) were considered to be observable and assessable by IP clinicians and physicians. A comparison of the mean number of objectives that were observed and practically assessed by (a) each group (IP clinicians vs. physicians) and (b) clinical service teams during the core developmental pediatrics rotations, were examined using independent t tests. Second, a thematic qualitative analysis of focus groups was used to develop a contextual understanding of the factors that influenced this process. Data were analyzed using three levels of open coding and descriptive qualitative analysis techniques. Physicians reported they could observe (M = 33.3, SD = 5.2, 83.3%) and assess (M = 31.5, SD = 7.3, 79%) a larger number of objectives compared to the IP clinician group (M = 24.7, SD = 8.6, 61.8% and M = 20.3, SD = 10.6, 51%, respectively). There were no differences between the clinical service teams (i

  13. Mothers' and Clinicians' Priorities for Obesity Prevention Among Black, High-Risk Infants. (United States)

    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


    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 (pobese, black mothers of infants highly prioritized learning about many effective obesity prevention strategies, including recognizing hunger and satiety cues, promoting infant activity, and maintaining regular routines. Clinicians may frame preventive guidance to be responsive to these priorities. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Clinician-parent discussions about influenza vaccination of children and their association with vaccine acceptance. (United States)

    Hofstetter, Annika M; Robinson, Jeffrey D; Lepere, Katherine; Cunningham, Morgan; Etsekson, Nicole; Opel, Douglas J


    To examine how clinicians communicate with parents about influenza vaccination and the effect of these communication behaviors on parental vaccine decision-making. We performed a secondary analysis of data obtained from a cross-sectional observational study in which health supervision visits between pediatric clinicians and English-speaking parents of young children were videotaped. Eligible visits occurred during the 2011-2012 and 2013-2014 influenza seasons, included children ≥6months, and contained an influenza vaccine discussion. A coding scheme of 10 communication behaviors was developed and applied to each visit. Associations between clinician communication behaviors and parental verbal vaccine acceptance and parental visit experience were examined using bivariate analysis and generalized linear mixed models. Fifty visits involving 17 clinicians from 8 practices were included in analysis. The proportion of parents who accepted influenza vaccine was higher when clinicians initiated influenza vaccine recommendations using presumptive rather than participatory formats (94% vs. 28%, pinfluenza vaccine concurrent with (vs. separate from) recommendations for other vaccines due at the visit (83% vs. 33%, pinfluenza vaccine recommendations, pursuit in the face of resistance, and concurrent vaccine recommendations appear to increase parental acceptance of influenza vaccine without negatively affecting visit experience. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Spasticity over time during acute rehabilitation: a study of patient and clinician scores. (United States)

    Bhimani, Rozina H; Peden-McAlpine, Cynthia; Gaugler, Joseph; Anderson, Lisa Carney


    The aims of this study were to describe spasticity trajectories as a function of time, gender, and diagnosis and to explore the correspondence between patient and clinician scores of spasticity. Discrepancy between examiner assessment and patient rating of spasticity exists. Assessments that include the patient perspective are critical for patient safety. This mixed-method study provided patient descriptors of spasticity integrated with clinical scales. Twenty-three participants provided spasticity descriptors and rated their spasticity based on Numeric Rating Scale (NRS) scores. A clinician evaluated spasticity daily using the Modified Ashworth Scale (MAS). This resulted in 1976 points of data for analysis. Spasticity was highly variable over time. The empirical correspondence between the clinician-rated MAS and the patient-rated NRS revealed that patient and examiner understanding of spasticity were diverged considerably. Clinical evaluation protocols should include patient reports on spasticity. Knowledge about patient word choice can enhance patient-provider communication. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Global market and consumers

    Directory of Open Access Journals (Sweden)

    Rakić Beba


    Full Text Available All consumers in the world share certain needs and desires. They show however, remarkable diversity in the way they satisfy these needs and desires. Understanding the consumer behavior is difficult enough in the confines of a single country. Can manager understand the consumer behavior in many different world markets? International marketer must learn how to satisfy customers with widely different buying behaviors.

  17. 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.


    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).

  18. 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 ...

  19. An Investigation of How Clinicians use Anatomical Knowledge in ...

    African Journals Online (AJOL)

    An Investigation of How Clinicians use Anatomical Knowledge in Diagnostic Reasoning: A Grounded Theory Study of Clinicians in Zambia. ... observations, self-administered questionnaires from 168 respondents (140 doctors and 28 medical students at UTH), and unstructured interviews with doctors working in hospitals.

  20. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis

    Directory of Open Access Journals (Sweden)

    Fry Margaret


    Full Text Available Abstract Background Venous Thromboembolism (VTE is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results Analysis of interviews revealed that barriers to evidence based practice include i the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.

  1. Understanding clinicians' attitudes toward a mobile health strategy to childhood asthma management: A qualitative study. (United States)

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


    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.

  2. European Union's consumer policy

    Directory of Open Access Journals (Sweden)

    Kovačević Maja


    Full Text Available EU's consumer protection legislation concerns product safety measures (general product safety and liability for defective products, as well as protection of the economic interests of consumers (misleading and comparative advertising, distance contracts, unfair terms in consumer contracts, etc.. In the future, EU's consumer policy will face various challenges due to the factors such as globalization of markets and technological developments, which have had a profound effect on products, services and in marketing. In order to respond to these challenges, more flexible approach will be needed.

  3. A general consumer-resource population model (United States)

    Lafferty, Kevin D.; DeLeo, Giulio; Briggs, Cheryl J.; Dobson, Andrew P.; Gross, Thilo; Kuris, Armand M.


    Food-web dynamics arise from predator-prey, parasite-host, and herbivore-plant interactions. Models for such interactions include up to three consumer activity states (questing, attacking, consuming) and up to four resource response states (susceptible, exposed, ingested, resistant). Articulating these states into a general model allows for dissecting, comparing, and deriving consumer-resource models. We specify this general model for 11 generic consumer strategies that group mathematically into predators, parasites, and micropredators and then derive conditions for consumer success, including a universal saturating functional response. We further show how to use this framework to create simple models with a common mathematical lineage and transparent assumptions. Underlying assumptions, missing elements, and composite parameters are revealed when classic consumer-resource models are derived from the general model.

  4. A teachable moment communication process for smoking cessation talk: description of a group randomized clinician-focused intervention

    Directory of Open Access Journals (Sweden)

    Flocke Susan A


    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



    Eduardo Biagi Almeida Santos; Otávio Bandeira De Lamônica Freire


    This present paper shows the influence of music used in a retail environment in relation to consumer behavior. For obtaining the information, we based this research on a literature review in national and international journals, by 4 databases including: Proquest, EBSCO Host, CAPES periódicos and Mendeley, in the period of 2008 and 2012, by the keywords: music behavior, music in retail environment, background music, music consumer, environmental music, music and consumer behavior and music in ...

  6. 47 CFR 15.118 - Cable ready consumer electronics equipment. (United States)


    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Cable ready consumer electronics equipment. 15... Unintentional Radiators § 15.118 Cable ready consumer electronics equipment. (a) All consumer electronics TV... provisions of this section. Consumer electronics TV receiving equipment that includes features intended for...

  7. Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW. (United States)

    Feinberg, Jodi L; Russell, David; Mola, Ana; Bowles, Kathryn H; Lipman, Terri H


    There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test. Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists. Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.

  8. Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines. (United States)

    Gurses, Ayse P; Marsteller, Jill A; Ozok, A Ant; Xiao, Yan; Owens, Sharon; Pronovost, Peter J


    Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions. A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models. Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance. An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.

  9. Collaborative research between clinicians and researchers: a multiple case study of implementation

    Directory of Open Access Journals (Sweden)

    Edlund Carrie


    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.

  10. Clinician search behaviors may be influenced by search engine design. (United States)

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


    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

  11. Consumers and Producers

    NARCIS (Netherlands)

    E. Maira (Elisa)


    markdownabstractIn the last few decades, advances in information and communication technology have dramatically changed the way consumers and producers interact in the marketplace. The Internet and social media have torn down the information barrier between producers and consumers, leading to

  12. Consumer perception of risk

    DEFF Research Database (Denmark)

    Scholderer, Joachim


    ' in risk perception research covering structure, process, and the social dynamics of risk debates. After that I will present results from a recently completed research project. In this project, we specifically looked into consumers' perceptions of gene technology applied to brewing, and how...... these perceptions related to consumers' attitudes and choice behavior....

  13. Consumers Should Know. (United States)

    Worthington, Robert M.

    Consumer education can be defined as "a study of intelligent and effective methods of buying and using goods and services, competent money management, and the relationship of the consumer to the economy, the workplace, and the home." An important role of government is providing the individual with information so that the individual can…

  14. The Consumer Rights Directive

    NARCIS (Netherlands)

    Luzak, J.A.; Mak, V.; Hartkamp, A.S.; Sieburgh, C.H.; Keus, L.A.D.; Kortmann, J.S.; Wissink, M.H.


    This contribution discusses the impact of the CRD on Dutch private law. How will the new directive influence consumer rights and how does this fit with existing law? Considering the background of the directive and its importance for European consumer law, however, we discuss these questions in the

  15. Consumer in insurance law

    Directory of Open Access Journals (Sweden)

    Čorkalo Milena


    Full Text Available The paper analyses the notion of consumer in the European Union law, and, in particular, the notion of consumer in insurance law. The author highligts the differences between the notion of consumer is in aquis communautaire and in insurance law, discussing whether the consumer can be defined in both field in the same way, concerning that insurance services differ a lot from other kind of services. Having regarded unequal position of contracting parties and information and technical disadvantages of a weaker party, author pleads for broad definition of consumer in insurance law. In Serbian law, the consumer is not defined in consistent way. That applies on Serbian insurance law as well. Therefore, the necessity of precise and broad definition of consumes is underlined, in order to delimit the circle of subject who are in need for protection. The author holds that the issue of determination of the circle of persons entitled to extended protection as consumers is of vital importance for further development of insurance market in Serbia.

  16. Observing Reasonable Consumers. (United States)

    Silber, Norman I.


    Although courts and legislators usually set legal standards that correspond to empirical knowledge of human behavior, recent developments in behavioral psychology have led courts to appreciate the limits and errors in consumer decision making. "Reasonable consumer" standards that are congruent with cognitive reality should be developed.…

  17. Transforming Consumers Into Brands

    DEFF Research Database (Denmark)

    Erz, Antonia; Christensen, Anna-Bertha Heeris


    The goal of this research is to explore the transformational power of a new consumption and production practice, the practice of blogging, to understand its impact on consumers' identity transformations beyond their self-concept as consumers and on the blogosphere as an organizational field. Thro...

  18. Cars, Cycles, and Consumers. (United States)

    Idleman, Hillis K. Ed.

    The purpose of this consumer education module is to provide information and skills, and the ability to raise questions and find answers, while seeking the best automobile or motorcycle buy available for the money. The module may be used for a full or part semester course. The five sections (cars and the consumer, renting and leasing cars, cars and…

  19. Patient- and clinician- reported outcome in eating disorders. (United States)

    Winkler, Laura Al-Dakhiel; Frølich, Jacob Stampe; Gudex, Claire; Hørder, Kirsten; Bilenberg, Niels; Støving, René Klinkby


    Patient-reported outcome is increasingly applied in health sciences. Patients with eating disorders (EDs) characteristically have a different opinion of their needs to that of the health professionals, which can lead to ambivalence towards treatment and immense compliance difficulties. This cross-sectional study compared data assessed by the clinician to patient-reported measures in patients with a history of EDs. We included data from a cohort of patients with EDs (n=544) referred to a specialized ED unit in Denmark. Patient-reported measures included the Eating Disorder Inventory-2 (EDI-2) and the Short Form 36 (SF-36), and clinical data included remission status and body mass index (BMI). We found a positive association between BMI and EDI-2 scores for anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS), reflecting increasing ED symptomatology with increasing BMI. This association was not observed in bulimia nervosa (BN). We did not find a correlation between SF-36 scores and BMI in any of the diagnostic groups. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Stuttering therapy in the elementary school setting: guidelines for clinician-teacher collaboration. (United States)

    Zebrowski, P M; Cilek, T D


    This article describes guidelines for developing an effective collaborative/consultative approach to the treatment of stuttering in an elementary school setting. Four primary areas of shared clinician/teacher responsibility are discussed, which include: education, observation, facilitation of fluent speech, and generalization of speech fluency. Although the speech-language pathologist should initiate the teacher's involvement in a child's therapy, both the clinician and teacher should work toward developing a mutually influential partnership, through which the specific needs of individual children who stutter can be addressed in a comprehensive manner.

  1. Extemporaneously compounded sterile medications: relevance of new United States pharmacopeial standards to pain clinicians. (United States)

    Rusho, William J


    The United States Pharmacopeia (USP) is the United States' congressionally authorized book of standards for pharmaceutical manufacturing in the United States. The most current edition of the USP includes a new chapter entitled Pharmaceutical Compounding-Sterile Preparations that sets standards for all health care professionals who prepare, store or dispense sterile preparations. Extemporaneously compounded sterile formulations are sometimes needed for symptom control in pain and palliative practice. The implications and relevance of this new USP chapter to pain and palliative care clinicians-and the importance of all clinicians understanding the implications of how their patient's compounded sterile products are prepared-are discussed.

  2. Environmentally Friendly Consumer

    DEFF Research Database (Denmark)

    Reijonen, Satu


    on the green consumer: cultural determinism, psycho-socio-demographic determinism and calculative determinism. An explanation of the green consumer in these terms, however, loses sight of the emergence and processuality of consumer behaviour. Process oriented constructionism, by contrast, is useful to recover...... these important aspects. This paper suggests a research agenda focused on socio-material processes and situated actions that lead to the emergence and stabilization of a particular type of consumer behaviour.......Several attempts have been made by academics in the past to explain the so-called ‘environmentally conscious’ consumer. These explanations share an important feature, namely determinism. This paper identifies three different sources of determinism that are distinguished in recent literature...

  3. Consumers' quality perception

    DEFF Research Database (Denmark)

    Bech, Anne C.; Grunert, Klaus G.; Bredahl, Lone


    is rapidly becoming a reality. On the other hand, still many consumers are in favour of local production, resulting in fierce competition between the multinational suppliers and the local producers of food. Under these market conditions, the importance of skills relating to hoe to study consumers' perception...... of quality and the ability of producers to react to changes in consumers' perception of quality may form the basis of market success or failure, independent of whether you are a local or multinational producer. This chapter deals with the analysis of consumers' quality perception. We will introduce a general...... framework, the Total Food Quality Model, which we believe is useful in understanding consumers perception of food quality. We will then illustrate applications of the model using two recent examples of the quality perception of meat and fish....

  4. Promoting educated consumer choices

    DEFF Research Database (Denmark)

    Edinger, Wieke Willemijn Huizing


    Contemporary EU food information legislation combines and balances two main consumer interests, i.e., a consumer right to information and the freedom of choice, into one single protective standard: informed choice. Although the recent legislative measures quite openly establish a link between...... informed choice and the rather abstract societal norm of “what is good for the consumer,” this does not justify the conclusion that food information legislation has become overly meddlesome in relation to EU consumers and their choice of food. Rather, there has been a gradual maturing of the EU legislator......’s perception of its task from the mere provision of food information to ensuring educated consumer choices. This development is a logical and necessary consequence of the growing complexity of food choices....

  5. A listening skill educational intervention for pediatric rehabilitation clinicians: A mixed-methods pilot study. (United States)

    King, Gillian; Servais, Michelle; Shepherd, Tracy A; Willoughby, Colleen; Bolack, Linda; Moodie, Sheila; Baldwin, Patricia; Strachan, Deborah; Knickle, Kerry; Pinto, Madhu; Parker, Kathryn; McNaughton, Nancy


    To prepare for an RCT by examining the effects of an educational intervention on the listening skills of pediatric rehabilitation clinicians, piloting study procedures, and investigating participants' learning experiences. Six experienced clinicians received the intervention, consisting of video simulations and solution-focused coaching regarding personal listening goals. Self- and observer-rated measures of listening skill were completed and qualitative information was gathered in interviews and a member checking session. Significant change on self-reported listening skills was found from pre- to post-test and/or follow-up. The pilot provided useful information to improve the study protocol, including the addition of an initial orientation to listening skills. Participants found the intervention to be a highly valuable and intense learning experience, and reported immediate changes to their clinical and interprofessional practice. The educational intervention has the potential to be an effective means to enhance the listening skills of practicing pediatric rehabilitation clinicians.

  6. Distraction of clinicians by smartphones in hospitals: a concept analysis. (United States)

    McBride, Deborah L


    To report an analysis of the concept of distraction of clinicians by smartphones and other mobile devices in hospitals. In the healthcare literature, the concept of distraction of clinicians by smartphones and other mobile devices in hospitals has no consistent definition. Concept analysis. Journal articles published from 2003-2014. Rodgers' Evolutionary Concept Analysis Method was used to analyse the concept of distraction of clinicians by smartphones and other mobile devices in hospitals. This analysis led to a definition of distraction of clinicians by smartphones as the interruption of a hospital clinician's primary task by the internally or externally initiated use of their smartphone or other mobile device. There are six attributes of distraction by smartphones and other mobile devices in hospitals. These attributes are: (1) an experience by a clinician; (2) an intrusion into a primary clinical task; (3) discontinuity of the clinical task; (4) externally or internally initiated; (5) situated in a healthcare setting; and (6) mediated by a smartphone or other mobile device. Use of the definition and the defining attributes of distraction of clinicians by smartphones will increase the validity and reliability of future studies. It will be extended to form a classification system of distractions within a framework of clinical practice, which will be used to unify and standardize future research studies. © 2015 John Wiley & Sons Ltd.

  7. The interface between clinicians and laboratory staff: A field study in northern Tanzania

    Directory of Open Access Journals (Sweden)

    Coosje J. Tuijn


    Conclusions: Hospital managers, clinicians and laboratory workers need to recognise the critical and complementary roles each professional plays and the importance of addressing the gap between them. Field application of the framework proved successful, justifying the expansion of this study to a larger geographical area to include additional healthcare institutions

  8. Treating the School Age Stutterer: A Guide for Clinicians. Publication No. 14. (United States)

    Dell, Carl W., Jr.

    This five-chapter book describes how clinicians (speech teachers, therapists, pathologists) can work effectively with young stutterers. The information contained in this booklet was obtained through an extensive program of study, testing, and research carried on for several years. The chapter on the "borderline stutterer" includes information on…

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

    Directory of Open Access Journals (Sweden)

    Quinn Grundy


    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

  10. Interactions between non-physician clinicians and industry: a systematic review. (United States)

    Grundy, Quinn; Bero, Lisa; Malone, Ruth


    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

  11. Randomised clinical trials with clinician-preferred treatment. (United States)

    Korn, E L; Baumrind, S


    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.

  12. Consumer Marketing and the Airline Industry (United States)

    Roy, W. R.


    The fundamentals of consumer marketing as applied to the airline industry are considered. An attempt is made to boil down the mystique and jargon which frequently surround the subject of marketing. Topics covered include: (1) The marketing concept; (2) consumer expectations from airlines; (3) planning of marketing strategy; and (4) the roles of advertising, sales, and middlemen.

  13. Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions. (United States)

    Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F


    Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for

  14. Integrating virtual reality video games into practice: clinicians' experiences. (United States)

    Levac, Danielle E; Miller, Patricia A


    The Nintendo Wii is a popular virtual reality (VR) video gaming system in rehabilitation practice and research. As evidence emerges related to its effectiveness as a physical therapy training method, clinicians require information about the pragmatics of its use in practice. The purpose of this descriptive qualitative study is to explore observations and insights from a sample of physical therapists (PTs) working with children with acquired brain injury regarding practical implications of using the Wii as a physical therapy intervention. Six PTs employed at a children's rehabilitation center participated in semi-structured interviews, which were transcribed and analyzed using content analysis. Two themes summarize the practical implications of Wii use: 1) technology meets clinical practice; and 2) onus is on the therapist. Therapists described both beneficial and challenging implications arising from the intersection of technology and practice, and reported the personal commitment required to orient oneself to the gaming system and capably implement this intervention. Findings include issues that may be relevant to professional development in a broader rehabilitation context, including suggestions for the content of educational initiatives and the need for institutional support from managers in the form of physical resources for VR implementation.

  15. Mendelian randomisation in cardiovascular research: an introduction for clinicians. (United States)

    Bennett, Derrick A; Holmes, Michael V


    Understanding the causal role of biomarkers in cardiovascular and other diseases is crucial in order to find effective approaches (including pharmacological therapies) for disease treatment and prevention. Classical observational studies provide naïve estimates of the likely role of biomarkers in disease development; however, such studies are prone to bias. This has direct relevance for drug development as if drug targets track to non-causal biomarkers, this can lead to expensive failure of these drugs in phase III randomised controlled trials. In an effort to provide a more reliable indication of the likely causal role of a biomarker in the development of disease, Mendelian randomisation studies are increasingly used, and this is facilitated by the availability of large-scale genetic data. We conducted a narrative review in order to provide a description of the utility of Mendelian randomisation for clinicians engaged in cardiovascular research. We describe the rationale and provide a basic description of the methods and potential limitations of Mendelian randomisation. We give examples from the literature where Mendelian randomisation has provided pivotal information for drug discovery including predicting efficacy, informing on target-mediated adverse effects and providing potential new evidence for drug repurposing. The variety of the examples presented illustrates the importance of Mendelian randomisation in order to prioritise drug targets for cardiovascular research. © 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.

  16. Myasthenia gravis: an update for the clinician. (United States)

    Sieb, J P


    This paper provides a thorough overview of the current advances in diagnosis and therapy of myasthenia gravis (MG). Nowadays the term 'myasthenia gravis' includes heterogeneous autoimmune diseases, with a postsynaptic defect of neuromuscular transmission as the common feature. Myasthenia gravis should be classified according to the antibody specificity [acetylcholine, muscle-specific receptor tyrosine kinase (MuSK), low-density lipoprotein receptor-related protein 4 (LRP4), seronegative], thymus histology (thymitis, thymoma, atrophy), age at onset (in children; aged less than or more than 50 years) and type of course (ocular or generalized). With optimal treatment, the prognosis is good in terms of daily functions, quality of life and survival. Symptomatic treatment with acetylcholine esterase inhibition is usually combined with immunosuppression. Azathioprine still remains the first choice for long-term immunosuppressive therapy. Alternative immunosuppressive options to azathioprine include cyclosporin, cyclophosphamide, methotrexate, mycophenolate mofetil and tacrolimus. Rituximab is a promising new drug for severe generalized MG. Emerging therapy options include belimumab, eculizumab and the granulocyte- macrophage colony-stimulating factor. One pilot study on etanercept has given disappointing results. For decades, thymectomy has been performed in younger adults to improve non-paraneoplastic MG. However, controlled prospective studies on the suspected benefit of this surgical procedure are still lacking. In acute exacerbations, including myasthenic crisis, intravenous immunoglobulin, plasmapheresis and immunoadsorption are similarly effective. © 2013 British Society for Immunology.

  17. Clinicians' assessment of mobile monitoring: a comparative study in Japan and Spain. (United States)

    Okazaki, Shintaro; Castañeda, José Alberto; Sanz, Silvia


    The gradual but steady shift toward telemedicine during the past decades is a clear response to important health problems that most industrialized countries have been facing. The growing elderly population and changing dietary habits have led to an increase in people with chronic diseases and overall health care expenditures. As more consumers use their mobile device as their preferred information and communication technology (ICT) device, mobile health monitoring has been receiving increasing attention in recent years. This study examines clinicians' perception of factors determining mobile health monitoring acceptance in Japan and Spain. The study proposes a causal model consisting of innovation seeking, new ICT attributes (perceived value, time-place flexibility, and compatibility), and usage intention. In addition, cross-country differences are posited for the hypothesized relationships among the proposed constructs. A questionnaire survey was performed to test our research model and hypotheses. The sample consisted of clinicians from various medical specialties. In total, 471 and 497 usable responses were obtained in Japan and Spain, respectively. In both countries, the collected data fit the model well with all the hypothesized paths among the constructs being supported. Furthermore, the moderating effects of psychic distance were observed in most of the paths. Our study demonstrates the importance of new ICT attributes, namely perceived value, time-place flexibility, and compatibility, in the clinicians' adoption of mobile health monitoring. In particular, our results clearly indicated that perceived medical value and ubiquitous nature of the tool are the two main benefits clinicians are likely to perceive (and appreciate) in both countries. This tendency will be stronger for those with a greater propensity to seek innovation in ICT. In terms of cross-country comparison, the strength of the path from innovation seeking to perceived value was greater in Japan

  18. Do self- reported intentions predict clinicians' behaviour: a systematic review

    Directory of Open Access Journals (Sweden)

    Dickinson Heather O


    Full Text Available Abstract Background Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice. Several interventions have been shown to be effective in changing health care professionals' behaviour, but heterogeneity within interventions, targeted behaviours, and study settings make generalisation difficult. Therefore, it is necessary to identify the 'active ingredients' in professional behaviour change strategies. Theories of human behaviour that feature an individual's "intention" to do something as the most immediate predictor of their behaviour have proved to be useful in non-clinical populations. As clinical practice is a form of human behaviour such theories may offer a basis for developing a scientific rationale for the choice of intervention to use in the implementation of new practice. The aim of this review was to explore the relationship between intention and behaviour in clinicians and how this compares to the intention-behaviour relationship in studies of non-clinicians. Methods We searched: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Science/Social science citation index, Current contents (social & behavioural med/clinical med, ISI conference proceedings, and Index to Theses. The reference lists of all included papers were checked manually. Studies were eligible for inclusion if they had: examined a clinical behaviour within a clinical context, included measures of both intention and behaviour, measured behaviour after intention, and explored this relationship quantitatively. All titles and abstracts retrieved by electronic searching were screened independently by two reviewers, with disagreements resolved by discussion. Discussion Ten studies were found that examined the relationship between intention and clinical behaviours in 1623 health professionals. The proportion of variance in behaviour explained by

  19. Representing distance, consuming distance

    DEFF Research Database (Denmark)

    Larsen, Gunvor Riber

    are being consumed in the contemporary society, in the same way as places, media, cultures and status are being consumed (Urry 1995, Featherstone 2007). An exploration of distance and its representations through contemporary consumption theory could expose what role distance plays in forming......Title: Representing Distance, Consuming Distance Abstract: Distance is a condition for corporeal and virtual mobilities, for desired and actual travel, but yet it has received relatively little attention as a theoretical entity in its own right. Understandings of and assumptions about distance...

  20. Linking consumer experiences

    DEFF Research Database (Denmark)

    Smed, Karina Madsen

    become part of the individual self, worldview, and behaviour. This paper seeks to explore links between consumer experiences through the exploration of narrative sequences in travel blogs. Findings indicate that non-consumption is a central element to the bloggers and also indicative of a community......Consumers consume products in various ways serving a number of purposes. Much attention has been paid to experiences attached to consumption, sometimes very explicitly, e.g. in tourism, the essence of which is experiences of various sorts, but often also implicitly as internalised experiences...



    Dr. K. Veerakumar


    The Consumer behavior or buyer behavior has gained increased importance in a consumer oriented marketing planning and management. The study of consumer behavior is an attempt to understand what the consumer want, why they want. Consumer behavior reflects the totality of consumer’s decisions with respect to acquisition, consumption and disposition of goods, services, time and idea by human decision making. It also includes whether, why, when, where, how, how much and how often and how long con...

  2. Consumers' various and surprising responses to direct-to-consumer advertisements in magazine print

    Directory of Open Access Journals (Sweden)

    Arney J


    Full Text Available Jennifer Arney,1–3 Richard L Street Jr,2–4 Aanand D Naik2,31Department of Sociology, University of Houston – Clear Lake, 2Houston VA Health Services Research and Development Center of Excellence, Michael E DeBakey Department of Veterans Affairs Medical Center, 3Section on Health Services Research, Baylor College of Medicine, Houston, 4Department of Communication, Texas A&M University, College Station, TX, USAAbstract: Direct-to-consumer advertising (DTCA is ubiquitous in media outlets, but little is known about the ways in which consumers' values, needs, beliefs, and biases influence the perceived meaning and value of DTCA. This article aims to identify the taxonomy of readership categories that reflect the complexity of how health care consumers interact with DTCA, with particular focus on individuals' perceptions of print DTCA in popular magazines. Respondent-driven sampling was used to recruit 18 male and female magazine readers and 18 male and female prescription medication users aged 18–71 years. Semi-structured, in-depth interviews with consumers about their attentiveness, motivations, perceived value, and behavioral responses to DTCA were conducted. The analyses were guided by principles of grounded theory analysis; four categories that vary in consumers' attentiveness, motivations, perceived value, and behavioral responses to DTCA were identified. Two categories – the lay physician and the informed shopper – see value in information from DTCA and are likely to seek medical care based on the information. One category – the voyeur – reads DTCA, but is not likely to approach a clinician regarding advertised information. The fourth category – the evader – ignores DTCA and is not likely to approach a clinician with DTCA information. Responses to DTCA vary considerably among consumers, and physicians should view patients' understanding and response to DTCA within the context of their health-related needs. Patients' comments

  3. Evaluation of a Curriculum to Improve Clinician Communication With Adolescents. (United States)

    Olejniczak, Amy; Otalora-Fadner, Hannah; Hanna, Christina; Hudson, Emma; Tess, Joanna; Royer, Heather


    While guidelines for health care clinicians working with adolescent patients encourage open communication and confidential visits, current practices often fall short and many adolescents do not receive confidential care or adequate communication about sexually transmitted infections, reproductive health, and other sensitive health topics. The Providers and Teens Communicating for Health (PATCH) program in Wisconsin aims to bridge communication gaps between adolescents and health care clinicians. Teen educators are hired and trained to lead 2 types of workshops-one targeting peers and one targeting clinicians. Pre- and post-intervention evaluations show improvements in clinician and teen knowledge, intentions to seek and provide quality care, and reported change in care delivery. The PATCH program curriculum shows promise for improving the care of young people throughout Wisconsin.

  4. Personalized medical education: Reappraising clinician-scientist training. (United States)

    DeLuca, Gabriele C; Ovseiko, Pavel V; Buchan, Alastair M


    Revitalizing the Oslerian ideal of the clinician-scientist-teacher may help in the training of the next generation of translational researchers. Copyright © 2016, American Association for the Advancement of Science.

  5. Clinicians' practices regarding blind versus open weighing among patients with eating disorders. (United States)

    Forbush, Kelsie T; Richardson, Jonathan H; Bohrer, Brittany K


    Empirically supported treatments for eating disorders, such as cognitive-behavioral therapy and family-based treatment, stress the importance of weighing patients during therapy and using this information as part of treatment. However, weighing practices vary widely across eating disorders professionals, including those that purport to provide empirically supported interventions. To characterize clinicians' practices regarding the decision to share (open weighing) or withhold (blind weighing) weight information with patients, a topic that has received limited prior attention. Clinicians (N = 114; 85% female) who regularly treat individuals with an eating disorder completed an online survey to identify factors that might impact their decision to practice blind or open weighing. Approximately half of the clinicians reported generally using open weighing procedures (n = 53; 46.49%). Endorsement of cognitive-behavioral or family-based therapeutic orientation was not significantly associated with open weighing. However, clinicians who endorsed therapeutic modalities that do not specifically encourage open weighing were significantly more likely to engage in blind weighing. Clinicians working with clients with anorexia nervosa were significantly more likely to practice blind weighing, compared to clients with other eating disorder diagnoses, and cognitive or emotional impairment from malnutrition emerged as the strongest predictor of clinicians' decisions to practice blind weighing, controlling for all other variables. Development of specific training modules may be useful for improving adherence to empirically supported protocols that recommend open weighing. More importantly, however, our results highlight the need for future treatment studies to identify whether blind or open weighing is beneficial for improving patient outcomes. © 2014 Wiley Periodicals, Inc.

  6. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. (United States)

    Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene


    Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. To measure selected UK primary care clinicians' current levels of knowledge, attitudes, and clinical skills in this area. Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Primary care clinicians' attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services.

  7. Nostalgia and Consumer Sentiment. (United States)

    Moriarty, Sandra Ernst; McGann, Anthony F.


    Concludes that designer magazine advertisements contain more traces of nostalgia than do those in consumer magazines and that they tend to be more extreme in their fluctuation patterns. Notes that nostalgia increases in ads when public confidence is decreasing. (FL)

  8. Consumer reports [electronic resource

    National Research Council Canada - National Science Library


    ... only. A limited number of selected reports, advice on product selection and safety alerts are freely available, as are a five year listing of product recalls, a listing of major consumer product...

  9. ChainConsumer (United States)

    Hinton, Samuel R.


    ChainConsumer is a python package written to consume the output chains of Monte-Carlo processes and fitting algorithms, such as the results of MCMC. ChainConsumer's main function is to produce plots of the likelihood surface inferred from the supplied chain. In addition to showing the two-dimensional marginalised likelihood surfaces, marginalised parameter distributions are given, and maximum-likelihood statistics are used to present parameter constraints. In addition to this, parameter constraints can be output in the form of a LaTeX table. Finally, ChainConsumer also provides the functionality to plot the chains as a series of walks in parameter values, which provides an easy visual check on chain mixing and chain convergence.

  10. Consumer Financial Protection Bureau (United States)

    ... Back About Us Overview The Bureau Budget & Strategy Payments to Harmed Consumers Recent Updates Blog Newsroom Events ... to help you reach your goals. Paying for College Owning a Home Planning for Retirement Standing up ...

  11. Consumer Product Category Database (United States)

    U.S. Environmental Protection Agency — The Chemical and Product Categories database (CPCat) catalogs the use of over 40,000 chemicals and their presence in different consumer products. The chemical use...

  12. Commonly Consumed Food Commodities (United States)

    Commonly consumed foods are those ingested for their nutrient properties. Food commodities can be either raw agricultural commodities or processed commodities, provided that they are the forms that are sold or distributed for human consumption. Learn more.

  13. 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). (United States)

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


    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

  14. Family presence during management of acute deterioration: Clinician attitudes, beliefs and perceptions of current practices. (United States)

    Youngson, Megan J; Currey, Judy; Considine, Julie


    The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration. To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients. Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience. Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  15. Old habits die hard: a case study on how new ways of teaching colonoscopy affect the habitus of experienced clinicians. (United States)

    Lund, Ole; Andersen, Berit; Christensen, Mette K


    The purpose of this study is to explore the habitual constraints and opportunities that affect how experienced clinicians learn new skills and, in particular, how new ways of teaching can influence these.   We conducted a case study based on a specialized training program for colonoscopy services in Denmark. Data was obtained from a short-term ethnographic fieldwork and in-depth interviews during this program. Participants were 12 experienced colonoscopists and three expert colonoscopy trainers from Denmark and UK. The analysis of data involved categorization, inductive coding, and theoretical reading inspired by sociological theory. The experienced clinicians' responsiveness to training was shaped by an underlying logic of colonoscopy practice that was characterized by tacit skills, routine work, lower status, skepticism and self-protectiveness. In order to overcome these habitual constraints, the trainers applied a pedagogical approach based on four methods: 1) intellectualization: 'academization' of skills and competencies, 2) sensing and scaffolding: hands-on experiences and learning by doing, 3) asymmetry: accentuating the authority and respect of the trainer, and 4) relation-building: building relationship and engagement between trainer and clinician. This multi-dimensional approach to teaching enabled the trainers to affect the clinicians' logic of practice and to create buy-in (so-called illusio). Clinical skills include socially constructed behaviors and unconscious competences which affect experienced clinicians' responsiveness to continuing medical education. This study suggests four educational strategies that may help trainers to establish new logics of practice in experienced clinicians and to improve the clinicians' conscious competence.

  16. Consumer rationality in choice


    Conlon, B.J.


    The dissertation concentrates on consumer choice and the ability of current modelling approaches to capture the underlying behaviour of the individual decision-makers. The standard assumption of a rational utility maximising individual and its implications for observed behaviour are examined and demonstrated empirically to be incompatible with actual consumer choices. In particular the complexity of the choice situation, and its various components, are found to be major determinants of the ch...

  17. Radioactive consumer products

    International Nuclear Information System (INIS)

    Sato, Otomaru


    Present situation of utilizing the radioactive consumer products and exposure dose were reviewed with published data. Practically, consumer products are divided into three categories, (1) radioactive nuclides intentionally incorporated into radioluminous dye, ionization chambers for smoke detector, eliminator of static electricity, and glow lamp (2) natural radioactive nuclides contained in false teeth, porcelain, glass, and gas mantle (3) natural radioactive nuclides accumulated as industrial waste at the consumption of coal, petroleum, and natural gas or in fertilizer and materials for construction. (Nakanishi, T.)

  18. The patient perspective: arthritis care provided by Advanced Clinician Practitioner in Arthritis Care program-trained clinicians

    Directory of Open Access Journals (Sweden)

    Warmington K


    Full Text Available Kelly Warmington,1 Carol A Kennedy,2 Katie Lundon,3 Leslie J Soever,4 Sydney C Brooks,5 Laura A Passalent,6 Rachel Shupak,7 Rayfel Schneider,8 1Learning Institute, Hospital for Sick Children, 2Musculoskeletal Health and Outcomes Research, St Michael’s Hospital, 3Continuing Professional Development, Faculty of Medicine, University of Toronto, 4University Health Network, 5Ontario Division, Arthritis Society, 6Toronto Western Hospital, 7Division of Rheumatology, St Michael's Hospital, 8Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Objective: To assess patient satisfaction with the arthritis care services provided by graduates of the Advanced Clinician Practitioner in Arthritis Care (ACPAC program. Materials and methods: This was a cross-sectional evaluation using a self-report questionnaire for data collection. Participants completed the Patient–Doctor Interaction Scale, modified to capture patient–practitioner interactions. Participants completed selected items from the Group Health Association of America's Consumer Satisfaction Survey, and items capturing quality of care, appropriateness of wait times, and a comparison of extended-role practitioner (ERP services with previously received arthritis care. Results: A total of 325 patients seen by 27 ERPs from 15 institutions completed the questionnaire. Respondents were primarily adults (85%, female (72%, and living in urban areas (79%. The mean age of participants was 54 years (range 3–92 years, and 51% were not working. Patients with inflammatory (51% and noninflammatory conditions (31% were represented. Mean (standard deviation Patient–Practitioner Interaction Scale subscale scores ranged from 4.50 (0.60 to 4.63 (0.48 (1 to 5 [greater satisfaction]. Overall satisfaction with the quality of care was high (4.39 [0.77], as was satisfaction with wait times (referral to appointment, 4.27 [0.86]; in clinic, 4.24 [0.91]. Ninety-eight percent of

  19. The clinician's role in the diagnosis of breast disease. (United States)

    Poma, S; Longo, A


    Until 20 or 30 years ago, the diagnosis and treatment of breast disease was managed exclusively by the surgeon. This situation has changed to some extent as a result of recent technological advances, and clinicians' contributions to the diagnostic work-up and/or treatment of these cases can begin at any time. If they are the first physician to see the patient after the examination and formulation of a diagnostic hypothesis, they will almost always have to order a panel of imaging/instrumental examinations that is appropriate for the type of lesion suspected, the patient's age, and other factors; if they intervene at the end of the diagnostic work-up, it will be their job to arrive at a conclusion based on all of the data collected. The clinical examination includes various steps - history taking and inspection and palpation of the breasts - each of which is essential and requires the use of appropriate methods and techniques. The diagnostic capacity of the examination will depend largely on the consistency of the breasts, but it is influenced even more strongly by the doctor-patient relationship. Physicians must know their patient well, listen to and understand what she is saying, explain their own findings and verify that the explanations have been understood, and they must be convincing. Clinicians must also be able to assess the results of imaging studies (rather than relying solely on the radiologist's report), and this requires interaction with other specialists. The days are over when a clinician or radiologist or sonographer worked alone, certain that his/her examination method was sufficient in itself: today, teamwork is essential. But this also means that each member of the team must be extremely competent in his/her own sector and be aware of the other team members' limitations and expectations. The clinical examination remains central to the process since it is the basis for selecting appropriate treatment. SOMMARIO: Da quando si conosce la patologia

  20. Reflex sympathetic dystrophy: reflections from a clinician. (United States)

    Small, Eric


    Reflex sympathetic dystrophy is defined as chronic musculoskeletal pain and autonomic dysfunction. It is a difficult diagnosis to make, and the adolescent often sees many specialists before arriving at the correct diagnosis. In this article I review reflex sympathetic dystrophy and reflect on the differential diagnosis, pertinent medical history, personal characteristics of patients with reflex sympathetic dystrophy, physical examination, and laboratory evaluation. Principles of management are considered, including physical therapy, pharmacology, psychological therapy, and alternative therapies. Accurate diagnosis and management are critical for not prolonging the adolescent's and the family's suffering. It is important to provide aggressive physical therapy, stress management, relaxation training, and close follow-up. It is also critical to avoid immobilization, surgery, or invasive procedures and unnecessary tests.

  1. Bronchiolitis: what the clinician should know

    Directory of Open Access Journals (Sweden)

    Roberto Antonucci


    Full Text Available Bronchiolitis is an acute infection of the lower respiratory tract affecting infants and young children, with Respiratory Syncytial Virus (RSV being the most common pathogen. Bronchiolitis is generally a mild disease, but may present with severe signs and symptoms requiring hospitalization. Risk factors including prematurity, bronchopulmonary dysplasia, immunodeficiency and congenital heart defects may predispose patients to develop a severe disease. The diagnosis should be based on clinical evaluation, without supportive radiographic and laboratory studies. Etiological diagnosis may be helpful to decrease the hospital transmission of virus and to avoid inappropriate use of antibiotics.The mainstay of therapy for bronchiolitis is supportive care, which should be directed at maintaining adequate oxygenation, ensuring a proper respiratory toilet, and meeting the requirements of fluids and nutrition. The use of nebulized hypertonic saline should be limited to hospitalized patients. Severe respiratory failure may require mechanical ventilatory support. Neither corticosteroids nor antibiotics offer consistent benefit in the treatment of bronchiolitis, and thus should not be used. A trial of a bronchodilator may be appropriate, but should be continued exclusively if a prompt favorable response occurs. Effective interventions to prevent the spread of RSV infection include hand washing or disinfection by caregivers and contact isolation. The use of palivizumab, a monoclonal antibody directed against RSV, is a safe prophylactic option, but should be restricted to children at high-risk for severe RSV disease, during the epidemic period. Current evidence suggests that early RSV bronchiolitis predisposes children to recurrent wheezing and asthma in the first decade of life.Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios

  2. Acceleration of clinician hand movements during spinal manipulative therapy. (United States)

    Gelley, Geoffrey M; Passmore, Steven R; MacNeil, Brian J


    This study used an observational design to examine the kinematics of spinal manipulative therapy (SMT) by determining the acceleration characteristics of the manipulative input at the cervical, thoracic, and lumbar spinal regions. Studies of SMT have been restricted to measuring the forces that result from the manipulative input. Several studies have indicated the rate of force development is a key parameter of clinically delivered SMT. Despite this, the movement strategies employed during SMT, including acceleration, have not been directly measured. Participants (n = 29) were recruited from a private practice chiropractic clinic. A wireless accelerometer attached to the clinician's hand was used to characterize the thrust phase of the SMT treatments. Significant differences were found across each spinal region for acceleration amplitude parameters (p acceleration during SMT (p acceleration properties of clinically delivered SMT. Consistent with that reported for SMT forces, acceleration amplitudes varied significantly across spinal regions with relatively little differences in acceleration latencies. Notably, acceleration amplitudes and latencies were not associated with each other within spinal regions. These findings indicate that changes in acceleration amplitude, rather than latency, are used to tailor SMT to individuals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Martha Wollstein: A pioneer American female clinician-scientist. (United States)

    Abrams, Jeanne; Wright, James R


    Martha Wollstein was not only the first fully specialized pediatric perinatal pathologist practicing exclusively in a North America children's hospital, she also blazed another pathway as a very early pioneer female clinician-scientist. Wollstein provided patient care at Babies Hospital of New York City from 1891 until her retirement in 1935, and also simultaneously worked for many years as a basic scientist at the prestigious Rockefeller Institute for Medical Research. Wollstein published over 65 papers, many frequently cited, during her career on a wide range of topics including pediatric and infectious diseases. Wollstein was a rare female in the field of pathology in an era when just a relatively small number of women became doctors in any medical specialty. Wollstein was born into an affluent Jewish American family in New York City in 1868 and graduated from the Women's Medical College in 1889. This paper explores her family support and ethnic and religious background, which helped facilitate her professional success. During her time, she was recognized internationally for her research and was respected for her medical and scientific skills; unfortunately today her important career has been largely forgotten.

  4. Dapsone-induced methemoglobinemia: a primer for clinicians. (United States)

    Barclay, James A; Ziemba, Stamatina E; Ibrahim, Rami B


    To present a comprehensive review of dapsone-induced methemoglobinemia and its management. Literature retrieval was accessed through MEDLINE (1966-March 2011), Cochrane Library, and EMBASE, using the terms dapsone and methemoglobinemia. All case reports, small case series, and randomized controlled trials published in English were evaluated. Because of the absence of comprehensive updates on this topic since 1996, publications between 1997 and March 2011 were included in this review. Between 1997 and March 2011, the majority of publications describing methemoglobinemia associated with dapsone use reported this adverse effect at therapeutic doses. Excluding overdose situations, 18 described symptomatic dapsone-associated methemoglobinemia and clinical presentation ranging from cyanosis to dyspnea. In almost all of the accounts, patients had a concurrent event such as anemia or pneumonia, suggesting an interplay between these comorbidities and the onset of symptomatic methemoglobinemia. Delayed hemolytic anemia was seen in patients with high methemoglobin levels at presentation. Management in most cases consisted of administration of methylene blue. Overall, most reports described a successful outcome, and no mortality resulted from methemoglobinemia associated with therapeutic use. Clinicians should recognize methemoglobinemia as an adverse effect associated with dapsone use and the potential factors that precipitate it. They should also know how to promptly and effectively manage this event.

  5. Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians

    Directory of Open Access Journals (Sweden)

    Gregory M. Asnis


    Full Text Available Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about “sleep-related complex behaviors”, e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects.

  6. The Clinician as Leader: Why, How, and When. (United States)

    Stoller, James K


    Clinicians are inveterate leaders. We lead patients through the difficult maze of illness, families through the travails of ill loved ones, and physicians-in-training through the gauntlet of learning medicine. Yet, in the context of a range of leadership styles that effective leaders must be able to deploy situationally, physician leaders have traditionally defaulted to a "command and control" style that fosters the concept of physicians as "Viking warriors" or "heroic lone healers." The perverse effects of "command and control" are that this style conspires against collaboration and tends to be perpetuated as aspiring leaders emulate their predecessors. Because healthcare faces challenges of cost, access, and quality and is in the throes of change, the current landscape requires effective leadership. Though still relatively uncommon among healthcare organizations, frontrunner organizations are offering leadership development programs. The design of such programs requires clarity about requisite leadership competencies and about how and when to best to deliver such curricula. As one example, the American Thoracic Society has launched its Emerging Leaders Program (ELP), which is currently offering a leadership development curriculum to 18 selected emerging leaders. The ATS ELP curriculum focuses on awareness of self and system and incorporates highly participatory sessions on emotional intelligence, teambuilding, change management, situational leadership, appreciative inquiry, process and quality improvement, strategic planning, and organizational culture. Short-term deliverables are the development and presentation of business plans for innovations proposed by the group. Hoped for longer-term outcomes include an enhanced leadership pipeline for global respiratory health.

  7. Bioethics for clinicians: 28. Protestant bioethics (United States)

    Pauls, Merril; Hutchinson, Roger C.


    “PROTESTANT” IS A TERM APPLIED TO MANY DIFFERENT Christian denominations, with a wide range of beliefs, who trace their common origin to the Reformation of the 16th century. Protestant ideas have profoundly influenced modern bioethics, and most Protestants would see mainstream bioethics as compatible with their personal beliefs. This makes it difficult to define a uniquely Protestant approach to bioethics. In this article we provide an overview of common Protestant beliefs and highlight concepts that have emerged from Protestant denominations that are particularly relevant to bioethics. These include the sovereignty of God, the value of autonomy and the idea of medicine as a calling as well as a profession. Most Canadian physicians will find that they share certain values and beliefs with the majority of their Protestant patients. Physicians should be particularly sensitive to their Protestant patients' beliefs when dealing with end-of-life issues, concerns about consent and refusal of care, and beginning-of-life issues such as abortion, genetic testing and the use of assisted reproductive technologies. Physicians should also recognize that members of certain Protestant groups and denominations may have unique wishes concerning treatment. Understanding how to elicit these wishes and respond appropriately will allow physicians to enhance patient care and minimize conflict. PMID:11868645

  8. Bioethics for clinicians: 28. Protestant bioethics. (United States)

    Pauls, Merril; Hutchinson, Roger C


    "Protestant" is a term applied to many different Christian denominations, with a wide range of beliefs, who trace their common origin to the Reformation of the 16th century. Protestant ideas have profoundly influenced modern bioethics, and most Protestants would see mainstream bioethics as compatible with their personal beliefs. This makes it difficult to define a uniquely Protestant approach to bioethics. In this article we provide an overview of common Protestant beliefs and highlight concepts that have emerged from Protestant denominations that are particularly relevant to bioethics. These include the sovereignty of God, the value of autonomy and the idea of medicine as a calling as well as a profession. Most Canadian physicians will find that they share certain values and beliefs with the majority of their Protestant patients. Physicians should be particularly sensitive to their Protestant patients' beliefs when dealing with end-of-life issues, concerns about consent and refusal of care, and beginning-of-life issues such as abortion, genetic testing and the use of assisted reproductive technologies. Physicians should also recognize that members of certain Protestant groups and denominations may have unique wishes concerning treatment. Understanding how to elicit these wishes and respond appropriately will allow physicians to enhance patient care and minimize conflict.

  9. Clinician-Friendly Physical Performance Tests for the Knee. (United States)

    Harrison, Jerrod J; Yorgey, Marissa K; Csiernik, Alexander J; Vogler, Joseph H; Games, Kenneth E


    Reference:  Hegedus EJ, McDonough S, Bleakley C, Cook CE, Baxter GD. Clinician-friendly lower extremity physical performance measures in athletes: a systematic review of measurement properties and correlation with injury. Part 1: the tests for knee function including the hop tests. Br J Sports Med. 2015;49(10):642-648.   Do individual physical performance tests (PPTs) used as measures for lower extremity function have any relationship to injuries in athletes aged 12 years or older?   Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to locate articles. The authors searched PubMed, EMBASE, and SPORTDiscus, in addition to searching by hand. The search strategy combined the terms athlete, lower extremity, and synonyms of performance test with the names of performance tests.   Studies were included if they involved a test that met the operational definition for a PPT. The included studies assessed components of sport function (eg, speed, agility, and power), determined readiness for return to sport, or predicted injury to the lower extremity. All PPT measures could be performed on the field, courtside, or in a gym with affordable, portable, and readily available equipment. Studies were excluded if they made use of 3-dimensional motion capture, force platforms, timing gates, treadmills, stationary bikes, metabolic charts, or another nonportable, costly testing device. Athletes were categorized on the Tegner Scale at a minimum of level 5, which is the lowest level that still encompasses competitive athletes. Studies were included if 50% or more of the participants were rated above 5 on the Tegner Scale. Studies were excluded if the sole purpose was to judge movement quality or range of motion. Studies were selected if they identified the knee or a knee injury as a focal point of the paper.   The Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) was used to critique the

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

    International Nuclear Information System (INIS)

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


    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

  11. Identification of the characteristics that drive consumer liking of butter. (United States)

    Krause, A J; Lopetcharat, K; Drake, M A


    This study identified and explored the sensory characteristics that drive consumer liking of butter. A trained descriptive panel evaluated 27 commercial butters using a defined sensory language. Two focus groups were conducted with butter consumers to gain an understanding of consumer use and consumption habits. Six representative butters and 2 vegetable oil spreads were selected for consumer acceptance testing. Both internal and external preference mapping techniques were applied to interpret consumer data. Key discriminating sensory characteristics of butters included color intensity; diacetyl, cooked, grassy, and milk fat flavors; and salty taste. From focus groups and quantitative consumer testing, the key butter features were a desirable flavor and a natural image. Negative aspects included price and cholesterol. Five consumer clusters with distinct butter and spread flavor likes and dislikes were identified. Butter is a desirable product to consumers. Sensory expectations of butter vary among consumers, and butters with specific sensory characteristics could be marketed to specific target market segments.

  12. Potential spillover educational effects of cancer-related direct-to-consumer advertising on cancer patients' increased information seeking behaviors: results from a cohort study. (United States)

    Tan, Andy S L


    Spillover effects of exposure to direct-to-consumer advertising (DTCA) of cancer treatments on patients' general inquiry about their treatments and managing their illness are not well understood. This study examines the effects of cancer patients' exposure to cancer-related DTCA on subsequent health information seeking behaviors from clinician and non-clinician sources (lay media and interpersonal contacts). Using a longitudinal survey design over 3 years, data was collected from cancer survivors diagnosed with colorectal, breast, or prostate cancer who were randomly sampled from the Pennsylvania Cancer Registry. Study outcome measures include patients' information engagement with their clinicians and information seeking from non-medical sources about cancer treatment and quality of life issues, measured in the second survey. The predictor variable is the frequency of exposure to cancer-related DTCA since diagnosis, measured at the round 1 survey. The analyses utilized lagged-weighted multivariate regressions and adjusted for round 1 levels of patient-clinician engagement, information seeking from nonmedical sources, and confounders. Exposure to cancer-related DTCA is associated with increased levels of subsequent patient-clinician information engagement (B = .023, 95% CI = .005-.040, p = .012), controlling for confounders. In comparison, exposure to DTCA is marginally significant in predicting health information seeking from non-clinician sources (B = .009, 95% CI = -.001-.018, p = .067). Cancer-related DTCA has potentially beneficial spillover effects on health information seeking behaviors among cancer patients. Exposure to DTCA predicts (a little) more patient engagement with their physicians.

  13. Health Literacy's Influence on Consumer Libraries. (United States)

    Six-Means, Amy


    Health literacy has been redefined in recent years to move beyond an individual's own communication skills to include the skills of persons working within health care organizations, including librarians. Provision of consumer health services and resources, while a long-standing practice in hospital libraries, has also been redefined. As definitions of health literacy have evolved, so too have hospital librarian services as they embrace their role within health literacy. Many hospital medical and consumer health librarians have developed programs, services, and collaborations to further health literacy awareness, education, and initiatives for consumers, health care professionals, and their parent organizations.

  14. Consumer reporting of adverse drug reactions

    DEFF Research Database (Denmark)

    Aagaard, Lise; Nielsen, Lars Hougaard; Hansen, Ebba Holme


    BACKGROUND: Reporting adverse drug reactions (ADRs) has traditionally been the sole province of healthcare professionals. Since 2003 in Denmark, consumers have been able to report ADRs directly to the authorities. The objective of this study was to compare ADRs reported by consumers with ADRs...... be actively included in systematic drug surveillance systems, including clinical settings, and their reports should be taken as seriously as reports from other sources....

  15. Consumers as co-developers

    DEFF Research Database (Denmark)

    Jeppesen, Lars Bo; Molin, Måns J.

    firms purposively can do to generate consumer innovation efforts. An explorative casestudy shows that consumer innovation can be structured, motivated, and partly organized by acommercial firm that lays out the infrastructure for interactive learning by consumers in a publicKeywords: Product Development......, Consumer-to-Consumer Interaction, Learning, Consumer Innovation, Community, User-toolkits. JEL code(s): L21; L23; O31; O32...

  16. Profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. (United States)

    Coates, Dominiek; Saleeba, Christine; Howe, Deborah


    The perinatal period is a time of great vulnerability for many women, in particular those with a range of psychosocial vulnerabilities and mental health risk factors. This paper outlines the psychosocial and mental health profile of consumers and their partners of a perinatal and infant mental health (PIMH) service in Australia. To establish the consumer profile, we analysed client vulnerabilities and demographical information maintained over a 6-year period for 406 consumers. Consumer information, including mental health problems, psychosocial vulnerabilities and demographical information, was entered into a standalone database by the allocated clinicians upon service allocation and throughout treatment. The women accepted by PIMH presented with an average of nine different vulnerabilities. Frequently endorsed risk factors included depression (72.66%), anxiety (71.43%), comorbid depression and anxiety (58.13%), self-harm (past, 7.88%, present, 16.26%), a history of family mental health issues (39.66%), childhood trauma (57.88%), limited support (68.84%), relationship conflict with partners (38.92%) and financial stress (47.29%). The women's partners also presented with a range of vulnerabilities, in particular childhood trauma (34.11%) and mental health issues (30.81%). This study contributes to our understanding of the profile of vulnerable women in the perinatal period, and in particular contributes to the literature by highlighting that in addition to depression, anxiety, self-harm and trauma are also significant in PIMH service delivery. © 2017 John Wiley & Sons Ltd.

  17. Using reflexivity to enhance in-depth interviewing skills for the clinician researcher

    Directory of Open Access Journals (Sweden)

    Hegarty Kelsey


    Full Text Available Abstract Background Primary health care clinicians are being encouraged to undertake qualitative research, however the in-depth interviewing skills required are not as straightforward as might be first supposed. While there are benefits and certain skills that clinicians can bring to interview-based research, there are important new skills to develop. To date there has been neither discussion about these new skills, nor any preparatory guidelines for clinicians entering into interview-based research in the qualitative research literature. In the absence of formal guidelines, we suggest the use of reflexivity throughout the interview process as a means to become more accomplished in this area. We present our own experiences as a novice general practitioner (GP researcher undertaking a PhD study and her experienced supervisors. The PhD study used critical phenomenology through in-depth interviews to understand the experience of the patient-doctor relationship between same-sex attracted women and their usual GP in Australia. Results We used reflexivity to improve the rigour of the data collection. This enabled improved probing, fewer assumptions, avoidance of premature interpretation, and an accentuated sense of curiosity during interviews. We also enlisted reciprocity between interviewer and interviewee as a tool to improve engagement and trust, share interview control, and ultimately improve the depth of the interview content. Conclusion Preparatory recommendations for novice clinician research interviewers include the importance of recognising the multiple identities that they bring to the interview. In this setting in particular this involves acknowledging the clinician interviewer as a potential insider in relation to interviewees and negotiating shared understanding to avoid insider assumptions. Other essential requirements are having an experienced research supervisor, arranging pilot interviews that include active feedback on interviewing

  18. Using reflexivity to enhance in-depth interviewing skills for the clinician researcher. (United States)

    McNair, Ruth; Taft, Angela; Hegarty, Kelsey


    Primary health care clinicians are being encouraged to undertake qualitative research, however the in-depth interviewing skills required are not as straightforward as might be first supposed. While there are benefits and certain skills that clinicians can bring to interview-based research, there are important new skills to develop. To date there has been neither discussion about these new skills, nor any preparatory guidelines for clinicians entering into interview-based research in the qualitative research literature. In the absence of formal guidelines, we suggest the use of reflexivity throughout the interview process as a means to become more accomplished in this area. We present our own experiences as a novice general practitioner (GP) researcher undertaking a PhD study and her experienced supervisors. The PhD study used critical phenomenology through in-depth interviews to understand the experience of the patient-doctor relationship between same-sex attracted women and their usual GP in Australia. We used reflexivity to improve the rigour of the data collection. This enabled improved probing, fewer assumptions, avoidance of premature interpretation, and an accentuated sense of curiosity during interviews. We also enlisted reciprocity between interviewer and interviewee as a tool to improve engagement and trust, share interview control, and ultimately improve the depth of the interview content. Preparatory recommendations for novice clinician research interviewers include the importance of recognising the multiple identities that they bring to the interview. In this setting in particular this involves acknowledging the clinician interviewer as a potential insider in relation to interviewees and negotiating shared understanding to avoid insider assumptions. Other essential requirements are having an experienced research supervisor, arranging pilot interviews that include active feedback on interviewing style from interviewees, and being reflexive during

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

    Directory of Open Access Journals (Sweden)

    Jane S. Chen


    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.

  20. An Academic Achievement Calculator for Clinician-Educators in Primary Care. (United States)

    Lin, Steven; Mahoney, Megan; Singh, Baldeep; Schillinger, Erika


    Academic medical centers need better ways to quantify the diverse academic contributions of primary care clinician-educators. We examined the feasibility and acceptability of an "academic achievement calculator" that quantifies academic activities using a point system. A cohort of 16 clinician-educators at a single academic medical center volunteered to assess the calculator using a questionnaire. Key measures included time needed to complete the calculator, how well it reflected participants' academic activities, whether it increased their awareness of academic opportunities, whether they intend to pursue more academic work, and their overall satisfaction with the calculator. Most participants (69%) completed the calculator in less than 20 minutes. Three-quarters (75%) reported that the calculator reflected the breadth of their academic work either "very well" or "extremely well". The majority (81%) stated that it increased their awareness of opportunities for academic engagement, and that they intend to pursue more academic activities. Overall, three-quarters (75%) were "very satisfied" or "extremely satisfied" with the calculator. To our knowledge, this is the first report of a tool designed to quantify the diverse academic activities of primary care clinician-educators. In this pilot study, we found that the use of an academic achievement calculator may be feasible and acceptable. This tool, if paired with an annual bonus plan, could help incentivize and reward academic contributions among primary care clinician-educators, and assist department leaders with the promotion process.

  1. Exploring Hearing Aid Problems: Perspectives of Hearing Aid Owners and Clinicians. (United States)

    Bennett, Rebecca J; Laplante-Lévesque, Ariane; Meyer, Carly J; Eikelboom, Robert H

    To gather perspectives of hearing aid owners and hearing healthcare clinicians with regard to problems that arise after hearing aid fitting and use these perspectives to generate a conceptual framework to gain a better understanding of these problems. Participants included a group of 17 hearing aid owners and a group of 21 hearing healthcare clinicians; data collection occurred separately for each group. Participants each attended two group sessions in Perth, Western Australia, wherein they: (1) generated statements describing the problems associated with hearing aids and (2) grouped and rated the statements to identify key themes. Concept mapping was used to generate a conceptual framework. Participants identified four concepts regarding hearing aid problems as follows: (1) hearing aid management; (2) hearing aid sound quality and performance; (3) feelings, thoughts, and behaviors; and (4) information and training. While hearing aid owners and clinicians generated similar results regarding the concepts derived, the clinicians reported that the problems identified had a greater negative impact on hearing aid success than did hearing aid owners. The magnitude and diversity of hearing aid problems identified in this study highlight the ongoing challenges that hearing aid owners face and suggest that current processes for hearing aid fitting can be improved. Problems relating to hearing aid management were most often deemed to have the greatest impact on hearing aid success and be the most preventable/solvable, and thus are a good starting point when addressing hearing aid-related problems.

  2. Tourists consuming distance

    DEFF Research Database (Denmark)

    Larsen, Gunvor Riber

    contribute to an understanding of how it is possible to change tourism travel behaviour towards becoming more sustainable. How tourists 'consume distance' is discussed, from the practical level of actually driving the car or sitting in the air plane, to the symbolic consumption of distance that occurs when......The environmental impact of tourism mobility is linked to the distances travelled in order to reach a holiday destination, and with tourists travelling more and further than previously, an understanding of how the tourists view the distance they travel across becomes relevant. Based on interviews...... travelling on holiday becomes part of a lifestyle and a social positioning game. Further, different types of tourist distance consumers are identified, ranging from the reluctant to the deliberate and nonchalant distance consumers, who display very differing attitudes towards the distance they all travel...

  3. Evolution of consumer cooperativism

    Directory of Open Access Journals (Sweden)

    Alejandro Martínez Charterina


    Full Text Available The origins of modern cooperativism can be found in the consumer cooperative. Many changes have taken place over time, some of which have been profound and rapid, affecting the way consumer cooperatives work and their very existence. They have evolved to give more complete service and keep their original purpose. The case of the Eroski cooperative is studied in depth. Eroski originated in the Basque Country and expanded its business activities to become one of the big distributors following a new model. A local neighbourhood cooperative, the Park Slope Food Coop in Brooklyn, is studied as an alternative to the former case. In both cases, consumers, their awareness and protection of their rights are of utmost importance.Received: 16.06.11Accepted: 05.07.11

  4. From leader to leadership: clinician managers and where to next? (United States)

    Fulop, Liz; Day, Gary E


    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.


    Federal Laboratory Consortium — These laboratories conduct a wide range of studies to characterize the sensory properties of and consumer responses to foods, beverages, and other consumer products....

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

    Prescott, Sarah; Fleming, Jennifer; Doig, Emmah


    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.

  7. Incorporating Transformative Consumer Research into the Consumer Behavior Course Experience (United States)

    Petkus, Ed, Jr.


    In contrast to understanding consumer behavior for the benefit of business organizations, transformative consumer research (TCR) seeks to understand consumer behavior for the benefit of consumers themselves. Following Mari's (2008) call for the incorporation of TCR in doctoral programs in marketing, this article outlines the relevance of TCR to…

  8. The relationship between consumer insight and provider-consumer agreement regarding consumer's quality of life. (United States)

    Hasson-Ohayon, Ilanit; Roe, David; Kravetz, Shlomo; Levy-Frank, Itamar; Meir, Taly


    This study examined the relationship between insight and mental health consumers and providers agreement regarding consumers rated quality of life (QoL). Seventy mental health consumers and their 23 care providers filled-out parallel questionnaires designed to measure consumer QoL. Consumers' insight was also assessed. For most QoL domains, agreement between consumers and providers was higher for persons with high insight. For the Psychological well being dimension a negative correlation was uncovered for persons with low insight indicating disagreement between consumer and provider. These findings are discussed within the context of the literature on insight and agreement between consumer and provider as related to the therapeutic alliance.

  9. Consumer rationality in choice

    NARCIS (Netherlands)

    Conlon, B.J.


    The dissertation concentrates on consumer choice and the ability of current modelling approaches to capture the underlying behaviour of the individual decision-makers. The standard assumption of a rational utility maximising individual and its implications for observed behaviour are examined and

  10. Essays on consumer welfare

    NARCIS (Netherlands)

    Lin, P.


    The fast-changing retail industry (with its numerous new product developments and new marketing channels) has policy makers worried about possible detrimental effects of these changes for consumer welfare. Despite the interest of policy makers, only few marketing studies have considered the impact

  11. Research in consumer behaviour

    DEFF Research Database (Denmark)

    Grunert, Klaus G.


    The present state of consumer behavior research is analysed here by Klaus Grunert, of the Aarhus Graduate School of Management, Denmark. Against the background of crisis in the existing research paradigm, he suggests a number of possible new directions in the field, at the same time emphasizing...

  12. Hermeneutics and Consumer Research.


    Arnold, Stephen J; Fischer, Eileen


    This article reviews the nature of hermeneutic philosophy and the assumptions and features of a textual interpretation consistent with this perspective. The relationship of hermeneutic philosophy to the interpretive and critical theory traditions in consumer research is also discussed. Copyright 1994 by the University of Chicago.

  13. Sustainable Consumer Voices

    DEFF Research Database (Denmark)

    Klitmøller, Anders; Rask, Morten; Jensen, Nevena


    Aiming to explore how user driven innovation can inform high level design strategies, an in-depth empirical study was carried out, based on data from 50 observations of private vehicle users. This paper reports the resulting 5 consumer voices: Technology Enthusiast, Environmentalist, Design Lover...... into disruptive emergence of product service systems, where quantitative user analyses rely on historical continuation....

  14. Field Report - Consumer Survey

    DEFF Research Database (Denmark)

    Nielsen, Kristian S.; Gwozdz, Wencke

    ). The consumer survey was conducted in four countries (Germany, Poland, Sweden, and United States) with approximately 1,000 respondents per country. The purpose of the survey was to explore consumption and psychological differences across markets and cultures. The collected data represents the empirical...

  15. Into beef consumers' mind

    DEFF Research Database (Denmark)

    de Barcellos, Marcia Dutra; Brei, Vinicius A.

    of involvement with beef consumption. Fulfillment and pleasantness were found to be positive emotions expected in special beef consumption situations. Relevant multicultural data were obtained. Segmented marketing campaigns and sales efforts can be market-driven towards consumers' needs and expectations....

  16. CONSUME: users guide. (United States)

    R.D. Ottmar; M.F. Burns; J.N. Hall; A.D. Hanson


    CONSUME is a user-friendly computer program designed for resource managers with some working knowledge of IBM-PC applications. The software predicts the amount of fuel consumption on logged units based on weather data, the amount and fuel moisture of fuels, and a number of other factors. Using these predictions, the resource manager can accurately determine when and...

  17. Understanding the Child Consumer (United States)

    Schor, Juliet B.


    A study was conducted to examine whether exposure to continuous commercial messages affects children's fundamental sense of well-being and whether they are at risk for a series of negative outcomes. Results show that consumer culture is harmful to adults and children, and both the American Academy of Pediatrics and the American Psychology…

  18. Consuming a Machinic Servicescape


    Hietanen, Joel; Andéhn, Mikael; Iddon, Thom; Denny, Iain; Ehnhage, Anna


    Consumer encounters with servicescapes tend to emphasize the harmonic tendency of their value-creating potential. We contest this assumption from a critical non-representational perspective that foregrounds the machinic and repressive potentiality of such con- sumption contexts. We offer the airport servicescape as an illustrative example. 

  19. Consumer financial behavior

    NARCIS (Netherlands)

    van Raaij, W.F.


    Consumer financial behavior is a domain between micro-economics, behavioral finance, and marketing. It is based on insights and behavioral theories from cognitive, economic, and social psychology (biases, heuristics, social influences), in the context of and sometimes in conflict with micro-economic

  20. Older Consumers in Malaysia

    Directory of Open Access Journals (Sweden)

    David R. Phillips


    Full Text Available The main objective of this study was to understand the concerns and problems faced by older people in an industrializing middle-income country, Malaysia, in their process of acquiring products to meet their everyday needs. Respondents aged 55 and over were interviewed in eight states throughout Peninsular Malaysia providing 1356 usable questionnaires; two-thirds from urban and one-third from rural areas. Education, health status, and life satisfaction were recorded. Service patronage behaviour was examined for four main categories of commonly-sought consumer goods: groceries, health supplements, apparel, eating outlets, plus selected services (public transport, vacation packages and financial services. The findings showed that older adults in Malaysia are rather discerning consumers. Many respondents are price conscious and have developed consumer attitudes with regard to attitude of staff and assistance rendered. Many display a good ability to discriminate and to select, especially on the basis of price and durability of products and many appear to be acting as effectively as consumers in any other age group.

  1. Consumer Product Category Database (United States)

    The Chemical and Product Categories database (CPCat) catalogs the use of over 40,000 chemicals and their presence in different consumer products. The chemical use information is compiled from multiple sources while product information is gathered from publicly available Material Safety Data Sheets (MSDS). EPA researchers are evaluating the possibility of expanding the database with additional product and use information.

  2. Eating disorder symptom severity scale: a new clinician rated measure. (United States)

    Henderson, Katherine A; Buchholz, Annick; Perkins, Julie; Norwood, Sarah; Obeid, Nicole; Spettigue, Wendy; Feder, Stephen


    This study describes the development and validation of the clinician-rated Eating Disorder Symptom Severity Scale (EDS(3)), created to address a gap in measurement options for youth with eating disorders. The EDS(3) is modeled on the Childhood Severity and Acuity of Psychiatric Illness Scales (Lyons, J. S, 1998). Factor analysis revealed a 5-factor solution and accounted for 78% of the variance, and internal consistency within the subscales was good (Cronbach alphas: 0.69 to 0.93). The EDS(3) is a valid and reliable measure designed for clinicians to help assess the severity of a youth's eating disorder and to facilitate outcomes research.

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

    Directory of Open Access Journals (Sweden)

    Ohlsson Bodil


    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

  4. A clinician's guide to CAMBRA: a simple approach. (United States)

    Young, Douglas A; Kutsch, V Kim; Whitehouse, Joe


    Caries risk assessment identifies those factors that are pathologic and suggests ways an astute clinician can implement protective strategies that can prevent progression and/or return the patient to health. Caries management by risk assessment (CAMBRA) focuses on treating and preventing the cause of the disease at an early stage, rather than waiting until it causes damage to tooth structure. This article summarizes and simplifies information previously published about CAMBRA implementation from the perspective of today's practicing clinician. The most recent science on prevention, remineralization, antimicrobials, and pH, as well as the use of fluoride, xylitol, and casein phosphopeptide-amorphous calcium phosphate (CCP-ACP) is also discussed.

  5. Exploring barriers to optimal anticoagulation for atrial fibrillation: interviews with clinicians

    Directory of Open Access Journals (Sweden)

    Decker C


    Full Text Available Carole Decker,1 Linda Garavalia,2 Brian Garavalia,1 Teresa Simon,3 Matthew Loeb,4 John Spertus6, William Daniel51Mid America Heart Institute at Saint Luke's Hospital in Kansas City Missouri, University of Missouri-Kansas City School of Nursing, 2University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, 3Bristol-Myers Squibb, Princeton, NJ, 4Plaza Primary Care and Geriatrics, 5Saint Luke's Cardiovascular Consultants, Kansas City, MO, 6Mid America Heart Institute at Saint Luke's Hospital in Kansas City Missouri, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USABackground: Warfarin, the most commonly used antithrombotic agent for stroke prophylaxis in atrial fibrillation (AF, requires regular monitoring, frequent dosage adjustments, and dietary restrictions. Clinicians' perceptions of barriers to optimal AF management are an important factor in treatment. Anticoagulation management for AF is overseen by both cardiology and internal medicine (IM practices. Thus, gaining the perspective of specialists and generalists is essential in understanding barriers to treatment. We used qualitative research methods to define key issues in the prescription of warfarin therapy for AF by cardiology specialists and IM physicians.Methods and results: Clinicians were interviewed to identify barriers to warfarin treatment in a large Midwestern city. Interviews were conducted until thematic saturation occurred. Content analysis yielded several themes. The most salient theme that emerged from clinician interviews was use of characteristics other than the patient's CHADS2 score to enact a treatment plan, such as the patient's social situation and past medication-taking behavior. Other themes included patient knowledge, real-world problems, breakdown in communication, and clinician reluctance.Conclusion: Warfarin treatment is associated with many challenges. The barriers identified by clinicians highlight the unmet need associated

  6. Training the next generation of Canadian Clinician-Scientists: charting a path to success. (United States)

    Yin, Charles; Steadman, Patrick E; Apramian, Tavis; Zhou, Tianwei E; Ishaque, Abdullah; Wang, Xin; Kuzyk, Alexandra; Warsi, Nebras


    Clinician-scientists are physicians with training in both clinical medicine and research that enables them to occupy a unique niche as specialists in basic and translational biomedical research. While there is widespread acknowledgement of the importance of clinician-scientists in today's landscape of evidence-based medical practice, training of clinician-scientists in Canada has been on the decline, with fewer opportunities to obtain funding. With the increasing length of training and lower financial compensation, fewer medical graduates are choosing to pursue such a career. MD-PhD programs, in which trainees receive both medical and research training, have the potential to be an important tool in training the next generation of clinician-scientists; however, MD-PhD trainees in Canada face barriers that include an increase in medical school tuition and a decrease in the amount of financial support. We examined the available data on MD-PhD training in Canada and identified a lack of oversight, a lack of funding and poor mentorship as barriers experienced by MD-PhD trainees. Specific recommendations are provided to begin the process of addressing these challenges, starting with the establishment of an overseeing national body that would track long-term outcome data for MD-PhD trainees. This national body could then function to implement best practices from individual programs across the country and to provide further mentorship and support for early-career physician-scientists. MD-PhD programs have the potential to address Canada's growing shortage of clinician-scientists, and strengthening MD-PhD programs will help to effect positive change.

  7. Third molar surgery: the patient's and the clinician's perspective

    Directory of Open Access Journals (Sweden)

    Jerjes Waseem


    Full Text Available Abstract Background In this report, the problems of third molar surgery have been reviewed from the perspective of both patient and clinician; additionally an overall analysis of preoperative imaging investigations was carried out. Specifically, three main areas of interest were investigated: the prediction of surgical difficulty and potential complications; the assessment of stress and anxiety and finally the assessment of postoperative complications and the surgeon's experience. Findings In the first study, the prediction of surgical difficulty and potential injury to the inferior alveolar nerve was assessed. This was achieved by examining the patient's orthopantomograms and by using the Pederson Difficulty Index (PDI. Several radiological signs were identified and a classification tree was created to help predict the incidence of such event. In the second study, a prospective assessment addressing the patient's stress and anxiety pre-, intra- and postoperatively was employed. Midazolam was the active drug used against placebo. Objective and subjective parameters were assessed, including measuring the cortisol level in saliva. Midazolam was found to significantly reduce anxiety levels and salivary cortisol was identified as an accurate anxiety marker. In the third study, postoperative complications and the surgeon's experience were examined. Few patients in this study suffered permanent nerve dysfunction. Junior surgeons reported a higher complication rate particularly in trismus, alveolar osteitis, infection and paraesthesia over the distributions of the inferior alveolar and lingual nerves. In apparent contrast, senior surgeons reported higher incidence of postoperative bleeding. Discussion These studies if well employed can lead to favourable alteration in patient management and might have a positive impact on future healthcare service.

  8. Consumers in mental health service leadership: A systematic review. (United States)

    Scholz, Brett; Gordon, Sarah; Happell, Brenda


    Contemporary mental health policies call for greater involvement of mental health service consumers in all aspects and at all levels of service planning, delivery, and evaluation. The extent to which consumers are part of the decision-making function of mental health organizations varies. This systematic review synthesizes empirical and review studies published in peer-reviewed academic journals relating to consumers in leadership roles within mental health organizations. The Cochrane Library, Medline, and PsycINFO were searched for articles specifically analysing and discussing consumers' mental health service leadership. Each article was critically appraised against the inclusion criteria, with 36 articles included in the final review. The findings of the review highlight current understandings of organizational resources and structures in consumer-led organizations, determinants of leadership involvement, and how consumer leadership interacts with traditional mental health service provision. It appears that organizations might still be negotiating the balance between consumer leadership and traditional structures and systems. The majority of included studies represent research about consumer-run organizations, with consumer leadership in mainstream mental health organizations being less represented in the literature. Advocates of consumer leadership should focus more on emphasizing how such leadership itself can be a valuable resource for organizations and how this can be better articulated. This review highlights the current gaps in understandings of consumer leadership in mental health, including a need for more research exploring the benefits of consumer leadership for other consumers of services. © 2016 Australian College of Mental Health Nurses Inc.

  9. Consumer perceptions of green power

    International Nuclear Information System (INIS)

    Rowlands, I.; Parker, P.; Scott, D.


    The relationship between consumer perceptions of the environmental impact of different energy sources and their willingness to pay a premium for green electricity was examined using the ANOVA analysis of variance and the chi-square test procedures. Since green power producers can include several energy resources in their offerings, it is important to understand the preferences of their customers. A survey sent to 480 residents in the Waterloo region of southern Ontario showed that when asked about purchasing nuclear, large scale hydropower or natural gas out of a choice of 11 energy sources, there was a wide discrepancy between those who stated a willingness to pay a large premium for green power and those who stated a willingness to pay only a small, or no, premium for green power. It was determined that these 3 energy resources were not popular among the most environmentally inclined portion of the consumer market. It was noted however that willingness to pay should be interpreted with caution because peoples' stated intentions to pay a premium for green power do not necessarily translate into action once they have the opportunity to buy power from renewable energy sources. However, marketing strategies could be used to improve the uptake of green power by consumers. The study suggests that landfill gas, is probably preferred to large-scale hydro. It was also suggested that the relative position of biomass, natural gas, garbage and nuclear power should be examined more closely. 29 refs., 3 tabs., 3 figs

  10. Journal of Consumer Sciences: Submissions

    African Journals Online (AJOL)

    Authors who have in the past submitted articles to the Journal of Family Ecology and Consumer Sciences are reminded that the name of this journal has changed to the Journal of Consumer Sciences (JCS). Guidelines for Submission to the Journal of Consumer Sciences (JCS). Contributions to the Journal of Consumer ...

  11. Teacher's Kit for Consumer Education. (United States)

    Hawaii State Dept. of Education, Honolulu. Office of Instructional Services.

    This curriculum guide on Consumer Education, designed for high school seniors, was developed to help students become aware of and knowledgeable about their role as consumers in today's society. The following key concepts for study are emphasized: general principles of consumer purchasing; consumer credit; general principles of fraud, quackery,…

  12. 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


    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

  13. Agreement between parents and clinicians on the communication function levels and relationship of classification systems of children with cerebral palsy. (United States)

    Mutlu, Akmer; Kara, Özgün Kaya; Livanelioğlu, Ayşe; Karahan, Sevilay; Alkan, Halil; Yardımcı, Bilge Nur; Hidecker, Mary Jo Cooley


    Functional classification systems have generally been used by clinicians and recently by parents to classify various functions of children with cerebral palsy (CP). This study evaluated the agreement between clinicians and parents when classifying the communication function of children with CP using the Communication Function Classification System (CFCS). In addition, the relationships between the Gross Motor Function Classification System - Expanded and Revised (GMFCS-E&R), the Manual Ability Classification System (MACS), and CFCS were investigated. This study was a cross-sectional study and included 102 children aged 4-18 years with CP and their parents. The parents and clinician classified the communication of children by using the Turkish language version of CFCS. Furthermore GMFCS-E&R and MACS were used for classification only by the clinician. The weighted Kappa agreement between CFCS results of the parents and clinicians was 0.95 (95% CI 0.95-0.96, p < 0.001). GMFCS-E&R levels were highly correlated with CFCS levels (r = 0.78 (95%CI 0.68-0.84, p < 0.001)). MACS and CFCS results were also highly correlated (r = 0.73 (95%CI 0.63-0.81, p < 0.001). The child's communication was classified as indicating higher functioning by the parents compared with the clinicians. The excellent agreement between parents and clinicians with the Turkish language version of CFCS for children with CP indicated that parents and clinicians could use the same language while classifying the communication function of children. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Cliniciansâ Experiences of the Application of Interpersonal Neurobiology as a Framework for Psychotherapy


    Myers, Kelsey Jane


    Interpersonal Neurobiology (IPNB) combines multiple fields of thought into one integrated framework. It has been utilized to expand conversation of the â mindâ and promote well-being across disciplines. Current literature outlines the IPNB framework, including suggestions for its application to psychotherapeutic practice; however, limited research has examined cliniciansâ experiences of using the IPNB framework. This study aims to add to the discussion on IPNB by examining the lived exp...

  15. The dawn of consumer-directed testing. (United States)

    Ramos, Erica; Weissman, Scott M


    As the public's interest in genetics and genomics has increased, there has been corresponding and unprecedented growth in direct-to-consumer genetic testing (DTC-GT). Although regulatory concerns have limited true DTC-GT available without a physician order, the paradigm has shifted to a model of consumer-directed genetic testing (CD-GT) in which patients are researching testing options and requesting specific genetic testing from their health-care providers. However, many nongenetics health-care providers do not have the background, education, interest, or time to order and/or interpret typical clinical genetic testing, let alone DTC-GT. The lines between CD-GT, DTC-GT, and traditional clinical genetic testing are also blurring with the same types of tests available in different settings (e.g., carrier screening) and tests merging medical and nonmedical results, increasing the complexity for consumer decision-making and clinician management. The genetics community has the training to work with CD-GT, but there has been a hesitancy to commit to working with these results and questions about what to do when consumers have more complicated asks, like interpretation of raw data. Additionally, at the rate with which CD-GT is growing, there are questions about having sufficient genetics professionals to meet the potential genetic counseling demand. While there are many complex questions and challenges, this market represents a chance for the genetics community to address and unmet need. We will review the history of the CD-GT/DTC-GT market and outline the issues and opportunities our profession is facing. © 2018 Wiley Periodicals, Inc.

  16. Research priorities in mental health occupational therapy: A study of clinician perspectives. (United States)

    Hitch, Danielle; Lhuede, Kate


    The evidence to support mental health occupational therapy has proliferated in the early years of this century, but this growth has tended to be organic rather than targeted. Previous efforts to identify research priorities in this area of practice are either out dated, or encompass discrete areas of practice. The aim of this study was to identify priority areas for research in mental health occupational therapy from clinician's perspectives. A Policy Delphi method was used to enable occupational therapists to define and differentiate their perspectives on research priorities. Forty-two occupational therapists took part in the first two rounds of this method, with 69% (n = 29) going on to complete the third and final round of data collection. A Likert scale was used to rate the importance of each priority, and descriptive quantitative analysis undertaken to identify those most consistently identified as being highly important. Four research priorities were identified as being highly important in this study: (i) working in an occupationally focussed way; (ii) consumer experience of therapy groups; (iii) identifying factors which increase consumer engagement in occupation; and (iv) engaging patients on the inpatient unit in meaningful and positive occupation. Two of the priority areas are already the subject of substantial evidence bases, but there has been far less research into consumer experiences of groups and occupational engagement in acute settings. Collaboration between research teams and greater consumer inclusion are recommended for the future. This study provides an updated indication of research priorities for mental health occupational therapy in Australia. © 2015 Occupational Therapy Australia.

  17. Does Consumer Confidence Forecast Household Spending? The Euro Area Case


    Dion, David Pascal


    The following analysis, based on error correction models, suggests that consumer confidence, together with traditional macroeconomic variables, contains a forecasting and explicative power on consumption. By including consumer confidence in a consumption function, consumer confidence releases a significant coefficient. Such a confidence-augmented consumption model provides good forecasting results.

  18. 14 CFR 1261.408 - Use of consumer reporting agency. (United States)


    ... third party to get the information from a consumer reporting agency. (b) NASA Headquarters Financial...), information about a debtor to a consumer reporting agency. Such information may include: (i) That a claim has... disclose to a consumer reporting agency the specific information to be disclosed under paragraph (b)(1) of...

  19. 77 FR 37616 - Disclosure of Consumer Complaint Data (United States)


    ... will be subject to public disclosure. Do not include sensitive personal information, such as account... INFORMATION CONTACT: Scott Pluta, Office of Consumer Response, Bureau of Consumer Financial Protection, at (202) 435-7306; or Will Wade-Gery, Division of Research, Markets and Regulations, Consumer Financial...

  20. Contributions of Socialization Theory to Consumer Behavior Research (United States)

    Ward, Scott


    Socialization theory can contribute to consumer research because it focuses on (1) youth and development, (2) interaction of factors affecting consumer behavior, and (3) linkages between mental processes and overt behavior. Various approaches to socialization research and consumer research are described, including cognitive development and…

  1. Integrating teamwork, clinician occupational well-being and patient safety - development of a conceptual framework based on a systematic review. (United States)

    Welp, Annalena; Manser, Tanja


    There is growing evidence that teamwork in hospitals is related to both patient outcomes and clinician occupational well-being. Furthermore, clinician well-being is associated with patient safety. Despite considerable research activity, few studies include all three concepts, and their interrelations have not yet been investigated systematically. To advance our understanding of these potentially complex interrelations we propose an integrative framework taking into account current evidence and research gaps identified in a systematic review. We conducted a literature search in six major databases (Medline, PsycArticles, PsycInfo, Psyndex, ScienceDirect, and Web of Knowledge). Inclusion criteria were: peer reviewed papers published between January 2000 and June 2015 investigating a statistical relationship between at least two of the three concepts; teamwork, patient safety, and clinician occupational well-being in hospital settings, including practicing nurses and physicians. We assessed methodological quality using a standardized rating system and qualitatively appraised and extracted relevant data, such as instruments, analyses and outcomes. The 98 studies included in this review were highly diverse regarding quality, methodology and outcomes. We found support for the existence of independent associations between teamwork, clinician occupational well-being and patient safety. However, we identified several conceptual and methodological limitations. The main barrier to advancing our understanding of the causal relationships between teamwork, clinician well-being and patient safety is the lack of an integrative, theory-based, and methodologically thorough approach investigating the three concepts simultaneously and longitudinally. Based on psychological theory and our findings, we developed an integrative framework that addresses these limitations and proposes mechanisms by which these concepts might be linked. Knowledge about the mechanisms underlying the

  2. Antiretroviral drug resistance: A guide for the southern African clinician

    African Journals Online (AJOL)

    Both private and public sector see a bewildering clinical array of patients taking failing antiretroviral (ARV) regimens. We intend this article to provide a practical guide to help clinicians understand and manage ARV drug resistance in an African context. ARV resistance is a rapidly evolving field, requiring expertise in dealing ...

  3. Attitude and Perceptions of Clinicians in Lagos to Autopsy Practice ...

    African Journals Online (AJOL)

    Using pretested questionnaire instrument, a cross sectional survey of clinicians working in the Lagos University Teaching Hospital to obtain their attitudes and perception towards autopsy practice. 230 questionnaires were administered and the response rate was 80.7% . 41.5% of respondents often requested for autopsy.

  4. Essential laboratory knowledge for the clinician | Omar | Continuing ...

    African Journals Online (AJOL)

    Essential laboratory knowledge for the clinician. F Omar. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  5. Clinician Perceptions of Childhood Risk Factors for Future Antisocial Behavior (United States)

    Koegl, Christopher J.; Farrington, David P.; Augimeri, Leena K.


    We asked 176 mental health clinicians to list factors that place a child at risk for engaging in future antisocial behavior. Participants were randomly assigned to do this in relationship to boys and girls. Listed factors were then coded into broad item categories using the Early Assessment Risk Lists (EARL). Of the 1,695 factors listed, 1,476…

  6. Clinician or Witness? The Intervener's Relationship with Traumatized Children (United States)

    Steele, William


    To heal the hurt child, one begins not as a clinician but as a person trying to witness how the child experiences trauma. This requires more than just talking since the child's terrifying memories are stored in the brain's senses and visual imagery, not in rational thoughts and words. The goal is to change these frightening sensory experiences…

  7. Perception of adults' smile esthetics among orthodontists, clinicians and laypeople

    Directory of Open Access Journals (Sweden)

    Enio Ribeiro Cotrim


    Full Text Available OBJECTIVE: Smile esthetics has become a major concern among patients and orthodontists. Therefore, the aim of this study was: (1 To highlight differences in perception of smile esthetics by clinicians, orthodontists and laypeople; (2 To assess factors such as lip thickness, smile height, color gradation, tooth size and crowding, and which are associated with smile unpleasantness. METHODS: To this end, edited photographs emphasizing the lower third of the face of 41 subjects were assessed by three groups (orthodontists, laypeople and clinicians who graded the smiles from 1 to 9, highlighting the markers that evince smile unpleasantness. Kruskall-Wallis test supplemented by Bonferroni test was used to assess differences among groups. Additionally, the prevailing factors in smile unpleasantness were also described. RESULTS: There was no significant difference (P = 0.67 among groups rates. However, the groups highlighted different characteristics associated with smile unpleasantness. Orthodontists emphasized little gingival display, whereas laypeople emphasized disproportionate teeth and clinicians emphasized yellow teeth. CONCLUSION: Orthodontists, laypeople and clinicians similarly assess smile esthetics; however, noticing different characteristics. Thus, the orthodontist must be careful not to impose his own perception of smile esthetics.

  8. Dysarthria of Motor Neuron Disease: Clinician Judgments of Severity. (United States)

    Seikel, J. Anthony; And Others


    This study investigated the relationship between the temporal-acoustic parameters of the speech of 15 adults with motor neuron disease. Differences in predictions of the progression of the disease and clinician judgments of dysarthria severity were found to relate to the linguistic systems of both speaker and judge. (Author/JDD)

  9. The Effectiveness of Clinician Education on the Adequate ...

    African Journals Online (AJOL)

    to insufficient, and/or illegible clinical information provided on laboratory request forms which may result in comments. The Effectiveness of Clinician Education on the. Adequate Completion of Laboratory Test Request. Forms at a Tertiary Hospital. Osegbe ID, Afolabi O1, Onyenekwu CP1. Department of Chemical Pathology, ...

  10. Empowering patients, empowering clinicians: How the lessons of ...

    African Journals Online (AJOL)

    2016. Accepted: 13 Mar. 2017. Published: 31 May 2017. How to cite this article: Mendelsohn A.S. Empowering patients, empowering clinicians: How the lessons of. HIV can inform chronic disease management across the primary healthcare system. S Afr J HIV Med. 2017;18(1), a692.

  11. Impact of the Canadian Diabetes Association Guidelines Dissemination Strategy on clinician knowledge and behaviour change outcomes. (United States)

    Yu, Catherine H; Lillie, Erin; Mascarenhas-Johnson, Alekhya; Gall Casey, Carolyn; Straus, Sharon E


    Implementation of clinical practice guideline(CPG) into clinical practice remains limited. Using the Knowledge-To-Action framework, a guideline dissemination and implementation strategy for the Canadian Diabetes Association's 2013 CPG was developed and launched to clinicians and people with diabetes. The RE-AIM framework guided evaluation of this strategy clinician; we report here one aspect of the effectiveness dimension using mixed methods. We measured impact of the strategy on clinican knowledge and behaviour change constructs using evaluation forms, national online survey and individual interviews. After attending a lecture, clinician confidence(n=915) increased(3.7(SD 0.7) to 4.5(SD 0.6) on a 5-point scale(pcontent, and education sessions facilitated uptake; lack of time, team-based consensus, and seamless integration into care and patient complexity were barriers. The complexity of diabetes care requires systemic adoption of organization of care interventions, including interprofessional collaboration and consensus. Augmenting our strategy to include scalable models for professional development, integration of guidelines into electronic medical records, and expansion of our target audience to include health care teams and patients, may optimize guideline uptake. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Consumer engagement: An insight from smart grid projects in Europe

    International Nuclear Information System (INIS)

    Gangale, Flavia; Mengolini, Anna; Onyeji, Ijeoma


    This paper provides an insight into consumer engagement in smart grid projects in Europe. Projects analysed are those included in the catalogue annexed in the JRC Report “Smart Grid projects in Europe: lessons learned and current developments”. The analysis suggests an increase in the interest in consumer engagement projects at European level and a strong focus on the residential sector, and emphasises the key importance of public funding to support these projects. The study also reveals that projects involving consumers are characterised by the pursuit of two main objectives: gaining deeper knowledge of consumer behaviour (observing and understanding the consumer) and motivating and empowering consumers to become active energy customers (engaging the consumer). The paper reviews the main activities undertaken to obtain these objectives and highlights trends and developments in the field. Finally, the paper discusses obstacles to consumer engagement and the strategies adopted by the projects surveyed to tackle them, highlighting the need to build consumer trust and to design targeted campaigns taking into consideration different consumer segments. The conclusions are in line with findings and analyses presented in the literature and underscore the need for further research and action at European level. - Highlights: • Consumers' key role in the success of the future electricity system (smart grids). • Survey on consumer engagement experiences in European smart grid projects. • Focus is on observing and understanding the consumers and on engaging them. • Trust and confidence as central elements. • Need to take into consideration different consumer segments/motivational factors

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

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


    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

  14. An extension of consumer environmental behavior research among expatriates


    Bhuian, Shahid N.; Amyx, Douglas A.; Shamma, Hamad M.


    A wealth of research has explored different configurations of consumer environmental beliefs, attitudes, and values, and their influence on consumer environmental behavior. It is essential that a more comprehensive understanding of what lies at the root of consumer environmental beliefs, attitudes, values, and behaviors be developed. This study aims to address some of the limitations in the current literature by theorizing and examining a consumer environmental behavior model that includes th...

  15. Model to Evaluate Pro-Environmental Consumer Practices


    Wendolyn Aguilar-Salinas; Sara Ojeda-Benitez; Samantha E. Cruz-Sotelo; Juan Ramón Castro-Rodríguez


    The consumer plays a key role in resource conservation; therefore, it is important to know consumer behavior to identify consumer profiles and to promote pro-environmental practices in society that encourage resource conservation and reductions in waste generation. The purpose of this paper is to implement a fuzzy model to evaluate consumer behavior in relation to three pro-environmental practices that can be implemented at the household level, including reductions in resource consumption (re...

  16. When Clinicians Drop Out and Start Over after Adverse Events. (United States)

    Rodriquez, Jason; Scott, Susan D


    The impact of adverse clinical events on health care workers has become a growing topic of research. Previous research has confirmed that after adverse clinical events, clinical staff often feel as though they failed not only their patient but also themselves, resulting in second-guessing of their clinical skills, competencies, and even career choices. This exploratory study reports on the experiences of health care providers who changed career paths as a consequence of an adverse clinical event. The authors designed a 39-question survey capturing personal and professional demographics, participant recall of the clinical event, insights into their lived experiences, health care institutions' response(s) to the event, decision-making influences relating to future employment, and insights into interventional strategies. Consistent with prior research, clinicians reported a pattern of inadequate social support after the event. Results further show the salience of emotional labor as a driving force among those who changed roles. In clinicians' own assessments about the lasting impact of the event, many felt less joy and meaning in their new clinical roles, but others thrived by rededicating their careers toward implementing patient safety initiatives and enhancing peer-support networks. Clinicians reported a desire for more transparency and support to help them recover. Clinicians aligned their emotional displays to be consistent with organizational expectations, resulting in suppressed feelings of guilt and shame that may have contributed to burnout, changed roles, or even premature retirement. Study findings highlight the need to develop better support systems for clinicians who are party to an adverse clinical event. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  17. The clinician's dilemma: two dimensions of ethical care. (United States)

    Gillett, Grant; Chamberlain, Joshua


    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.

  18. Classification models for the prediction of clinicians' information needs. (United States)

    Del Fiol, Guilherme; Haug, Peter J


    Clinicians face numerous information needs during patient care activities and most of these needs are not met. Infobuttons are information retrieval tools that help clinicians to fulfill their information needs by providing links to on-line health information resources from within an electronic medical record (EMR) system. The aim of this study was to produce classification models based on medication infobutton usage data to predict the medication-related content topics (e.g., dose, adverse effects, drug interactions, patient education) that a clinician is most likely to choose while entering medication orders in a particular clinical context. We prepared a dataset with 3078 infobutton sessions and 26 attributes describing characteristics of the user, the medication, and the patient. In these sessions, users selected one out of eight content topics. Automatic attribute selection methods were then applied to the dataset to eliminate redundant and useless attributes. The reduced dataset was used to produce nine classification models from a set of state-of-the-art machine learning algorithms. Finally, the performance of the models was measured and compared. Area under the ROC curve (AUC) and agreement (kappa) between the content topics predicted by the models and those chosen by clinicians in each infobutton session. The performance of the models ranged from 0.49 to 0.56 (kappa). The AUC of the best model ranged from 0.73 to 0.99. The best performance was achieved when predicting choice of the adult dose, pediatric dose, patient education, and pregnancy category content topics. The results suggest that classification models based on infobutton usage data are a promising method for the prediction of content topics that a clinician would choose to answer patient care questions while using an EMR system.

  19. Consuming technologies - developing routines

    DEFF Research Database (Denmark)

    Gram-Hanssen, Kirsten


    technologies and in this article these processes will be investigated from three different perspectives: an historical perspective of how new technologies have entered homes, a consumer perspective of how both houses and new technologies are purchased and finally, as the primary part of the article, a user...... perspective of how routines develop while these technologies are being used. In the conclusion these insights are discussed in relation to possible ways of influencing routines....


    Directory of Open Access Journals (Sweden)

    Nicoleta -Andreea Neacşu


    Full Text Available Marketing communication has evolved steadily in the direction of increasing complexity and increasing volume of funds needed to run their own actions. More than ever, consumers are exposed to an overwhelming variety of sources and communication tehniques, the information received being numerous, diverse and polyvalent. The desire to make more efficient the marketing communication activity urges the broadcasters to encode messages, to use effective means of propagation in order to obtain a high degree of control on receptors and to influence the consumption attitudes. Between the means used for this purpose, manipulation tehniques are well known. This paper highlights the main conclusions drawn as a result of a quantitative marketing research on the adult population from Braşov in order to identify the attitudes and opinions of consumers from Braşov regarding the manipulation techniques used by commercial practices and advertising.The results of the research have shown that 82% of the respondents buy products in promotional offers, and 18% choose not to buy these products and 61% of the respondents consider that they have not been manipulated not even once, while only 39% believe that they have been manipulated at least once through advertising or commercial practices. Advertisements on TV have a strong influence on consumers, 81% of the respondents considering that at least once they have bought a product because of a TV commercial.

  1. Western Balkans consumers' attitudes toward food labeling

    Directory of Open Access Journals (Sweden)

    Ognjanov Galjina


    Full Text Available The main purpose of this study is to shed light on consumers' attitudes toward food labelling in the Western Balkans. Pioneering in this respect, we present the results obtained from a cross-national consumer survey on a random representative sample of 3085 respondents, i.e. at least 500 respondents per country included. The survey covered six Western Balkans countries (WBC, namely Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Serbia and Slovenia. Differences in consumers' attitudes toward food labels as well as in self-perceived level of information about food with health claims were tested according to a number of socio-demographic criteria, including gender, age, education, type of settlement and the country of the Western Balkans where the respondent lives. The variables were also included as independents in a binary logistic model to achieve better understanding of the factors that may influence consumers' confidence in the usefulness of health claims on product labels. The results showed that self-perceived level of information about functional food as well as consumers' attitudes toward food labelling are influencing factors of consumers' confidence in usefulness of health claims on product labels when making food choices. Based on the mentioned, we provide conclusions and implications for marketing managers, decision makers in public health and for further research.

  2. Innovations in Statistical Observations of Consumer Prices

    Directory of Open Access Journals (Sweden)

    Olga Stepanovna Oleynik


    Full Text Available This article analyzes the innovative changes in the methodology of statistical surveys of consumer prices. These changes are reflected in the “Official statistical methodology for the organization of statistical observation of consumer prices for goods and services and the calculation of the consumer price index”, approved by order of the Federal State Statistics Service of December 30, 2014 no. 734. The essence of innovation is the use of mathematical methods in determining the range of studies objects of trade and services, in calculating the sufficient observable price quotes based on price dispersion, the proportion of the observed product (service, a representative of consumer spending, as well as the indicator of the complexity of price registration. The authors analyzed the mathematical calculations of the required number of quotations for observation in the Volgograd region in 2016, the results of calculations are compared with the number of quotes included in the monitoring. The authors believe that the implementation of these mathematical models allowed to substantially reduce the influence of the subjective factor in the organization of monitoring of consumer prices, and therefore to increase the objectivity of the resulting statistics on consumer prices and inflation. At the same time, the proposed methodology needs further improvement in terms of payment for goods, products (services by representatives having a minor share in consumer expenditure.

  3. Clinician Descriptions of Communication Strategies to Improve Treatment Engagement by Racial/Ethnic Minorities in Mental Health Services: A Systematic Review (United States)

    Aggarwal, Neil Krishan; Pieh, Matthew C.; Dixon, Lisa; Guarnaccia, Peter; Alegría, Margarita; Lewis-Fernández, Roberto


    Objective To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Methods Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Results Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. Conclusion Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. Practice implications Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations. PMID:26365436

  4. Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review. (United States)

    Aggarwal, Neil Krishan; Pieh, Matthew C; Dixon, Lisa; Guarnaccia, Peter; Alegría, Margarita; Lewis-Fernández, Roberto


    To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences. Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect. Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Consumer motivations for creating and consumer responses to consumer generated advertising


    Campbell, Colin Leslie


    Three papers are presented on the emerging phenomenon of consumer generated advertising. These papers provide knowledge and build theory related to both how consumers choose to create such advertisements and also how consumers respond to them. The first details a qualitative exploration of the motives of consumers that create advertisements. The paper draws on literature related to brand relationships, intrinsic motivation, and consumer creation to help inform and direct an investigation of 6...

  6. Primary care clinicians' attitudes towards point-of-care blood testing: a systematic review of qualitative studies. (United States)

    Jones, Caroline H D; Howick, Jeremy; Roberts, Nia W; Price, Christopher P; Heneghan, Carl; Plüddemann, Annette; Thompson, Matthew


    Point-of-care blood tests are becoming increasingly available and could replace current venipuncture and laboratory testing for many commonly used tests. However, at present very few have been implemented in most primary care settings. Understanding the attitudes of primary care clinicians towards these tests may help to identify the barriers and facilitators to their wider adoption. We aimed to systematically review qualitative studies of primary care clinicians' attitudes to point-of-care blood tests. We systematically searched Medline, Embase, ISI Web of Knowledge, PsycINFO and CINAHL for qualitative studies of primary care clinicians' attitudes towards point-of-care blood tests in high income countries. We conducted a thematic synthesis of included studies. Our search identified seven studies, including around two hundred participants from Europe and Australia. The synthesis generated three main themes: the impact of point-of-care testing on decision-making, diagnosis and treatment; impact on clinical practice more broadly; and impact on patient-clinician relationships and perceived patient experience. Primary care clinicians believed point-of-care testing improved diagnostic certainty, targeting of treatment, self-management of chronic conditions, and clinician-patient communication and relationships. There were concerns about test accuracy, over-reliance on tests, undermining of clinical skills, cost, and limited usefulness. We identified several perceived benefits and barriers regarding point-of-care tests in primary care. These imply that if point-of-care tests are to become more widely adopted, primary care clinicians require evidence of their accuracy, rigorous testing of the impact of introduction on patient pathways and clinical practice, and consideration of test funding.

  7. Teaching About Better Family–Clinician Partnerships in High-Risk Pediatric Asthma Care

    Directory of Open Access Journals (Sweden)

    Georgia Michalopoulou PhD


    Full Text Available Family–clinician partnership including communication, trust, respect, and power leveling is essential in pediatrics. Our case study illustrates elements supporting/hindering partnership in a high-risk urban pediatric asthma clinic. Data from observation of a 100-minute visit were qualitatively analyzed by applying codes to themes, using family-centered principles. Three key categories emerged from examining interactions and their sequencing: (1 partnership supported, (2 partnership missed, and (3 partnership hindered. Practitioners must become more sensitive to families’ lives and skilled in family-centered care delivery. Clinician education about partnership can help with negotiating workable treatment strategies for complex conditions such as asthma and reduce health disparities.

  8. Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

    Directory of Open Access Journals (Sweden)

    Yeo Chay Leng


    Full Text Available Abstract Our prospective-audit-and-feedback antimicrobial stewardship (AS program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. However, process indicators including the number of recommendations and recommendation acceptance rates fell significantly during the year, with accompanying increases in broad-spectrum antibiotic prescription. The trends were reversed only upon reverting to the original setup. Dedicated clinicians play a crucial role in AS programs involving immunocompromised patients. Structured training and adequate succession/contingency planning is critical for sustainability.

  9. An educational program to assist clinicians in identifying elder investment fraud and financial exploitation. (United States)

    Mills, Whitney L; Roush, Robert E; Moye, Jennifer; Kunik, Mark E; Wilson, Nancy L; Taffet, George E; Naik, Aanand D


    Due to age-related factors and illnesses, older adults may become vulnerable to elder investment fraud and financial exploitation (EIFFE). The authors describe the development and preliminary evaluation of an educational program to raise awareness and assist clinicians in identifying older adults at risk. Participants (n = 127) gave high ratings for the program, which includes a presentation, clinician pocket guide, and patient education brochure. Thirty-five respondents returned a completed questionnaire at the 6-month follow-up, with 69% (n = 24) of those indicating use of the program materials in practice and also reporting having identified 25 patients they felt were vulnerable to EIFFE. These findings demonstrate the value of providing education and practical tools to enhance clinic-based screening of this underappreciated but prevalent problem.

  10. The globalization of healthcare: implications of medical tourism for the infectious disease clinician. (United States)

    Chen, Lin H; Wilson, Mary E


    Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documented in many reports. Medical tourists are at risk for hospital-associated and procedure-related infections as well as for locally endemic infections. Patients may not volunteer details about care abroad, so clinicians must inquire about medical procedures abroad as well as recent travel. Special infection control measures may be warranted. Healthcare abroad is associated with diverse financial, legal, ethical, and health-related issues. We focus on problems the infectious disease clinician may encounter and provide a framework for evaluating returned medical tourists with suspected infections. A better system is needed to ensure broad access to high-quality health services, continuity of care, and surveillance for complications.

  11. Situational awareness - what it means for clinicians, its recognition and importance in patient safety. (United States)

    Green, B; Parry, D; Oeppen, R S; Plint, S; Dale, T; Brennan, P A


    A thorough understanding of the role of human factors in error in health care for improving patient safely is paramount. One area particularly crucial for optimising clinical performance is the recognising the importance of situational awareness. Loss of situation awareness can occur in many different settings, particularly during stressful and unexpected situations. Tunnel vision is a classic example where clinicians focus on one aspect of care, often to the detriment of overall patient management. Loss of situational awareness can result in serious compromise to patient safety if it is not recognised by either the individual or clinical team. We provide an introduction to situational awareness for those not familiar with it, including some important theory which explains how awareness can be lost, and discuss the important approaches we use in our day-to-day practice to safeguard both patients and clinicians in the workplace environment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Education on Patient-Ventilator Synchrony, Clinicians' Knowledge Level, and Duration of Mechanical Ventilation. (United States)

    Lynch-Smith, Donna; Thompson, Carol Lynn; Pickering, Rexann G; Wan, Jim Y


    Improved recognition of patient-ventilator asynchrony may reduce duration of mechanical ventilation. To evaluate the effects of education about patient-ventilator synchrony on clinicians' level of knowledge and patients' mean duration of mechanical ventilation. A quasi-experimental 1-group pretest-posttest study was performed in a 16-bed intensive care unit. Analysis included 33 clinicians and 97 ventilator patients. The intervention consisted of PowerPoint lectures on patient-ventilator synchrony. Data included test scores before and after the education, scores on the Acute Physiology and Chronic Health Evaluation II, and mean duration of mechanical ventilation. Differences in scores before and after education, mean duration of mechanical ventilation, and mean health evaluation scores before and after education were determined by using t tests. Of the 33 clinicians, 17 were registered nurses and 16 were respiratory therapists. Posttest scores were 63% higher than pretest scores (P mechanical ventilation of 5.4 (SD, 4.6) days. After the lecture, 50 patients had a mean health evaluation score of 24.6 (SD, 8.2) and mean duration of mechanical ventilation of 4.8 (SD, 4.3) days. Mean health evaluation score was marginally higher after the lecture (P = .054). Mean duration of mechanical ventilation did not differ (P = .54). Clinicians' test scores increased significantly after patient-ventilator synchrony lectures. Mean duration of mechanical ventilation decreased by 0.6 days and health evaluation scores were marginally higher after the lectures. ©2016 American Association of Critical-Care Nurses.

  13. Using a predictive model of clinician intention to improve continuing health professional education on cancer survivorship. (United States)

    Buriak, S E; Potter, J; Bleckley, M Kathryn


    Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  14. Modelling consumer preferences for novel foods

    DEFF Research Database (Denmark)

    Dolgopolova, Irina; Teuber, Ramona; Bruschi, Viola


    food products than a random utility approach. We draw on data from a survey and second-price Vickrey auction for novel foods with health and environmental benefits. First, we analyze consumer choices within a random utility framework and compare stated and revealed preferences. Second, reference point......Advances in the bioeconomy lead to a range of innovative products appearing at the consumer markets. However, these products often face consumer resistance. In this chapter we test if a reference point effects approach can provide more information about consumers decision-making regarding novel...... effects are included into the methodological framework and weighted and unweighted models for revealed preferences are obtained. Results of the random utility estimations provide information on attributes value and the evidence of overestimated stated preferences. The reference point approach indicates...

  15. The consumer competence of young adults

    DEFF Research Database (Denmark)

    Grønhøj, Alice


    Purpose The consumer competence concept is loaded with ambiguity in the academic as well as in the public use of the term. The purpose of this paper was to examine the concept theoretically and empirically. Methodology/Approach Consumer socialization theories were compared and combined...... for the theoretical background, and a mixed-methods methodology was applied for the empirical part. The study included young adults aged 18-25, who had recently established their first household. Qualitative and quantitative methods were used to explore the way in which young consumers establish their first household......, particularly with respect to how new, complex buying decisions are managed. Findings Guidance from family and friends was found to be of major significance as regards complex consumer decisions made in the transition period from home to first household. The young adults did not display very high levels...

  16. Consumer knowledge and attitudes toward nutritional labels. (United States)

    Cannoosamy, Komeela; Pugo-Gunsam, Prity; Jeewon, Rajesh


    To determine Mauritian consumers' attitudes toward nutritional labels based on the Kano model and to identify determinants of the use and understanding of nutrition labels. The researchers also used a Kano model questionnaire to determine consumers' attitudes toward nutrition labeling. Four hundred consumers residing in Mauritius. Information was elicited via a questionnaire that assessed nutritional knowledge and information about the use and understanding of nutritional labels and demographic factors. Nutritional label use and understanding, nutrition knowledge, and association of demographic factors with label use. Statistical tests performed included 1-way ANOVA and independent samples t tests. Statistically significant relationships (P consumer dissatisfaction. Age, education, income, household size, and nutrition knowledge had an impact on nutritional label use. Health promoters should aim to increase the use of nutritional labels. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  17. Cross-disciplinary consumer citizenship education

    DEFF Research Database (Denmark)

    Nielsen, Sanne Schnell; Gottschau, Jette


    This paper examines a cross-disciplinary, problem-oriented workshop dealing with consumer issues. The workshop forms part of the four-year Danish teacher training course offered by the Copenhagen Day and Evening College of Teacher Training. The workshop covers issues related to civic, environmental...... and consumer education, along with pedagogical issues, with the aim of developing a holistic, integrated approach to consumer citizenship education. The workshop concept is based on the “IVAC” (Investigation, Visions, Actions & Changes) model (Jensen 1997). As our point of departure, we take a practical...... these competences in their practical teaching of consumer citizenship education in Danish comprehensive schools. Comprehensive schools are state schools combining primary and lower secondary education. In Denmark, teacher training includes 24 weeks of teaching practice. The workshop forms an integral part...

  18. Understanding Clinicians' Use of Cues When Assessing the Future Risk of Violence: A Clinical Judgement Analysis in the Psychiatric Setting. (United States)

    Brown, Barbara; Rakow, Tim


    Research is sparse on how clinicians' judgement informs their violence risk assessments. Yet, determining preferences for which risk factors are used, and how they are weighted and combined, is important to understanding such assessments. This study investigated clinicians' use of static and dynamic cues when assessing risk in individual patients and for dynamic cues considered in the recent and distant past. Clinicians provided three violence risk assessments for 41 separate hypothetical cases of hospitalized patients, each defined by eight cues (e.g., psychopathy and past violence severity/frequency). A clinical judgement analysis, using regression analysis of judgements for multiple cases, created linear models reflecting the major influences on each individual clinician's judgement. Risk assessments could be successfully predicted by between one and four cues, and there was close agreement between different clinicians' models regarding which cues were relevant for a given assessment. However, which cues were used varied between assessments: history of recent violence predicted assessments of in-hospital risk, whereas violence in the distant past predicted the assessed risk in the community. Crucially, several factors included in actuarial/structured risk assessment tools had little influence on clinicians' assessments. Our findings point to the adaptivity in clinicians' violence risk assessments, with a preference for relying on information consistent with the setting for which the assessment applies. The implication is that clinicians are open to using different structured assessment tools for different kinds of risk assessment, although they may seek greater flexibility in their assessments than some structured risk assessment tools afford (e.g., discounting static risk factors). Across three separate violence risk assessments, clinicians' risk assessments were more strongly influenced by dynamic cues that can vary over time (e.g., level of violence) than by

  19. Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. (United States)

    Chung, Esther K; Siegel, Benjamin S; Garg, Arvin; Conroy, Kathleen; Gross, Rachel S; Long, Dayna A; Lewis, Gena; Osman, Cynthia J; Jo Messito, Mary; Wade, Roy; Shonna Yin, H; Cox, Joanne; Fierman, Arthur H


    Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources. Copyright © 2016 Mosby, Inc. All rights reserved.

  20. Consuming the Fashion Tattoo

    DEFF Research Database (Denmark)

    Kjeldgaard, Dannie; Bengtsson, Anders


    From being considered a marginal and sometimes deviant behavior, the consumption of tattoos has become a mass consumer phenomenon. As tattoos have gained in popularity, it can be expected that the reasons for why people get tattoos have shifted as well. This paper explores consumers’ motivations...... for getting a fashion tattoo and the meaning associated with its consumption. Through phenomenological interviews with fashion tattooees, the themes 'art/fashion’, 'personalization and biographing’, 'contextual representation of self’, and 'meanings?’ are related to existing consumption theory....

  1. Sustainable Consumer Voices

    DEFF Research Database (Denmark)

    Klitmøller, Anders; Rask, Morten; Jensen, Nevena


    Aiming to explore how user driven innovation can inform high level design strategies, an in-depth empirical study was carried out, based on data from 50 observations of private vehicle users. This paper reports the resulting 5 consumer voices: Technology Enthusiast, Environmentalist, Design Lover......, Pragmatist and Status Seeker. Expedient use of the voices in creating design strategies is discussed, thus contributing directly to the practice of high level design managers. The main academic contribution of this paper is demonstrating how applied anthropology can be used to generate insights...

  2. Consumer involvement profiles: An application of consumer involvement in mobile industry


    Homa Rahbarian; Fattaneh Alizadeh Meshkani


    This paper investigates consumer involvement profile among people who intend to purchase mobile devises. The study considers the effects of various factors influencing on purchase intention including consumers’ personal characteristics such as age, gender, income as well as some external factors including advertisement. The study uses a questionnaire in Likert scale, originally developed by O’Cass (2000) [O’Cass, A. (2000). An assessment of consumers' product, purchase decision, advertising a...

  3. How do consumers describe wine astringency? (United States)

    Vidal, Leticia; Giménez, Ana; Medina, Karina; Boido, Eduardo; Ares, Gastón


    Astringency is one of the most important sensory characteristics of red wine. Although a hierarchically structured vocabulary to describe the mouthfeel sensations of red wine has been proposed, research on consumers' astringency vocabulary is lacking. In this context, the aim of this work was to gain an insight on the vocabulary used by wine consumers to describe the astringency of red wine and to evaluate the influence of wine involvement on consumers' vocabulary. One hundred and twenty-five wine consumers completed and on-line survey with five tasks: an open-ended question about the definition of wine astringency, free listing the sensations perceived when drinking an astringent wine, free listing the words they would use to describe the astringency of a red wine, a CATA question with 44 terms used in the literature to describe astringency, and a wine involvement questionnaire. When thinking about wine astringency consumers freely elicited terms included in the Mouth-feel Wheel, such as dryness and harsh. The majority of the specific sub-qualities of the Mouth-feel Wheel were not included in consumer responses. Also, terms not classified as astringency descriptors were elicited (e.g. acid and bitter). Only 17 out of the 31 terms from the Mouth-feel Wheel were used by more than 10% of participants when answering the CATA question. There were no large differences in the responses of consumer segments with different wine involvement. Results from the present work suggest that most of the terms of the Mouth-feel Wheel might not be adequate to communicate the astringency characteristics of red wine to consumers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. The cultural divide: exploring communication barriers between scientists and clinicians. (United States)

    Restifo, Linda L; Phelan, Gerald R


    Despite remarkable advances in basic biomedical science that have led to improved patient care, there is a wide and persistent gap in the abilities of researchers and clinicians to understand and appreciate each other. In this Editorial, the authors, a scientist and a clinician, discuss the rift between practitioners of laboratory research and clinical medicine. Using their first-hand experience and numerous interviews throughout the United States, they explore the causes of this 'cultural divide'. Members of both professions use advanced problem-solving skills and typically embark on their career paths with a deeply felt sense of purpose. Nonetheless, differences in classroom education, professional training environments, reward mechanisms and sources of drive contribute to obstacles that inhibit communication, mutual respect and productive collaboration. More than a sociological curiosity, the cultural divide is a significant barrier to the bench-to-bedside goals of translational medicine. Understanding its roots is the first step towards bridging the gap.

  5. The cultural divide: exploring communication barriers between scientists and clinicians

    Directory of Open Access Journals (Sweden)

    Linda L. Restifo


    Despite remarkable advances in basic biomedical science that have led to improved patient care, there is a wide and persistent gap in the abilities of researchers and clinicians to understand and appreciate each other. In this Editorial, the authors, a scientist and a clinician, discuss the rift between practitioners of laboratory research and clinical medicine. Using their first-hand experience and numerous interviews throughout the United States, they explore the causes of this ‘cultural divide’. Members of both professions use advanced problem-solving skills and typically embark on their career paths with a deeply felt sense of purpose. Nonetheless, differences in classroom education, professional training environments, reward mechanisms and sources of drive contribute to obstacles that inhibit communication, mutual respect and productive collaboration. More than a sociological curiosity, the cultural divide is a significant barrier to the bench-to-bedside goals of translational medicine. Understanding its roots is the first step towards bridging the gap.

  6. Conflict of Interest in Research--The Clinician Scientist's Perspective. (United States)

    Kong, Nicole H Y; Chow, Pierce K H


    Conflict of interest (COI) in research represents situations that pose risks of undue influence on scientific objectivity and judgment because of secondary interests. This is complex but is inherent to biomedical research. The role of a clinician scientist can be conflicted when scientific objectivity is perceived to compete with scientific success (publications, grants), partiality to patients (clinical trials), obligations to colleagues (allowing poor scholarship to pass), research sponsors (industry), and financial gains (patents, royalties). While there are many ways which COIs can occur in research, COI mitigations remain reliable. Collaborations between investigators and industry are valuable to the development of novel therapies and undue discouragement of these relationships may inadvertently harm the advancement of healthcare. As a result, proper management of COI is fundamental and crucial to the maintenance of long-term, mutually beneficial relationships between industry and academia. The nature of COI in research and methods of mitigation are discussed from the perspective of a clinician scientist.

  7. Attitudes towards psychotherapy manuals among clinicians treating eating disorders. (United States)

    Waller, Glenn; Mountford, Victoria A; Tatham, Madeleine; Turner, Hannah; Gabriel, Chloe; Webber, Rebecca


    Clinicians have relatively low uptake and implementation of evidence-based psychotherapies for the eating disorders, and this problem appears to be associated with low use of manualized approaches. This study examines clinicians' positive and negative attitudes to manuals, and possible beliefs and emotional factors that might drive those attitudes. The participants were 125 psychological therapists working with eating-disordered patients. Each completed standardised measures of attitudes to manuals and emotional states. A number of beliefs about the content of manuals were associated with both positive attitudes to the outcome of treatment and negative attitudes to their impact on the treatment process. In addition, a more positive mood was associated with more positive attitudes. Suggestions are made regarding how attitudes might be made more positive, in order to facilitate the use of evidence-based therapies for eating disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Consumers' perceptions of African wildlife meat

    DEFF Research Database (Denmark)

    Radder, Laetitia; Grunert, Klaus G.


    attributes included low levels of fat, dryness, novelty, and special preparation requirements. Significant values included security, self-esteem, hedonism, tradition, and stimulation. Promoters of the product are advised to capitalize on consumers' interest in health and the health benefits of the meat...

  9. Digitizing the Facebow: A Clinician/Technician Communication Tool. (United States)

    Kalman, Les; Chrapka, Julia; Joseph, Yasmin


    Communication between the clinician and the technician has been an ongoing problem in dentistry. To improve the issue, a dental software application has been developed--the Virtual Facebow App. It is an alternative to the traditional analog facebow, used to orient the maxillary cast in mounting. Comparison data of the two methods indicated that the digitized virtual facebow provided increased efficiency in mounting, increased accuracy in occlusion, and lower cost. Occlusal accuracy, lab time, and total time were statistically significant (Pcommunication.

  10. Communication skills in healthcare: academic, clinician and patient perspectives




    This PhD explores healthcare communication skills from the perspectives of academics, clinicians and patients. We know that communication is key to effective healthcare and this research has revealed new approaches for teaching and learning these skills. Findings indicate that we need to consider multiple stakeholders in the design of communication education, we need to develop healthcare professionals’ skills at assessing their own communication and asking for feedback, and workplace teachin...

  11. Web 2.0: easy tools for busy clinicians. (United States)

    Phillippi, Julia C; Buxton, Margaret


    Internet content has become interactive; new tools can help clinicians market their practice and provide evidence-based care. Many of these tools are free or low cost and are easily mastered using simple video tutorials found on the Internet. This article highlights the uses of e-mail, social networking, smartphones, RSS feeds, social bookmarking, and collaborative Web 2.0 tools in clinical practice. (c) 2010 American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.

  12. Gloves-off Consumer Economics. (United States)

    McGowan, Daniel A.


    The evolution of the consumer economics course at Hobart and William Smith College demonstrates its mainstreaming in the liberal arts curriculum. The course uses principles of economics to address broad and often controversial consumer issues. (SK)

  13. Consumer's Guide to Radon Reduction (United States)

    ... Protection Agency Search Search Radon Contact Us Share Consumer's Guide to Radon Reduction: How to Fix Your ... See EPA’s About PDF page to learn more. Consumer's Guide to Radon Reduction: How to Fix Your ...

  14. Improved STD syndrome management by a network of clinicians and pharmacy workers in Peru: The PREVEN Network. (United States)

    García, Patricia J; Carcamo, Cesar P; Garnett, Geoff P; Campos, Pablo E; Holmes, King K


    Sexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru. After a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. "Prevention Salespersons" visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities. Training pharmacy workers linked to a referral network of clinicians proved

  15. Development of a clinician reputation metric to identify appropriate problem-medication pairs in a crowdsourced knowledge base. (United States)

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


    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

  16. Clinical Practice: Direct-to-consumer genetic testing: To test or not to ...

    African Journals Online (AJOL)

    In direct-to-consumer (DTC) genetic testing, laboratory-based genetic services are offered directly to the public without an independent healthcare professional being involved. The committee of the Southern African Society for Human Genetics (SASHG) appeals to the public and clinicians to be cautious when considering ...

  17. Knowledge and Practice of Clinicians regarding Syndromic Management of Sexually Transmitted Infections in Public Health Facilities of Gamo Gofa Zone, South Ethiopia

    Directory of Open Access Journals (Sweden)

    Addisu Alemayehu


    Full Text Available Background. Sexually Transmitted Infections (STIs are the leading causes of morbidity among young adults. This study assessed the knowledge and practice of clinicians regarding syndromic management of STIs in public health facilities of Gamo Gofa Zone, Southern Ethiopia. Methods. Facility based cross-sectional study with mixed methods of data collection was conducted in public health facilities of Gamo Gofa Zone. The study included 250 clinicians and 12 health facilities, 26 mystery clients were hired, and 120 STI patient cards were reviewed. Data was entered in EPI info version 7.0.1 and analyzed by SPSS version 20. Results. Of the participated clinicians, 32 (12.8% were trained on syndromic management of STIs. Highest knowledge of clinicians was for urethral discharge (27.2%. Professional category of clinicians and type of health facility (AOR = 0.194; 95% CI = 0.092, 0.412 were determinants of urethral discharge knowledge. Of the cards reviewed, only in 8.3% of cards and 19.23% of mystery clients did the clinicians correctly follow the guideline. Conclusion. Knowledge and practice of clinicians regarding syndromic management of STIs in study area were poor. Efforts should be made to increase the knowledge of clinicians by providing training on syndromic management of STIs and supportive supervision should be regular.

  18. Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study

    Directory of Open Access Journals (Sweden)

    John Rihari-Thomas


    Full Text Available Background Systemic and structural issues of rapid response system (RRS models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses experience and negotiate care for deteriorating patients within the RRS. Methods Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis. Results Thirty-four participants (21 physicians and 13 registered nurses [RNs] participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1 responsibility is inversely proportional to clinical experience; (2 actions around system flexibility contribute to deviation from protocol; (3 misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4 poor communication and documentation of RRS increases clinician workloads. Conclusion Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.

  19. An overview of meta-analysis for clinicians (United States)

    Lee, Young Ho


    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

  20. Understanding academic clinicians' intent to treat pediatric obesity. (United States)

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


    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.

  1. Reiki Reduces Burnout Among Community Mental Health Clinicians. (United States)

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


    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.

  2. 78 FR 54629 - Consumer Advisory Board meeting (United States)


    ... From the Federal Register Online via the Government Publishing Office CONSUMER FINANCIAL PROTECTION BUREAU Consumer Advisory Board meeting AGENCY: Bureau of Consumer Financial Protection. ACTION... Consumer Advisory Board (``CAB'' or ``Board'') of the Consumer Financial Protection Bureau (Bureau). The...

  3. Consumer networks and firm reputation

    DEFF Research Database (Denmark)

    Tyran, Jean-Robert; Huck, Steffen; Lünser, Gabriele K.


    We examine the role of consumer networks in markets that suffer from moral hazard. Consumers exchange information with neighbors about past experiences with different sellers. Networks foster incentives for reputation building and enhance trust and efficiency in markets.......We examine the role of consumer networks in markets that suffer from moral hazard. Consumers exchange information with neighbors about past experiences with different sellers. Networks foster incentives for reputation building and enhance trust and efficiency in markets....

  4. Consumer Savvy: Conceptualisation and Measurement.


    Macdonald, Emma K.; Uncles, Mark D.


    The notion of savvy consumers increasingly appears in the e-marketing and e-management literatures, usually in discussions about the importance of consumer-centricity. A synthesis of the literature identifies six broad characteristics of these savvy consumers: they are enabled by competencies in relation to technological sophistication, interpersonal networking, online networking and marketing/advertising literacy, and they are empowered by consumer self-efficacy and by their expectations of ...

  5. Occupational therapy with people with depression: using nominal group technique to collate clinician opinion. (United States)

    Hitch, Danielle; Taylor, Michelle; Pepin, Genevieve


    This aim of this study was to obtain a consensus from clinicians regarding occupational therapy for people with depression, for the assessments and practices they use that are not currently supported by research evidence directly related to functional performance. The study also aimed to discover how many of these assessments and practices were currently supported by research evidence. Following a previously reported systematic review of assessments and practices used in occupational therapy for people with depression, a modified nominal group technique was used to discover which assessments and practices occupational therapists currently utilize. Three online surveys gathered initial data on therapeutic options (survey 1), which were then ranked (survey 2) and re-ranked (survey 3) to gain the final consensus. Twelve therapists completed the first survey, whilst 10 clinicians completed both the second and third surveys. Only 30% of the assessments and practices identified by the clinicians were supported by research evidence. A consensus was obtained on a total of 35 other assessments and interventions. These included both occupational-therapy-specific and generic assessments and interventions. Principle conclusion. Very few of the assessments and interventions identified were supported by research evidence directly related to functional performance. While a large number of options were generated, the majority of these were not occupational therapy specific.

  6. Evaluating performance feedback: a research study into issues of credibility and utility for nursing clinicians. (United States)

    Fereday, Jennifer; Muir-Cochrane, Eimear


    Performance feedback is information provided to employees about how well they are performing in their work role. The nursing profession has a long history of providing formal, written performance reviews, traditionally from a manager to subordinate, with less formal feedback sources including peers, clients and multidisciplinary team members. This paper is based on one aspect of a PhD research study exploring the dynamics of performance feedback primarily from the nursing clinicians' perspective. The research reported here discusses the impact of the social relationship (between the source and recipient of performance feedback) on the recipient's evaluation of feedback as being 'credible' and 'useful' for self-assessment. Focus group interviews were utilised to ascertain the nursing clinicians' perspectives of performance feedback. Thematic analysis of the data was informed by the Social Phenomenology of Alfred Schutz (1967) specifically his theories of intersubjective understanding. Findings supported the level of familiarity between the feedback source and the nursing clinician as a significant criterion influencing the acceptance or rejection of feedback. Implications for the selection of performance feedback sources and processes within nursing are discussed.

  7. Clinician, Society and Suicide Mountain: Reading Rogerian Doctrine of Unconditional Positive Regard (UPR

    Directory of Open Access Journals (Sweden)

    Chinedum Amadi


    Full Text Available Carl Rogers has become a legendary personage in the mental health field. Rogers (1957 “has been cited in the literature over a thousandtimes, in professional writings originating in 36 countries” (Goldfried, 2007, p. 249. Clinicians in the behavioral health field (psychiatry, socialwork, counseling and psychology are exposed to his teachings about human behavior. Of all the ideas propagated by Rogers, the conceptof unconditional positive regard (UPR has been elevated to the level of a doctrine (Schmitt, 1980. What then is unconditional positive regard?How can clinicians be faithful to the demands of unconditional positive regard in the face of other competing realities such as threat of suicideor terrorism? This paper seeks to discuss the impossible nature of Rogers' UPR, highlighting its inherent linguistic contradiction. Sincepsychotherapy is culturally normative, the doctrine of unconditional positive regard negates this fundamental principle. In this article, the authortakes a critical look at the influence of American philosophy of education on Rogers – he was a product of his culture. Furthermore, this paperasserts that clinicians are guided by societal norms or “conditions” which regulate clinical practice, including unconditional positive regard(Gone, 2011.

  8. Patient-clinician ethnic concordance and communication in mental health intake visits. (United States)

    Alegría, Margarita; Roter, Debra L; Valentine, Anne; Chen, Chih-nan; Li, Xinliang; Lin, Julia; Rosen, Daniel; Lapatin, Sheri; Normand, Sharon-Lise; Larson, Susan; Shrout, Patrick E


    This study examines how communication patterns vary across racial and ethnic patient-clinician dyads in mental health intake sessions and its relation to continuance in treatment, defined as attending the next scheduled appointment. Observational study of communication patterns among ethnically/racially concordant and discordant patient-clinician dyads. Primary analysis included 93 patients with 38 clinicians in race/ethnic concordant and discordant dyads. Communication was coded using the Roter Interaction Analysis System (RIAS) and the Working Alliance Inventory Observer (WAI-O) bond scale; continuance in care was derived from chart reviews. Latino concordant dyad patients were more verbally dominant (pcommunication (pmodels that adjusted for non-communication variables. When communication, global affect, and therapeutic process variables were adjusted for, differences were reversed and white dyad patients had higher continuance in care rates than other dyad patients. Communication patterns seem to explain the role of ethnic concordance for continuance in care. Improve intercultural communication in cross cultural encounters appears significant for retaining minorities in care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination. (United States)

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


    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.

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


    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.

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


    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


    Directory of Open Access Journals (Sweden)

    Andrie Prasetyo


    Full Text Available Complaining is one form of communication for consumers to express their dissatisfaction. Understanding the consumer complaint behavior is an important thing for businesses; however, it is not easy to do. The initial step in understanding this behavior of consumer complaints is to map consumers based on their behavior of complaints and analyze the factors that influence this. This study examines the complaint behavior of consumers in Cibubur who have experienced dissatisfaction with a product.  The objectives of this study are to map the consumer complaint behavior and identify its relationship with various factors such as consumer demographics, personality, attitude to businesses, attribution of the causes of dissatisfaction, and product attributes. A crosstab descriptive analysis method was used to map the consumers, while the Pearson correlation analysis methods was used to analyze consumer complaint behavioral relationships with various factors. The results of this study indicated that consumers in Cibubur based on their complaint behavior are classified into four groups: passive, voicers, irates and activist. The passive consumers dominate the category with a percentage of 49%.  The voicers, irates, and activist belong to the complaining type and are dominated by young women, with high levels of education and income. Keywords: consumer complaint behavior, product, crosstab, pearson correlation

  13. Consumer Acceptance of Novel Foods

    NARCIS (Netherlands)

    Fischer, A.R.H.; Reinders, M.J.


    The success of novel foods depends to a considerable extent on whether consumers accept those innovations. This chapter provides an overview of current knowledge relevant to consumer acceptance of innovations in food. A broad range of theories and approaches to assess consumer response to

  14. 75 FR 78632 - Consumer Leasing (United States)


    ... 213.7 imposes certain requirements on advertisements for consumer leases. In order to provide guidance... advertisements for consumer leases, as defined in Sec. 213.2(e). As discussed above, a lease is exempt from the.... 213.7 does not apply to an advertisement for a specific consumer lease if the total contractual...

  15. 76 FR 18349 - Consumer Leasing (United States)


    ... contractual obligation of advertised lease. Section 213.7 applies to advertisements for consumer leases, as... certain requirements on advertisements for consumer leases. In order to provide guidance regarding the.... 213.7 does not apply to an advertisement for a specific consumer lease if the total contractual...

  16. 76 FR 35721 - Consumer Leasing (United States)


    ...] Consumer Leasing AGENCY: Board of Governors of the Federal Reserve System. ACTION: Final rule, staff... requirements of Regulation M, which implements the Consumer Leasing Act (CLA). Effective July 21, 2011, the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act) amends the CLA by increasing...

  17. Invitation to Consumer Behavior Analysis (United States)

    Foxall, Gordon R.


    This article presents an introduction to consumer behavior analysis by describing the Behavioral Perspective Model of consumer choice and showing how research has, first, confirmed this framework and, second, opened up behavior analysis and behavioral economics to the study of consumer behavior in natural settings. It concludes with a discussion…

  18. Variables associated with environmental scanning among clinicians at substance abuse treatment clinics

    Directory of Open Access Journals (Sweden)

    Alison L. Koch


    Full Text Available Introduction. Environmental scanning, as a component of absorptive capacity, has been shown to be associated with increased use of innovative treatment techniques at substance abuse treatment programmes. As the transfer of innovative, evidence-based treatment techniques from research to practice is gaining attention, we aimed to identify variables associated with higher levels of environmental scanning among substance abuse treatment clinicians. Method. A cross-sectional survey was administered to 162 clinicians at 15 substance abuse treatment clinics in Michigan. Measures: Environmental scanning was measured by frequency of use of the Internet, journals, seminars or conferences, and people at other treatment clinics for new substance abuse treatment information. Clinicians were asked for their perceptions of their clinic’s openness to new treatment techniques and support for acquiring new information, access to and satisfaction with information sources at work, as well as if they feel it is their job to keep up to date with current treatment research. Additional measures included whether they intended to quit their jobs and whether they were emotionally drained from work. Findings: We found positive associations between environmental scanning and perceived clinic support for acquiring new information, perceived clinic openness to new treatment techniques, access to e-mail and Internet at work, and satisfaction with resources. Turnover intention and being emotionally drained were negatively associated with environmental scanning. Conclusion. : Individual and organizational level variables were found to be associated with higher levels of environmental scanning activity. Although the causal directions of these associations are not known, the findings suggest ways to increase environmental scanning among clinicians.

  19. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians (United States)

    Ramsay, Jean; Rutterford, Clare; Gregory, Alison; Dunne, Danielle; Eldridge, Sandra; Sharp, Debbie; Feder, Gene


    Background Domestic violence affects one in four women and has significant health consequences. Women experiencing abuse identify doctors and other health professionals as potential sources of support. Primary care clinicians agree that domestic violence is a healthcare issue but have been reluctant to ask women if they are experiencing abuse. Aim To measure selected UK primary care clinicians’ current levels of knowledge, attitudes, and clinical skills in this area. Design and setting Prospective observational cohort in 48 general practices from Hackney in London and Bristol, UK. Method Administration of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), comprising five sections: responder profile, background (perceived preparation and knowledge), actual knowledge, opinions, and practice issues. Results Two hundred and seventy-two (59%) clinicians responded. Minimal previous domestic violence training was reported by participants. Clinicians only had basic knowledge about domestic violence but expressed a positive attitude towards engaging with women experiencing abuse. Many clinicians felt poorly prepared to ask relevant questions about domestic violence or to make appropriate referrals if abuse was disclosed. Forty per cent of participants never or seldom asked about abuse when a woman presented with injuries. Eighty per cent said that they did not have an adequate knowledge of local domestic violence resources. GPs were better prepared and more knowledgeable than practice nurses; they also identified a higher number of domestic violence cases. Conclusion Primary care clinicians’ attitudes towards women experiencing domestic violence are generally positive but they only have basic knowledge of the area. Both GPs and practice nurses need more comprehensive training on assessment and intervention, including the availability of local domestic violence services. PMID:22947586

  20. How may consumer policy empower consumers for sustainable lifestyles?

    DEFF Research Database (Denmark)

    Thøgersen, John

    consumers are constrained by limited resources in terms of finances, time, cognitive capacity, energy, and knowledge, and in everyday life lots of activities and goals compete for the same limited resources. In addition, there are external conditions affecting the effectiveness of an individual consumer......'s striving for sustainability. The relevant external conditions are an extremely diverse set of factors, perhaps their only commonality being that, unless making an organized effort, consumers can do nothing about them. Because external conditions influence all or many consumers, making them more...... facilitating for sustainable consumption can be much more effective than anything an individual consumer can do. Many of the external constraints facing consumers who want to adopt a more sustainable lifestyle are of a relative nature and their impact depends on the individual's resources. For instance...

  1. Consumers' perceptions of preconception health. (United States)

    Squiers, Linda; Mitchell, Elizabeth W; Levis, Denise M; Lynch, Molly; Dolina, Suzanne; Margolis, Marjorie; Scales, Monica; Kish-Doto, Julia


    To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers. We present formative findings based on the four Ps of social marketing: product, price, promotion, and place. We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010. We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups. The focus group guide was designed to elicit participants' responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data. Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as "promoting" a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels. The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign.

  2. Consumer reporting of adverse events following immunization (United States)

    Clothier, Hazel J; Selvaraj, Gowri; Easton, Mee Lee; Lewis, Georgina; Crawford, Nigel W; Buttery, Jim P


    Surveillance of adverse events following immunisation (AEFI) is an essential component of vaccine safety monitoring. The most commonly utilized passive surveillance systems rely predominantly on reporting by health care providers (HCP). We reviewed adverse event reports received in Victoria, Australia since surveillance commencement in July 2007, to June 2013 (6 years) to ascertain the contribution of consumer (vaccinee or their parent/guardian) reporting to vaccine safety monitoring and to inform future surveillance system development directions. Categorical data included were: reporter type; serious and non-serious AEFI category; and, vaccinee age group. Chi-square test and 2-sample test of proportions were used to compare categories; trend changes were assessed using linear regression. Consumer reporting increased over the 6 years, reaching 21% of reports received in 2013 (P <0.001), most commonly for children aged less than 7 years. Consumer reports were 5% more likely to describe serious AEFI than HCP (P = 0.018) and 10% more likely to result in specialist clinic attendance (P <0.001). Although online reporting increased to 32% of all report since its introduction in 2010, 85% of consumers continued to report by phone. Consumer reporting of AEFI is a valuable component of vaccine safety surveillance in addition to HCP reporting. Changes are required to AEFI reporting systems to implement efficient consumer AEFI reporting, but may be justified for their potential impact on signal detection sensitivity. PMID:25483686

  3. Considerations in evaluating emissions from consumer products (United States)

    Girman, John R.; Hodgson, Alfred T.; Wind, Marilyn L.

    While several indoor air quality studies suggest consumer products (e.g. aerosol sprays, paint removers, etc.) can be significant sources of volatile organic compounds, until recently characterizing emissions from consumer products has received relatively little attention. Many considerations that must be addressed in designing studies of consumer product emissions are similar to those addressed in studies of the emissions from building materials and combustion appliances. These similarities are discussed and, in addition, the considerations unique to studies of consumer product emissions are discussed with reference to an ongoing study of consumer products that contain methylene chloride. These unique considerations include bulk chemical analysis, the form of the product (e.g. liquid, aerosol or paste) and the related consumer usage pattern. The issue of personal exposure of the product user vs the average area concentration resulting from product use must be considered, as well as the challenge of incorporating results into predictive models that adequately treat the effect of different usage patterns. Finally, post-study considerations, such as exploring new issues discovered in the study, studying similar products, and validating predictive models through extension into field studies are summarized.

  4. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician?s guide


    Lubbe, Welma; ten Ham-Baloyi, Wilma


    Background The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. Discussion Suck-swallow-breathe coordina...

  5. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians? (United States)

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


    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.

  6. Perspective: Entering uncharted waters: navigating the transition from trainee to career for the nonphysician clinician-scientist. (United States)

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


    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.

  7. Feedback mechanisms of change: How problem alerts reported by youth clients and their caregivers impact clinician-reported session content (United States)

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


    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

  8. Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions. (United States)

    Haider, Adil H; Schneider, Eric B; Sriram, N; Dossick, Deborah S; Scott, Valerie K; Swoboda, Sandra M; Losonczy, Lia; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A; Freischlag, Julie A


    Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012. We administered clinical vignettes, each with 3 management questions. Eight vignettes assessed the relationship between unconscious bias and clinical decision making. We performed ordered logistic regression analysis on the Implicit Association Test (IAT) scores and used multivariable analysis to determine whether implicit bias was associated with the vignette responses. Differential response times (D scores) on the IAT as a surrogate for unconscious bias. Patient management vignettes varied by patient race or social class. Resulting D scores were calculated for each management decision. In total, 215 clinicians were included and consisted of 74 attending surgeons, 32 fellows, 86 residents, 19 interns, and 4 physicians with an undetermined level of education. Specialties included surgery (32.1%), anesthesia (18.1%), emergency medicine (18.1%), orthopedics (7.9%), otolaryngology (7.0%), neurosurgery (7.0%), critical care (6.0%), and urology (2.8%); 1.9% did not report a departmental affiliation. Implicit race and social class biases were present in most respondents. Among all clinicians, mean IAT D scores for race and social class were 0.42 (95% CI, 0.37-0.48) and 0.71 (95% CI, 0.65-0.78), respectively. Race and class scores were similar across departments (general surgery, orthopedics, urology, etc), race, or age. Women demonstrated less bias concerning race (mean IAT D score, 0.39 [95% CI, 0.29-0.49]) and social class (mean IAT D score

  9. Geographic Distribution of Nonphysician Clinicians Who Independently Billed Medicare for Common Dermatologic Services in 2014. (United States)

    Adamson, Adewole S; Suarez, Elizabeth A; McDaniel, Philip; Leiphart, Paul A; Zeitany, Alana; Kirby, Joslyn S


    Nurse practitioners (NPs) and physician assistants (PAs) are nonphysician clinicians (NPCs) who can deliver dermatology services. Many of these services are provided independently. Little is known about the types of services provided or where NPCs provide independent care. To examine characteristics of dermatology care for Medicare enrollees billed independently by NPCs. Retrospective review of the 2014 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File, which reflects fee-for-service payments to clinicians for services rendered to Medicare beneficiaries. Clinician location was matched with county-level demographic data from the American Community Survey, US Census Bureau. Clinicians identified using National Provider Identifier as NPs or PAs with at least 11 claims for common dermatology-associated Healthcare Common Procedure Coding System procedure codes were included. Total services provided by service type category, density of dermatologists and nondermatologists who perform dermatology-related services, and geographic location by county. Among the cohort of NPCs were 824 NPs (770 [93.5%] female) and 2083 PAs (1602 [76.9%] female) who independently billed Medicare $59 438 802 and $171 645 943, respectively. Dermatologists were affiliated with 2667 (92%) independently billing NPCs. Most payments were for non-evaluation and management services including destruction of premalignant lesions, biopsies, excisions of skin cancer, surgical repairs, flaps/grafts, and interpretation of pathologic analysis. Nurse practitioners and PAs billed for a similar distribution of service categories overall. A total of 2062 (70.9%) NPCs practiced in counties with dermatologist density of greater than 4 per 100 000 population. Only 3.0% (86) of independently billing NPCs practiced in counties without a dermatologist. Both dermatologists and NPCs were less likely to be in rural counties than in urban counties. Nonphysician

  10. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew


    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  11. Globalization of consumer confidence

    Directory of Open Access Journals (Sweden)

    Çelik Sadullah


    Full Text Available The globalization of world economies and the importance of nowcasting analysis have been at the core of the recent literature. Nevertheless, these two strands of research are hardly coupled. This study aims to fill this gap through examining the globalization of the consumer confidence index (CCI by applying conventional and unconventional econometric methods. The US CCI is used as the benchmark in tests of comovement among the CCIs of several developing and developed countries, with the data sets divided into three sub-periods: global liquidity abundance, the Great Recession, and postcrisis. The existence and/or degree of globalization of the CCIs vary according to the period, whereas globalization in the form of coherence and similar paths is observed only during the Great Recession and, surprisingly, stronger in developing/emerging countries.

  12. Consumer Protection in Cyberspace

    Directory of Open Access Journals (Sweden)

    Oscar H. Gandy, Jr.


    Full Text Available This critical essay introduces the problem of discrimination enabled through the use of transaction-generated-information derived from the analysis of user behaviors within the network environment. The essay begins by describing how segments of the population that are already vulnerable become further victimized through the strategic use of discriminatory algorithms in support of identification, classification, segmentation, and targeting. In response, it evaluates a set of policy options that might be used to limit the harm and compensate the victims of these inherently dangerous technologies. Traditional approaches that stress the protection of privacy through restrictions on the collection and use of personal information are compared with alternatives based on individual and class actions under tort law, as well as more traditional regulatory approaches developed in the area of consumer products safety and environmental regulation.

  13. Food safety and consumer behaviour

    DEFF Research Database (Denmark)

    Frewer, Lynn; Fischer, Arnout; Scholderer, Joachim


    Food safety is a priority for many consumers, and there is an expectation throughout society that the food supplied for human consumption is safe and nutritious to eat. Understanding technical risk estimates alone, however, will not explain the risk-related behaviours of consumers. On the one hand...... appropriate risk mitigation measures through the food chain, not least in the domestic kitchen. However, factors related to consumer psychology may increase the risks to consumers as they produce barriers to self-protective behaviours (Frewer & Fischer, in press; Worsfold & Griffith, 1997). In contrast...... communities have frequently bemoaned negative consumer attitudes towards some food technologies, such as genetic engineering, while failing to consider the origins of these consumer attitudes. The behaviour of consumers in relation to food safety issues can only be properly understood if there is systematic...

  14. Consumer perception of bread quality. (United States)

    Gellynck, Xavier; Kühne, Bianka; Van Bockstaele, Filip; Van de Walle, Davy; Dewettinck, Koen


    Bread contains a wide range of important nutritional components which provide a positive effect on human health. However, the consumption of bread is declining during the last decades. This is due to factors such as changing eating patterns and an increasing choice of substitutes like breakfast cereals and fast foods. The aim of this study is to investigate consumer's quality perception of bread towards sensory, health and nutrition attributes. Four consumer segments are identified based on these attributes. The different consumer segments comprise consumers being positive to all three quality aspects of bread ("enthusiastic") as wells as consumers perceiving bread strongly as "tasteless", "non-nutritious" or "unhealthy". Moreover, factors are identified which influence the consumers' quality perception of bread. The results of our study may help health professionals and policy makers to systematically inform consumers about the positive effects of bread based on its components. Furthermore, firms can use the results to build up tailor-made marketing strategies.

  15. The Relationship between Clinicians' Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder (United States)

    Hedley, Darren; Brewer, Neil; Nevill, Rose; Uljarevic, Mirko; Butter, Eric; Mulick, James A.


    The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical…

  16. Optical modulator including grapene (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang


    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  17. Patient cues and symptoms of psychosocial distress: what predicts assessment and treatment of distress by oncology clinicians? (United States)

    Sheldon, Lisa Kennedy; Blonquist, Traci M; Hilaire, Dany M; Hong, Fangxin; Berry, Donna L


    Psychosocial concerns arise after a cancer diagnosis and during treatment requiring oncology clinicians to initiate discussions to identify distress. This study examined patient-clinician communication about psychosocial concerns and predictors of assessment and treatment/referral for distress. Secondary analysis of existing dataset coded to explore patient-clinician communication during ambulatory visits in two comprehensive cancer centers was carried out. Sample included adult patients with various cancers and stages. Dataset included audio-recordings and symptom/QOL reports 4-6 weeks after starting treatment from all distressed patients (n = 66) in parent study and random sample of nondistressed patients (n = 23). Distressed patients had moderate-to-severe depression (Patient Health Questionnaire-9 scores ≥10) and/or poor emotional functioning (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire emotional function scores Medical Interview Aural Rating System. The remaining patients gave 222 cues of psychosocial concerns: 183 from 46 distressed patients and 39 from nine nondistressed patients. Distressed patients were younger, were female, had higher symptom burden, and/or gave more cues. Significantly, more distressed patients had at least one cue/visit. Clinicians initiated 62% of discussions overall with no statistical difference between distressed and nondistressed groups. More explicit cues and more than four cues predicted treatment/referral for distress. Distressed patients were younger, were female, had higher symptom burden, and/or gave more verbal cues. Clinicians responded to explicit and more frequent cues by providing treatment and/or referrals for distress. Further exploration is needed regarding clinician factors related to assessment of psychosocial concerns. Copyright © 2014 John Wiley & Sons, Ltd.

  18. Consumer perceptions of organic wine

    Directory of Open Access Journals (Sweden)



    Full Text Available The paper develops a study on the Romanians’ attitudes towards the organic wines. The analysis has been done in two stages – at a quantitative level and a qualitative one. The quantitative study has been done on a sample of 122 respondents – consumers and non-consumersin low percentage. The questionnaire investigated the general perception of wines, and included a dedicated section for the organic wines, addressed to the respondents aware of this product.The qualitative stage has been realized through a sensorial analysis, where three white wines and two red wines have been tasted by trained tasters. Among the five wines, one white – Chardonnay was organicwine. Both studies proved that the organic wine has a potential in Romania due to the sensorial qualities and people’s perception. However, the development of organic wine market won’t be a quick process and it will require first of all improving Romanians’ ‘organic’ culture.

  19. Clinician empathy is associated with differences in patient-clinician communication behaviors and higher medication self-efficacy in HIV care. (United States)

    Flickinger, Tabor E; Saha, Somnath; Roter, Debra; Korthuis, P Todd; Sharp, Victoria; Cohn, Jonathan; Eggly, Susan; Moore, Richard D; Beach, Mary Catherine


    We examined associations of clinicians' empathy with patient-clinician communication behaviors, patients' rating of care, and medication self-efficacy. We analyzed 435 adult patients and 45 clinicians at four outpatient HIV care sites in the United States. Negative binomial regressions investigated associations between clinician empathy and patient-clinician communication, assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions investigated associations between clinician empathy and patient ratings of clinician communication, overall satisfaction, and medication self-efficacy. Clinicians in the highest vs. lowest empathy tertile engaged in less explicitly emotional talk (IRR 0.79, pself-efficacy (OR 1.80, 95% CI 1.16-2.80; OR 2.13, 95% CI 1.37-3.32). Clinician empathy may be expressed through addressing patient engagement in care, by fostering cognitive, rather than primarily emotional, processing. Clinicians should consider enhancing their own empathic capacity, which may encourage patients' self-efficacy in medication adherence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Percussion use and training: a survey of music therapy clinicians. (United States)

    Scheffel, Stephanie; Matney, Bill


    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

  1. Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review. (United States)

    Lundgren, Ingela; Smith, Valerie; Nilsson, Christina; Vehvilainen-Julkunen, Katri; Nicoletti, Jane; Devane, Declan; Bernloehr, Annette; van Limbeek, Evelien; Lalor, Joan; Begley, Cecily


    The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC. The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, 'Effective Public Health Practice Project'. The primary outcome measure was VBAC rates. 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates. This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were

  2. Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.

    LENUS (Irish Health Repository)

    Lundgren, Ingela


    BackgroundThe number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.MethodsThe bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, `Effective Public Health Practice Project¿. The primary outcome measure was VBAC rates.Results238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.ConclusionsThis systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that

  3. Fathers with mental illness: implications for clinicians and health services. (United States)

    Fletcher, Richard J; Maharaj, O'Neil N; Fletcher Watson, Chloe H; May, Chris; Skeates, Nigel; Gruenert, Stefan


    A significant proportion of fathers living with their natural, adopted, step or foster children experience mental illness. Psychiatric illness among fathers can have a devastating impact on children's wellbeing, and even milder forms of paternal mental illness can have serious developmental effects on children. While several pathways linking paternal mental illness with poor child outcomes have been identified, fathers' impaired parenting is an important, potentially malleable factor. Clinicians can assist fathers with mental illness and their families by proactively inquiring about children and by exploring fathering-focused psychological support.

  4. Hospital clinicians' iPad use: an interim report. (United States)

    Witman, Lydia


    An increasing number of hospital libraries are supporting the use of tablet computers such as iPads for access to information resources. To date, this adoption of tablets is not supported by high-quality research evidence. This article provides an interim report on a formal study of clinicians' use of iPads in the hospital setting, currently being conducted at Pennsylvania Hospital in Philadelphia. Other hospital librarians may wish to consider similar factors when beginning to support the use of tablet computers at their own institutions.

  5. November 8, 2016: The day I became a White clinician. (United States)

    Bodnar, Susan


    When Donald Trump became president of the United States, I discovered that my clients who identified as Black saw me as a White clinician. With that came a host of nefarious attributions. To preserve therapeutic efficacy, and the genuine relationships with people about whom I cared, I had to distinguish myself from the president; thus, I learned not only how it feels to be seen through the bias of skin color but what I needed to do to identify as a person rather than a White person. "Welcome to my world," said one African American client. © 2018 Wiley Periodicals, Inc.

  6. Provisional materials: advances lead to extensive options for clinicians. (United States)

    Comisi, John C


    The progression of provisional materials to bis-acrylics has lead to such improvements as easier handling, improved compressive and tensile strength, less water sorption, and less shrinkage. The end-result is more options for clinicians for high-quality chairside provisional restorations. Newer provisional materials are easy to manipulate and bring increased comfort to the patient. This review of current products affirms that the choices of provisional materials available for the dental professional today are quite extensive and have advanced the quality of interim restorations.

  7. Canary: An NLP Platform for Clinicians and Researchers. (United States)

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


    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.

  8. Consumer Generated Advertising and Brand Trust in The Consumer Experience


    Reeves, C


    Increasing media clutter now exposes consumers to thousands of commercial messages every day (Gritten, 2007). The advent of the internet and technology over the past twenty years now means consumer-generated media such as blogs, podcasts, and online social networking sites are a further source (Gritten, 2007). Building brand trust remains, now more than ever, crucial to corporate marketers, in a world where consumers are losing faith in traditional marketing strategies. Social media has give...

  9. Breast-feeding and human immunodeficiency virus infection: assessment of knowledge among clinicians in Kenya. (United States)

    Murila, Florence; Obimbo, Moses M; Musoke, Rachel; Tsikhutsu, Isaac; Migiro, Santau; Ogeng'o, Julius


    In Kenya, human immunodeficiency virus (HIV) prevalence ranks among the highest in the world. Approximately 60 000 infections yearly are attributed to vertical transmission including the process of labour and breast-feeding. The vast of the population affected is in the developing world. Clinical officers and nurses play an important role in provision of primary health care to antenatal and postnatal mothers. There are a few studies that have explored the clinicians' knowledge on breast-feeding in the face of HIV and in relation to vertical transmission this being a vital component in prevention of maternal-to-child transmission. The aim of this study was to evaluate clinicians' knowledge on HIV in relation to breast-feeding in Kenya. A cross-sectional survey was conducted to assess knowledge of 161 clinical officers and nurses serving in the maternity and children' wards in various hospitals in Kenya. The participants were derived from all district and provincial referral facilities in Kenya. A preformatted questionnaire containing a series of questions on HIV and breast-feeding was administered to clinicians who were then scored and analyzed. All the 161 participants responded. Majority of clinicians (92%) were knowledgeable regarding prevention of mother-to-child transmission. Regarding HIV and breast-feeding, 49.7% thought expressed breast milk from HIV-positive mothers should be heated before being given. Majority (78.3%) thought breast milk should be given regardless of availability of alternatives. According to 74.5% of the participants, exclusive breast-feeding increased chances of HIV transmission. Two-thirds (66.5%) would recommend breast-feeding for mothers who do not know their HIV status (66.5%). This study observes that a majority of the clinicians have inadequate knowledge on breast-feeding in the face of HIV. There is need to promote training programmes on breast-feeding and transmission of HIV from mother to child. This can be done as in

  10. Consumer Empowerment Profile in Rural and Urban Area

    Directory of Open Access Journals (Sweden)

    Megawati Simanjuntak


    Full Text Available The purpose of this research was to analyze the profile of consumer empowerment and the influence of demographic characteristics, socio-economic status and cosmopoliteness on consumer empowerment in rural and urban area. The research finding indicated a low consumer empowerment in urban and rural area. In general, most respondents who were not categorized as empowered consumer were aged >37 years old, working in rural areas, included in income category ranged IDR 397,874.57/capita/month both in rural and urban areas, family size of ≤ 4 persons in rural areas,length of education ≤9 years in rural areas and not cosmopolite in rural areas. Higher level of education and the more cosmopolite the respondents would increase consumer empowerment both in ruraland urban area. One of the attempts in empowering consumers is by intensifying consumer education involving government, NGOs, and private sector.

  11. Measuring Consumer Engagement: A Review of Tools and Findings. (United States)

    Jacobs, Laurie M; Brindis, Claire D; Hughes, Dana; Kennedy, Caitlin E; Schmidt, Laura A


    Consumer engagement is increasingly emphasized in healthcare initiatives and has been a priority in healthcare reforms. Consumer engagement takes multiple forms, including increased involvement of consumers in their own care, in organizational design, and in broader policy decision-making processes. Determining the effectiveness of such involvement requires both effective measurement and empirical study, both of which have yet to be standardized or fully explored. In this review, we examine both existing measurement tools for consumer engagement and current empirical knowledge regarding the outcomes associated with each of three levels of consumer engagement. Although measurement and results at the level of direct care are more established, measurement of consumer engagement, let alone its effects at the organizational design or policy level, is less well developed. Building on our review, we make suggestions for how to fill the current gaps in understanding the measurement and outcomes of consumer engagement.

  12. How may consumer policy empower consumers for sustainable lifestyles?

    DEFF Research Database (Denmark)

    Thøgersen, John


    Consumer policy can empower consumers for changing lifestyles by reducing personal constraints and limitations, but it should also attempt to loosen some of the external constraints that make changes towards a more sustainable lifestyle difficult. In terms of reducing consumers' subjectively felt...... restrictions on their ability to change lifestyle, the two approaches are equivalent. Policies that increase a feeling of empowerment may also have a positive effect on consumers' motivation to make an effort, thus amplifying its effects. In this paper both types of constraints on lifestyle changes...

  13. How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation? (United States)

    Giles, Tracey; de Lacey, Sheryl; Muir-Cochrane, Eimear


    To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. Secondary analysis of an existing qualitative data set using deductive category application of content analysis. We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the

  14. Approaches to psychotherapy for borderline personality: demonstrations by four master clinicians. (United States)

    Hopwood, Christopher J; Swenson, Charles; Bateman, Anthony; Yeomans, Frank E; Gunderson, John G


    Several efficacious therapies for borderline personality disorder (BPD) now exist despite longstanding skepticism in the field regarding amenability to treatment. In this article, 4 master clinicians describe a brief interaction with an actress playing the part of a patient with BPD that occurred at the First Annual Meeting of the North American Society for the Study of Personality Disorders in Boston, April 2013. The approaches include dialectical behavior therapy, transference focused psychotherapy, mentalization based therapy, and good psychiatric management. The paper concludes with a discussion of what these approaches have in common, how they differ, and future directions for the treatment of BPD.

  15. Planning Ahead: Consumer Expenditure Patterns in Retirement. (United States)

    Paulin, Geofrey D.; Duly, Abby L.


    Looks at spending patterns for families who are near retirement and compares them with patterns of those who have already retired. Provides information about the impact of retirement on consumer spending. Includes appendices on the results of regression analysis and regression techniques. (Author/JOW)

  16. Consumer Views: Importance of Fuel Economy

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Mark [National Renewable Energy Lab. (NREL), Golden, CO (United States)


    This presentation includes data captured by the National Renewable Energy Laboratory (NREL) to support the U.S. Department of Energy's Vehicle Technologies Office (VTO) research efforts. The data capture consumer views on the importance of fuel economy amongst other vehicle attributes and views on which alternative fuel types would be the best and worst replacements for gasoline.

  17. Consumer acceptance of irradiated food

    Energy Technology Data Exchange (ETDEWEB)

    Loaharanu, P. [Head, Food Preservation Section, Joint FAO/ IAEA Division of Nuclear Techniques in Food and Agriculture, Wagramerstr. 5, A-1400, Vienna (Austria)


    There was a widely held opinion during the 1970`s and 1980`s that consumers would be reluctant to purchase irradiated food, as it was perceived that consumers would confuse irradiated food with food contaminated by radionuclides. Indeed, a number of consumer attitude surveys conducted in several western countries during these two decades demonstrated that the concerns of consumers on irradiated food varied from very concerned to seriously concerned.This paper attempts to review parameters conducting in measuring consumer acceptance of irradiated food during the past three decades and to project the trends on this subject. It is believed that important lessons learned from past studies will guide further efforts to market irradiated food with wide consumer acceptance in the future. (Author)

  18. Food quality and the consumers

    DEFF Research Database (Denmark)

    Lassen, Jesper


    certain attributes of food products or materials which may contradict consumer intentions. Economic pressure to reduce costs may lead to deteriorating quality. 5. While the information supplied by the market may be enough to give feed back on products launched based on the trial-and-error method......Executive Summary: 1. Consumers and professionals in the food sector will differ in the way they view food quality. Professionals have knowledge and resources to establish quality based on objective criteria. Consumers lack both, and they are typically concerned with many different products....... Quality perception is therefore the best way to describe how consumers relate to the quality of food products. 2. The way consumers perceive quality is only imperfectly related to how they act on the market. There are many reasons why food choice can deviate from consumer intentions: lack of economic...

  19. Consumer acceptance of irradiated food

    International Nuclear Information System (INIS)

    Loaharanu, P.


    There was a widely held opinion during the 1970's and 1980's that consumers would be reluctant to purchase irradiated food, as it was perceived that consumers would confuse irradiated food with food contaminated by radionuclides. Indeed, a number of consumer attitude surveys conducted in several western countries during these two decades demonstrated that the concerns of consumers on irradiated food varied from very concerned to seriously concerned.This paper attempts to review parameters conducting in measuring consumer acceptance of irradiated food during the past three decades and to project the trends on this subject. It is believed that important lessons learned from past studies will guide further efforts to market irradiated food with wide consumer acceptance in the future. (Author)

  20. Do attitudes predict consumer's behavior?

    Directory of Open Access Journals (Sweden)

    Đelošević Ivana


    Full Text Available There are many themes in marketing to analyze the psychological and marketing aspect of research. The survey of consumer attitudes is one of them. The consumer attitudes have long been discussed and written about. For this purpose, numerous theories, models and researches have emerged. The research of powerful feelings of consumers towards products is something that marketers are constantly trying to achieve. Therefore it is very important for them to understand the factors affecting the attitudes of consumers. Issues related to consumers' attitudes have always been subject matter of the marketers who are trying to keep and maintain the positive and minimize negative attitudes towards the products and services of company. Bearing in the mind that attitudes play a central role in purchase decision, marketers are trying to explore the relation between attitudes and behavior of consumers.

  1. Review of The psychotherapist's own psychotherapy: Patient and clinician perspectives. (United States)

    Wong, Philip S


    Reviews the book, The psychotherapist's own psychotherapy: Patient and clinician perspectives by Jesse D. Geller, John C. Norcross, and David E. Orlinsky (2005). The editors of this book have two aims: 1) "to synthesize and explicate the accumulated knowledge on psychotherapy with psychotherapists," and 2) "to provide clinically tested and empirically grounded assistance to psychotherapists treating fellow therapists, as well as to those clinicians who seek personal treatment themselves." The editors seem to be walking a fine line between asserting their own integrative conclusions and setting the conditions for readers to arrive at conclusions on their own. The tendency is toward the latter. With this propensity in mind, readers might approach the book as a truly encyclopedic collection- best approached in piecemeal (nonintegrative) fashion, focusing on fascinating morsels that can stand alone. In contrast, for those readers who are drawn toward integration, the book may elicit contrasting experiences of deep familiarity and understanding, and disorienting befuddlement about what was just read. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  2. The nature of sexual desire: a clinician's perspective. (United States)

    Levine, Stephen B


    Sexual desire is the sum of the forces that lean us toward and away from sexual behavior. The ordinary spectrum of sexual desire's intensity ranges between aversion, disinclination, indifference, interest, need, and passion. Although many individuals have a characteristic pattern of desire throughout their adult lives, this spectrum evolves considerably over the life cycle. It is clinically useful to think of desire as consisting of drive (biological), motive (individual and relationship psychology), and wish (cultural) components. Four master variables--age, gender, social situation, and health--affect sexual desire so basically that many remain blind to their presence. Five dark paradoxes of desire envelop most people at some time in their privacy: (1) Drive and motive are not in sync; (2) Behavioral fidelity is often associated with longing for infidelity; (3) Despite moral proscriptions, lust is possible; (4) Familiarity diminishes sexual interest; and (5) Derogation enhances sexual expression. Clinicians cannot afford to simplify desire's inherent contradictions. Researchers must simplify desire in order to measure it. In both the clinician's and the researcher's hands, sexual desire is a slippery concept.

  3. Patient satisfaction with clinicians in colorectal 2-week wait clinics. (United States)

    Cock, Karen; Kent, Bridie


    To determine if patient satisfaction is affected by the clinician (nurse or doctor), conducting the colorectal 2-week wait (2ww) clinics. A prospective non-randomised comparative cohort study of 339 consecutive patients (divided by blind allocation into nurse-led (n=216) and doctor-led (n=123) cohorts) conducted over a 3-month period. Patient satisfaction in both cohorts was assessed by an adapted version of the Grogan et al validated patient satisfaction questionnaire. The questionnaire was piloted first and was found to have high internal reliability (Cronbach's alpha=0.91). The study had a response rate of 78% (n=258/331) and overall satisfaction scores showed 85% (n=149/175) of patients in the nurse-led cohort and 65% (n=54/83) of patients in the doctor-led cohort strongly agreed that they were satisfied with the care they received. Mean overall satisfaction scores in the two cohorts revealed that the nurse-led cohort achieved significantly more 'strongly agree' responses than the doctor-led cohort (ppatient satisfaction was affected by the clinician conducting the 2ww clinic, in that the nurse-led cohort displayed significantly higher patient satisfaction. However, there are areas that merit further research.

  4. Consumer evaluation of scab-resistant apple cultivars in Sweden

    Directory of Open Access Journals (Sweden)



    Full Text Available The feasibility of using untrained consumers for sensory evaluation was investigated on Swedish-grown scab-resistant apple cultivars in 2002 (11 cultivars and 2003 (15 cultivars. The consumers evaluated five cultivars each, including the control cultivar ‘Aroma’. Each cultivar was scored for appearance, texture, juiciness, taste and overall impression by a minimum of 100 consumers in 2002 and by 200 in 2003. All quality attributes were positively correlated when calculations were performed across all consumer scores, with overall impression and taste having the strongest association. ‘Rubinola’ and K:1160 emerged as the best liked cultivars overall. Cultivar means were analysed for relationships with some previously scored or measured variables and with consumer profile data. Positive correlations with overall impression were obtained for amount of red colour in 2002, and for sugar levels in 2003. Among consumer profile variables, age had the largest influence on consumer scores, with some indications that older consumers preferred (or at least tolerated soft-fleshed cultivars better than did younger consumers. Minimum number of consumers needed to obtain reliable results was determined by computer simulations indicating that the error rate became stabilized already with 50 consumers.;

  5. Consumers in Slovenia: values, personality types and consumerist attitudes

    Directory of Open Access Journals (Sweden)

    Tomaž Kolar


    Full Text Available The aim of our paper is to investigate the links between terminal and instrumental values, personality types, consumer attitudes and behavior that are relevant to marketing decision-making. The understanding of the personality and values of individual consumers should enable us to predict their preferences and behavior. Our set of consumer attitudes and behavior includes reported peer influence on shopping behavior, consumer ethnocentrism, value shopping and hedonism in shopping. Two multidimensional statistical approaches are considered: a cluster analysis of the individual’s personality and values and a factor analysis of consumer attitudes and behavior. An analysis of data from a representative sample of 1,094 Slovenian consumers (PGM, Valicon, 2007 reveals five clusters: conscientious-non-agreeable consumers differ in their consumer attitudes from extroversive consumers, neurotic-with-low-values, open-with-high-values and agreeable-conscious-non-open consumers. Implications for marketing decision-making and strategy development are considered, together with a possible extension of the study to multiple national groups of consumers from Central and Eastern Europe (CEE.

  6. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships. (United States)

    Bell, Sigall K; Gerard, Macda; Fossa, Alan; Delbanco, Tom; Folcarelli, Patricia H; Sands, Kenneth E; Sarnoff Lee, Barbara; Walker, Jan


    OpenNotes, a national movement inviting patients to read their clinicians' notes online, may enhance safety through patient-reported documentation errors. To test an OpenNotes patient reporting tool focused on safety concerns. We invited 6225 patients through a patient portal to provide note feedback in a quality improvement pilot between August 2014 and 2015. A link at the end of the note led to a 9-question survey. Patient Relations personnel vetted responses, shared safety concerns with providers and documented whether changes were made. 2736/6225(44%) of patients read notes; among these, 1 in 12 patients used the tool, submitting 260 reports. Nearly all (96%) respondents reported understanding the note. Patients and care partners documented potential safety concerns in 23% of reports; 2% did not understand the care plan and 21% reported possible mistakes, including medications, existing health problems, something important missing from the note or current symptoms. Among these, 64% were definite or possible safety concerns on clinician review, and 57% of cases confirmed with patients resulted in a change to the record or care. The feedback tool exceeded the reporting rate of our ambulatory online clinician adverse event reporting system several-fold. After a year, 99% of patients and care partners found the tool valuable, 97% wanted it to continue, 98% reported unchanged or improved relationships with their clinician, and none of the providers in the small pilot reported worsening workflow or relationships with patients. Patients and care partners reported potential safety concerns in about one-quarter of reports, often resulting in a change to the record or care. Early data from an OpenNotes patient reporting tool may help engage patients as safety partners without apparent negative consequences for clinician workflow or patient-clinician relationships. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  7. Evaluation of the implementation of a bowel management protocol in intensive care: effect on clinician practices and patient outcomes. (United States)

    Knowles, Serena; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy


    To evaluate the effect of a multifaceted implementation of a bowel management protocol on outcomes for intensive care patients, in particular the incidence of constipation and diarrhoea, and on clinicians' bowel management practices. Complications associated with poor bowel management for critically ill patients result in adverse outcomes. Implementation of protocols requires strategies proven to change clinician behaviour. Before and after study. Our bowel management protocol was implemented using three evidence-based elements: education sessions, printed educational materials in the form of a fact sheet and reminders. We retrospectively collected data from patients' medical records admitted at two time points within three Sydney metropolitan intensive care units (preimplementation, n = 101; postimplementation, n = 107). No significant difference was found in the incidence of constipation and diarrhoea pre and postimplementation of the protocol. Seventy-two per cent (n = 73) of patients preimplementation and 70% (n = 75) of patients postimplementation experienced one or more episodes of constipation (bowels not open for 72 hours or greater), and 16% (n = 16) of patients preimplementation and 20% (n = 21) of patients postimplementation experienced one or more episodes of diarrhoea. There was a slight nonsignificant increase in bowel assessment on admission by medical officers postimplementation (pre, 47%, n = 48; post, 60%, n = 64). Targeted multifaceted implementation of a bowel management protocol did not have an impact on the incidence of constipation or diarrhoea for intensive care patients or on clinician practices. The lack of impact on patient outcomes may be due to clinicians' nonadherence to our bowel management protocol. Reasons clinicians' practices did not change may include the influences of clinical decision-making on behaviour. This study highlights difficulties inherent in changing clinician behaviour and practices to improve patient outcomes

  8. Real-time feedback on nonverbal clinical communication. Theoretical framework and clinician acceptance of ambient visual design. (United States)

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


    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

  9. Credit constraints and consumer spending


    Beaton, Kimberly


    This paper examines the relationship between aggregate consumer spending and credit availability in the United States. The author finds that consumer spending falls (rises) in response to a reduction (increase) in credit availability. Moreover, she provides a formal assessment of the possibility that credit availability is particularly important for consumer spending when it undergoes large changes. In this respect, she estimates a consumption function in which only large expansions and contr...

  10. Financial literacy and consumer loans


    Lukešová, Martina


    The Bachelor's thesis deals with problems of financial literacy. The problem with financial literacy is an extensive topic, therefore the paper focuses only on consumer loans which belong to the most used products by citizens. The thesis gives basic information about companies, which offer consumer loans and warn against incorrect financial institutions and loan sharks. One of the chapters dedicates the indicator of advantages of consumer loans. It shows issues of indicator annual percentage ...

  11. Consumer protection in electronic commerce

    Directory of Open Access Journals (Sweden)

    Nicoleta Andreea NEACŞU


    Full Text Available Electronic commerce is one of the most important aspects of the Internet and allows people to buy instant. Fast and easy development of e-commerce has led to the necessity of consumer protection in cyberspace, where trade takes place, so as to ensure consumer safety and security matters. This article examines e-commerce in terms of consumer protection and data security, which concerns equally all stakeholders in the electronic market: buyers, sellers, banks, courier cargo and other participants.

  12. Consumer Networks and Firm Reputation

    DEFF Research Database (Denmark)

    Huck, Steffen; Lünser, Gabriele K.; Tyran, Jean-Robert

    Arguing that consumers are the carriers of firms' reputations, we examine the role of consumer networks for trust in markets that suffer from moral hazard. When consumers are embedded in a network, they can exchange information with their neighbours about their private experiences with different...... sellers. We find that such information exchange fosters firms' incentives for reputation building and, thus, enhances trust and efficiency in markets. This efficiency-enhancing effect is already achieved with a rather low level of network density...

  13. Cognitive style and consumer innovativeness


    Foxall, Gordon R.; Haskins, Christopher


    The identification of consumer innovators offers marketing managers the opportunity to tailor new products to the buyers who initiate the diffusion of innovations. Progress has been made in identifying such consumers in economic and social terms, but there are advantages of cost and convenience in isolating the personality profiles of innovators, especially during prelaunch product testing. But innovative consumers' distinctive personality traits have proved elusive. This paper reports an inv...

  14. Women as Video Game Consumers


    Kiviranta, Hanna


    The purpose of this Thesis is to study women as video game consumers through the games that they play. This was done by case studies on the content of five video games from genres that statistically are popular amongst women. To introduce the topic and to build the theoretical framework, the key terms and the video game industry are introduced. The reader is acquainted with theories on consumer behaviour, buying processes and factors that influence our consuming habits. These aspects are...

  15. Consumer behavior in corporate banking

    Directory of Open Access Journals (Sweden)

    Đorđević Bojan


    Full Text Available Deregulation and the emergence of new forms of technology have created highly competitive market conditions which have had a critical impact upon consumer behavior in corporate banking. Bank providers must, therefore, attempt to better understand their corporate clients in an attempt not only to anticipate but also to influence and determine consumer buying behavior. The paper accordingly presents and develops a model which attempts to articulate and classify corporate consumer behavior in the purchasing of financial products and services.

  16. Empirical analysis of consumer behavior


    Huang, Yufeng


    This thesis consists of three essays in quantitative marketing, focusing on structural empirical analysis of consumer behavior. In the first essay, he investigates the role of a consumer's skill of product usage, and its imperfect transferability across brands, in her product choice. It shows that experienced consumers have higher but more specialized demand towards high-end products. The second essay investigates a consumer’s choice of considering a product before purchase. Because considera...

  17. Do attitudes predict consumer's behavior?


    Đelošević Ivana; Dević Željko; Spasojević Branka


    There are many themes in marketing to analyze the psychological and marketing aspect of research. The survey of consumer attitudes is one of them. The consumer attitudes have long been discussed and written about. For this purpose, numerous theories, models and researches have emerged. The research of powerful feelings of consumers towards products is something that marketers are constantly trying to achieve. Therefore it is very important for them to understand the factors affecting the atti...

  18. Priority order and consumer behavior


    浜田, 文雅


    This paper attempts to propose an alternative microeconomic theory of consumer behavior in terms of distributional approach. A model determining the optimal priority order of and demand for consumer goods not only of the homogeneous type but also of the heterogeneous type under the budget constraint of a consumer and the market conditions is presented. Utility of a commodity is decomposed into the value in use and the value in quality. The latter is assumed to depend on personal income level....

  19. Consumer Online Grocery Buying Intention


    Hansen, Torben; Jensen, Jan Møller; Solgaard, Hans Stubbe


    This paper tests the ability of two consumer theories - the theory of reasoned action and the theory of planned behavior - in predicting consumer online grocery buying intention. In addition, a comparison of the two theories is conducted. Data were collected from two web-based surveys of Danish (n=1222) and Swedish (n=1038) consumers using self-administered questionnaires. Lisrel results suggest that the theory of planned behavior (with the inclusion of a path from subjective norm to attitude...

  20. Mental health consumers' with medical co-morbidity experience of the transition through tertiary medical services to primary care. (United States)

    Cranwell, Kate; Polacsek, Meg; McCann, Terence V


    Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers' experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. © 2016 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd. on behalf of Australian College of Mental Health Nurses Inc.

  1. How Best To Evaluate Clinician-Educators and Teachers for Promotion? (United States)

    Glick, Thomas H.


    Asserting that evaluation of clinician-educators should be oriented to the impact of their work, offers an "impact map" as a way of graphically portraying the track record of an individual clinician-educator. (EV)

  2. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. (United States)

    Pollak, Kathryn I; Nagy, Paul; Bigger, John; Bilheimer, Alicia; Lyna, Pauline; Gao, Xiaomei; Lancaster, Michael; Watkins, R Chip; Johnson, Fred; Batish, Sanjay; Skelton, Joseph A; Armstrong, Sarah


    Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Consumer demand and quality assurance

    DEFF Research Database (Denmark)

    Grunert, Klaus G; Wognum, Nel; Trienekens, Jacques


    Consumers differ in their demands, and this mau have implications for the type of supply chain governance that is most suitable for serving them. We present a segmentation of pork consumers in the EU based on their food-related lifestyles and demand for different pork products. We then present...... an inventory of pork chain governance and quality management systems, also resulting from a pan-European study, and attempt to match types of chains to consumer segments, arguing that the type of quality demanded by the consumers has implications especially for the quality management system governing the chain...

  4. Psychological Factors Influencing Consumer Behaviour


    Vainikka, Bianca


    This paper’s aim is to provide an in-depth elucidation of the many aspects that influence consumer behaviour. The study of consumer behaviour emphasizes the “why” and “how” questions involved in decision making and buying behaviour. This exciting field visits a dynamic blend of themes of consumer marketing strategies, psychology and behavioural discipline. Consumer behaviour in this day and age is highly applicable to modern society as it is an integral part of our everyday lives. This paper ...

  5. Clinicians' attitude towards family planning and timing of diagnosis in autosomal dominant polycystic kidney disease. (United States)

    De Rechter, Stéphanie; Kringen, Jonathan; Janssens, Peter; Liebau, Max Christoph; Devriendt, Koenraad; Levtchenko, Elena; Bergmann, Carsten; Jouret, François; Bammens, Bert; Borry, Pascal; Schaefer, Franz; Mekahli, Djalila


    Several ethical aspects in the management of Autosomal Dominant Polycystic Kidney Disease (ADPKD) are still controversial, including family planning and testing for disease presence in at-risk individuals. We performed an online survey aiming to assess the opinion and current clinical practice of European pediatric and adult nephrologists, as well as geneticists. A total of 410 clinicians (53% male, mean (SD) age of 48 (10) years) responded, including 216 pediatric nephrologists, 151 adult nephrologists, and 43 clinical geneticists. While the 3 groups agreed to encourage clinical testing in asymptomatic ADPKD minors and adults, only geneticists would recommend genetic testing in asymptomatic at-risk adults (Pdiagnosis, termination of pregnancy and pre-implantation genetic diagnosis (PGD) for ADPKD. Particularly, PGD is ethically justified according to geneticists (4.48 (1.63)), whereas pediatric (3.08 (1.78); Pplanning, including PGD. The present data highlight the need for a consensus among clinicians, to avoid that ADPKD families are being given conflicting information.

  6. Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico. (United States)

    Hoffman, Steven J; Guindon, G Emmanuel; Lavis, John N; Randhawa, Harkanwal; Becerra-Posada, Francisco; Boupha, Boungnong; Shi, Guang; Turdaliyeva, Botagoz S


    It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. This

  7. Price Intransparency, Consumer Decision Making and European Consumer Law

    NARCIS (Netherlands)

    W.H. van Boom (Willem)


    textabstractPrice comparison is a basic element of competition. For comparison to work, at least prices need to be transparent. Moreover, price is usually a focal point in consumer thinking and deciding on transactions. Hence, obfuscating prices can be detrimental to consumers. Therefore, it is

  8. Consumer Behavior: Developing Skills for Assertiveness. Consumer Education Training Module. (United States)

    Thayer, Lou

    The goal of this inservice guide for teaching consumer education at the secondary and adult level is to help consumers become more assertive when buying goods and services. A major section in the guide defines assertiveness. The four basic components of assertive behavior are the ability to express emotions openly, the capacity to exercise one's…

  9. fundamental consumer rights under the consumer protection act 68

    African Journals Online (AJOL)

    Castle walk

    resolution agent. These different enforcement mechanisms may lead to confusion and forum-shopping in an instance in which an aggrieved consumer has to ...... 3.4.5 Sales records. Section 26 provides that a written record of each transaction must be given to the consumer. 224. The Act further provides for the type of ...


    Directory of Open Access Journals (Sweden)

    Eduardo Biagi Almeida Santos


    Full Text Available This present paper shows the influence of music used in a retail environment in relation to consumer behavior. For obtaining the information, we based this research on a literature review in national and international journals, by 4 databases including: Proquest, EBSCO Host, CAPES periódicos and Mendeley, in the period of 2008 and 2012, by the keywords: music behavior, music in retail environment, background music, music consumer, environmental music, music and consumer behavior and music in purchase decision. The use of music has been applied in traditional areas such as psychology, trough the discipline of environmental psychology (DONOVAN & ROSSITER, 1982.; marketers use this tool as a motivator in a purchase decision in different shopping environments. This paper shows that there is an influence of background music in purchase decision but it’s still needs an explanations of some variables. At the end this paper will present some suggestions for future research.


    Spector-Bagdady, Kayte


    The market for direct-to-consumer (DTC) health services continues to grow rapidly with former patients converting to customers for the opportunity to purchase varied diagnostic tests without the involvement of their clinician. For the first time a DTC genetic testing company is advertising health-related reports "that meet [Food and Drug Administration] standards for being clinically and scientifically valid." Ethicists and regulatory agencies alike have recognized the need for a more informed transaction in the DTC context, but how should we classify a commercial transaction for something normally protected by a duty of care? How can we assure informed agreements in an industry with terms and conditions as varied as the services performed? The doctrine of "informed consent" began as an ethical construct building on the promise of beneficence in the clinical relationship and elevating the principle of autonomy--but in the DTC context should we hold providers to legal standards of informed consent and associated medical malpractice liability, or contractual obligations where consumers would seek remedy for breach? This Article analyzes the fine balance that must be struck in an industry where companies are selling services for entertainment or non-medical purposes that possess the capacity to produce serious and disquieting medical information. It begins by reviewing current standards of consent in the clinical setting from both a legal and ethical perspective and then lays forth current standards for DTC consent using two currently controversial case studies: that of keepsake fetal ultrasound and genetic testing. DTC keepsake ultrasound and genetic testing providers attempt to de-medicalize the devices used for these procedures from their intended medical uses to non-medical uses. But while keepsake ultrasound is marketed as "intended for entertainment purposes only," it can provide medical information as an incidental finding. 23andMe currently purports to be the

  12. Consumer sexual relationships in a forensic mental health hospital: perceptions of nurses and consumers. (United States)

    Quinn, Chris; Happell, Brenda


    The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes 'therapeutic', 'feeling normal', 'restrictions and barriers', and 'lack of support and secrecy'. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required. © 2014 Australian College of Mental Health Nurses Inc.

  13. Sustainable Consumer Behaviour: A Collection of Empirical Studies

    Directory of Open Access Journals (Sweden)

    Gerrit Antonides


    Full Text Available We summarise the contributions in this special issue on sustainable consumer behaviour and place them in perspective. Several studies focus on macro- and meso-issues, and others on micro-issues of consumer behaviour. The studies employ a variety of methods, including surveys, field experiments, eye tracking, scale development, and contingent valuation. The 12 contributions from authors of 13 different countries show the wide and varied application of consumer research focused on sustainability issues.

  14. Losing Consciousness: Automatic Influences on Consumer Judgment, Behavior, and Motivation.


    Bargh, John A


    Consumer research has largely missed out on two key developments in social cognition research: the growing evidence that much of social judgment and behavior occur without conscious awareness or intent and the substantial moderating influence of social- and self-related goal pursuits on basic cognitive and reasoning processes. This evidence is described and its implications are drawn for nonconscious--including subliminal--influences on consumer behavior. The consumer research domain appears ...

  15. Prison Clinicians' Perceptions of Antisocial Personality Disorder as a Formal Diagnosis. (United States)

    Stevens, Gail Flint


    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…

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

    NARCIS (Netherlands)

    de Vries, A.M.; de Roten, Y.; Meystre, C.; Passchier, J.; Depland, J.N.; Stiefel, F.


    Objective The aim of this study was to review the literature on clinician characteristics influencing patient-clinician communication or patient outcome in oncology. Methods Studies investigating the association of clinician characteristics with quality of communication and with outcome for adult

  17. Prediction of mandibular rotation: an empirical test of clinician performance. (United States)

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


    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


    Directory of Open Access Journals (Sweden)

    Mihaela-Irina IONESCU


    Full Text Available The article provides an image to the point on information provided to consumers before the conclusion of a credit contract, starting with the importance of information and ending with the legal framework. A high consumer protection may be achieved primarily through consumer information. The complexity of banking services but also the vulnerability of consumers in relation to the banks and the unbalanced relationship led to the need to develop specific legislation that clearly establishes the rights and obligations of the parties of a credit agreement for consumers. In this regard, in 2008, after many debates, Directive 2008/48/EC of the European Parliament and of the Council on credit agreements for consumers was adopted. At national level, the Directive was transposed by the Government Emergency Ordinance no. 50/2010 on credit agreements for consumers. Taking into account national specificities, such as lack of experience of consumers in financial products, the irresponsible lending and the unfair practices of creditors, the national act includes wider provisions than the European Directive, such as those relating to fees limitations or those related to the calculation of the variable interest rate. Also the GEO no 50/2010 applies to all credit agreements concluded by consumers and creditors. As regards the advertising, any advertisement shall include a series of standard information. Also, pre-contractual information is standard information, is provided to consumers 15 days before the contract is concluded and is transmitted through the “European Consumer Credit Information sheet Standard”. The article presents when, how and what information should be given to consumers and insists on the importance of annual percentage rate and to what consumers should pay attention in order to be able to compare different offers.

  19. Consumers' conceptualization of ultra-processed foods. (United States)

    Ares, Gastón; Vidal, Leticia; Allegue, Gimena; Giménez, Ana; Bandeira, Elisa; Moratorio, Ximena; Molina, Verónika; Curutchet, María Rosa


    Consumption of ultra-processed foods has been associated with low diet quality, obesity and other non-communicable diseases. This situation makes it necessary to develop educational campaigns to discourage consumers from substituting meals based on unprocessed or minimally processed foods by ultra-processed foods. In this context, the aim of the present work was to investigate how consumers conceptualize the term ultra-processed foods and to evaluate if the foods they perceive as ultra-processed are in concordance with the products included in the NOVA classification system. An online study was carried out with 2381 participants. They were asked to explain what they understood by ultra-processed foods and to list foods that can be considered ultra-processed. Responses were analysed using inductive coding. The great majority of the participants was able to provide an explanation of what ultra-processed foods are, which was similar to the definition described in the literature. Most of the participants described ultra-processed foods as highly processed products that usually contain additives and other artificial ingredients, stressing that they have low nutritional quality and are unhealthful. The most relevant products for consumers' conceptualization of the term were in agreement with the NOVA classification system and included processed meats, soft drinks, snacks, burgers, powdered and packaged soups and noodles. However, some of the participants perceived processed foods, culinary ingredients and even some minimally processed foods as ultra-processed. This suggests that in order to accurately convey their message, educational campaigns aimed at discouraging consumers from consuming ultra-processed foods should include a clear definition of the term and describe some of their specific characteristics, such as the type of ingredients included in their formulation and their nutritional composition. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Transportation Consumer Education Curriculum Guide. (United States)

    Finn, Peter; And Others

    Materials in this curriculum guide represent a selection of the major transportation consumer topics and ideas and are designed to set the stage for more intensive transportation consumer education curriculum development and teacher efforts. (Eleven manuals covering the four transportation topics of public transportation, transportation and the…

  1. Consumer acceptance of functional foods

    DEFF Research Database (Denmark)

    Frewer, Lynn J.; Scholderer, Joachim; Lambert, Nigel


    In the past, it has been assumed that consumers would accept novel foods if there is a concrete and tangible consumer benefit associated with them, which implies that those functional foods would quickly be accepted. However, there is evidence that individuals are likely to differ in the extent t...

  2. Archives: Journal of Consumer Sciences

    African Journals Online (AJOL)

    Items 1 - 24 of 24 ... Archives: Journal of Consumer Sciences. Journal Home > Archives: Journal of Consumer Sciences. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 24 of 24 ...

  3. The Vulnerability of Elderly Consumers. (United States)

    McGhee, Jerrie L.


    Reviews research on the vulnerability of the elderly to consumer fraud. Patterns of consumption, situational characteristics, education and product knowledge, psychological losses, social isolation, and psychosocial transitions influence the elderly's vulnerability and ability to cope with consumer abuse. Higher educational attainment and greater…

  4. Price Discrimination: Lessons for Consumers. (United States)

    Maynes, E. Scott


    Explains price and product discrimination, showing how intelligent consumers can achieve increased purchasing power of their income and discusses how consumer educators can explain this discrimination. Evaluates the pros and cons of price/product discrimination from the social viewpoint. (Author/JOW)

  5. How consumers choose health insurance. (United States)

    Chakraborty, G; Ettenson, R; Gaeth, G


    The authors used choice-based conjoint analysis to model consumers' decision processes when evaluating and selecting health insurance in a multiplan environment. Results indicate that consumer choice is affected by as many as 19 attributes, some of which have received little attention in previous studies. Moreover, the importance of the attributes varies across different demographic segments, giving marketers several targeting opportunities.

  6. Empirical analysis of consumer behavior

    NARCIS (Netherlands)

    Huang, Yufeng


    This thesis consists of three essays in quantitative marketing, focusing on structural empirical analysis of consumer behavior. In the first essay, he investigates the role of a consumer's skill of product usage, and its imperfect transferability across brands, in her product choice. It shows that

  7. Attention, motivation, and consumer judgement

    DEFF Research Database (Denmark)

    Orquin, Jacob Lund

    and what happens when they process it? The dissertation contains four papers which report nine different experiments. The first three papers are concerned with the question of what health information consumers process while the last paper explores the consequences of strategically exposing consumers...

  8. Influencing the online consumer's behavior

    NARCIS (Netherlands)

    Constantinides, Efthymios


    Addresses one of the fundamental issues of e-marketing: how to attract and win over the consumer in the highly competitive Internet marketplace. Analyses the factors affecting the online consumer's behavior and examines how e-marketers can influence the outcome of the virtual interaction and buying

  9. Consumer Education for Today's Youth. (United States)

    Nickols, Sharon Y.; Powell, Claire L.


    A random survey of Oklahoma Four H Club members was made by Oklahoma State University to better understand the factors influencing adolescent consumer behavior. Based on this study, suggestions for improving extension consumer education through the Four H Clubs are made. (MF)

  10. Consumer views on DTCA advertising.

    NARCIS (Netherlands)

    Dijk, L. van; Vervloet, M.; Friele, R.D.


    Background: In most Western countries, except for New Zealand and the USA, direct-to-consumer advertising of prescription drugs is prohibited. Currently, at European level, there is an ongoing discussion whether or not to allow pharmaceutical companies to inform consumers about prescription drugs.

  11. Micro-managing or leading: the clinician's challenge. (United States)

    Kerfoot, K


    There are many reasons people micro-manage in leadership positions. Anyone who has moved into the ranks of leadership from a clinical position will experience the angst of having to adjust to a "hands off" style and to trust that working through others to get the job done will work. The first step is to recognize this tendency and to admit that it is perfectly natural for a clinician to have to make the transition from doing it alone to working through others. The next step is to take the time to surround yourself with people who are capable of becoming better at certain specialized areas than you are and then allowing them to work. And finally, it is important to always assess your ability to work through others effectively. One of the most demoralizing behaviors a leader can display is that of communicating distrust and lack of confidence by continually interfering with a person's ability to work effectively.

  12. Reflections on scientific collaboration between basic researchers and clinicians. (United States)

    Muia, J; Casari, C


    Early career researchers face uncertainties with respect to their job prospects due to dwindling job markets, decreased availability of funding and undefined career paths. As basic researchers and clinicians tend to have different approaches to scientific problems, there are many advantages from successful collaborations between them. Here, we discuss how collaborations between basic and clinical scientists should be promoted early in their careers. To achieve this, researchers, both basic and clinical, must be proactive during their training and early stages of their careers. Mentors can further augment collaborative links in many ways. We suggest that universities and institutions might reassess their involvement in promoting collaborations between basic and clinical researchers. We hope that this paper will serve as a reminder of the importance of such collaborations, and provide the opportunity for all members of the scientific community to reflect on and ameliorate their own contributions. © 2016 International Society on Thrombosis and Haemostasis.

  13. The brand images of Coca-Cola and Pepsi and buying motives of cola consumers: a consumer research study


    Yılmaz, Emre


    Ankara : The Department of Management and Graduate School of Business Administration of Bilkent University, 1997. Thesis (Master's) -- Bilkent University, 1997. Includes bibliographical references leaves 54-55 Cola is one of the heavily consumed products all over the world by almost every individual. Today there are two main competitors in the world to convince consumers to consume their brand; Coca-Cola and Pepsi. Both companies give a big importance to understand their con...

  14. Online Continuing Education for Expanding Clinicians' Roles in Breastfeeding Support. (United States)

    Edwards, Roger A; Colchamiro, Rachel; Tolan, Ellen; Browne, Susan; Foley, Mary; Jenkins, Lucia; Mainello, Kristen; Vallu, Rohith; Hanley, Lauren E; Boisvert, Mary Ellen; Forgit, Julie; Ghiringhelli, Kara; Nordstrom, Christina


    Lack of health professional support is an important variable affecting mothers' achievement of breastfeeding goals. Online continuing education is a recognized pathway for disseminating content for improving clinicians' knowledge and supporting efforts to change practices. At the time we developed our project, free, accredited continuing education for physicians related to breastfeeding management that could be easily accessed using portable devices (via tablets/smartphones) was not available. Such resources were in demand, especially for facilities pursuing designation through the Baby-Friendly Hospital Initiative. We assembled a government, academic, health care provider, and professional society partnership to create such a tutorial that would address the diverse content needed for supporting breastfeeding mothers postdischarge in the United States. Our 1.5-hour-long continuing medical and nursing education was completed by 1606 clinicians (1172 nurses [73%] and 434 physicians [27%]) within 1 year. More than 90% of nurses and over 98% of physicians said the tutorial achieved its 7 learning objectives related to breastfeeding physiology, broader factors in infant feeding decisions and practices, the American Academy of Pediatrics' policy statement, and breastfeeding management/troubleshooting. Feedback received from the tutorial led to the creation of a second tutorial consisting of another 1.5 hours of continuing medical and nursing education related to breast examination and assessment prior to delivery, provision of anticipatory guidance to pregnant women interested in breastfeeding, maternity care practices that influence breastfeeding outcomes, breastfeeding preterm infants, breastfeeding's role in helping address disparities, and dispelling common myths. The tutorials contribute to achievement of 8 Healthy People 2020 Maternal, Infant and Child Health objectives. © The Author(s) 2015.

  15. Paramedic literature search filters: optimised for clinicians and academics. (United States)

    Olaussen, Alexander; Semple, William; Oteir, Alaa; Todd, Paula; Williams, Brett


    Search filters aid clinicians and academics to accurately locate literature. Despite this, there is no search filter or Medical Subject Headings (MeSH) term pertaining to paramedics. Therefore, the aim of this study was to create two filters to meet to different needs of paramedic clinicians and academics. We created a gold standard from a reference set, which we measured against single terms and search filters. The words and phrases used stemmed from selective exclusion of terms from the previously published Prehospital Search Filter 2.0 as well as a Delphi session with an expert panel of paramedic researchers. Independent authors deemed articles paramedic-relevant or not following an agreed definition. We measured sensitivity, specificity, accuracy and number needed to read (NNR). We located 2102 articles of which 431 (20.5%) related to paramedics. The performance of single terms was on average of high specificity (97.1% (Standard Deviation 7.4%), but of poor sensitivity (12.0%, SD 18.7%). The NNR ranged from 1 to 8.6. The sensitivity-maximising search filter yielded 98.4% sensitivity, with a specificity of 74.3% and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and thus a NNR of 1.48. We have created the first two paramedic specific search filters, one optimised for sensitivity and one optimised for specificity. The sensitivity-maximising search filter yielded 98.4% sensitivity, and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and a NNR of 1.48. A paramedic MeSH term is needed.

  16. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care. (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A


    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO ® (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  17. Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes. (United States)

    Blosnich, John R; Cashy, John; Gordon, Adam J; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Fine, Michael J


    Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status. The objective of this study was to determine the extent to which patients' clinician notes in EMR contained transgender-related terms that could corroborate ICD-coded transgender identity. Data are from the US Department of Veterans Affairs Corporate Data Warehouse. Transgender patients were defined by the presence of ICD9 and ICD10 codes associated with transgender-related clinical services, and a 3:1 comparison group of nontransgender patients was drawn. Patients' clinician text notes were extracted and searched for transgender-related words and phrases. Among 7560 patients defined as transgender based on ICD codes, the search algorithm identified 6753 (89.3%) with transgender-related terms. Among 22 072 patients defined as nontransgender without ICD codes, 246 (1.1%) had transgender-related terms; after review, 11 patients were identified as transgender, suggesting a 0.05% false negative rate. Using ICD-defined transgender status can facilitate health services research when self-identified gender identity data are not available in EMR.

  18. Promoting Faculty Scholarship – An evaluation of a program for busy clinician-educators

    Directory of Open Access Journals (Sweden)

    Stacia Reader


    Full Text Available Background: Clinician educators face barriers to scholarship including lack of time, insufficient skills, and access to mentoring. An urban department of family medicine implemented a federally funded Scholars Program to increase the participants’ perceived confidence, knowledge and skills to conduct educational research. Method: A part-time faculty development model provided modest protected time for one year to busy clinician educators. Scholars focused on designing, implementing, and writing about a scholarly project. Scholars participated in skill seminars, cohort and individual meetings, an educational poster fair and an annual writing retreat with consultation from a visiting professor. We assessed the increases in the quantity and quality of peer reviewed education scholarship. Data included pre- and post-program self-assessed research skills and confidence and semi-structured interviews. Further, data were collected longitudinally through a survey conducted three years after program participation to assess continued involvement in educational scholarship, academic presentations and publications. Results: Ten scholars completed the program. Scholars reported that protected time, coaching by a coordinator, peer mentoring, engagement of project leaders, and involvement of a visiting professor increased confidence and ability to apply research skills. Participation resulted in academic presentations and publications and new educational leadership positions for several of the participants. Conclusions: A faculty scholars program emphasizing multi-level mentoring and focused protected time can result in increased confidence, skills and scholarly outcomes at modest cost.

  19. Comparative effectiveness research for the clinician researcher: a framework for making a methodological design choice. (United States)

    Williams, Cylie M; Skinner, Elizabeth H; James, Alicia M; Cook, Jill L; McPhail, Steven M; Haines, Terry P


    Comparative effectiveness research compares two active forms of treatment or usual care in comparison with usual care with an additional intervention element. These types of study are commonly conducted following a placebo or no active treatment trial. Research designs with a placebo or non-active treatment arm can be challenging for the clinician researcher when conducted within the healthcare environment with patients attending for treatment.A framework for conducting comparative effectiveness research is needed, particularly for interventions for which there are no strong regulatory requirements that must be met prior to their introduction into usual care. We argue for a broader use of comparative effectiveness research to achieve translatable real-world clinical research. These types of research design also affect the rapid uptake of evidence-based clinical practice within the healthcare setting.This framework includes questions to guide the clinician researcher into the most appropriate trial design to measure treatment effect. These questions include consideration given to current treatment provision during usual care, known treatment effectiveness, side effects of treatments, economic impact, and the setting in which the research is being undertaken.

  20. Consumer perceptions of beef healthiness

    DEFF Research Database (Denmark)

    Van Wezemael, Lynn; Verbeke, Wim; Dutra de Barcellos, Marcia


    of beef consumed. Focus group participants were not in favour of improving beef healthiness during processing, but rather focussed on appropriate consumption behaviour and preparation methods. CONCLUSIONS: The individual responsibility for health implies that consumers should be able to make correct......BACKGROUND: Consumer perception of the healthiness of beef is an important determinant of beef consumption. However, little is known about how consumers perceive the healthiness of beef. The aim of this study is to shed light on the associations between beef and health. METHODS: Eight focus group...... as well as negative effects of beef consumption on their health. Labelled, branded, fresh and lean beef were perceived as signalling healthful beef, in contrast with further processed and packaged beef. Consumers felt that their individual choices could make a difference with respect to the healthiness...

  1. Food safety and consumer behaviour

    DEFF Research Database (Denmark)

    Frewer, Lynn; Fischer, Arnout; Scholderer, Joachim


    Food safety is a priority for many consumers, and there is an expectation throughout society that the food supplied for human consumption is safe and nutritious to eat. Understanding technical risk estimates alone, however, will not explain the risk-related behaviours of consumers. On the one hand......, consumers may not pay enough attention to some types of food safety issue, such as the risk of food poisoning from microbial contamination, which may at best be debilitating, and at worst fatal (Center for Disease Control and Prevention, 1994). This risk is certainly largely avoidable through taking...... appropriate risk mitigation measures through the food chain, not least in the domestic kitchen. However, factors related to consumer psychology may increase the risks to consumers as they produce barriers to self-protective behaviours (Frewer & Fischer, in press; Worsfold & Griffith, 1997). In contrast...

  2. Consumers' Attitude Towards Fish Meat. (United States)

    Conte, Francesca; Passantino, Annamaria; Longo, Sabrina; Voslářová, Eva


    The overall aim of this paper is to show the factors that may affect consumers' attitude towards farmed fish products. Consumers ask new products on the basis of different quality attributes: stability, safety, composition, better health effects, environment protection, etc . Different and controversial opinions on farmed and wild fish are also explored by literature review. The authors pay attention also to fish welfare as an emerging issue and effective information about fish products as a factor exerting a positive influence on consumers' decision of purchase. Some relevant legislative notes on the paper's topics are also cited. The qualitative aspects of aquaculture fish and the consumers' demand and choice need further studies, according to some factors, such as the changing consumers' attitudes towards fish products, the different fish quality perception and the development in the aquaculture systems.

  3. The Role of Consumer's Identification in Consumer Behavior and Branding

    Directory of Open Access Journals (Sweden)

    Mana Razeghi


    Full Text Available The purpose of this paper is to investigate relationships between congruity of consumer and brand values, brand identification, brand commitment, and word of mouth. In order to test the relationships between variables 600 questionnaire were distributed in Dubai Malls (Sun and Sand Sports and 334 of questionnaires were received and analyzed. To verify the validity of the questionnaire and to test the significance of observer variables (questionnaire and latent variables (factors, confirmatory factor analysis was used, and Cronbach's alpha was employed to test the reliability. To evaluate the association between variables, the Pearson correlation test is used, and then to verify the conceptual model test the structural equation modeling (SEM and LISREL software are deployed. The result shows that Value congruity positively influences consumers' identification with a brand and Value congruity positively influences consumers ‘commitment to brand. The result also shows that Consumer identification has a positive influence on brand commitment and mediating variable between value congruity and brand commitment and Consumers commitment to a brand has a positive influence on positive WOM and mediating variable between consumers' identification and WOM. The results also demonstrate that Consumer identification positively influences positive WOM.

  4. Clinicians' perspectives on cognitive therapy in community mental health settings: implications for training and implementation. (United States)

    Stirman, Shannon Wiltsey; Gutiérrez-Colina, Ana; Toder, Katherine; Esposito, Gregory; Barg, Frances; Castro, Frank; Beck, Aaron T; Crits-Christoph, Paul


    Policymakers are investing significant resources in large-scale training and implementation programs for evidence-based psychological treatments (EBPTs) in public mental health systems. However, relatively little research has been conducted to understand factors that may influence the success of efforts to implement EBPTs for adult consumers of mental health services. In a formative investigation during the development of a program to implement cognitive therapy (CT) in a community mental health system, we surveyed and interviewed clinicians and clinical administrators to identify potential influences on CT implementation within their agencies. Four primary themes were identified. Two related to attitudes towards CT: (1) ability to address client needs and issues that are perceived as most central to their presenting problems, and (2) reluctance to fully implement CT. Two themes were relevant to context: (1) agency-level barriers, specifically workload and productivity concerns and reactions to change, and (2) agency-level facilitators, specifically, treatment planning requirements and openness to training. These findings provide information that can be used to develop strategies to facilitate the implementation of CT interventions for clients being treated in public-sector settings.

  5. Antidepressant efficacy and side-effect burden: a quick guide for clinicians

    Directory of Open Access Journals (Sweden)

    Daniel Santarsieri


    Full Text Available Prescribing of antidepressant treatment (ADT for major depressive disorder (MDD has increased in quantity and popularity over the last two decades. This is likely due to the approval of safer medications, better education of clinicians and their patients, direct-to-consumer marketing practices, and less stigma associated with those taking ADT. This trend has also been met with some controversy, however, as the ongoing safety and effectiveness of these treatments have at times been called into question. This paper discusses the differing levels of evidence that support the use of ADT based on (A Food and Drug Administration approvals, (B data from randomized controlled trials or meta-analyses and, where these are not available, the authors discuss and apply, (C theoretical pharmacodynamic principles to justify antidepressant choice in the treatment of MDD patients. The final section discusses standard psychopharmacology guideline approaches to better alert the reader as to which practices are commonplace compared with those which are more outside of the standard of care.

  6. Antidepressant efficacy and side-effect burden: a quick guide for clinicians. (United States)

    Santarsieri, Daniel; Schwartz, Thomas L


    Prescribing of antidepressant treatment (ADT) for major depressive disorder (MDD) has increased in quantity and popularity over the last two decades. This is likely due to the approval of safer medications, better education of clinicians and their patients, direct-to-consumer marketing practices, and less stigma associated with those taking ADT. This trend has also been met with some controversy, however, as the ongoing safety and effectiveness of these treatments have at times been called into question. This paper discusses the differing levels of evidence that support the use of ADT based on (A) Food and Drug Administration approvals, (B) data from randomized controlled trials or meta-analyses and, where these are not available, the authors discuss and apply, (C) theoretical pharmacodynamic principles to justify antidepressant choice in the treatment of MDD patients. The final section discusses standard psychopharmacology guideline approaches to better alert the reader as to which practices are commonplace compared with those which are more outside of the standard of care.

  7. Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds. (United States)

    Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L


    Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes

  8. Is clinician refusal to treat an emerging problem in injury compensation systems? (United States)

    Brijnath, Bianca; Mazza, Danielle; Kosny, Agnieszka; Bunzli, Samantha; Singh, Nabita; Ruseckaite, Rasa; Collie, Alex


    The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Compensable injury management in general practice in Melbourne, Australia. 25 GPs who were treating, or had treated a patient with compensable injury. The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  9. Interpreting the results of patient reported outcome measures in clinical trials: The clinician's perspective

    Directory of Open Access Journals (Sweden)

    Schünemann Holger J


    Full Text Available Abstract This article deals with the problem of interpreting health-related quality of life (HRQL outcomes in clinical trials. First, we will briefly describe how dichotomization and item response theory can facilitate interpretation. Based on examples from the medical literature for the interpretation of HRQL scores we will show that dichotomies may help clinicians understand information provided by HRQL instruments in RCTs. They can choose thresholds to calculate proportions of patients benefiting based on absolute scores or change scores. For example, clinicians interpreting clinical trial results could consider the difference in the proportion of patients who achieve a mean score of 50 before and after an intervention on a scale from 1 to 100. For the change score approach, they could consider the proportion of patients who have changed by a score of 5 or more. Finally, they can calculate the proportion of patients benefiting and transform these numbers into a number needed to treat or natural frequencies. Second, we will describe in more detail an approach to the interpretation of HRQL scores based on the minimal important difference (MID and proportions. The MID is the smallest difference in score in the outcome of interest that informed patients or informed proxies perceive as important, either beneficial or harmful, and that would lead the patient or clinician to consider a change in the management. Any change in management will depend on the downsides, including cost and inconvenience, associated with the intervention. Investigators can help with the interpretation of HRQL scores by determining the MID of an HRQL instrument and provide mean differences in relation to the MID. For instance, for an MID of 0.5 on a seven point scale investigators could provide the mean change on the instrument as well as the proportion of patients with scores greater than the MID. Thus, there are several steps investigators can take to facilitate this

  10. Thomas L Petty's lessons for the respiratory care clinician of today. (United States)

    Pierson, David J


    Because of the importance of his original contributions and their practical relevance today, Thomas L Petty (1932-2009) was arguably the most important physician in the history of respiratory care. As much as any single individual, he was responsible for the concept of intensive and multidisciplinary respiratory care. In the 1960s and 1970s, he made key observations and introduced pioneering therapies in the ICU and in the home. He was the first to describe and name ARDS and to show how to use PEEP to treat life-threatening hypoxemia. He was one of the first anywhere to organize a pulmonary rehabilitation program and to show the beneficial effects of long-term oxygen therapy in COPD. Dr Petty emphasized the importance of practical, hands-on respiratory care education for both physicians and non-physicians using a collaborative team approach. He targeted educational activities and practical resources specifically to patients, and he showed how researchers and clinicians could interact responsibly with innovators in industry to the benefit of both. His life and career provide 6 important lessons for respiratory clinicians today and in the future: (1) whatever their roles, RTs and other clinicians in this field need to be experts in its core areas, such as mechanical ventilation, ARDS, and COPD; (2) respiratory care is a team activity: every member is important, and all the members need to communicate well and work together; (3) education needs to be targeted to those in the best position to benefit the patient, including primary care providers and family members; (4) everyone in the field needs to understand the important role of the respiratory care industry and to deal with it responsibly; (5) it must never be forgotten that it is all about the patient; and (6) respiratory care should be exciting and fun. Copyright © 2014 by Daedalus Enterprises.

  11. Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury. (United States)

    Roszko, Paul J D; Ameli, Jonathan; Carter, Patrick M; Cunningham, Rebecca M; Ranney, Megan L


    Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:

  12. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?

    International Nuclear Information System (INIS)

    Konen, Eli; Konen, Osnat; Katz, Miriam; Levy, Yair; Rozenman, Judith; Hertz, Marjorie


    AIM: The purpose of our study was to assess the level of awareness of referring clinicians to populations at risk for complications of intravascular administration of iodinated contrast media. SUBJECTS AND METHODS: Two hundred and three physicians from three university hospitals completed an anonymous questionnaire regarding risk factors and contraindications to the intravenous administration of iodinated contrast media. The questionnaire included medical conditions with increased risk for anaphylactoid reaction (asthma, hay fever and food allergy) as well as chemotoxic (ischaemic heart disease, phaeochromocytoma and myasthenia gravis) adverse reactions, some with dependence on renal function (metformin treatment, diabetes mellitus and multiple myeloma). Two additional multiple-choice questions addressed pre-medication protocols and risk of nephrotoxicity in diabetic patients. RESULTS: Asthma, food allergy and hay fever were recognized as risk factors by 81·3%, 77·8% and 61·6% of respondents respectively, while ischaemic heart disease, phaeochromocytoma and myasthenia gravis were defined as such only by 9·8%, 30·0% and 28·6% respectively. Metformin treatment, diabetes mellitus and multiple myeloma, in the presence of normal renal function, were considered as risk factors by 46·3%, 38·9% and 58·1% of respondents respectively. One of the generally accepted pre-medication protocols was selected by 89·8%. The risk of nephrotoxicity in a diabetic patient was correctly assessed by 63·5% of respondents. CONCLUSION: We found a relatively high awareness among referring clinicians of a potential anaphylactoid reaction and nephrotoxicity due to iodinated contrast media. However, additional chemotoxic adverse reactions are less well known. Future efforts to improve communication between clinicians and radiologists should be focused in this direction. Konen, E. et al. (2002)

  13. The Frontier of Research in the Consumer Interest. Proceedings of the International Conference on Research in the Consumer Interest (Racine, Wisconsin, August 16-19, 1986). (United States)

    Maynes, E. Scott, Ed.; And Others

    The following papers are included: "JFK's Four Consumer Rights" (Lampman); "Product Safety" (Gerner); "Use of Cost-Benefit Analysis in Product Safety Regulation" (Crandall); "CPCS's Voluntary Standards" (Ault); "Consumer Safety and Issue Emergence Process" (Mayer); "Reflections on Research in…

  14. A comparison of electronic monitoring vs. clinician rating of antipsychotic adherence in outpatients with schizophrenia. (United States)

    Byerly, Matthew; Fisher, Robert; Whatley, Katrina; Holland, Rhiannon; Varghese, Femina; Carmody, Thomas; Magouirk, Brianne; Rush, A John


    Antipsychotic non-adherence rates of outpatients with schizophrenia or schizoaffective disorder was assessed by electronic monitoring and clinician rating. Antipsychotic adherence was determined monthly over 3 consecutive months with (1) the Medication Event Monitoring System (MEMS) cap and (2) the Clinician Rating Scale. Non-adherence was defined as daily adherence of <70% during any one of three monthly evaluations for MEMS and ratings of Clinician Rating Scale. Non-adherence was detected in 12 of 25 patients (48%) by MEMS and 0% by the Clinician Rating Scale. Clinician assessment dramatically underestimated antipsychotic non-adherence.

  15. Clinician styles of care: transforming patient care at the intersection of leadership and medicine. (United States)

    Huynh, Ho P; Sweeny, Kate


    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.


    The U.S. Environmental Protection Agency’s (EPA) Office of Transportation and Air Quality (OTAQ) has recently sponsored the development of a Consumer Vehicle Choice Model (CVCM) by the Oak Ridge National Laboratory (ORNL). The specification by OTAQ to ORNL for consumer choice model development was to develop a Nested Multinomial Logit (NMNL) or other appropriate model capable of estimating the consumer surplus impacts and the sales mix effects of greenhouse gas (GHG) emission standards. The CVCM will use output from the EPA’s Optimization Model for reducing Emissions of Greenhouse gases from Automobiles (OMEGA), including changes in retail price equivalents, changes in fuel economy, and changes in emissions, to estimate these impacts. In addition, the CVCM will accept approximately 60 vehicle types, with the flexibility to function with fewer or more vehicle types, and will use a 15 year planning horizon, matching the OMEGA parameters. It will be calibrated to baseline sales projection data provided by the EPA and will include a buy/no-buy option to simulate the possibility that consumers will choose to keep their old vehicle or to buy a used vehicle. To support EPA's future assessment of potential light duty greenhouse gas standards

  17. The rights of patients as consumers: An ancient view. (United States)

    Barapatre, Nishant Bhimraj; Joglekar, Vishnu Prabhakar


    As far as the rights of consumers are concerned, the International Organization of Consumer's Union (IOCU) in 1983 has specified about the eight rights of a consumer. The Consumer Protection Act (CPA), 1986 then prescribed six "Rights of Consumers," which are protected under the act. However, these rights can be observed in the ancient Indian texts such as Brihat-trayee , Narad Smruti , and Kautilya Arthashastra ., in the form of rights given to patients. For the purpose of present study, the implemented methodology includes - (1) study of the consumer rights described by IOCU and CPA, (2) detailed review of literature for observance of replication of these consumer rights in the ancient Indian texts and (3) a comparative study of the present consumer rights with the rights of patients observed in ancient Indian texts. This study shows that the substance of consumer rights is not a recent evolution, but the foundation of these rights has been laid well beforehand in the ancient times, which were provided to the patients by medical profession as well as by the rulers. The current scenario of protection of consumer rights is the replication of this ancient practice only.

  18. Ethical and clinical practice considerations for genetic counselors related to direct-to-consumer marketing of genetic tests. (United States)

    Wade, Christopher H; Wilfond, Benjamin S


    Several companies utilize direct-to-consumer (DTC) advertising for genetic tests and some, but not all, bypass clinician involvement by offering DTC purchase of the tests. This article examines how DTC marketing strategies may affect genetic counselors, using available cardiovascular disease susceptibility tests as an illustration. The interpretation of these tests is complex and includes consideration of clinical validity and utility, and the further complications of gene-environment interactions and pleiotropy. Although it is unclear to what extent genetic counselors will encounter clients who have been exposed to DTC marketing strategies, these strategies may influence genetic counseling interactions if they produce directed interest in specific tests and unrealistic expectations for the tests' capacity to predict disease. Often, a client's concern about risk for cardiovascular diseases is best addressed by established clinical tests and a family history assessment. Ethical dilemmas may arise for genetic counselors who consider whether to accept clients who request test interpretation or to order DTC-advertised tests that require a clinician's authorization. Genetic counselors' obligations to care for clients extend to interpreting DTC tests, although this obligation may be fulfilled by referral or consultation with specialists. Genetic counselors do not have an obligation to order DTC-advertised tests that have minimal clinical validity and utility at a client's request. This can be a justified restriction on autonomy based on consideration of risks to the client, the costs, and the implications for society. Published 2006 Wiley-Liss, Inc.

  19. Patients' and clinicians' experiences of holistic needs assessment using a cancer distress thermometer and problem list: A qualitative study. (United States)

    Biddle, Lucy; Paramasivan, Sangeetha; Harris, Susan; Campbell, Rona; Brennan, James; Hollingworth, William


    Psychosocial needs assessment is recommended for patients undergoing cancer treatment, but trials of effectiveness of assessment tools provide mixed results. This qualitative study aimed to understand how such tools are experienced by patients and clinicians in order to optimise use in the future. Qualitative interviews were used in a mixed-methods sequential design following a randomised controlled trial of needs assessment using the Distress Thermometer and Problem List (DT&PL), and explored patients' and clinicians' evaluations of the needs assessment process. Benefits of needs assessment using the DT&PL included the potential to detect hidden distress, allow opportunity for distress to be discussed, and to deliver outcomes to address problems. However, effectiveness and patient willingness to report all forms of distress could be hindered by: clinicians feeling ill-equipped to deal with 'non-physical' distress and patients questioning their appropriateness to do so; time constraints; insufficient support services and referral guidelines; inappropriate timing; and lack of follow-up. The benefits of a holistic needs assessment cannot be realised without matching time and frequency of administration to the dynamic nature of distress during cancer, and making changes to the context of delivery - for instance, providing protected time, increasing referral options and clinician training. Significant investment is needed to optimise potential benefits for patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study

    Directory of Open Access Journals (Sweden)

    Schene Aart


    Full Text Available Abstract Background Health clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians. Methods The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews, quantitative (survey, and mixed methods (Delphi-procedure research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups. Results A structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out. Conclusions Intervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care.