Sample records for advice improves patient

  1. Improving driving advice provided to cardiology patients on discharge.

    PubMed

    Vusirikala, Amoolya; Backhouse, Mark; Schimansky, Sarah

    2018-01-01

    Certain cardiac conditions can limit patients' ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors. We therefore designed a quality improvement project using Plan-Do-Study-Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education. After collecting baseline data, we created a template with cardiology-specific DVLA advice. During the second PDSA cycle, we improved the electronic template and also introduced a hard copy on the ward. During the third PDSA cycle, we incorporated information on DVLA guidance in the specialty induction session. We also evaluated junior doctors' confidence of providing driving advice before and after this intervention. Baseline measurements showed that 10% (9/92) of all discharge summaries included driving advice. This improved to 49% (34/69) after the third PDSA cycle. Importantly, after receiving information on driving advice in the induction, junior doctors felt more confident in providing driving advice to cardiology patients on discharge. In conclusion, the provision of driving advice on discharge is an important element of patient safety. However, clinicians' knowledge and awareness of current DVLA guidance is often limited. We demonstrated a significant increase in the provision of driving advice by introducing a standardised template.

  2. Improving driving advice provided to cardiology patients on discharge

    PubMed Central

    Vusirikala, Amoolya; Backhouse, Mark; Schimansky, Sarah

    2018-01-01

    Certain cardiac conditions can limit patients’ ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors. We therefore designed a quality improvement project using Plan–Do–Study–Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education. After collecting baseline data, we created a template with cardiology-specific DVLA advice. During the second PDSA cycle, we improved the electronic template and also introduced a hard copy on the ward. During the third PDSA cycle, we incorporated information on DVLA guidance in the specialty induction session. We also evaluated junior doctors’ confidence of providing driving advice before and after this intervention. Baseline measurements showed that 10% (9/92) of all discharge summaries included driving advice. This improved to 49% (34/69) after the third PDSA cycle. Importantly, after receiving information on driving advice in the induction, junior doctors felt more confident in providing driving advice to cardiology patients on discharge. In conclusion, the provision of driving advice on discharge is an important element of patient safety. However, clinicians’ knowledge and awareness of current DVLA guidance is often limited. We demonstrated a significant increase in the provision of driving advice by introducing a standardised template. PMID:29610769

  3. Patient-centred advice is effective in improving adherence to medicines.

    PubMed

    Clifford, Sarah; Barber, Nick; Elliott, Rachel; Hartley, Elaine; Horne, Rob

    2006-06-01

    To assess the effects of pharmacists giving advice to meet patients' needs after starting a new medicine for a chronic condition. A prospective health technology assessment including a randomised controlled trial of a pharmacist-delivered intervention to improve adherence using a centralised telephone service to patients at home in England. Patients were eligible for recruitment if they were receiving the first prescription for a newly prescribed medication for a chronic condition and were 75 or older or suffering from stroke, cardiovascular disease, asthma, diabetes or rheumatoid arthritis. Incidence of non-adherence, problems with the new medicine, beliefs about the new medicine, safety and usefulness of the interventions. Five hundred patients consented and were randomised. At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% vs. 16%, P = 0.032). The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021). Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the "necessity-concerns differential" (5.0 vs. 3.5, P = 0.007). The phone calls took a median of 12 min each. Most advice was judged by experts to be safe and helpful, and patients found it useful. Overall, these findings show benefits from pharmacists meeting patients' needs for information and advice on medicines, soon after starting treatment. While a substantially larger trial would be needed to confirm that the effect is real and sustained, these initial findings suggest the service may be safe and useful to patients.

  4. Which patients receive advice on diet and exercise?

    PubMed Central

    Sinclair, Jennifer; Lawson, Beverley; Burge, Fred

    2008-01-01

    , improving relationships between patients and their physicians, and improving physicians’ ability to help their patients feel enabled to act on advice and cope with their illnesses. Physicians should be aware of their counseling practices and consider discussing healthy behaviour with patients with no obvious risk factors. This would be practising true primary prevention. PMID:18337535

  5. Which patients receive advice on diet and exercise? Do certain characteristics affect whether they receive such advice?

    PubMed

    Sinclair, Jennifer; Lawson, Beverley; Burge, Fred

    2008-03-01

    To examine whether patients' characteristics, familiarity with the clinic, or perspectives on the quality of their care predict whether they receive advice from physicians regarding diet and exercise. Secondary data analysis of responses to the Primary Care Practice Survey. Capital District Health Authority in Nova Scotia. Residents of the Capital District Health Authority 18 years old and older (N = 1562). Percentage of patients who reported frequently receiving advice from their family physicians regarding diet and exercise. Almost 38% of respondents reported frequently receiving advice from their physicians on diet. Those more likely to receive advice on diet were male (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.2 to 2.1), were 35 to 54 years old (compared with those aged 18 to 34) (AOR 1.5, 95% CI 1.1 to 2.2), had more chronic illnesses (AOR 1.3, 95% CI 1.2 to 1.6), had good relationships with their health care providers (AOR 2.3, 95% CI 1.8 to 3.1), or reported higher scores on an enablement scale (AOR 2.2, 95% CI 1.6 to 3.1). Respondents who reported their health status as excellent were less likely to receive advice on diet (AOR 0.5, 95% CI 0.3 to 0.9). About 42% of respondents reported frequently receiving advice on exercise. Men (AOR 1.7, 95% CI 1.3 to 2.2), those older than 35 years (AOR 1.7, 95% CI 1.2 to 2.4 for those aged 35 to 54; AOR 1.6, 95% CI 1.1 to 2.3 for those 55 and older), those rating their health as good (AOR 1.6, 95% CI 1.1 to 2.4), those with more chronic illnesses (AOR 1.3, 95% CI 1.1 to 1.5), and those reporting higher scores on communication (AOR 3.2, 95% CI 2.3 to 4.4) and enablement (AOR 1.8, 95% CI 1.3 to 2.4) scales were more likely to receive advice on exercise. Strategies to increase the number of patients who receive advice on diet and exercise would likely include enhancing communication between patients and their physicians, improving relationships between patients and their physicians, and improving

  6. The Straightforwardness of Advice: Advice-Giving in Interactions Between Swedish District Nurses and Patients.

    ERIC Educational Resources Information Center

    Leppanen, Vesa

    1998-01-01

    A study examined advice-giving interactions between Swedish district nurses and patients, comparing these sequences with parallel interactions between British health visitors and first-time mothers in previous research. Analysis focused on how advice-giving is organized in the settings, including how advice is initiated and designed, its…

  7. Communication of alcohol and smoking lifestyle advice to the gastroenterological patient.

    PubMed

    Spence, Andrew D; Khasawneh, Mais; Allen, Patrick B; Addley, Jennifer

    2017-10-01

    Effective communication between healthcare staff and patients is central to development of the patient-professional relationship. Many barriers influence this communication, often resulting in patients' lack of understanding and retention of information, particularly affecting advice regarding lifestyle habits, such as alcohol consumption and smoking. Alcohol and smoking misuse are potentially modifiable risk factors known to adversely affect a variety of gastroenterological conditions and improvements in communication with patients regarding this is an important management component. This review discusses the clinical impact of these factors and how healthcare professionals can improve communication. We discuss how enhancing verbal communication skills through medical training leads to greater outcomes in patient satisfaction and adherence to treatment and advice. In addition, with the rapid digitalisation of society, platforms such as social media and smartphone applications may be considered as adjuncts to traditional forms of communication. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. A pilot study to improve adherence among MS patients who discontinue treatment against medical advice.

    PubMed

    Bruce, Jared; Bruce, Amanda; Lynch, Sharon; Strober, Lauren; O'Bryan, Sean; Sobotka, Deborah; Thelen, Joan; Ness, Abigail; Glusman, Morgan; Goggin, Kathy; Bradley-Ewing, Andrea; Catley, Delwyn

    2016-04-01

    Between 30 and 50% of MS patients may prematurely discontinue disease modifying therapies. Little research has examined how to best talk with patients who have discontinued treatment against medical advice. The aim of this pilot study was to determine whether telephone counseling increases disease modifying therapy (DMT) re-initiation among nonadherent patients with multiple sclerosis (MS). Participants were eligible if they had relapsing-remitting disease, had stopped taking a DMT, and had no plan to re-initiate treatment despite a provider recommendation. Following a baseline assessment, 81 patients were randomly assigned to either five 20 min, weekly sessions of Motivational Interviewing/Cognitive Behavioral Therapy (MI-CBT) or Treatment as Usual (TAU) with brief education. At 10 weeks, patients initially assigned to TAU switched over to MI-CBT. Compared to patients in the TAU group, patients undergoing MI-CBT were significantly more likely to indicate they were re-initiating DMT (41.7 vs. 14.3%). These significant results were replicated among patients crossing over from TAU to MI-CBT. Treatment satisfaction was high, with 97% of participants reporting that they would recommend MI-CBT to other patients with MS. Results of this pilot study provide initial support for the use of MI-CBT among MS patients who have discontinued treatment against medical advice.Clinicaltrials.gov: NCT01925690.

  9. Patients who leave the emergency department against medical advice.

    PubMed

    Lee, Choung Ah; Cho, Joon Pil; Choi, Sang Cheon; Kim, Hyuk Hoon; Park, Ju Ok

    2016-06-01

    Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group. We compared these groups with respect to age, gender, trauma or non-trauma status, type of hospital, health insurance, level of consciousness on admission, and diagnosis. Of 8,000,529 patients, 222,389 (2.78%) left against medical advice. The risk factors for DAMA across all age groups were as follows: no medical insurance (odds ratio [OR], 1.993), initial response to voice (OR, 2.753) or pain (OR, 2.101), trauma admission (OR, 1.126), admission to a local emergency medical center (OR, 1.215), and increased age. A high risk of DAMA was observed among patients with immune, endocrine, psychiatric, neurological, circulatory diseases, and external causes of morbidity and mortality. Although DAMA cases account for only a small percentage of hospital discharges, they are important because DAMA patients have high readmission and mortality rates. It is therefore important to understand the general characteristics and predictors of DAMA in order to improve patient outcome and minimize the economic burden on the healthcare system.

  10. Development of an occupational advice intervention for patients undergoing lower limb arthroplasty (the OPAL study).

    PubMed

    Baker, Paul; Coole, Carol; Drummond, Avril; McDaid, Catriona; Khan, Sayeed; Thomson, Louise; Hewitt, Catherine; McNamara, Iain; McDonald, David; Fitch, Judith; Rangan, Amar

    2018-06-28

    There are an increasing number of patients of working age undergoing hip and knee replacements. Currently there is variation in the advice and support given about sickness absence, recovery to usual activities and return to work after these procedures. Earlier, sustainable, return to work improves the health of patients and benefits their employers and society. An intervention that encourages and supports early recovery to usual activities, including work, has the potential to reduce the health and socioeconomic burden of hip and knee replacements. A two-phase research programme delivered over 27 months will be used to develop and subsequently test the feasibility of an occupational advice intervention to facilitate return to work and usual activities in patients undergoing lower limb arthroplasty. The 2 phases will incorporate a six-stage intervention mapping process: Phase 1: Intervention mapping stages 1-3: 1 Needs assessment (including rapid evidence synthesis, prospective cohort analysis and structured stakeholder interviews) 2 Identification of intended outcomes and performance objectives 3 Selection of theory-based methods and practical strategies Phase 2: Intervention mapping stages 4-6: 4 Development of components and materials for the occupational advice intervention using a modified Delphi process 5 Adoption and implementation of the intervention 6 Evaluation and feasibility testing The study will be undertaken in four National Health Service (NHS) hospitals in the United Kingdom and two Higher Education Institutions. OPAL (Occupational advice for Patients undergoing Arthroplasty of the Lower limb) aims to develop an occupational advice intervention to support early recovery to usual activities including work, which is tailored to the requirements of patients undergoing hip and knee replacements. The developed intervention will then be assessed with a specific focus on evaluating its feasibility as a potential trial intervention to improve speed of

  11. Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.

    PubMed

    Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E

    2015-03-01

    Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

  12. Patient characteristics associated with receipt of lifestyle behavior advice.

    PubMed

    Corsino, Leonor; Svetkey, Laura P; Ayotte, Brian J; Bosworth, Hayden B

    2009-01-01

    Lifestyle behaviors such as reducing weight if overweight or obese, reducing salt intake, exercising, reducing alcohol intake, quitting smoking, and eating a healthy diet are related to the prevention and control of chronic diseases. However the amount of lifestyle advice provided by clinicians has been declining over the last decade. In 2002, a telephone survey was conducted to assess the quality of preventive care offered by health care providers. The study was a cross-sectional observational study of a randomly selected sample of 516 diverse individuals in Durham County, North Carolina. Information regarding age, sex, race, education, health conditions, and self-reported receipt of lifestyle advice was examined in the study. The odds of receiving advice to engage in preventive lifestyle behaviors were significantly higher for those with a pre-existing diagnosis of diabetes or hypertension and for participants reporting poor health status. For example, the odds of receiving advice to control or lose weight was 8.32 (95% CI, 2.65, 26.75) among individuals reporting a diagnosis of diabetes. Similarly, the odds of reporting "receiving advice to reduce salt intake" was 6.97 (95% CI, 3.74, 13.00) among subjects reporting a diagnosis of hypertension. The results are from a cross-sectional study of a sample of individuals in only one county. Additionally, the results are based on patient self-reported information, which could be subject to recall and social desirability bias. Patients with identified health problems were more likely than others to report being advised to adopt healthy lifestyle recommendations. Future research should examine methods to encourage health care providers to offer lifestyle advice to those without pre-existing illness.

  13. Lifestyle advice provision to teenage and young adult cancer patients: the perspective of health professionals in the UK.

    PubMed

    Pugh, Gemma; Hough, Rachael; Gravestock, Helen; Williams, Kate; Fisher, Abigail

    2017-12-01

    Health professionals are an important source of information for teenage and young adult (TYA) cancer patients. However, little is known about health professionals' provision of lifestyle advice to young people with cancer who are in their care. An online survey was distributed to health professionals within the UK who identified themselves as working with TYA cancer patients. Health professional awareness of lifestyle guidance, provision of lifestyle advice to young people and views on lifestyle information format and delivery were explored. Ninety-five health professionals (44% nurses; 28% allied health professionals; 17% physicians) completed the survey. The majority (72%) of respondents were aware of some lifestyle guidance for cancer patients. However, less than half of TYA health professionals (46%) were able to successfully recall the source of the guidelines and less than a third reported proving specific advice to the majority of their patients on weight management, smoking, alcohol consumption and sun safety. Many health professionals (38%) felt that they were not the right person to provide advice and cited lack of resources as a key barrier to advice provision. The majority (95%) reported being interested in a resource containing relevant lifestyle information that could be given to young people with cancer. TYA health professionals' awareness of lifestyle guidance and provision of advice regarding health behaviour is sub-optimal. Clear and comprehensive guidance written specifically for TYA health professionals could overcome the reported barriers and improve professionals' confidence in addressing and providing advice on lifestyle to young people with cancer.

  14. Impact of weight-related advice from healthcare professionals on body mass index of patients in the USA.

    PubMed

    Yang, H-Y; Chen, H-J; Hsu, Y-J; Cheskin, L J; Wang, Y

    2018-06-01

    Healthcare professionals (HCPs) can help promote healthy eating and active living in patients. This study assessed the effects of weight-related advice from HCPs on change in body mass index (BMI) of patients in the USA. A 1-year follow-up study of 20,002 adults who participated in a nationally representative survey between 2004 and 2008. Using the 2004-2008 Medical Expenditure Panel Survey data, 1-year BMI and weight status changes were compared between patients who did and did not report receiving advice on exercise or on restricted intake of fat and cholesterol from their HCPs. Patients who received weight-related advice had a greater increase in BMI compared with those who did not receive weight-related advice. Stratified by the baseline weight status of patients (i.e. normal weight, overweight or obese), adverse direction of BMI change was only significantly associated with advice on exercise. Patients who received advice to exercise more were more likely to move to a higher weight status than remaining at the same weight status, compared with patients who did not receive advice to exercise more. This study did not find that weight-related advice from HCPs had a positive impact on BMI loss in patients. On the contrary, patients who reported receiving weight-related advice from HCPs had worse weight outcomes 1 year later than patients who did not report receiving weight-related advice. Further research is warranted to elucidate the role of weight-related advice from HCPs on lifestyle change and obesity prevention and control. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  15. Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.

    PubMed

    Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

    2014-03-30

    Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.

  16. Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions.

    PubMed

    Chavez, Laura J; Williams, Emily C; Lapham, Gwen T; Rubinsky, Anna D; Kivlahan, Daniel R; Bradley, Katharine A

    2016-05-01

    Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP; 2007-2011) who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C ≥ 5) was estimated for each year. Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation.

  17. Nutritional advice for community patients: insights from a panel discussion.

    PubMed

    Thomas, Linda V; Jenkins, Gill; Belton, Julie; Clements, Suzie; Jacob, Ciara; Johnson, Naomi; Joy, Deirdre; Low, Jennifer; Munson, Eileen; Sheppard, Jessica

    2016-03-01

    This article describes the conclusions of an expert panel that discussed four case studies; these were examples of patients typically encountered by nurses working in the community. The panel considered the nutritional and lifestyle advice that could be given by nurses relating to conditions such as irritable bowel syndrome (IBS), depression, chronic fatigue syndrome, vulnerability to common infections, elderly care, recurrent urinary tract infection, antibiotic use, and risk of type 2 diabetes. A general conclusion was the importance of motivational interviewing techniques in achieving full understanding of patients' concerns and to determine the best health strategy. As well as specific guidance appropriate for each disorder, a range of information sources for both health professionals and patients are listed in the paper. The panel noted that, although general nutritional advice can be given by nurses working at GP surgeries and in the community, patients should always be referred to registered dietitians or nutritionists if significant dietary changes are considered.

  18. Belief revision and delusions: how do patients with schizophrenia take advice?

    PubMed

    Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

    2012-01-01

    The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed.

  19. Pre‐operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight‐losing patients with colorectal cancer: single‐blind randomized controlled trial

    PubMed Central

    Gibson, Debra J.; Lal, Simon; Hill, James; Pilling, Mark; Soop, Mattias; Ramesh, Aswatha; Todd, Chris

    2017-01-01

    ONS group vs. 10.2% (IQR 5.1–18.5) in controls (P = 0.016). Conclusions Compared with dietary advice alone, ONS resulted in patients having fewer infections and less weight loss following surgery for colorectal cancer. We have demonstrated that pre‐operative oral nutritional supplementation can improve clinical outcome in weight losing patients with colorectal cancer. PMID:28052576

  20. Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department.

    PubMed

    Heng, K W J; Tham, K Y; How, K Y; Foo, J S; Lau, Y H; Li, A Y K

    2007-12-01

    Most patients presenting to the emergency department (ED) with minor head injury (HI) can be discharged, provided a caregiver is present and careful discharge instructions are given. The study ED uses an advice leaflet with verbal reinforcement to patients and caregivers detailing post-discharge instructions and warning symptoms of worsening HI. We aim to evaluate local patients' and caregivers' compliance to discharge instructions and their ability to recall HI advice. A prospective study was conducted in an adult ED between April 10, 2006 and May 1, 2006. All patients with minor HI discharged from the ED or its 24-hour observation ward were included in the study. A telephone survey was conducted within 48 hours of discharge using a standardised questionnaire. During the study period, 292 patients had HI, of which 182 were eligible for the study. 71 were uncontactable and one refused to participate, leaving 110 patients in the study. Patients' age ranged between 7 and 109 years (median 41 years). 100 confirmed receiving HI advice (57 percent received by patients, 26 percent caregivers, 16 percent both patients and caregivers). 29 percent of respondents reported non-compliance to discharge advice. Mean HI-symptom recall score was 1.9 (SD 1.6) (total 9 symptoms). 30 percent cited other symptoms not part of the HI advice, which they believed necessitated a return to the ED. Recall scores were not statistically different, regardless of mode of instruction (verbal or printed) or the recipient (patient, caregiver or both). Our study raises concerns about the reliability of discharge advice for minor HI patients.

  1. Belief Revision and Delusions: How Do Patients with Schizophrenia Take Advice?

    PubMed Central

    Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

    2012-01-01

    The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed. PMID:22536329

  2. Nutrition Advice and Recipes

    MedlinePlus

    ... Sign-Up Home Patient Information Nutrition Advice & Recipes Nutrition Advice & Recipes This is a very important section ... information on all aspects of daily life, including nutrition, medical treatments, pain management, and practical tips. For ...

  3. [Life style advice provided by primary health care to prevent cardiovascular diseases].

    PubMed

    Meland, E; Ellekjaer, H; Gjelsvik, B; Kimsås, A; Holmen, J; Hetlevik, I

    2000-09-20

    The Working Group on Hypertension of the Norwegian College of General Practitioners reports in this paper on the documentation on behavioural advice in the prevention of cardiovascular disease. Emphasis is given to hypertension. The recommendations are mainly based on updated metaanalyses and randomised controlled trials. Hypertension is treated to prevent cardiovascular disease; that is why we put emphasis on documentation with significant end points. The validity of the documentation for general practice is assessed. We have also assessed whether certain methods or theories for behavioural change could be helpful to the general practitioner. The value of advice against smoking, dietary advice (increased intake of grain products, vegetables, fruit, poultry and fish), and advice about exercise are well documented and applicable in general practice. Respect for the patient's autonomy and interest in the patients and their health-related habits seem to be important factors for improving doctor's chances of influencing patient behaviour. The value of life-style advice is well documented and should play an important role in clinical strategies to prevent cardiovascular disease in high-risk patients.

  4. The information filter: how dentists use diet diary information to give patients clear and simple advice.

    PubMed

    Arheiam, Arheiam; Brown, Stephen L; Higham, Susan M; Albadri, Sondos; Harris, Rebecca V

    2016-12-01

    Diet diaries are recommended for dentists to monitor children's sugar consumption. Diaries provide multifaceted dietary information, but patients respond better to simpler advice. We explore how dentists integrate information from diet diaries to deliver useable advice to patients. As part of a questionnaire study of general dental practitioners (GDPs) in Northwest England, we asked dentists to specify the advice they would give a hypothetical patient based upon a diet diary case vignette. A sequential mixed method approach was used for data analysis: an initial inductive content analysis (ICA) to develop coding system to capture the complexity of dietary assessment and delivered advice. Using these codes, a quantitative analysis was conducted to examine correspondences between identified dietary problems and advice given. From these correspondences, we inferred how dentists reduced problems to give simple advice. A total of 229 dentists' responses were analysed. ICA on 40 questionnaires identified two distinctive approaches of developing diet advice: a summative (summary of issues into an all-encompassing message) and a selective approach (selection of a main message approach). In the quantitative analysis of all responses, raw frequencies indicated that dentists saw more problems than they advised on and provided highly specific advice on a restricted number of problems (e.g. not eating sugars before bedtime 50.7% or harmful items 42.4%, rather than simply reducing the amount of sugar 9.2%). Binary logistic regression models indicate that dentists provided specific advice that was tailored to the key problems that they identified. Dentists provided specific recommendations to address what they felt were key problems, whilst not intervening to address other problems that they may have felt less pressing. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Patients who leave the hospital against medical advice: the role of the psychiatric consultant.

    PubMed

    Holden, P; Vogtsberger, K N; Mohl, P C; Fuller, D S

    1989-01-01

    Previous studies have identified characteristics of patients who threaten to leave non-psychiatric units against medical advice, but few have described the role of the psychiatric consultant in the patient's decision. This study compared the medical records of 31 patients who threatened to leave the hospital against medical advice (AMA) and who were seen in consultation with the records of AMA-discharged patients who were not seen by a psychiatric consultant. Most patients who received consultations remained hospitalized or were discharged in regular fashion. Those seen soon after admission were most likely to stay. Patients were more likely to remain hospitalized if the consultant's recommendations had a practical, rather than a psychological, orientation.

  6. Text messaging improves preoperative exercise in patients undergoing bariatric surgery.

    PubMed

    Lemanu, Daniel P; Singh, Primal P; Shao, Robert Y; Pollock, Terina T; MacCormick, Andrew D; Arroll, Bruce; Hill, Andrew G

    2018-06-25

    To investigate whether a text message intervention improves adherence to preoperative exercise advice prior to laparoscopic sleeve gastrectomy (LSG). A single-blinded parallel design 1:1 ratio randomized controlled trial was performed in patients undergoing LSG as a single-stage bariatric procedure for morbid obesity. The intervention group received preoperative daily text messages. The primary outcome was adherence to preoperative exercise advice as assessed by the number of participants partaking in ≥450 metabolic equivalent minutes (METmin -1 ) exercise activity per week preoperatively. Eighty-eight patients were included in the analysis with 44 allocated to each arm. Adherence and exercise activity increased significantly from baseline in the exposure group (EG) but not in the control group (CG). Adherence was significantly higher in the EG at the end of the intervention period compared to the CG. Despite increased exercise activity, there was no improvement in 6-min walk test or surgical recovery. A daily text message intervention improved adherence to preoperative exercise advice, but this did not correlate with improved surgical recovery. © 2018 Royal Australasian College of Surgeons.

  7. Patients' perceptions of their general practitioner's health and weight influences their perceptions of nutrition and exercise advice received.

    PubMed

    Fraser, Sally E; Leveritt, Michael D; Ball, Lauren E

    2013-12-01

    General practitioners (GPs) play an important role in the management of patients who are overweight or obese. Previous research suggests that GPs' physical characteristics may influence patients' perceptions of health care received during consultations, mediating the likelihood of patients following health advice provided by GPs. This study aimed to explore patients' perceptions of their GP's health status and its influence on patients' perceptions of healthy eating and exercise advice. An interpretive approach to phenomenology underpinned the qualitative inquiry and study design. Twenty-one participants (aged 55.9 ± 6.5 years; 14 females, 7 males) who had previously received healthy eating and/or exercise advice from a GP participated in an individual semi-structured interview. A constant comparison approach to thematic analysis was conducted. Participants identified three key indicators of perceived health of their GP. These included the GP's physical appearance, particularly weight status; perceived absence of ill health; and disclosure of a GP's health behaviours. Participants expressed favourable perceptions of the weight status of their GP. Participants expected their GP to be a healthy role model and often, but not always, felt more confident receiving advice from a GP that they perceived as healthy. The findings highlight that a GP's perceived health status influences patients' perceptions of the health advice received during consultations. These findings provide a foundation for future research that may allow GPs to modify patients' perceptions of their health status in order to facilitate behaviour change in overweight or obese patients.

  8. Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice

    PubMed Central

    Fridman, Ilona; Scherr, Karen; Glare, Paul; Higgins, E. Tory

    2017-01-01

    Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician’s advice (emphasizing gains vs. avoiding losses) and the participants’ motivational orientation (promotion vs. prevention) improves participants’ evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants’ initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants’ cognitive involvement in the evaluation of the option. PMID:27341845

  9. Optimal management of Alzheimer’s disease patients: Clinical guidelines and family advice

    PubMed Central

    Haberstroh, Julia; Hampel, Harald; Pantel, Johannes

    2010-01-01

    Family members provide most of the patient care and administer most of the treatments to patients with Alzheimer’s disease (AD). Family caregivers have an important impact on clinical outcomes, such as quality of life (QoL). As a consequence of this service, family caregivers suffer high rates of psychological and physical illness as well as social and financial burdens. Hence, it is important to involve family caregivers in multimodal treatment settings and provide interventions that are both suitable and specifically tailored to their needs. In recent years, several clinical guidelines have been presented worldwide for evidence-based treatment of AD and other forms of dementia. Most of these guidelines have considered family advice as integral to the optimal clinical management of AD. This article reviews current and internationally relevant guidelines with emphasis on recommendations concerning family advice. PMID:20520788

  10. Patient demand for smoking cessation advice in dentist offices after introduction of graphic health warnings in Australia.

    PubMed

    Afifah, Rm; Schwarz, E

    2008-09-01

    The effectiveness of smoking cessation intervention by dentists has not been conclusively established. This study aimed to investigate whether the inclusion of graphic health warning pictures (including mouth and throat cancer) as part of the Australian National Tobacco Campaign strategy would elicit measurably increased demand for smoking cessation advice in dental practices. A cross-sectional survey of private dental practices in New South Wales, Australia. Separate questionnaires were answered by dentists and patients from their practice. Questions comprised smoking practices and attitudes toward smoking cessation activities in dental practice. The majority of dentists (85.7 per cent; n = 29) and dental patients (92.4 per cent; n = 800) recalled seeing the graphic health warnings, with mouth and throat cancer the most commonly observed. Television was the main medium. Nineteen per cent of dental patients (n = 152) reported themselves as current smokers. Half of them were planning to quit within six months (49.7 per cent) and agreed that graphic health warnings made them more likely to quit (47.7 per cent). Dentists showed positive attitudes toward cessation activities but believed many patients lacked motivation to quit smoking; a perception that was seen to be the main barrier in offering smoking cessation advice. Forty per cent of smokers would try to quit if asked by their dentists, but only 28.4 per cent preferred a dentist for cessation advice. In general, dentists found no change in demand for smoking cessation advice since the launch of the National Tobacco Campaign in 2006. Health warning pictures seemed to increase the patients' awareness and intention to quit smoking, however it did not appear to generate more demand for smoking cessation advice from their dentists. Dentists had low expectations about their patients' motivation to stop smoking.

  11. Using a Non-Fit Message Helps to De-Intensify Negative Reactions to Tough Advice.

    PubMed

    Fridman, Ilona; Scherr, Karen A; Glare, Paul A; Higgins, E Tory

    2016-08-01

    Sometimes physicians need to provide patients with potentially upsetting advice. For example, physicians may recommend hospice for a terminally ill patient because it best meets their needs, but the patient and their family dislike this advised option. We explore whether regulatory non-fit could be used to improve these types of situations. Across five studies in which participants imagined receiving upsetting advice from a physician, we demonstrate that regulatory non-fit between the form of the physician's advice (emphasizing gains vs. avoiding losses) and the participants' motivational orientation (promotion vs. prevention) improves participants' evaluation of an initially disliked option. Regulatory non-fit de-intensifies participants' initial attitudes by making them less confident in their initial judgments and motivating them to think more thoroughly about the arguments presented. Furthermore, consistent with previous research on regulatory fit, we showed that the mechanism of regulatory non-fit differs as a function of participants' cognitive involvement in the evaluation of the option. © 2016 by the Society for Personality and Social Psychology, Inc.

  12. Using Advice from Multiple Sources to Revise and Improve Judgments

    ERIC Educational Resources Information Center

    Yaniv, Ilan; Milyavsky, Maxim

    2007-01-01

    How might people revise their opinions on the basis of multiple pieces of advice? What sort of gains could be obtained from rules for using advice? In the present studies judges first provided their initial estimates for a series of questions; next they were presented with several (2, 4, or 8) opinions from an ecological pool of advisory estimates…

  13. Parastomal hernia and physical activity. Are patients getting the right advice?

    PubMed

    Russell, Sarah

    2017-09-28

    This article draws on a large nationwide survey (2631 respondents) that investigated the physical health and wellbeing of people living with stomas in the UK. It specifically considers the findings relating to parastomal hernia (where additional loops of bowel protrude through the abdominal wall around the stoma, creating a bulge). In this survey, 26% of respondents reported that they had a medically diagnosed parastomal hernia, which is below average when compared with other estimates. The impact of parastomal hernia on physical activity levels was the most significant finding: 32% of those with a medically diagnosed hernia reported being 'much less active' than they were prior to their surgery (compared with 19% without a hernia). This creates a more serious problem for general health-significantly increasing their risk of co-morbidities such as cancer, stroke, diabetes and other chronic conditions related to physical inactivity. Clinical guidelines clearly state that patients should be informed of exercises to strengthen core muscles, as part of hernia prevention, but 88% of patients did not engage in any sort of abdominal or core exercises. When asked, 69% of patients did not realise it was important and 82% of patients could not recall being given advice to do abdominal exercises as part of their recovery. There is a significant gap in the patient care pathway regarding advice on physical activity, core/abdominal exercises and hernia prevention and management after stoma surgery. This is an area that urgently needs more research and education for patients and all health professionals.

  14. Is Some Provider Advice on Smoking Cessation Better Than No Advice? An Instrumental Variable Analysis of the 2001 National Health Interview Survey

    PubMed Central

    Bao, Yuhua; Duan, Naihua; Fox, Sarah A

    2006-01-01

    Research Objective To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome. Data Source The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care. Study Design We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail. Principal Findings Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p<.001) and clinical significance. Conclusions Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces. PMID:17116112

  15. Advice to stay active as a single treatment for low back pain and sciatica.

    PubMed

    Hilde, G; Hagen, K B; Jamtvedt, G; Winnem, M

    2002-01-01

    simple LBP, and found improvement in functional status and reduction in sick leave in favour of advice to stay active. The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

  16. A systematic review of interventions to improve recall of medical advice in healthcare consultations.

    PubMed

    Watson, Philip W B; McKinstry, Brian

    2009-06-01

    In order for patients to adhere to healthcare advice, it is essential that they are able to recall this following a consultation. Although psychological research exists which highlights techniques and factors postulated to influence recall, only a limited body of work has been conducted to evaluate their effectiveness in a clinical context. To carry out a systematic review of intervention trials designed to enhance recall of medical information. We searched Medline (1950-April 2007); Embase (1980-April 2007); Cinahl (1982-April 2007); PsychINFO (1969-2007); and the Cochrane Library Collection. Secondary searches were made through reference to relevant journals and reference lists from relevant papers/review papers. From 69 papers provisionally identified, 34 papers met the inclusion criteria. Nine recall interventions had been evaluated (audio recordings, written materials, adjunct questions, prompt sheets, visual aids, cognitive strategies, rehearsal, communication styles and personalized teaching). Despite the experimental and theoretical evidence which could have informed cognitive interventions to enhance recall of healthcare advice, most studies primarily focused on the use of written and/or audio-recorded medical instructions. Although the majority of studies supported these approaches insofar as they enhanced recall, the findings were equivocal. While written and tape-recorded instructions appear to improve recall in most situations, a dearth of interventions incorporating psychological theory was readily apparent. Further research is required in clinical settings to determine if cognitive interventions based on a more over-arching psychological model of recall are effective.

  17. Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel.

    PubMed

    Webb, J; Foster, J; Poulter, E

    2016-04-01

    Being physically active has multiple benefits for cancer patients. Despite this only 23% are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers a teachable moment in which patients might be more receptive to lifestyle changes. Nurses are well placed to offer physical activity advice, however, only 9% of UK nurses involved in cancer care talk to all cancer patients about physical activity. A change in the behaviour of nurses is needed to routinely deliver physical activity advice to cancer patients. As recommended by the Medical Research Council, behavioural change interventions should be evidenced-based and use a relevant and coherent theoretical framework to stand the best chance of success. This paper presents a case study on the development of an intervention to improve the frequency of delivery of very brief advice (VBA) on physical activity by nurses to cancer patients, using the Behaviour Change Wheel (BCW). The eight composite steps outlined by the BCW guided the intervention development process. An iterative approach was taken involving key stakeholders (n = 45), with four iterations completed in total. This was not defined a priori but emerged during the development process. A 60 min training intervention, delivered in either a face-to-face or online setting, with follow-up at eight weeks, was designed to improve the capability, opportunity and motivation of nurses to deliver VBA on physical activity to people living with cancer. This intervention incorporates seven behaviour change techniques of goal setting coupled with commitment; instructions on how to perform the behaviour; salience of the consequences of delivering VBA; a demonstration on how to give VBA, all delivered via a credible source with objects added to the environment to support behavioural change. The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control

  18. The health care provider's role and patient compliance to health promotion advice from the user's perspective: analysis of the 2006 National Health Interview Survey data.

    PubMed

    Ndetan, Harrison; Evans, Marion Willard; Bae, Sejong; Felini, Martha; Rupert, Ronald; Singh, Karan P

    2010-01-01

    The recommendations of health care providers have been shown to be a predictor of future healthy behaviors. However, patient adherence to these recommendations may differ based upon the type of health care professional providing the information. This study explored patient compliance in the United States over a 12-month period and contracted the patient response to recommendations given by chiropractors versus medical doctors. Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 24 275). Analyses were performed separately for recommendation and compliance of weight loss, increase exercise, and diet change by health profession subtype (chiropractor and medical doctor). About 30.5% of the respondents reported receiving advice from their provider. Among these, 88.0% indicated they complied with the advice they received. Patients who were advised were more likely to comply (odds ratio [OR] [95% CI], 10.41[9.34-11.24]). Adjusting for seeing a physical therapist, age, and body mass index, chiropractors were less likely to advice patients compared to medical doctors (OR [95% CI], 0.38 [0.30-0.50]). In general, there was a 21% increased odds that patients who received and complied with health promotion advice from their health care provider would report an improved health status (OR [95% CI], 1.21 [1.10-1.33]) compared with those who did not comply or were not advised. Chiropractors in the United States give health promotion recommendation to their patients but are less likely to do so than general medical doctors. Patients tend to comply with health providers' recommendations and those who do report better health. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  19. Why people seek advice from community pharmacies about skin problems.

    PubMed

    Tucker, Rod; Stewart, Derek

    2015-04-01

    The objective of this study was to explore the reasons why patients with undiagnosed skin problems seek advice at pharmacies. Semi-structured telephone interviews were conducted with patients presenting at pharmacies requesting advice for their own (or their child's) undiagnosed skin problem. Twenty-five patients were interviewed. Key themes around choice of pharmacy were convenience of professional advice, triage to general practitioner (GP) care if warranted, inaccessibility of GP care and perceived non-serious nature of the condition. Interviewees also described high levels of trust in their pharmacists. Few concerns were noted, but those that were centred on lack of privacy and the potential for misdiagnosis. Almost all participants felt positive about their pharmacy care and would re-visit for future skin problems. Patients with undiagnosed skin problems seek advice from pharmacies for reasons of professional advice, accessibility, familiarity and trust and because they perceive their conditions as non-serious. © 2014 Royal Pharmaceutical Society.

  20. An Advice Mechanism for Heterogeneous Robot Teams

    NASA Astrophysics Data System (ADS)

    Daniluk, Steven

    The use of reinforcement learning for robot teams has enabled complex tasks to be performed, but at the cost of requiring a large amount of exploration. Exchanging information between robots in the form of advice is one method to accelerate performance improvements. This thesis presents an advice mechanism for robot teams that utilizes advice from heterogeneous advisers via a method guaranteeing convergence to an optimal policy. The presented mechanism has the capability to use multiple advisers at each time step, and decide when advice should be requested and accepted, such that the use of advice decreases over time. Additionally, collective collaborative, and cooperative behavioural algorithms are integrated into a robot team architecture, to create a new framework that provides fault tolerance and modularity for robot teams.

  1. Developing the public health role of a front line clinical service: integrating stop smoking advice into routine podiatry services.

    PubMed

    Gray, Jackie; Eden, Gary; Williams, Maria

    2007-06-01

    Although smoking is a major public health problem, many clinicians do not routinely provide evidence-based health improvement advice to smokers to help them to quit. Plan, Do, Study, Act (PDSA) cycle methodology was used to design and implement a service development so that health improvement advice for smokers featured in all podiatry consultations provided by a Primary Care Trust in North East England. IT systems were developed to record the number and proportion of patients for whom smoking status was assessed, and the number and proportion of smokers who were given advice to quit and referred for specialist support. A questionnaire to staff explored their perceptions of the development on their clinics and consultations. During a 6-month period, smoking status was recorded for all 8831 (100%) patients attending podiatry clinics; 83% of smokers were given brief advice to quit; 7% of smokers were given help to access specialist stop smoking support services. Improvements were introduced within existing budgets and did not prolong clinics. It is straightforward and inexpensive to develop clinical services so that public health guidance is routinely implemented. More widespread implementation of similar service developments could lead to national improvements in public health.

  2. Prevalence of and Reasons for Patients Leaving Against Medical Advice from Paediatric Wards in Oman.

    PubMed

    Al-Ghafri, Mohamed; Al-Bulushi, Abdullah; Al-Qasmi, Ahmed

    2016-02-01

    The objective of this study was to determine the prevalence of and reasons for patients leaving against medical advice (LAMA) in a paediatric setting in Oman. This retrospective study was carried out between January 2007 and December 2009 and assessed patients who left the paediatric wards at the Royal Hospital, Muscat, Oman, against medical advice. Of 11,482 regular discharges, there were 183 cases of LAMA (prevalence: 1.6%). Dissatisfaction with treatment and a desire to seek a second opinion were collectively the most cited reasons for LAMA according to data from the hospital's electronic system (27.9%) and telephone conversations with patients' parents (55.0%). No reasons for LAMA were documented in the hospital's electronic system for 109 patients (59.6%). The low observed prevalence of LAMA suggests good medical practice at the Royal Hospital. This study indicates the need for thorough documentation of all LAMA cases to ensure the availability of high-quality data for healthcare workers involved in preventing LAMA.

  3. WITHDRAWN: Advice to stay active as a single treatment for low-back pain and sciatica.

    PubMed

    Hilde, G; Hagen, K B; Jamtvedt, G; Winnem, M

    2007-07-18

    simple LBP, and found improvement in functional status and reduction in sick leave in favour of advice to stay active. The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

  4. A systematic review of interventions to improve recall of medical advice in healthcare consultations

    PubMed Central

    Watson, Philip WB; McKinstry, Brian

    2009-01-01

    Abstract Background In order for patients to adhere to healthcare advice, it is essential that they are able to recall this following a consultation. Although psychological research exists which highlights techniques and factors postulated to influence recall, only a limited body of work has been conducted to evaluate their effectiveness in a clinical context. Aim To carry out a systematic review of intervention trials designed to enhance recall of medical information. Methods We searched Medline (1950–April 2007); Embase (1980–April 2007); Cinahl (1982–April 2007); PsychINFO (1969–2007); and the Cochrane Library Collection. Secondary searches were made through reference to relevant journals and reference lists from relevant papers/review papers. Results From 69 papers provisionally identified, 34 papers met the inclusion criteria. Nine recall interventions had been evaluated (audio recordings, written materials, adjunct questions, prompt sheets, visual aids, cognitive strategies, rehearsal, communication styles and personalized teaching). Despite the experimental and theoretical evidence which could have informed cognitive interventions to enhance recall of healthcare advice, most studies primarily focused on the use of written and/or audio-recorded medical instructions. Although the majority of studies supported these approaches insofar as they enhanced recall, the findings were equivocal. Conclusion While written and tape-recorded instructions appear to improve recall in most situations, a dearth of interventions incorporating psychological theory was readily apparent. Further research is required in clinical settings to determine if cognitive interventions based on a more over-arching psychological model of recall are effective. PMID:19531618

  5. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study.

    PubMed

    de Roest, R H; Dobbs, B R; Chapman, B A; Batman, B; O'Brien, L A; Leeper, J A; Hebblethwaite, C R; Gearry, R B

    2013-09-01

    Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients. Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed. Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 [95% confidence interval (CI) 2.01-25.0], bloating OR 8.71 (95% CI 2.76-27.5), flatulence OR 7.64 (95% CI 2.53-23.0) and diarrhoea OR 3.39 (95% CI 1.17-9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms. The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet. © 2013 John Wiley & Sons Ltd.

  6. Good Advice

    ERIC Educational Resources Information Center

    Dryden, Lisa S.

    2005-01-01

    Letter writing in a "Dear Abby" format can encourage your reluctant writers to dig deeper into books by dispensing advice to troubled characters When this author's triplet daughters were in the fifth grade and wrote the advice column for their school newspaper, she discovered giving advice can motivate reluctant writers. This realization prompted …

  7. [New model of doctor-nurse communication based on electronic medical advice platform].

    PubMed

    Cao, Yang; Ding, Aimin; Wang, Yan

    2012-01-01

    This article introduces a new model of the communication between doctors and nurses, with the aid of the electronic medical advice platform. This model has achieved good results in improving doctor and nurse's co-working efficiency, treating patients safely, preventing medical accidents, reducing medical errors and so on.

  8. A self-help book is better than sleep hygiene advice for insomnia: a randomized controlled comparative study.

    PubMed

    Bjorvatn, Bjørn; Fiske, Eldbjørg; Pallesen, Ståle

    2011-12-01

    The objective was to compare the effects of two types of written material for insomnia in a randomized trial with follow-up after three months. Insomniacs were recruited through newspaper advertisements to a web-based survey with validated questionnaires about sleep, anxiety, depression, and use of sleep medications. A self-help book focusing on cognitive behavioral therapy for insomnia was compared to standard sleep hygiene advice; 77 and 78 participants were randomized to self-help book or sleep hygiene advice, respectively. The response rate was 81.9%. The self-help book gave significantly better scores on the sleep questionnaires compared to sleep hygiene advice. The proportion using sleep medications was reduced in the self-help book group, whereas it was increased in the sleep hygiene group. Compared to pre-treatment, the self-help book improved scores on the sleep (effect sizes 0.61-0.62) and depression (effect size 0.18) scales, whereas the sleep hygiene advice improved scores on some sleep scales (effect sizes 0.24-0.28), but worsened another (effect size -0.36). In addition, sleep hygiene advice increased the number of days per week where they took sleep medications (effect size -0.50). To conclude, in this randomized controlled trial, the self-help book improved sleep and reduced the proportion using sleep medications compared to sleep hygiene advice. The self-help book is an efficient low-threshold intervention, which is cheap and easily available for patients suffering from insomnia. Sleep hygiene advice also improved sleep at follow-up, but increased sleep medication use. Thus, caution is warranted when sleep hygiene advice are given as a single treatment. © 2011 The Authors. Scandinavian Journal of Psychology © 2011 The Scandinavian Psychological Associations.

  9. Reasons for discharges against medical advice: a qualitative study.

    PubMed

    Onukwugha, Eberechukwu; Saunders, Elijah; Mullins, C Daniel; Pradel, Françoise G; Zuckerman, Marni; Weir, Matthew R

    2010-10-01

    There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multicategory provider focus-group interviews (FGIs). Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical centre along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group and one nurse/social worker group were held. Focus-group interviews were transcribed, and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Eighteen patients, five physicians, six nurses and four social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker FGIs of reasons why patients leave against medical advice: (1) drug addiction, (2) pain management, (3) external obligations, (4) wait time, (5) doctor's bedside manner, (6) teaching hospital setting and (7) communication. Solutions to tackle DAMA identified by participants revolved mainly around enhanced communication and provider education. In a large, academic medical centre, the authors find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication.

  10. Lifestyle advice and lifestyle change: to what degree does lifestyle advice of healthcare professionals reach the population, focusing on gender, age and education?

    PubMed

    Brobeck, Elisabeth; Bergh, Håkan; Odencrants, Sigrid; Hildingh, Cathrine

    2015-03-01

    Health promotion practice in health care has a high priority in the endeavour to achieve equal opportunities for health and diversity in health among the population. The purpose of the study was to investigate whether there is any connection between the lifestyle advice given by healthcare professionals and the lifestyle change of the population, focusing on age, gender and education level. The study is based on the data from a national population survey in Sweden in which 52 595 patients who had attended health care were interviewed by phone. The participants were asked whether healthcare professionals had raised the subject of lifestyle during the visit and whether the advice they gave had contributed to a lifestyle change. The results indicated that lifestyle issues were raised with 32.2% of those who attended health care, particularly among men, younger patients and those with a high education level. When lifestyle issues were raised, the advice contributed to 39.2% of patients making a lifestyle change, to a higher extent among men, older patients and those with a low education level. The study shows that lifestyle advice given by healthcare professionals, during both emergency and outpatient healthcare visits, is an important contributor to patients' lifestyle change. © 2014 Nordic College of Caring Science.

  11. [How to handle the dilemma of driving for patients with Alzheimer's disease? A survey of advices provided by French caregivers guides].

    PubMed

    Mietkiewicz, Marie-Claude; Ostrowski, Madeleine

    2015-09-01

    For many old people, driving takes an important place in the daily living activities and contributes to carry on their autonomy and self-esteem. However, many studies showed a link between car accidents and Alzheimer's disease, even in the early stages of dementia, and people caring for these patients inevitably ask the question: "Is my patient with Alzheimer's disease still able to drive his car?" Guides devoted to caregivers can play an important role to improve the knowledge of Alzheimer's disease and to afford advices for patients managing. To assess how these guides handle the question of patients driving, we made a survey of the 46 French caregiver guides (re)published between 1988 and 2013. The question of driving is raised with more or less details in 31 guides. All state that driving should be discontinued but that the consequences of this decision on the patient autonomy should be taken into account. A few guides provide clues to assess driving competence for the patients, and many propose advices to support the implementation of the driving discontinuity decision, such as to discuss with the patient to persuade him to stop driving, to ask for assistance by the family physician, to hide the car's keys or to disconnect its battery... In France, physicians are not allowed to prohibit driving or to report dangerous driving to authorities. Ultimately, the caregivers remain faced with the ethical dilemma to choose between safety and the patient's autonomy preservation. Therefore the responsibility for the patient to persist or give up driving only falls to them.

  12. Reasons for discharges against medical advice: a qualitative study

    PubMed Central

    Onukwugha, Eberechukwu; Saunders, Elijah; Mullins, C. Daniel; Pradel, Françoise G.; Zuckerman, Marni; Weir, Matthew R.

    2013-01-01

    Background There is limited information in the literature about reasons for discharges against medical advice (DAMA) as supplied by patients and providers. Information about the reasons for DAMA is necessary for identifying workable strategies to reduce the likelihood and health consequences of DAMA. The objective of this study is to identify the reasons for DAMA based on patient and multi-category provider focus group interviews (FGIs). Methods Patients who discharged against medical advice between 2006 and 2008 from a large, academic medical center along with hospital providers reporting contact with patients who left against medical advice were recruited. Three patient-only groups, one physician-only group, and one nurse/social worker group were held. Focus group interviews were transcribed and a thematic analysis was performed to identify themes within and across groups. Participants discussed the reasons for patient DAMA and identified potential solutions. Results Eighteen patients, 5 physicians, 6 nurses and 4 social workers participated in the FGIs. Seven themes emerged across the separate patient, doctor, nurse/social worker group FGIs of reasons why patients leave against medical advice: 1) drug addiction, 2) pain management, 3) external obligations, 4) wait time, 5) doctor’s bedside manner, 6) teaching hospital setting, and 7) communication. Solutions to tackle DAMA identified by participants revolve mainly around enhanced communication and provider education. Conclusions In a large, academic medical center we find some differences and many similarities across patients and providers in identifying the causes of and solutions to DAMA, many of which relate to communication. PMID:20538627

  13. Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change

    PubMed Central

    2010-01-01

    Background Alcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change. Methods The study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care. Results Among the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use - fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men

  14. Teledermatologist expert skin advice: A unique model of care for managing skin disorders and adverse drug reactions in hepatitis C patients.

    PubMed

    Charlston, Samuel; Siller, Gregory

    2018-03-23

    To conduct an audit of teledermatologist expert skin advice, a store and forward tele-dermatological service, to determine its effectiveness and user satisfaction in managing cutaneous adverse drug reactions in patients with hepatitis C, and to demonstrate a unique collaborative model of care for patients receiving specialised drug therapy. A retrospective analysis of data on teledermatologist expert skin advice referrals from January 2014 to December 2015 was performed. The primary outcomes assessed included number of referrals, referral locations, diagnoses, response times, quality of clinical information provided and user satisfaction ratings. Altogether 43 consultations from 29 referring sites were received from Australian metropolitan and rural settings. Of the patients, 43 were diagnosed with an adverse drug reaction related to the use of either telaprevir or simeprevir. The average time taken for the dermatologist to reply electronically with a final diagnosis and management plan was 1 h 57 min. As many as 26% of referrals required additional photos to establish a diagnosis due to poor-quality images or insufficient detail. Altogether 18 clinicians completed the customer satisfaction survey, all of whom rated teledermatologist expert skin advice nine or above on a scale of one to 10. Teledermatologist expert skin advice was regarded by clinicians as a valuable patient care service. The platform is a novel modality that supports patients undergoing specialised treatments at risk of cutaneous adverse drug reaction. © 2018 The Australasian College of Dermatologists.

  15. The role of time and risk preferences in adherence to physician advice on health behavior change.

    PubMed

    van der Pol, Marjon; Hennessy, Deirdre; Manns, Braden

    2017-04-01

    Changing physical activity and dietary behavior in chronic disease patients is associated with significant health benefits but is difficult to achieve. An often-used strategy is for the physician or other health professional to encourage behavior changes by providing advice on the health consequences of such behaviors. However, adherence to advice on health behavior change varies across individuals. This paper uses data from a population-based cross-sectional survey of 1849 individuals with chronic disease to explore whether differences in individuals' time and risk preferences can help explain differences in adherence. Health behaviors are viewed as investments in health capital within the Grossman model. Physician advice plays a role in the model in that it improves the understanding of the future health consequences of investments. It can be hypothesized that the effect of advice on health behavior will depend on an individuals' time and risk preference. Within the survey, which measured a variety of health-related behaviors and outcomes, including receipt and compliance with advice on dietary and physical activity changes, time preferences were measured using financial planning horizon, and risk preferences were measured through a commonly used question which asked respondents to indicate their willingness to take risks on a ten-point scale. Results suggest that time preferences play a role in adherence to physical activity advice. While time preferences also play a role in adherence to dietary advice, this effect is only apparent for males. Risk preferences do not seem to be associated with adherence. The results suggest that increasing the salience of more immediate benefits of health behavior change may improve adherence.

  16. A nurse- and pharmacist-led treatment advice clinic for patients attending an HIV outpatient clinic.

    PubMed

    Griffiths, C; Miles, K; Aldam, D; Cornforth, D; Minton, J; Edwards, S; Williams, I

    2007-05-01

    This paper is a report of a study to map care pathways, examine the approach of different treatment advisors and explore the acceptability of a nurse- and pharmacist-led treatment advice clinic in order to aid decision-making for the future development and evaluation of the clinic. High levels of adherence to antiretroviral drugs are a prerequisite for a successful and durable virological and immunological response to HIV. Treatment guidelines acknowledge that adherence is a process, not a single event, and that adherence support must be integrated into clinical follow-up for all patients receiving these drugs. Data were collected between September 2004 and January 2005 through 17 consultation observations and 10 patient interviews in a specialist treatment advice clinic located within a central London HIV outpatient clinic providing care for over 2200 patients, of whom more than 1300 are taking highly active antiretroviral therapy. The nurses and pharmacist had similar consultation approaches, although follow-up care varied in extent. Benefits of the clinic approach included permitting patients to observe real tablets, tailoring regimens to lifestyles and telephone follow-up. These factors, particularly telephone support, were perceived by patients to assist with adherence. The role of telephone support, perceived to assist with initial adherence, requires further investigation. Future work is also needed to explore the health economics of this approach and to determine the actual impact of the clinic on clinical and adherence outcomes.

  17. Analysis of free online physician advice services.

    PubMed

    Cohen, Raphael; Elhadad, Michael; Birk, Ohad

    2013-01-01

    Online Consumer Health websites are a major source of information for patients worldwide. We focus on another modality, online physician advice. We aim to evaluate and compare the freely available online expert physicians' advice in different countries, its scope and the type of content provided. Using automated methods for information retrieval and analysis, we compared consumer health portals from the US, Canada, the UK and Israel (WebMD,NetDoctor,AskTheDoctor and BeOK). The evaluated content was generated between 2002 and 2011. We analyzed the different sites, looking at the distribution of questions in the various health topics, answer lengths and content type. Answers could be categorized into longer broad-educational answers versus shorter patient-specific ones, with different physicians having personal preferences as to answer type. The Israeli website BeOK, providing 10 times the number of answers than in the other three health portals, supplied answers that are shorter on average than in the other websites. Response times in these sites may be rapid with 32% of the WebMD answers and 64% of the BeOK answers provided in less than 24 hours. The voluntary contribution model used by BeOK and WebMD enables generation of large numbers of physician expert answers at low cost, providing 50,000 and 3,500 answers per year, respectively. Unlike health information in online databases or advice and support in patient-forums, online physician advice provides qualified specialists' responses directly relevant to the questions asked. Our analysis showed that high numbers of expert answers could be generated in a timely fashion using a voluntary model. The length of answers varied significantly between the internet sites. Longer answers were associated with educational content while short answers were associated with patient-specific content. Standard site-specific guidelines for expert answers will allow for more desirable content (educational content) or better throughput

  18. Who Do Hospital Physicians and Nurses Go to for Advice About Medications? A Social Network Analysis and Examination of Prescribing Error Rates.

    PubMed

    Creswick, Nerida; Westbrook, Johanna Irene

    2015-09-01

    To measure the weekly medication advice-seeking networks of hospital staff, to compare patterns across professional groups, and to examine these in the context of prescribing error rates. A social network analysis was conducted. All 101 staff in 2 wards in a large, academic teaching hospital in Sydney, Australia, were surveyed (response rate, 90%) using a detailed social network questionnaire. The extent of weekly medication advice seeking was measured by density of connections, proportion of reciprocal relationships by reciprocity, number of colleagues to whom each person provided advice by in-degree, and perceptions of amount and impact of advice seeking between physicians and nurses. Data on prescribing error rates from the 2 wards were compared. Weekly medication advice-seeking networks were sparse (density: 7% ward A and 12% ward B). Information sharing across professional groups was modest, and rates of reciprocation of advice were low (9% ward A, 14% ward B). Pharmacists provided advice to most people, and junior physicians also played central roles. Senior physicians provided medication advice to few people. Many staff perceived that physicians rarely sought advice from nurses when prescribing, but almost all believed that an increase in communication between physicians and nurses about medications would improve patient safety. The medication networks in ward B had higher measures for density, reciprocation, and fewer senior physicians who were isolates. Ward B had a significantly lower rate of both procedural and clinical prescribing errors than ward A (0.63 clinical prescribing errors per admission [95%CI, 0.47-0.79] versus 1.81/ admission [95%CI, 1.49-2.13]). Medication advice-seeking networks among staff on hospital wards are limited. Hubs of advice provision include pharmacists, junior physicians, and senior nurses. Senior physicians are poorly integrated into medication advice networks. Strategies to improve the advice-giving networks between senior

  19. Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial.

    PubMed

    Bobb, C; Ritz, T; Rowlands, G; Griffiths, C

    2010-01-01

    Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control. In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy. Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s > or =15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups. Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control. ISRCTN45684820.

  20. Virtual patients: practical advice for clinical authors using Labyrinth.

    PubMed

    Begg, Michael

    2010-09-01

    Labyrinth is a tool originally developed in the University of Edinburgh's Learning Technology Section for authoring and delivering branching case scenarios. The scenarios can incorporate game-informed elements such as scoring, randomising, avatars and counters. Labyrinth has grown more popular internationally since a version of the build was made available on the open source network Source Forge. This paper offers help and advice for clinical educators interested in creating cases. Labyrinth is increasingly recognised as a tool offering great potential for delivering cases that promote rich, situated learning opportunities for learners. There are, however, significant challenges to generating such cases, not least of which is the challenge for potential authors in approaching the process of constructing narrative-rich, context-sensitive cases in an unfamiliar authoring environment. This paper offers a brief overview of the principles informing Labyrinth cases (game-informed learning), and offers some practical advice to better prepare educators with little or no prior experience. Labyrinth has continued to grow and develop, from its roots as a research and development environment to one that is optimised for use by non-technical clinical educators. The process becomes increasingly iterative and better informed as the teaching community push the software further. The positive implications of providing practical advice and concept insight to new case authors is that it ideally leads to a broader base of users who will inform future iterations of the software. © Blackwell Publishing Ltd 2010.

  1. Instructional Advice, Time Advice and Learning Questions in Computer Simulations

    ERIC Educational Resources Information Center

    Rey, Gunter Daniel

    2010-01-01

    Undergraduate students (N = 97) used an introductory text and a computer simulation to learn fundamental concepts about statistical analyses (e.g., analysis of variance, regression analysis and General Linear Model). Each learner was randomly assigned to one cell of a 2 (with or without instructional advice) x 2 (with or without time advice) x 2…

  2. E-Cigarette Advice to Patients From Physicians and Dentists in the United States.

    PubMed

    Drouin, Olivier; McMillen, Robert C; Klein, Jonathan D; Winickoff, Jonathan P

    2018-06-01

    To report on adults' recall of discussion by physicians and dentists about e-cigarettes. A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Adults who ever used e-cigarettes. Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child's doctor in the past 12 months. Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child's doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child's doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child's doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

  3. Physicians’ duty to recontact and update genetic advice

    PubMed Central

    Stevens, Yvonne A; Senner, Grant D; Marchant, Gary E

    2017-01-01

    This perspective addresses whether physicians have a duty to recontact former or current patients to update clinical advice based on newly discovered genomic information. Genetic information is unique compared with other medical data in that the underlying data do not appreciably change during the patients’ lifetime, but the clinical significance of that information will continue to evolve. Based on relevant case law and guidelines, there is no general, established legal duty for physicians to affirmatively recontact former or current patients to update clinical advice based on newly discovered genetic information. However, integration of genomics into clinical practice is advancing quickly, and there may be limited, specific situations where a physician may have a duty to provide updated genetic information. PMID:29158769

  4. How does cot death prevention advice influence parents' behaviour?

    PubMed

    Miller, L H; Fraser, A; Moy, R

    2008-09-01

    To explore parents' understanding of the recommended cot death prevention strategies, and to discuss what they are doing in practice. If there is a difference between knowledge and implementation measures, possible reasons for this will be considered. A qualitative study using thematic analysis, aimed at finding out attitudes and opinions of parents about cot death prevention measures. Twelve participants were interviewed from two disadvantaged communities in south Birmingham. Parents found that much of the cot death prevention advice they were provided with was conflicting and caused confusion. As such, many parents chose to follow advice from non-healthcare sources. Some parents were carrying out preventative measures but were not aware of the reason for doing it. Many felt they did not receive enough advice relating to cot death prevention. Cot death health promotion advice appears to be inadequate among patients from a deprived socioeconomic background. Some of these issues could be resolved with increased training addressing these matters.

  5. The implementation of ergonomics advice and the stage of change approach.

    PubMed

    Rothmore, Paul; Aylward, Paul; Karnon, Jonathan

    2015-11-01

    This paper investigates the implementation of injury prevention advice tailored according to the Stage of Change (SOC) approach. The managers of 25 workgroups, drawn from medium to large companies across a wide range of occupational sectors were allocated to receive either standard ergonomics advice or ergonomics advice tailored according to the workgroup SOC. Twelve months after the advice was provided, semi-structured interviews were conducted with each manager. In a multivariate model, managers who had received tailored advice were found to have implemented significantly more of the recommended changes (IRR = 1.68, 95% CI 1.07-2.63) and more "additional" changes (IRR = 1.90, 95% CI 1.12-3.20). Qualitative analysis identified that the key barriers and facilitators to the implementation of changes were largely related to worker resistance to change and the attitudes of senior managers towards health and safety. The findings from this study suggest that the implementation of ergonomics recommendations may be improved by the tailoring of advice according to SOC principles. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  6. Advice to young behavioral and cognitive scientists.

    PubMed

    Weisman, Ronald G

    2008-02-01

    Modeled on Medawar's Advice to a Young Scientist [Medawar, P.B., 1979. Advice to a Young Scientist. Basic Books, New York], this article provides advice to behavioral and cognitive scientists. An important guiding principle is that the study of comparative cognition and behavior are natural sciences tasked with explaining nature. The author advises young scientists to begin with a natural phenomenon and then bring it into the laboratory, rather than beginning in the laboratory and hoping for an application in nature. He suggests collaboration as a way to include research outside the scientist's normal competence. He then discusses several guides to good science. These guides include Tinbergen's [Tinbergen, N., 1963. On aims and methods of ethology. Zeitschrift für Tierpsychologie, 20, 410-433. This journal was renamed Ethology in 1986. Also reprinted in Anim. Biol. 55, 297-321, 2005] four "why" questions, Platt's [Platt, J.R., 1964. Strong inference. Science 146, 347-353, (http://weber.ucsd.edu/~jmoore/courses/Platt1964.pdf)] notion of strong inference using multiple alternative hypotheses, and the idea that positive controls help scientists to follow Popper's [Popper, K.R., 1959. The Logic of Scientific Discovery. Basic Books, New York, p. 41] advice about disproving hypotheses. The author also recommends Strunk and White's [Strunk, W., White, E.B., 1979. The Elements of Style, third ed. Macmillan, New York] rules for sound writing, and he provides his personal advice on how to use the anticipation of peer review to improve research and how to decode editors' and reviewers' comments about submitted articles.

  7. Discharge Against Medical Advice in the Pediatric Wards in Boo-ali Sina Hospital, Sari, Iran 2010.

    PubMed

    Mohseni Saravi, Benyamin; Reza Zadeh, Esmaeil; Siamian, Hasan; Yahghoobian, Mahboobeh

    2013-12-01

    Since children neither comprehended nor contribute to the decision, discharge against medical advice is a challenge of health care systems in the world. Therefore, the current study was designed to determine the rate and causes of discharge against medical advice. This descriptive cross-sectional study was done by reviewing the medical records by census method. Data was analyzed using SPSS software and x(2) statistics was used to determine the relationship between variables. The value of P<0.05 was considered significant. Rate of discharged against medical advice was 108 (2.2%). Mean of age and length of stay were 2.8±4 (SD).3 years old and 3.7±5.4 (SD) days, respectively. Totally, 95 patients (88.7%) had health insurance and 65 (60.2%) patients lived in urban areas. History of psychiatric disease and addiction in 22 (20.6%) of the parents were negative. In addition, 100 (92.3%) patients admitted for medical treatment and the others for surgery. The relationship of the signatory with patients (72.3%) was father. Of 108 patients discharged against medical advice, 20 (12%) were readmitted. The relationship between the day of discharge and discharge against medical advice was significant (ρ =0/03). Rate of discharge against medical advice in Boo-ali hospital is the same as the other studies in the same range. The form which is used for this purpose did not have suitable data elements about description of consequence of such discharge, and it has not shown the real causes of discharge against medical advice.

  8. The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study.

    PubMed

    Pearson, Jennifer; Richardson, Jane; Calnan, Michael; Salisbury, Chris; Foster, Nadine E

    2016-03-28

    In response to long waiting lists and problems with access to primary care physiotherapy, several Primary Care Trusts (PCTs) (now Clinical Commissioning Groups CCGs) developed physiotherapy-led telephone assessment and treatment services. The Medical Research Council (MRC) funded PhysioDirect trial was a randomised control trial (RCT) in four PCTs, with a total of 2252 patients that compared this approach with usual physiotherapy care. This nested qualitative study aimed to explore the acceptability of the PhysioDirect telephone assessment and advice service to patients with musculoskeletal conditions. We conducted 57 semi-structured interviews with adults from 4 PCTs who were referred from general practice to physiotherapy with musculoskeletal conditions and were participating in the PhysioDirect trial. The Framework method was used to analyse the qualitative data. The PhysioDirect service was largely viewed as acceptable although some saw it as a first step to subsequent face-to-face physiotherapy. Most participants found accessing the PhysioDirect service straightforward and smooth, and they valued the faster access to physiotherapy advice offered by the telephone service. Participants generally viewed both the PhysioDirect service and the physiotherapists providing the service as helpful. Participants' preferences and priorities for treatment defined the acceptable features of PhysioDirect but the acceptable features were traded off against less acceptable features. Some participants felt that the PhysioDirect service was impersonal and impaired the development of a good relationship with their physiotherapist, which made the service feel remote and less valuable. The PhysioDirect service was broadly acceptable to participants since it provided faster access to physiotherapy advice for their musculoskeletal conditions. Participants felt that it is best placed as one method of accessing physiotherapy services, in addition to, rather than as a replacement for

  9. Is organizational justice associated with clinical performance in the care for patients with diabetes in primary care? Evidence from the improving Quality of care in Diabetes study.

    PubMed

    Elovainio, Marko; Steen, Nick; Presseau, Justin; Francis, Jill; Hrisos, Susan; Hawthorne, Gillian; Johnston, Marie; Stamp, Elaine; Hunter, Margaret; Grimshaw, Jeremy M; Eccles, Martin P

    2013-02-01

    Type 2 diabetes is an increasingly prevalent illness, and there is considerable variation in the quality of care provided to patients with diabetes in primary care. The aim of this study was to explore whether organizational justice and organizational citizenship behaviour are associated with the behaviours of clinical staff when providing care for patients with diabetes. The data were from an ongoing prospective multicenter study, the 'improving Quality of care in Diabetes' (iQuaD) study. Participants (N = 467) were clinical staff in 99 primary care practices in the UK. The outcome measures were six self-reported clinical behaviours: prescribing for glycaemic control, prescribing for blood pressure control, foot examination, giving advice about weight management, providing general education about diabetes and giving advice about self-management. Organizational justice perceptions were collected using a self-administered questionnaire. The associations between organizational justice and behavioural outcomes were tested using linear multilevel regression modelling. Higher scores on the procedural component of organizational justice were associated with more frequent weight management advice, self-management advice and provision of general education for patients with diabetes. The associations between justice and clinical behaviours were not explained by individual or practice characteristics, but evidence was found for the partial mediating role of organizational citizenship behaviour. Quality improvement efforts aimed at increasing advice and education provision in diabetes management in primary care could target also perceptions of procedural justice.

  10. 16 CFR 1.3 - Advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... views. (b) Any advice given by the Commission is without prejudice to the right of the Commission to... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Advice. 1.3 Section 1.3 Commercial Practices... Guidance Advisory Opinions § 1.3 Advice. (a) On the basis of the materials submitted, as well as any other...

  11. 16 CFR 1.3 - Advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... views. (b) Any advice given by the Commission is without prejudice to the right of the Commission to... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Advice. 1.3 Section 1.3 Commercial Practices... Guidance Advisory Opinions § 1.3 Advice. (a) On the basis of the materials submitted, as well as any other...

  12. Knowledge, attitudes, and practices of US practitioners who provide pre-travel advice.

    PubMed

    Kogelman, Laura; Barnett, Elizabeth D; Chen, Lin H; Quinn, Emily; Yanni, Emad; Wilson, Mary E; Benoit, Christine; Karchmer, Adolf W; Ooi, Winnie W; Jentes, Emily S; Hamer, Davidson H

    2014-01-01

    As international travel increases, many health care professionals are being asked to provide pre-travel advice. We designed an anonymous web-based survey to assess the extent to which primary care providers (PCPs) provide travel medicine advice and how their understanding and delivery of itinerary-specific advice and management compare with that of travel medicine specialists. We surveyed randomly selected US PCPs registered in the Pri-Med Institute (now pmiCME) database and US travel medicine specialists from the International Society of Travel Medicine (ISTM), American Society of Tropical Medicine and Hygiene (ASTMH), and Centers for Disease Control and Prevention (CDC) yellow fever (YF) vaccine provider mailing lists. SAS software (SAS Institute, Cary, NC, USA) was used for all analyses. Of 14,932 e-mails sent to valid e-mail addresses, 902 yielded complete or partially completed surveys (6.0% response rate). Eighty percent of respondents personally provided pre-travel advice (95% of travel medicine specialists versus 73% of PCPs). About two thirds of PCPs (68%) providing pre-travel consultations saw <50 travelers per year whereas 30% of travel medicine specialists saw <50 travelers per year. More travel medicine specialists (59%) than PCPs (18%) saw >500 travelers per year. Familiarity with travel-specific vaccines (YF, Japanese encephalitis) and provision of written educational materials increased as volume of travelers increased. Familiarity with antimalarial side effects and malaria resistance patterns, and knowledge scores based on brief pre-travel scenarios were higher in travel medicine specialists, ASTMH or ISTM certificate holders, and respondents who saw more pre-travel patients. Many PCP survey participants provided pre-travel advice, but most saw few travelers. Volume of travelers and holding an ASTMH or ISTM certificate had the greatest influence on knowledge of travel medicine and provision of appropriate advice and recommendations. Creating easily

  13. Can Secure Patient-Provider Messaging Improve Diabetes Care?

    PubMed

    Chung, Sukyung; Panattoni, Laura; Chi, Jeffrey; Palaniappan, Latha

    2017-10-01

    Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied ( N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering. Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA 1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages. Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice. © 2017 by the American Diabetes Association.

  14. It is important that they care - older persons' experiences of telephone advice nursing.

    PubMed

    Holmström, Inger K; Nokkoudenmäki, Mai-Britt; Zukancic, Selma; Sundler, Annelie J

    2016-06-01

    The aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres. Telephone advice nursing is expanding worldwide, and the older population is increasing. Little is known about older persons' experiences of telephone advice nursing provided by primary healthcare. This study has a descriptive design with a qualitative inductive approach. Data were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis. The older persons' experiences were described in two themes: the patient-friendly aspects of telephone advice nursing and the patient-unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven subthemes. This study contributes to increased awareness of the advantages and disadvantages of the telephone advice nursing system as experienced by older persons. To be the focus of attention during calls was highlighted as important; and clear communication was deemed crucial. When the communication between the nurse and the older persons was perceived as good and the perspective of the caller was the focus, an experience of safety and satisfaction was described. Older persons had great confidence in the telephone nurses' competence and perceived their ability to access the service as mostly good, even if it was sometimes difficult to use the service. The communicative competence of telephone nurses is essential when providing telephone advice nursing to older persons. In addition, a person-centred approach is important to provide optimal care in telephone advice nursing. © 2016 John Wiley & Sons Ltd.

  15. A survey of exercise advice and recommendations in United Kingdom paediatric cardiac clinics.

    PubMed

    Williams, Craig A; Gowing, Lucy; Horn, Richard; Stuart, Alan Graham

    2017-07-01

    Physical activity and exercise have important health benefits for children and adolescents with CHD. The objective of this study was to survey the provision of advice and recommendations in United Kingdom paediatric CHD clinics. A three-page questionnaire was sent out to paediatric cardiac consultants in the United Kingdom, paediatric consultants with expertise in cardiology, and nursing staff (Paediatricians with Expertise in Cardiology Special Interest Group), as well as all members of the British Congenital Cardiovascular Association. The aim of this questionnaire was to determine the extent and scope of current information provision and to assess the importance that clinicians place on this advice. There were 68 responses in total, and the data showed that, of these, 24 (36%) clinicians had never provided paediatric CHD patients with written advice about exercise. Only 27 (39%) clinicians provided physical activity advice at every appointment. Lack of time during consultation (n=39, 56.9%), lack of training (n=38, 55.2%), and uncertainty about appropriate recommendations (n=38, 55.2%) were identified as the main factors preventing clinicians from providing patients with advice about physical activity. Although healthcare providers consider physical activity to be very important, the provision of clear, specific advice and recommendations is underutilised; therefore, more education and provision of resources to support the promotion of exercise need to be provided to clinicians and their support teams.

  16. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial.

    PubMed

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2016-04-01

    We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized to a structured lifestyle advice program with or without PFMT. Both groups received similar lifestyle advice in six separate group sessions. The combined group performed group PFMT after an individual assessment. Primary outcome was a global improvement scale at six-month follow-up. Secondary outcomes were the global scale and objective POP at three-month follow-up, symptoms and quality of life including sexuality, at three and six-month follow-up. A clinically relevant change of symptoms was defined as ≥ 15 %. We included 109 women. Eighty-nine women (82 %) completed three months follow-up; 85 (78 %) completed six-month follow-up. At both follow-ups, significantly more women in the combined group reported improvement in the global scale. At the three-month follow-up, the combined group only had significant improvement of POP symptoms while only the lifestyle advice group had significant improvement of quality of life. Change in objective POP and sexuality was nonsignificant. The symptom score improved 17 % in the combined group and 14 % in the lifestyle advice group (P = 0.57). Significantly more women in the lifestyle advice group had sought further treatment at the six-month follow-up. Adding PFMT to a structured lifestyle advice program gave superior results in a global scale and for POP symptoms. Overall effect of either intervention barely reached clinical relevance.

  17. Preconception lifestyle advice for people with subfertility.

    PubMed

    Anderson, Kirsty; Norman, Robert J; Middleton, Philippa

    2010-04-14

    Infertility is a prevalent problem and has significant consequences for individuals, families and the wider community. People's chance of having a healthy, live birth may be impacted upon by factors such as weight, diet, smoking, other substance abuse, environmental pollutants, infections, medical conditions, medications and family medical history. However, there is no current guideline about what preconception advice should be offered to people presenting for infertility treatment. It is important to determine what preconception advice should be given about these types of factors to such people in order to help them to make positive changes and hopefully improve their chances of conception and delivering a healthy, live baby. To assess the effects of preconception advice on the chances of a live birth for people who perceive that they may be infertile and are investigating the possibility of medical treatment to address subfertility. All published and unpublished randomised controlled trials addressing preconception advice to influence lifestyle factors in people who perceived that they may be infertile and investigated the possibility of medical treatment to address subfertility were sought from the Cochrane Menstrual Disorders and Subfertility Review Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, MEDLINE, PubMed, EMBASE, PsycINFO, AMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), LILACS, trial registers for ongoing and registered trials, citation indexes, ISI Web of Knowledge, Clinical Study Results database, OpenSIGLE database, China National Knowledge Infrastructure (CNKI) Periodical Index and Google (inception to 5 October 2009). Only randomised controlled trials (RCTs), including cluster-randomised (group-randomised) trials, that considered preconception advice given to individuals who perceived that they may be infertile and were investigating the possibility of medical treatment

  18. Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol.

    PubMed

    Forster, N; Dalkin, S M; Lhussier, M; Hodgson, P; Carr, S M

    2016-01-20

    Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

    PubMed Central

    Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

    2016-01-01

    Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

  20. Trust in Sources of Advice about Infant Care Practices: The SAFE Study.

    PubMed

    Hwang, Sunah S; Rybin, Denis V; Heeren, Timothy C; Colson, Eve R; Corwin, Michael J

    2016-09-01

    Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

  1. Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community.

    PubMed

    Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

    2006-02-01

    Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a specialty clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong

  2. Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study.

    PubMed

    Tran, Duong Thuy; Gibson, Amy; Randall, Deborah; Havard, Alys; Byrne, Mary; Robinson, Maureen; Lawler, Anthony; Jorm, Louisa R

    2017-08-01

    Middle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call. Records of calls to the Australian healthdirect helpline (July 2008-December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice "Attend ED immediately"; "See a doctor (immediately, within 4 hours, or within 24 hours)"; "Self-care"; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics. This study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices "Attend ED immediately", "See a doctor" and "Self-care" were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice "Attend ED immediately" was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice "See a doctor" was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas

  3. Combined effect of new complete dentures and simple dietary advice on nutritional status in edentulous patients: study protocol for a randomized controlled trial.

    PubMed

    Komagamine, Yuriko; Kanazawa, Manabu; Iwaki, Maiko; Jo, Ayami; Suzuki, Hiroyuki; Amagai, Noriko; Minakuchi, Shunsuke

    2016-11-09

    Individuals who are edentulous have a lower intake of fruit, vegetables, fiber, and protein compared with their dentate counterparts because tooth loss is accompanied by a decrease in ability to chew. Whether or not a combination of prosthetic rehabilitation and simple dietary advice produces improvement in dietary intake among edentulous persons is unclear. We aim to investigate the effect of a simultaneous combination of simple dietary advice delivered by dentists and provision of new complete dentures on dietary intake in edentulous individuals who request new dentures. Through a double-blinded, parallel, randomized controlled trial in which 70 edentate persons who request new complete dentures will be enrolled, eligible study participants will be randomly allocated to either a dietary intervention group receiving dietary advice or to a control group receiving only advice on the care and maintenance of dentures. Outcome measures include daily intake of nutrients and food items, assessed using a brief self-administered diet history questionnaire; antioxidant capacity, determined using blood and urine samples; nutritional status, assessed with the Mini-Nutritional Assessment-Short Form; oral health-related quality of life, assessed with the Japanese version of the Oral Health Impact Profile-EDENT and the Geriatric Oral Health Assessment Index; subjective chewing ability; masticatory performance, assessed using a color-changeable chewing gum and a gummy jelly; patient self-assessment of dentures; mild cognitive impairment, assessed with the Japanese version of the Montreal Cognitive Assessment; and functional capacity, assessed with the Japan Science and Technology Agency Index of Competence. Outcome measures, except for antioxidant capacity, are to be implemented at three time points: at baseline and at 3 and 6 months following intervention. Antioxidant capacity data are to be collected twice: at baseline and at 3 months following intervention. Differences

  4. Lifestyle advice for Korean Americans and native Koreans with hypertension.

    PubMed

    Kim, Mi Ja; Lee, Suk Jeong; Ahn, Yang-Heui; Lee, Hyeonkyeong

    2011-03-01

    This paper is a report of a comparison of advice on lifestyle given by healthcare providers and subsequent action by recipients between Korean Americans and native Koreans with hypertension. High blood pressure is controllable by having a healthy lifestyle, such as weight control, dietary change, exercise, low-sodium diet, alcohol restriction and smoking cessation, and by taking medication. Healthcare providers play an important role in teaching individuals with hypertension on healthy lifestyles. This descriptive comparative study was conducted with a convenience sample of 100 Korean Americans and 100 native Koreans with hypertension. They were interviewed between May 2003 and June 2004 on the advice they received from healthcare providers on lifestyle and their subsequent action in terms of taking medication, weight control, dietary change, exercise, low-sodium diet, smoking cessation, alcohol restriction and tension reduction. Nutrient profiles were examined using the 24-hour dietary recall method. Korean Americans received advice on lifestyle less than did native Koreans, but more Korean Americans followed healthy lifestyle advice on dietary change and exercise than did native Koreans (P<0.001). Weight control was the least adhered to behaviour among the Korean Americans, although almost two-thirds of them were overweight or obese. Both groups exceeded the Dietary Reference Intakes of sodium, but perceived their sodium consumption as low. Native Korean participants need to pay closer attention to carrying out the advice, whereas healthcare providers to Korean Americans need to give more advice on culturally acceptable healthy lifestyles, particularly on dietary changes and weight control. Both groups need to monitor their sodium intake more realistically. It is not only advice from healthcare providers that is integral to control of hypertension, but also that patients should follow that advice. © 2010 Blackwell Publishing Ltd.

  5. How do stroke survivors and their carers use practitioners' advice on secondary prevention medications? Qualitative study of an online forum.

    PubMed

    Izuka, Nkeonye J; Alexander, Matthew A W; Balasooriya-Smeekens, Chantal; Mant, Jonathan; De Simoni, Anna

    2017-09-01

    Secondary prevention medications reduce risk of stroke recurrence, yet many people do not receive recommended treatment, nor take medications optimally. Exploring how patients report making use of practitioners' advice on secondary prevention medicines on an online forum and what feedback was received from other participants. Thematic analysis of the archive of Talkstroke (2004-2011), UK. Posts including any secondary prevention medication terms, General Practitioner (GP) and their replies were identified. Fifity participants talked about practitioners' advice on secondary prevention medications in 43 discussion threads. Patients consulted practitioners for reassurance and dealing with side effects. Practitioners' advice varied from altering to maintaining current treatment. Three main themes emerged from the use of practitioners' advice: patients following advice (reassured, happy when side effects made tolerable, or still retaining anxiety about treatment); patients not following advice (admitting adherence on-off or stopping medications as side effects still not tolerable); asking other participants for feedback on advice received. Practitioners' advice was disregarded mainly when related to dealing with statin side effects, after one or two consultations. Themes for feedback involved sharing experience, directing back to practitioners, or to external evidence. Side effects of secondary prevention medications and statins in particular, cause anxiety and resentment in some patients, and their concerns are not always addressed by practitioners. Practitioners could consider more proactive strategies to manage such side effects. Forum feedback was appropriate and supportive of the practitioners' advice received. Our findings from peer-to-peer online conversations confirm and widen previous research. © The Author 2017. Published by Oxford University Press.

  6. The role of cystovaginoscopy and hygienic advice in girls referred for symptoms of vulvovaginitis.

    PubMed

    Ram, Ashok Daya; Hurst, Katherine Victoria; Steinbrecher, Henrik

    2012-05-01

    Vulvovaginitis is a common presenting symptom referred to a paediatric urology clinic. Some of these patients undergo diagnostic cystovaginoscopy to determine whether there is any underlying anatomical cause for the persistent infection. However, in the majority of the patients, no underlying abnormality is found and they are given hygienic advice and prescribed bio yoghurt postoperatively. This study examines the outcome in these patients after hygienic advice is given: determining whether cystovaginoscopy was really necessary and whether it changed the management of vulvovaginitis.

  7. Predicting disease progression from short biomarker series using expert advice algorithm

    NASA Astrophysics Data System (ADS)

    Morino, Kai; Hirata, Yoshito; Tomioka, Ryota; Kashima, Hisashi; Yamanishi, Kenji; Hayashi, Norihiro; Egawa, Shin; Aihara, Kazuyuki

    2015-05-01

    Well-trained clinicians may be able to provide diagnosis and prognosis from very short biomarker series using information and experience gained from previous patients. Although mathematical methods can potentially help clinicians to predict the progression of diseases, there is no method so far that estimates the patient state from very short time-series of a biomarker for making diagnosis and/or prognosis by employing the information of previous patients. Here, we propose a mathematical framework for integrating other patients' datasets to infer and predict the state of the disease in the current patient based on their short history. We extend a machine-learning framework of ``prediction with expert advice'' to deal with unstable dynamics. We construct this mathematical framework by combining expert advice with a mathematical model of prostate cancer. Our model predicted well the individual biomarker series of patients with prostate cancer that are used as clinical samples.

  8. Predicting disease progression from short biomarker series using expert advice algorithm.

    PubMed

    Morino, Kai; Hirata, Yoshito; Tomioka, Ryota; Kashima, Hisashi; Yamanishi, Kenji; Hayashi, Norihiro; Egawa, Shin; Aihara, Kazuyuki

    2015-05-20

    Well-trained clinicians may be able to provide diagnosis and prognosis from very short biomarker series using information and experience gained from previous patients. Although mathematical methods can potentially help clinicians to predict the progression of diseases, there is no method so far that estimates the patient state from very short time-series of a biomarker for making diagnosis and/or prognosis by employing the information of previous patients. Here, we propose a mathematical framework for integrating other patients' datasets to infer and predict the state of the disease in the current patient based on their short history. We extend a machine-learning framework of "prediction with expert advice" to deal with unstable dynamics. We construct this mathematical framework by combining expert advice with a mathematical model of prostate cancer. Our model predicted well the individual biomarker series of patients with prostate cancer that are used as clinical samples.

  9. Watchful Waiting for Cases of Pediatric Otitis Media: Modeling Parental Response to Physician Advice.

    PubMed

    MacGeorge, Erina L; Smith, Rachel A; Caldes, Emily P; Hackman, Nicole M

    2016-08-01

    Watchful waiting (WW) can reduce unnecessary antibiotic use in the treatment of pediatric otitis media (ear infection), but its utility is impaired by underutilization and noncompliance. Guided by advice response theory, the current study proposes advantage and capacity as factors that predict how caregivers evaluate and respond affectively to WW. Parents (N = 373) of at least 1 child age 5 years or younger completed questionnaires that assessed responses to hypothetical WW advice for their youngest child. Perceptions of advantage from WW and the capacity to monitor and manage symptoms predicted advice quality, physician trust, and future compliance both directly and indirectly through negative affect. The findings suggest the elaboration of advice response theory to include more aspects of advice content evaluation (e.g., advantage) and the influence of negative affect. The study also provides practical guidance for physicians seeking to improve caregiver reception of WW advice.

  10. Sickness certification for common mental disorders and GP return-to-work advice.

    PubMed

    Gabbay, Mark; Shiels, Chris; Hillage, Jim

    2016-09-01

    Aim To report the types and duration of sickness certification for different common mental disorders (CMDs) and the prevalence of GP advice aimed at returning the patient to work. In the United Kingdom, common mental health problems, such and depression and stress, have become the main reasons for patients requesting a sickness certificate to abstain from usual employment. Increasing attention is being paid to mental health and its impact on employability and work capacity in all parts of the welfare system. However, relatively little is known about the extent to which different mental health diagnoses impact upon sickness certification outcomes, and how the GP has used the new fit note (introduced in 2010) to support a return to work for patients with mental health diagnoses. Sickness certification data was collected from 68 UK-based general practices for a period of 12 months. Findings The study found a large part of all sickness absence certified by GPs was due to CMDs (29% of all sickness absence episodes). Females, younger patients and those living in deprived areas were more likely to receive a fit note for a CMD (compared with one for a physical health problem). The highest proportion of CMD fit notes were issued for 'stress'. However, sickness certification for depression contributed nearly half of all weeks certified for mental health problems. Only 7% of CMD fit notes included any 'may be fit' advice from the GP, with type of advice varying by mental health diagnostic category. Patients living in the most socially deprived neighbourhoods were less likely to receive 'may be fit' advice on their CMD fit notes.

  11. The Normative Context of Advice as Social Support.

    ERIC Educational Resources Information Center

    Goldsmith, Daena J.; Fitch, Kristine

    1997-01-01

    Documents the multiple goals and implications of advice among white, middle-class, college students. Identifies three dilemmas of seeking, receiving, and giving advice: (1) advice may be seen as helpful or as "butting-in"; (2) advice may be experienced as honest or supportive; and (3) seeking and taking advice may enact respect and…

  12. Pediatrician's perspectives on discharge against medical advice (DAMA) among pediatric patients: a qualitative study.

    PubMed

    Macrohon, Bernadette C

    2012-06-18

    The phenomenon of discharge against medical advice (DAMA) among pediatric patients places pediatricians in a dilemma between respect for the parent's decision and the desire to provide complete care for the vulnerable child-patient. Little has been written about factors that affect a pediatrician's decision to allow a parent to discharge his child against medical advice. This qualitative study aims to answer the question of how pediatric residents in a tertiary government hospital perceive and decide on a DAMA request from a parent or primary caregiver. Using a focus group discussion approach, 11 pediatric residents from a government-run tertiary hospital were recruited for the study. The session was digitally recorded and dominant themes were coded and identified. There were three prominent themes that arose in the discussion: variability of definitions of DAMA, factors considered before "allowing" the patient to be DAMA, and the implications of a DAMA request on their performance as pediatricians. Definitions vary from one resident to another based on the main reason for DAMA (terminal, cultural, or financial). A conflict was noted in the definition of Home per Request (HPR) versus DAMA. Factors that influence a pediatrician to sign out a case as DAMA include: their ability to do something about the reason given for the DAMA request, the condition of the patient when the DAMA request was given, their impression of the kind of care that the parents provide, and their legal liabilities. Pediatric residents generally maintain a positive attitude towards the parents who request for DAMA and in the event of readmission, accept the patient into their care again.The occurrence of a variety of definitions and subcategories for DAMA may cause confusion among the pediatricians and should be clarified. The familiarity with cultural traditions contributes to their ability to handle situations that may lead to DAMA but this should always be considered in the context of the

  13. Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol.

    PubMed

    Pérula, Luis A; Bosch, Josep M; Bóveda, Julia; Campiñez, Manuel; Barragán, Nieves; Arboniés, Juan C; Prados, Jose A; Martín, Enrique; Martín, Remedios; Massons, Josep; Criado, Margarita; Ruiz, Roger; Fernández, José A; Buitrago, Francisco; Olaya, Inmaculada; Pérez, Modesto; Ruiz, Joaquin

    2011-11-05

    The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help

  14. Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol

    PubMed Central

    2011-01-01

    Background The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. Methods/Design An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. Discussion Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential

  15. International travel in the immunocompromised patient: a cross-sectional survey of travel advice in 254 consecutive patients.

    PubMed

    Bialy, C; Horne, K; Dendle, C; Kanellis, J; Littlejohn, G; Ratnam, I; Woolley, I

    2015-06-01

    Our primary aim was to determine the rate of overseas travel in immunocompromised individuals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology. We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital. We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive individuals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups. Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics. © 2015 Royal Australasian College of Physicians.

  16. Quality of travel health advice in a French travel medicine and vaccine center: a prospective observational study.

    PubMed

    Bouldouyre, Marie-Anne; De Verdière, Nathalie Colin; Pavie, Juliette; De Castro, Nathalie; Ponscarme, Diane; Hamane, Samia; Rachline, Anne; Ferret, Samuel; Molina, Jean-Michel

    2012-01-01

    The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France. We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines. A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized. Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care. © 2012 International Society of Travel Medicine.

  17. Health Professional Advice and Adult Action to Reduce Sodium Intake.

    PubMed

    Jackson, Sandra L; Coleman King, Sallyann M; Park, Soyoun; Fang, Jing; Odom, Erika C; Cogswell, Mary E

    2016-01-01

    Excessive sodium intake is a key modifiable risk factor for hypertension and cardiovascular disease. Although 95% of U.S. adults exceed intake recommendations, knowledge is limited regarding whether doctor or health professional advice motivates patients to reduce intake. Our objectives were to describe the prevalence and determinants of taking action to reduce sodium, and to test whether receiving advice was associated with action. Analyses, conducted in 2014, used data from the 2013 Behavioral Risk Factor Surveillance System, a state-based telephone survey representative of non-institutionalized adults. Respondents (n=173,778) from 26 states, the District of Columbia, and Puerto Rico used the new optional sodium module. We estimated prevalence ratios (PRs) based on average marginal predictions, accounting for the complex survey design. Fifty-three percent of adults reported taking action to reduce sodium intake. Prevalence of action was highest among adults who received advice (83%), followed by adults taking antihypertensive medications, adults with diabetes, adults with kidney disease, or adults with a history of cardiovascular disease (range, 73%-75%), and lowest among adults aged 18-24 years (29%). Overall, 23% of adults reported receiving advice to reduce sodium intake. Receiving advice was associated with taking action (prevalence ratio=1.59; 95% CI=1.56, 1.61), independent of sociodemographic and health characteristics, although some disparities were observed across race/ethnicity and BMI categories. Our results suggest that more than half of U.S. adults in 26 states and two territories are taking action to reduce sodium intake, and doctor or health professional advice is strongly associated with action. Published by Elsevier Inc.

  18. Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community

    PubMed Central

    Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

    2006-01-01

    Problem Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Design and setting Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. Key measures for improvement The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a speciality clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Strategies for change Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. Effects of change A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. Lessons learnt A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different

  19. Determinants of physical activity frequency and provider advice during pregnancy.

    PubMed

    Santo, Eilann C; Forbes, Peter W; Oken, Emily; Belfort, Mandy B

    2017-09-05

    Our aims were to (1) describe the frequency of physical activity and prenatal healthcare provider advice about physical activity during pregnancy and (2) examine determinants and correlates of 3rd trimester physical activity and receipt of physical activity advice. We analyzed data from the 2008 Pregnancy Risk Assessment Monitoring System. We studied 2669 women from North Carolina and Colorado with data on physical activity frequency in the 3 months prior to pregnancy and during the 3rd trimester and 1584 women from Oklahoma with data on provider advice regarding physical activity during pregnancy. Respondents reported physical activity, defined as 30 min or more of exercise/physical activity (excluding vocationally related activity), in in these categories: <1 day/week, 1-4 days/week, and ≥5 days/week. We defined adherence to American College of Obstetrics & Gynecology (ACOG) criteria as physical activity ≥5 days/week in the 3rd trimester. We performed logistic regression analyses weighted for sampling and adjusted for socio-demographic factors. Forty-two percent of women in North Carolina and Colorado reported 3rd trimester physical activity <1 day/week, 42% 1-4 days/week, 9% ≥5 days/week; 7% reported being told not to exercise. Seventy-two percent of women in Oklahoma reported receiving physical activity advice from a prenatal care provider. Low activity frequency (<1 day/week) prior to pregnancy was strongly associated with low likelihood of ACOG guideline adherence in the 3rd trimester (aOR 0.10, 95% CU 0.04, 0.30 vs. 1-4 days/week). Underweight women were more likely to adhere to ACOG guidelines than normal weight women (aOR 2.27, 95% CI 1.36, 3.79). Overweight women were more likely to receive physical activity advice (aOR 2.9, 95% CI 1.3, 6.3 vs. normal weight), but obese women were not (aOR 0.65, 95% CI 0.4, 1.2). Few women meet ACOG guideline criteria for physical activity during pregnancy. Improving physical activity and weight status

  20. Maternal perceptions of advice on sleep in young children: How, what, and when?

    PubMed

    Hatton, Rosalind E M; Gardani, Maria

    2018-05-01

    Parental knowledge on sleep hygiene in children may be a contributing factor for sleep difficulties in preschoolers. As sleep is crucial for healthy development, it is important to understand how parental knowledge can be improved. The aim of this qualitative study was to develop an understanding of advice available in the United Kingdom (UK) on sleep in young children. This study employed constructivist grounded theory methodology. Participants were recruited via social media and a previously constructed participant database. Interviews were audio-recorded, transcribed, and analysed. Fourteen mothers were interviewed independently, whilst one mother was interviewed together with her husband. Themes relating to how UK mothers wish advice on sleep to be formulated, what they believe it should include and when they would like to receive it, were identified from the data. Specifically, this study suggests that UK mothers value experience and thus recommends that advice be made through collaboration projects involving both professionals and parents. It also suggests that advice should be readily available and given to expecting parents prior to the arrival of their baby as well as at regular follow-ups. In addition, the participating mothers wanted advice to be balanced and non-judgemental. This study looks at the views of mainly White British mothers currently residing within the United Kingdom. Thus, it may not represent the views of everyone in the United Kingdom. Nevertheless, it still makes important recommendations for practice. For example, relationships between health professionals and parents need to be improved and information on different sleeping practices widely dispersed. Statement of contribution What is already known on this subject? Poor sleep is common in young children. Young children's sleep quality can be affected by parental behaviours. Parents lack knowledge of sleep in young children. What does this study add? According to this study: It would

  1. Travel health advice: benefits, compliance, and outcome.

    PubMed

    Angelin, Martin; Evengård, Birgitta; Palmgren, Helena

    2014-06-01

    Travel health advice is an important and difficult part of a pre-travel consultation. The aim of this study was to determine whether the travel health advice given is followed by the traveller and whether it affects disease and injury experienced during travel. A prospective survey study was carried out from October 2009 to April 2012 at the Travel Medicine Clinic of the Department of Infectious Diseases, Umeå University Hospital, Umeå, Sweden. The Travel Medicine Clinic in Umeå is the largest travel clinic in northern Sweden. We included 1277 individuals in the study; 1059 (83%) responded to the post-travel questionnaire. Most visitors (88%) remembered having received travel health advice; among these, 95% found some of the health advice useful. Two-thirds (67%) claimed to have followed the advice, but fell ill during travel to the same extent as those who did not. Younger travellers (< 31 y) found our travel health advice less beneficial, were less compliant with the advice, took more risks during travel, and fell ill during travel to a greater extent than older travellers. Helping travellers stay healthy during travel is the main goal of travel medicine. Younger travellers are a risk group for illness during travel and there is a need to find new methods to help them avoid illness. Travellers find travel health advice useful, but it does not protect them from travel-related illness. Factors not easily influenced by the traveller play a role, but a comprehensive analysis of the benefits of travel health advice is needed.

  2. The Clinical Findings Useful for Driving Safety Advice for Parkinson's Disease Patients.

    PubMed

    Ando, Rina; Iwaki, Hirotaka; Tsujii, Tomoaki; Nagai, Masahiro; Nishikawa, Noriko; Yabe, Hayato; Aiba, Ikuko; Hasegawa, Kazuko; Tsuboi, Yoshio; Aoki, Masashi; Nakashima, Kenji; Nomoto, Masahiro

    2018-02-28

    Objective We conducted a study to obtain information that could be used to provide Parkinson's disease (PD) patients with appropriate advice on safe driving. Methods Consecutive PD patients who visited our office were studied. Among these patients, those who had experienced driving after being diagnosed with PD were interviewed by neurologists and a trained nurse to investigate their previous car accidents, motor function, cognitive function, sleepiness, levodopa equivalent dose (LED), and emotional dysregulation. The rates of major car accidents before and after the onset of PD were compared. Results Fifteen patients had experienced a major car accident resulting in human injury or serious property damage since the onset of PD. When the rates of major car accidents before and after the onset of PD were compared, the ratio was 4.3 (95% CI 1.9-9.7). The incidence of accidents after the onset of PD was correlated with age, disease duration, LED, the cognitive function (MMSE, MoCA-J), but not the motor symptom score (UPDRS part III at the time of the study). The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) score was also higher in patients with major car accidents. Conclusion The severity of symptoms (Hoehn-Yahr classification), cognitive function, and disease duration were expected to be risk factors for car accidents. However, the motor symptom score (UPDRS part III) was not associated with the incidence of major car accidents. In addition to a low cognitive function and the severity of symptoms, the QUIP score might be an independent factor that can be referenced when advising PD patients to refrain from driving.

  3. 5 CFR 2638.502 - Recommendations and advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... recommendation may be made or the advice given either orally or in writing. In addition, the Director shall... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Recommendations and advice. 2638.502... Cases Involving Individual Executive Agency Employees § 2638.502 Recommendations and advice. The...

  4. 5 CFR 2638.502 - Recommendations and advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... recommendation may be made or the advice given either orally or in writing. In addition, the Director shall... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Recommendations and advice. 2638.502... Cases Involving Individual Executive Agency Employees § 2638.502 Recommendations and advice. The...

  5. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics Branch...

  6. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics Branch...

  7. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 5 2014-07-01 2014-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics Branch...

  8. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics Branch...

  9. 32 CFR 776.10 - Informal ethics advice.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 5 2013-07-01 2013-07-01 false Informal ethics advice. 776.10 Section 776.10... § 776.10 Informal ethics advice. (a) Advisors. Covered attorneys may seek informal ethics advice either... of Director, JA Division, HQMC; and (5) Head, Standards of Conduct/Government Ethics Branch...

  10. Physician tobacco screening and advice to quit among U.S. adolescents - National Survey on Drug Use and Health, 2013.

    PubMed

    Collins, Lauren; Smiley, Sabrina L; Moore, Rakiya A; Graham, Amanda L; Villanti, Andrea C

    2017-01-01

    Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued smoking. Physician screening for tobacco use increases the odds of physicians intervening with patients who smoke; However, without appropriate follow-through by the physician, screening for tobacco use is not enough to significantly increase cessation rates. Given the critical phase of development adolescence poses in tobacco use and evidence that physician intervention improves adult cessation efforts, we sought to examine physician tobacco use screening and advice to quit among adolescents (12-17 years). Using data from the 2013 National Survey on Drug Use and Health (NSDUH), we examined the prevalence and correlates of tobacco use screening in adolescent respondents who reported visiting their physician within the past year ( N  = 12,798). Multivariable logistic regression analyses explored the relationship between tobacco use screening and physician advice to quit in a sub-set of the sample who reported on physician advice to quit ( n  = 1,868), controlling for sociodemographics, cigarette use, and substance use and screening. Only 49% of adolescents who visited a physician within the past year reported being screened for tobacco use. Adolescents who were screened by their physician were predominantly female (56.6%), White (60.1%), in late adolescence (83.0%), and covered by private health insurance (63.8%). Screening for tobacco use was highly correlated with physician advice to quit smoking, controlling for sociodemographic characteristics and cigarette use; this relationship was attenuated, but remained significant, after screening for alcohol and marijuana were added to the model. Hispanic adolescents were significantly less likely to receive physician advice to quit in all multivariable models. Our findings suggest missed opportunities for youth tobacco use prevention and cessation efforts in the clinical setting. Further research is needed to better

  11. Factors underlying variation in receipt of physician advice on diet and exercise: applications of the behavioral model of health care utilization.

    PubMed

    Honda, Keiko

    2004-01-01

    usual care sites. Poorer self-rated health status (AOR = 5.2, 95% CI = 4.12-6.57 for diet; AOR = 2.63, 95% CI = 2.04-3.38 for exercise) and obesity (AOR = 2.32, 95% CI = 2.02-2.66 for diet; AOR = 3.01, 95% CI = 2.46-3.69 for exercise) was positively associated with the likelihood of receiving physician advice on diet and exercise. Effective strategies to increase receipt of physician advice should include efforts to improve access to regular source of care and patient-physician communication. Sociodemographic factors remain independent and important predictors of who obtains such advice.

  12. Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669).

    PubMed

    Wynne-Jones, Gwenllian; Artus, Majid; Bishop, Annette; Lawton, Sarah A; Lewis, Martyn; Jowett, Sue; Kigozi, Jesse; Main, Chris; Sowden, Gail; Wathall, Simon; Burton, A Kim; van der Windt, Danielle A; Hay, Elaine M; Foster, Nadine E

    2017-10-30

    Musculoskeletal pain is a common cause of work absence, and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service into primary care to provide occupational support. Six general practices were randomised; patients were eligible if they were consulting their general practitioner with musculoskeletal pain and were employed and struggling at work or absent from work <6 months. Practices in the intervention arm could refer patients to a vocational advisor embedded within the practice providing a case-managed stepwise intervention addressing obstacles to working. The primary outcome was number of days off work, over 4 months. Participants in the intervention arm (n = 158) had fewer days work absence compared with the control arm (n = 180) (mean 9.3 [SD 21·7] vs 14·4 [SD 27·7]) days, incidence rate ratio 0·51 (95% confidence interval 0·26, 0·99), P = 0·048). The net societal benefit of the intervention compared with best care was £733: £748 gain (work absence) vs £15 loss (health care costs). The addition of a vocational advice service to best current primary care for patients consulting with musculoskeletal pain led to reduced absence and cost savings for society. If a similar early intervention to the one tested in this trial was implemented widely, it could potentially reduce days absent over 12 months by 16%, equating to an overall societal cost saving of approximately £500 million (US $6 billion) and requiring an investment of only £10 million.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

  13. Pre-travel advice: an overview.

    PubMed

    Sanford, Christopher

    2002-12-01

    The message of the pre-travel provider is necessarily paradoxic. First the provider lists a score of causes of illness and premature demise, and then states, "But it sounds like a great trip and I think you'll have fun." Pre-travel providers need to walk a fine line: they must encourage patients to be cautious but not paranoid, optimistic but realistic. This discussion is complicated further by the fact that risk reduction is not the only consideration; if it were, practitioners would advise patients to remain in the developed world and foray from their homes only to visit health clubs and the fruit-and-vegetable section of grocery stores. A tacit assumption in travel medicine is that some degree of acceptance of heightened risk is tolerated for the benefit of improved quality of life offered by travel abroad. The amount of risk that is reasonable to accept for a given benefit in quality of life yielded by travel cannot be quantified, however. Providers must render judgments on what is "reasonable" and what is not, and this complex decision is based on equal parts medical knowledge and intuition. At one extreme, mountaineers in Nepal have been found to have a 2.4% mortality rate per expedition [83,84]. The travel provider might make the reasonable decision to counsel these travelers to avoid that activity. These travelers most likely will ignore that advice, at which point the provider must endeavor to reduce risk to the extent possible. Other situations in which the provider should advise a change in itinerary or activities include counseling parents who plan to take an infant to high altitude or a pregnant woman who plans to scuba dive. If travelers remain cloistered in their hotel rooms, eating all meals from room service and watching CNN, then it could be suggested that they are overly risk-adverse and might consider foraying out of the hotel, despite the potential associated increased risks to health. Conversely, if travelers find themselves on motorcycles

  14. Caution required when relying on a colleague's advice; a comparison between professional advice and evidence from the literature

    PubMed Central

    Schaafsma, Frederieke; Verbeek, Jos; Hulshof, Carel; van Dijk, Frank

    2005-01-01

    Background Occupational Physicians rely especially on advice from colleagues when answering their information demands. On the other hand, Evidence-based Medicine (EBM) promotes the use of up-to-date research literature instead of experts. To find out if there was a difference between expert-based practice and EBM we compared professional advice on occupational health topics with best evidence from the literature. Methods We asked 14 occupational physicians to consult their usual information sources on 12 pre-conceived occupational health problems. The problems were presented in the form of case vignettes which contained sufficient clinical information to be used by the occupational physicians for the consultation of their experts. We had searched the literature for the best available evidence on the 12 problems, which made it possible to answer the clinical questions with a clear yes or no. Results The cases could be used by the occupational physicians as arising from their own practice. All together the occupational physicians consulted 75 different experts. Almost half of the consulted experts were near colleagues, 10% were industrial hygienists, 8% medical specialists and the rest had a varied background. Fifty three percent (95% confidence interval 42% to 65%) of all professional advice was not in line with the research literature. In 18 cases (24%) professional advice explicitly referred to up-to-date research literature as their used source. These cases were substantially less incorrect (17%) than advice that had not mentioned the literature as a source (65%) (difference 48%, 95% Confidence Interval from 27% to 69%). Conclusion Advice that occupational physicians routinely get in their daily practice differs substantially from best evidence from the literature. Occupational physicians who ask professional advice should always ask about the evidence of this advice. PMID:16131405

  15. Factors associated with prevalence and types of 'may be fit' advice on fit notes: a cross-sectional primary care analysis.

    PubMed

    Shiels, Chris; Gabbay, Mark; Hillage, Jim

    2014-03-01

    The 'fit note', with the opportunity for the GP to advise that a patient 'may be fit' to do some work, was introduced in April 2010. To estimate numbers of fit notes with 'may be fit' advice, the types of advice, and factors associated with any inclusion of such advice in the fit note. Cross-sectional analysis of fit note data from 68 general practices in eight regions of England, Wales and Scotland. Collection of practice fit note data via GP use of carbonised pads of fit notes for a period of 12 months. The 'may be fit' box was ticked on 5080 fit notes (6.4% of all fit notes in study). But there was a wide variation in completion rates across the 68 practices (from 1% to 15%). The most prevalent individual item of advice was to 'amend duties' of patient as a prerequisite for return to work (included in 42% of all notes containing any 'may be fit' advice). Advice was often incomplete or irrelevant, with some GPs failing to comply with official guidance. Inclusion of any 'may be fit' advice was independently associated with the patient being female, less socially deprived and having a physical health reason for receiving a fit note. Unlike other studies that have relied upon eliciting opinion, this study investigates how the fit note is being used in practice. Findings provide some evidence that the fit note is not yet being used to the optimum benefit of patients (and their employers).

  16. Medication monitoring attitudes and perceived determinants to offering medication adherence advice to older hypertensive adults: a factorial survey of community pharmacy interns.

    PubMed

    Dillon, Paul; Smith, Susan M; Gallagher, Paul; Cousins, Gráinne

    2018-06-13

    Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring. © 2018 Royal Pharmaceutical Society.

  17. Influence of Antiflatulent Dietary Advice on Intrafraction Motion for Prostate Cancer Radiotherapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lips, Irene M., E-mail: I.M.Lips@umcutrecht.nl; Kotte, Alexis N.T.J.; Gils, Carla H. van

    Purpose: To evaluate the effect of an antiflatulent dietary advice on the intrafraction prostate motion in patients treated with intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Between February 2002 and December 2009, 977 patients received five-beam IMRT for prostate cancer to a dose of 76 Gy in 35 fractions combined with fiducial markers for position verification. In July 2008, the diet, consisting of dietary guidelines to obtain regular bowel movements and to reduce intestinal gas by avoiding certain foods and air swallowing, was introduced to reduce the prostate motion. The intrafraction prostate movement was determined from the portalmore » images of the first segment of all five beams. Clinically relevant intrafraction motion was defined as {>=}50% of the fractions with an intrafraction motion outside a range of 3 mm. Results: A total of 739 patients were treated without the diet and 105 patients were treated with radiotherapy after introduction of the diet. The median and interquartile range of the average intrafraction motion per patient was 2.53 mm (interquartile range, 2.2-3.0) without the diet and 3.00 mm (interquartile range, 2.4-3.5) with the diet (p < .0001). The percentage of patients with clinically relevant intrafraction motion increased statistically significant from 19.1% without diet to 42.9% with a diet (odds ratio, 3.18; 95% confidence interval, 2.07-4.88; p < .0001). Conclusions: The results of the present study suggest that antiflatulent dietary advice for patients undergoing IMRT for prostate cancer does not reduce the intrafraction movement of the prostate. Therefore, antiflatulent dietary advice is not recommended in clinical practice for this purpose.« less

  18. 21 CFR 14.174 - Advice and recommendations in writing.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... § 14.174 Advice and recommendations in writing. Advice and recommendations given by a committee on a... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Advice and recommendations in writing. 14.174... of the advice and recommendations of the committee. ...

  19. 21 CFR 14.174 - Advice and recommendations in writing.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... § 14.174 Advice and recommendations in writing. Advice and recommendations given by a committee on a... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Advice and recommendations in writing. 14.174... of the advice and recommendations of the committee. ...

  20. Evaluation of a telephone advice nurse in a nursing faculty managed pediatric community clinic.

    PubMed

    Beaulieu, Richard; Humphreys, Janice

    2008-01-01

    Nurse-managed health centers face increasing obstacles to financial viability. Efficient use of clinic resources and timely and appropriate patient care are necessary for sustainability. A registered nurse with adequate education and support can provide high-quality triage and advice in community-based practice sites. The purpose of this program evaluation was to examine the effect of a telephone advice nurse service on parent/caregiver satisfaction and access to care. A quasi-experimental separate pre-post sample design study investigated parent/caregiver satisfaction with a telephone advice nurse in an urban pediatric nurse-managed health center. The clinic medical information system was used to retrieve client visit data prior to the service and in the first year of the program. Statistically significant differences were found on two items from the satisfaction with the advice nurse survey: the reason for calling (P < .05), and the importance of being involved in decision making (P < .05). A telephone advice nurse may increase both parent/caregiver and provider satisfaction and access to care.

  1. Disentangling the Effects of Advisor Consensus and Advice Proximity

    ERIC Educational Resources Information Center

    Wanzel, Stella K.; Schultze, Thomas; Schulz-Hardt, Stefan

    2017-01-01

    When advice comes from interdependent sources (e.g., from advisors who use the same database), less information should be gained as compared to independent advice. On the other hand, since individuals strive for consistency, they should be more confident in consistent compared to conflicting advice, and interdependent advice should be more…

  2. Pediatrician’s perspectives on discharge against medical advice (DAMA) among pediatric patients: a qualitative study

    PubMed Central

    2012-01-01

    Background The phenomenon of discharge against medical advice (DAMA) among pediatric patients places pediatricians in a dilemma between respect for the parent’s decision and the desire to provide complete care for the vulnerable child-patient. Little has been written about factors that affect a pediatrician’s decision to allow a parent to discharge his child against medical advice. This qualitative study aims to answer the question of how pediatric residents in a tertiary government hospital perceive and decide on a DAMA request from a parent or primary caregiver. Methods Using a focus group discussion approach, 11 pediatric residents from a government-run tertiary hospital were recruited for the study. The session was digitally recorded and dominant themes were coded and identified. Results There were three prominent themes that arose in the discussion: variability of definitions of DAMA, factors considered before “allowing” the patient to be DAMA, and the implications of a DAMA request on their performance as pediatricians. Definitions vary from one resident to another based on the main reason for DAMA (terminal, cultural, or financial). A conflict was noted in the definition of Home per Request (HPR) versus DAMA. Factors that influence a pediatrician to sign out a case as DAMA include: their ability to do something about the reason given for the DAMA request, the condition of the patient when the DAMA request was given, their impression of the kind of care that the parents provide, and their legal liabilities. Pediatric residents generally maintain a positive attitude towards the parents who request for DAMA and in the event of readmission, accept the patient into their care again. The occurrence of a variety of definitions and subcategories for DAMA may cause confusion among the pediatricians and should be clarified. The familiarity with cultural traditions contributes to their ability to handle situations that may lead to DAMA but this should always be

  3. Critiquing: A Different Approach to Expert Computer Advice in Medicine

    PubMed Central

    Miller, Perry L.

    1984-01-01

    The traditional approach to computer-based advice in medicine has been to design systems which simulate a physician's decision process. This paper describes a different approach to computer advice in medicine: a critiquing approach. A critiquing system first asks how the physician is planning to manage his patient and then critiques that plan, discussing the advantages and disadvantages of the proposed approach, compared to other approaches which might be reasonable or preferred. Several critiquing systems are currently in different stages of implementation. The paper describes these systems and discusses the characteristics which make each domain suitable for critiquing. The critiquing approach may prove especially well-suited in domains where decisions involve a great deal of subjective judgement.

  4. Clinician advice to quit smoking among seniors.

    PubMed

    Shadel, William G; Elliott, Marc N; Haas, Ann C; Haviland, Amelia M; Orr, Nate; Farmer, Melissa M; Ma, Sai; Weech-Maldonado, Robert; Farley, Donna O; Cleary, Paul D

    2015-01-01

    Little smoking research in the past 20years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics. In 2012-4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 (n=346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation. 12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65-69, 3% of 85+) and education (12-15% with no high school degree, 5-6% with BA+). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African-American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice "always" or "usually" at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p<0.05. Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors

    PubMed Central

    Dewa, Carolyn S.; Trojanowski, Lucy; Tamminga, Sietske J.; Ringash, Jolie; McQuestion, Maurene; Hoch, Jeffrey S.

    2016-01-01

    Purpose The purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people? Methods Data were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center’s head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes. Results Work-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication. Discussion The study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers. Conclusions In this exploratory study, HNC clinic patients’ advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis. PMID:27070654

  6. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study.

    PubMed

    Presseau, Justin; Francis, Jill J; Campbell, Neil C; Sniehotta, Falko F

    2011-07-15

    The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control. Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional behaviour.

  7. The best advice I ever got.

    PubMed

    Wademan, Daisy

    2005-01-01

    A young manager faces an impasse in his career. He goes to see his mentor at the company, who closes the office door, offers the young man a chair, recounts a few war stories, and serves up a few specific pointers about the problem at hand. Then, just as the young manager is getting up to leave, the elder executive adds one small kernel of avuncular wisdom--which the junior manager carries with him through the rest of his career. Such is the nature of business advice. Or is it? The six essays in this article suggest otherwise. Few of the leaders who tell their stories here got their best advice in stereotypical form, as an aphorism or a platitude. For Ogilvy & Mather chief Shelly Lazarus, profound insight came from a remark aimed at relieving the tension of the moment. For Novartis CEO Daniel Vasella, it was an apt comment, made on a snowy day, back when he was a medical resident. For publishing magnate Earl Graves and Starwood Hotels' Barry Sternlicht, advice they received about trust from early bosses took on ever deeper and more practical meaning as their careers progressed. For Goldman Sachs chairman Henry Paulson, Jr., it was as much his father's example as it was a specific piece of advice his father handed down to him. And fashion designer Liz Lange rejects the very notion that there's inherent wisdom in accepting other people's advice. As these stories demonstrate, people find wisdom when they least expect to, and they never really know what piece of advice will transcend the moment, profoundly affecting how they later make decisions, evaluate people, and examine--and reexamine--their own actions.

  8. Self-help advice as a process integral to traditional acupuncture care: implications for trial design.

    PubMed

    MacPherson, Hugh; Thomas, Kate

    2008-04-01

    In the literature on acupuncture research, the active (or specific) component of acupuncture is almost always presented as acupuncture needling alone. However, specific components, by definition, should include all interventions driven by acupuncture theory that are also believed to be causally associated with outcome. In this paper, we explore the delivery of self-help advice as a component of the process of acupuncture care, and discuss the implications for future trial designs. In a nested qualitative study, six acupuncturists were interviewed about the treatments they provided within a pragmatic clinical trial. The acupuncturists practised individualised acupuncture according to traditional principles. Audiotapes were transcribed and coded and the contents analysed by case and by theme. The analysis focuses on a priori and emergent themes associated with the process of delivering self-help advice as described by the practitioners. Individualised self-help advice is seen by practitioners as being an integral part of the acupuncture treatment that they provide for patients with low back pain. Several categories of generic advice were described; all were embedded in the acupuncture diagnosis. These included; movement, exercise and stretching to move 'qi stagnation'; rest in cases of 'qi deficiency'; diet when the digestive system was compromised; protection from the elements where indicated by the diagnosis, e.g. Bi Syndrome. According to the practitioners, longer-term benefits require the active participation of patients in their self-care. Simplified concepts derived from acupuncture theory, such as 'stagnation' and 'energy', are employed as an integral part of the process of care, in order to engage patients in lifestyle changes, help them to understand their condition, and to see ways in which they can help themselves. Within acupuncture care, self-help advice is not seen as an 'add-on' but rather as an integral and interactive component of a theory

  9. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§ 2638.201...

  10. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§ 2638.201...

  11. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§ 2638.201...

  12. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§ 2638.201...

  13. 5 CFR 2635.107 - Ethics advice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Ethics advice. 2635.107 Section 2635.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH General Provisions § 2635.107 Ethics advice. (a) As required by §§ 2638.201...

  14. What do patients think about the role of optometrists in providing advice about smoking and nutrition?

    PubMed

    Downie, Laura E; Douglass, Amanda; Guest, Daryl; Keller, Peter R

    2017-03-01

    Tobacco smoking and nutrition are key lifestyle factors with long-term effects on eye health. However, little is known about patients' perceptions and experiences in these areas in relation to the care received from optometrists. The main aim was to survey patients' perceptions and prior experience regarding the role of optometrists in enquiring and providing advice about tobacco smoking and nutrition. An anonymous, paper-based survey was distributed to a convenience sample of 225 adults attending the University of Melbourne eye care clinic. Respondents provided demographic and other information (age, sex, length of time since last eye examination, country of most recent eye examination, smoking status and intake of nutritional supplements) and indicated their level of agreement (using a five-step Likert scale) with a series of statements relating to the care provided by optometrists in the areas of health, smoking and nutrition. The statements were designed to assess the perceived scope of practice of optometrists and the extent to which patients expect, and feel comfortable, discussing these issues with their optometrist. 220 completed surveys were returned. Most respondents (>80%) agreed that they visit their optometrist to quantify their refractive error and to examine their eye health. About two-thirds of respondents indicated that they expect their optometrist to ask about their general health, with almost half expecting their optometrist to communicate with their general medical practitioner. Approximately one-third of respondents indicated having been routinely questioned about their smoking status, diet and nutritional supplement intake by their optometrist. This was despite about half expecting their optometrist to question them about these factors and almost three out of four respondents indicating that they felt comfortable talking with their optometrist about these lifestyle behaviours. This study provides novel insight into patients' perceptions and

  15. 29 CFR 1912.36 - Advice of advisory committees.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... members of an advisory committee shall not be a reason for not giving advice to the Assistant Secretary... 29 Labor 7 2010-07-01 2010-07-01 false Advice of advisory committees. 1912.36 Section 1912.36... Advice of advisory committees. (a) Approval by a majority of all members of an advisory committee is...

  16. 29 CFR 1912.36 - Advice of advisory committees.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... members of an advisory committee shall not be a reason for not giving advice to the Assistant Secretary... 29 Labor 7 2011-07-01 2011-07-01 false Advice of advisory committees. 1912.36 Section 1912.36... Advice of advisory committees. (a) Approval by a majority of all members of an advisory committee is...

  17. 29 CFR 1912a.5 - Advice and recommendations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and recommendations. Any advice or recommendations of the Committee shall be given or made with approval of a majority... 29 Labor 7 2011-07-01 2011-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor...

  18. 29 CFR 1912a.5 - Advice and recommendations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and recommendations. Any advice or recommendations of the Committee shall be given or made with approval of a majority... 29 Labor 7 2010-07-01 2010-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor...

  19. Stepwise Advice Negotiation in Writing Center Peer Tutoring

    ERIC Educational Resources Information Center

    Park, Innhwa

    2014-01-01

    While the delivery and reception of advice is a practice integral to a wide range of settings, little attention has been given to the detailed practices of advice resistance and how it leads to advice negotiation. Based on 7 hours of videotaped tutoring interactions among 6 tutors and 11 tutees, this conversation analytic study examines the…

  20. Experience of dietary advice among Pakistani-born persons with type 2 diabetes in Oslo.

    PubMed

    Fagerli, Rønnaug Aa; Lien, Marianne E; Wandel, Margareta

    2005-12-01

    Experience and implementation of dietary advice are influenced by various factors including ethnic, cultural and religious background. The aim is to explore how ethnic minority persons with diabetes experience dietary advice given by Norwegian health-workers, which strategies they have in response to the advice and how they explain their actions. In-depth interviews were performed with 15 Pakistani-born persons with type 2 diabetes living in Oslo. The analyses are based on the principles of Giorgi's interpretation of phenomenology. The participants expressed great concern to follow the advice. However, narratives about constraints were numerous. These concerned different life-situational factors, but more importantly they were related to communication problems arising from discontinuities between universalising medical knowledge and lay knowledge, as well as between different types of culturally defined lay knowledge. As a consequence, advice was generally experienced as inadequately based on the participant's food-cultural background, leaving the person with diabetes to do the translation between different levels of knowledge. In general health-workers would benefit from expanding their knowledge of the many positive aspects of their patients' cultural background, and apply their knowledge thereafter, whether it concerns (food)-culture or the impact of religion in everyday life.

  1. 3D Visualization as a Communicative Aid in Pharmaceutical Advice-Giving over Distance

    PubMed Central

    Dahlbäck, Nils; Petersson, Göran Ingemar

    2011-01-01

    Background Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information. Objective To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker. Methods We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies’ call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features. Results In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In

  2. Integrating health technology assessment requirements in the clinical development of medicines: the experience from NICE scientific advice.

    PubMed

    Maignen, François; Osipenko, Leeza; Pinilla-Dominguez, Pilar; Crowe, Emily

    2017-03-01

    The primary objective of the study was to analyse the proposed clinical development and economic evaluation plans for investigational medicinal products for which pharmaceutical companies have sought health technology assessment (HTA) scientific advice (SA). We have selected and analysed all the scientific advice procedures undertaken by National Institute for Health and Care Excellence (NICE) SA between 1 January 2009 and 3 December 2015 for investigational medicinal products. We have mapped the questions asked by the companies and the areas of advice highlighted in the advice reports to the sections of the NICE methods guide to the technology appraisals (2013). An overwhelming proportion of SA procedures have addressed questions related to the clinical development and specifically the main pivotal efficacy studies. Approximately a quarter of the questions relate to the approaches to economic evaluation. Questions raised in European Medicines Agency-HTA procedures generally focus on clinical efficacy issues whereas cost-effectiveness ones tend to dominate in NICE-only procedures. Our analysis shows that the issues mostly discussed in the HTA SA are the choice of comparator, the generalisability of the clinical trial evidence to the NHS practice and the impact of the clinical trial outcomes on quality of life and survival. Less disagreement with the developers' plans was seen in the choice of clinical endpoints, population definition, position of the technology in the treatment pathway and study design. Scientific advice is designed to improve the quality of evidence and approaches to evidence generation for future regulatory approval and HTA evaluation. Our experience to date suggests that payer requirements are inconsistently integrated in the clinical development programmes. More efforts should be dedicated to demonstrating the clinical value of new medicinal products to patients and key decision-makers.

  3. Survey of UK and New Zealand gastroenterologists’ practice regarding dietary advice and food exclusion in irritable bowel syndrome and inflammatory bowel disease

    PubMed Central

    Inns, Stephen James; Emmanuel, Anton V

    2013-01-01

    Background This study aimed to assess the dietary advice practice of UK and New Zealand (NZ) adult gastroenterologists in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Methods A questionnaire regarding dietary advice practice was emailed or mailed to all members of the British Society of Gastroenterology (n=983) and the NZ Society of Gastroenterology (n=54). Results 363 questionnaires were returned in the UK (response rate 37%) and 51 in NZ (94%). More respondents gave specific dietary advice to more than 25% of their patients on IBS than IBD (84% vs 27% UK, 90% vs 55% NZ; p=0.001 for both) and gave advice about dietary exclusions to more than 25% of patients on IBS than IBD (61% vs 13% UK, 77% vs 14% NZ; p<0.001 for both). They were most likely to provide dietary advice to patients with small bowel Crohn's disease, difficult to control IBD, diarrhoea predominant IBS and difficult to control IBS. The majority of respondents agreed strongly or a little that dietary exclusion was effective in the treatment of IBS, compared to the minority in IBD (71% vs 39% UK, 84% vs 43% p<0.05 for both). Conclusions UK and NZ gastroenterologists give dietary advice more commonly to IBS than IBD patients. The majority of gastroenterologists have some confidence in the use of dietary exclusion in IBS, the converse is true in IBD. However, the advice given is largely empiric and mostly comprises the exclusion of fibre, dairy and wheat. PMID:28839699

  4. Following celebrities’ medical advice: meta-narrative analysis

    PubMed Central

    Tan, Charlie

    2013-01-01

    Objective To synthesise what is known about how celebrities influence people’s decisions on health. Design Meta-narrative analysis of economics, marketing, psychology, and sociology literatures. Data sources Systematic searches of electronic databases: BusinessSource Complete (1886-), Communication & Mass Media Complete (1915-), Humanities Abstracts (1984-), ProQuest Political Science (1985-), PsycINFO (1806-), PubMed (1966-), and Sociology Abstracts (1952-). Inclusion criteria Studies discussing mechanisms of celebrities’ influence on people in any context. Results Economics literature shows that celebrity endorsements act as signals of credibility that differentiate products or ideas from competitors and can catalyse herd behaviour. Marketing studies show that celebrities transfer their desirable attributes to products and use their success to boost their perceived credibility. Psychology shows that people are classically conditioned to react positively to the advice of celebrities, experience cognitive dissonance if they do not, and are influenced by congruencies with their self conceptions. Sociology helps explain the spread of celebrity medical advice as a contagion that diffuses through social networks and people’s desire to acquire celebrities’ social capital. Conclusions The influence of celebrity status is a deeply rooted process that can be harnessed for good or abused for harm. A better understanding of celebrity can empower health professionals to take this phenomenon seriously and use patient encounters to educate the public about sources of health information and their trustworthiness. Public health authorities can use these insights to implement regulations and restrictions on celebrity endorsements and design counter marketing initiatives—perhaps even partnering with celebrities—to discredit bogus medical advice while promoting evidence based practices.

  5. Health behaviour advice from health professionals to Canadian adults with hypertension: results from a national survey.

    PubMed

    Walker, Robin L; Gee, Marianne E; Bancej, Christina; Nolan, Robert P; Kaczorowski, Janusz; Joffres, Michel; Bienek, Asako; Gwadry-Sridhar, Femida; Campbell, Norman R C

    2011-01-01

    Health professionals play an important role in providing health information to patients. The objectives of this study were to examine the type of advice that Canadians with hypertension recall receiving from health professionals to manage their condition, and to assess if there is an association between health behaviour advice provided by health professionals and self-reported engagement in health behaviour modification. Respondents of the 2009 Survey on Living with Chronic Diseases in Canada (N = 6142) were asked about sociodemographic characteristics, health care utilization, and health behaviour modification to control hypertension. Association between receipt of advice from health professional and ever engaging, continuing to engage, and not engaging in health behaviour modification was quantified by prevalence rate ratios. Most participants (90.9%; 95% confidence interval [CI], 89.6-92.2) reported that the health professional most responsible for treating their high blood pressure was their general practitioner. Approximately 9% reported that they had not received or do not recall receiving any advice for blood pressure control. The most commonly reported advice received from a health professional was to participate in physical activity or exercise (70.0%). Respondents who had received advice on health behaviour change to manage their high blood pressure were more likely to report engaging in the behaviour compared with those who did not receive such advice. Many Canadians with hypertension receive health behaviour change advice from their health professionals. Receiving this advice was associated with a greater likelihood of attempting health behaviour change and attempting to sustain that change. Copyright © 2011 Canadian Cardiovascular Society. All rights reserved.

  6. General physical health advice for people with serious mental illness.

    PubMed

    Tosh, Graeme; Clifton, Andrew; Bachner, Mick

    2011-02-16

    There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this. To assess the effects of general physical health advice as a means of reducing morbidity, mortality and improving or maintaining quality of life in people with serious mental illness. We searched the Cochrane Schizophrenia Group Trials Register (November 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. All randomised clinical trials focusing on general physical health advice. We extracted data independently. For binary outcomes we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. For the comparison of physical healthcare advice versus standard care we identified five studies (total n = 884) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.00 CI -0.67 to 0.67) but another did (n = 407, 1 RCT, MD Quality of Life Medical Outcomes Scale - mental component 3.7 CI 1.7 to 5.6). There was no difference between groups for the outcome of death (n = 407, 1 RCT, RR 1.3 CI 0.3 to 6.0), for the outcome of uptake of ill-health prevention services, one study found percentages significantly greater in the advice group (n = 363, 1 RCT, MD 36.9 CI 33.1 to 40.7). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 884, 5 RCTs, RR 1.18 CI 0.97 to 1.43). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer term benefits such as reduced mortality or morbidity. On the

  7. 19 CFR 177.11 - Requests for advice by field offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Requests for advice by field offices. 177.11... advice by field offices. (a) Generally. Advice or guidance as to the interpretation or proper application... prospective, current, or completed. Advice as to the proper application of the Customs and related laws to a...

  8. 19 CFR 177.11 - Requests for advice by field offices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Requests for advice by field offices. 177.11... advice by field offices. (a) Generally. Advice or guidance as to the interpretation or proper application... prospective, current, or completed. Advice as to the proper application of the Customs and related laws to a...

  9. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: An exploratory prospective study

    PubMed Central

    2011-01-01

    Background The theory of planned behaviour has well-evidenced utility in predicting health professional behaviour, but focuses on a single behaviour isolated from the numerous potentially conflicting and facilitating goal-directed behaviours performed alongside. Goal conflict and goal facilitation may influence whether health professionals engage in guideline-recommended behaviours, and may supplement the predictive power of the theory of planned behaviour. We hypothesised that goal facilitation and goal conflict contribute to predicting primary care health professionals' provision of physical activity advice to patients with hypertension, over and above predictors of behaviour from the theory of planned behaviour. Methods Using a prospective predictive design, at baseline we invited a random sample of 606 primary care health professionals from all primary care practices in NHS Grampian and NHS Tayside (Scotland) to complete postal questionnaires. Goal facilitation and goal conflict were measured alongside theory of planned behaviour constructs at baseline. At follow-up six months later, participants self-reported the number of patients, out of those seen in the preceding two weeks, to whom they provided physical activity advice. Results Forty-four primary care physicians and nurses completed measures at both time points (7.3% response rate). Goal facilitation and goal conflict improved the prediction of behaviour, accounting for substantial additional variance (5.8% and 8.4%, respectively) in behaviour over and above intention and perceived behavioural control. Conclusions Health professionals' provision of physical activity advice in primary care can be predicted by perceptions about how their conflicting and facilitating goal-directed behaviours help and hinder giving advice, over and above theory of planned behaviour constructs. Incorporating features of multiple goal pursuit into the theory of planned behaviour may help to better understand health professional

  10. Provider smoking cessation advice among California Asian-American smokers.

    PubMed

    Tong, Elisa K; Tang, Hao; Chen, Moon S; McPhee, Stephen J

    2011-01-01

    To determine proportions of provider advice to quit smoking for Asian-American smokers and to describe factors that may affect the provision of such advice. Secondary data analysis of population-based survey. California. Current smokers from the California Tobacco Use Surveys for Chinese-Americans (n = 2117, participation rate = 52%), Korean-Americans (n = 2545, participation rate = 48%), and Vietnamese-Americans (n = 2179, participation rate = 63.5%). Sociodemographics including insurance status, smoking frequency, provider visit in past year, and provider advice to quit. Multivariate logistic regression models examined dependent outcomes of (1) provider visit in past year and (2) provider advice to quit. Less than a third (30.5%) of smokers in our study reported both seeing a provider (50.8%) and then receiving advice to quit (60.1%). Factors associated with provider visits included being female, being 45 years or older, having health insurance, and being Vietnamese. Among smokers who saw a provider, factors associated with provider advice to quit included having health insurance and being a daily smoker. Asian-American smokers reported low proportions of provider advice to quit in the past year, largely because only half of smokers saw a provider. Providers who see such smokers may need greater awareness that several effective cessation treatments do not require health insurance, and that intermittent smokers need advice to quit.

  11. General physical health advice for people with serious mental illness.

    PubMed

    Tosh, Graeme; Clifton, Andrew V; Xia, Jun; White, Margueritte M

    2014-03-28

    care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer-term benefits such as reduced mortality or morbidity. On the other hand, it is possible clinicians are expending much effort, time and financial resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.

  12. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial

    PubMed Central

    Bendtsen, Preben; Müssener, Ulrika; Karlsson, Nadine; López-Pelayo, Hugo; Palacio-Vieira, Jorge; Colom, Joan; Gual, Antoni; Reynolds, Jillian; Wallace, Paul; Segura, Lidia; Anderson, Peter

    2016-01-01

    Objectives The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. Design The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. Setting A total of 120 primary healthcare centres from 5 jurisdictions in Europe. Participants 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Primary outcome Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. Results The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Conclusions Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. Trial registration number NCT01501552; Post-results. PMID:27311902

  13. Implementing referral to an electronic alcohol brief advice website in primary healthcare: results from the ODHIN implementation trial.

    PubMed

    Bendtsen, Preben; Müssener, Ulrika; Karlsson, Nadine; López-Pelayo, Hugo; Palacio-Vieira, Jorge; Colom, Joan; Gual, Antoni; Reynolds, Jillian; Wallace, Paul; Segura, Lidia; Anderson, Peter

    2016-06-16

    The objective of the present study was to explore whether the possibility of offering facilitated access to an alcohol electronic brief intervention (eBI) instead of delivering brief face-to-face advice increased the proportion of consulting adults who were screened and given brief advice. The study was a 12-week implementation study. Sixty primary healthcare units (PHCUs) in 5 jurisdictions (Catalonia, England, the Netherlands, Poland and Sweden) were asked to screen adults who attended the PHCU for risky drinking. A total of 120 primary healthcare centres from 5 jurisdictions in Europe. 746 individual providers (general practitioners, nurses or other professionals) participated in the study. Change in the proportion of patients screened and referred to eBI comparing a baseline 4-week preimplementation period with a 12-week implementation period. The possibility of referring patients to the eBI was not found to be associated with any increase in the proportion of patients screened. However, it was associated with an increase in the proportion of screen-positive patients receiving brief advice from 70% to 80% for the screen-positive sample as a whole (p<0.05), mainly driven by a significant increase in brief intervention rates in England from 87% to 96% (p<0.01). The study indicated that staff displayed a low level of engagement in this new technology. Staff continued to offer face-to-face advice to a larger proportion of patients (54%) than referral to eBI (38%). In addition, low engagement was seen among the referred patients; on average, 18% of the patients logged on to the website with a mean log-on rate across the different countries between 0.58% and 36.95%. Referral to eBI takes nearly as much time as brief oral advice and might require more introduction and training before staff are comfortable with referring to eBI. NCT01501552; Post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  14. An Exercise Prescription Course to Improve Pharmacy Students' Confidence in Patient Counseling

    PubMed Central

    2009-01-01

    Objectives To create, implement, and evaluate an elective course on the foundational aspects of exercise prescription to increase pharmacy students' knowledge about exercise and confidence in offering exercise advice in pharmacy practice. Design A course was designed as an elective using the American College of Sports Medicine guidelines for exercise prescription for healthy and clinical populations. Assessment Surveys of students who did and did not take the elective were conducted over 2 years to assess the impact of the course on students' confidence in knowledge and counseling. Students' confidence in counseling patients about exercise increased after taking the course and remained higher after 6 months. Conclusions This course increased pharmacy students' knowledge and confidence in incorporating exercise prescriptions in their advice to various patient populations. PMID:19960077

  15. Development and usability of a computer-tailored pedometer-based physical activity advice for breast cancer survivors.

    PubMed

    De Cocker, K; Charlier, C; Van Hoof, E; Pauwels, E; Lechner, L; Bourgois, J; Spittaels, H; Vandelanotte, C; De Bourdeaudhuij, I

    2015-09-01

    This observational study aimed to adapt a computer-tailored step advice for the general population into a feasible advice for breast cancer survivors and to test its usability. First, several adaptations were made to the original design (adding cancer-related physical activity (PA) barriers and beliefs, and self-management strategies to improve survivors' personal control). Second, the adapted advice was evaluated in two phases: (1) a usability testing in healthy women (n = 3) and survivors (n = 6); and (2) a process evaluation during 3 weeks in breast cancer survivors (n = 8). Preliminary usability testing revealed no problems during logging-in; however, three survivors misinterpreted some questions. After refining the questionnaire and advice, survivors evaluated the advice as interesting, attractive to read, comprehensible and credible. Inactive survivors found the advice novel, but too long. The process evaluation indicated that the majority of the women (n = 5/8) reported increased steps. Monitoring step counts by using a pedometer was perceived as an important motivator to be more active. To conclude, this study provides initial support for the usability and acceptability of a computer-tailored pedometer-based PA advice for breast cancer survivors. After testing efficacy and effectiveness of this intervention, this tool can broaden the reach of PA promotion in breast cancer survivors. © 2014 John Wiley & Sons Ltd.

  16. 31 CFR 10.37 - Requirements for other written advice.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Revenue Service § 10.37 Requirements for other written advice. (a) Requirements. A practitioner must not give written advice (including electronic communications) concerning one or more Federal tax issues if... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Requirements for other written advice...

  17. 31 CFR 10.37 - Requirements for other written advice.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Revenue Service § 10.37 Requirements for other written advice. (a) Requirements. A practitioner must not give written advice (including electronic communications) concerning one or more Federal tax issues if... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Requirements for other written advice...

  18. Advice for acute low back pain: a comparison of what research supports and what guidelines recommend.

    PubMed

    Stevens, Matthew L; Lin, Chung-Wei C; de Carvalho, Flavia A; Phan, Kevin; Koes, Bart; Maher, Chris G

    2017-10-01

    Advice is widely considered an effective treatment for acute low back pain (LBP); however, details on what and how to deliver this intervention is less clear. We assessed and compared clinical trials that test advice for acute LBP with practice guidelines for their completeness of reporting and concordance on the content, method of delivery, and treatment regimen of advice interventions. Systematic review. Advice randomized controlled trials were identified through a systematic search. Guidelines were taken from recent overviews of guidelines for LBP. Completeness of reporting was assessed using the Template for Intervention Description and Replication checklist. Thematic analysis was used to characterize advice interventions into topics across the aspects of content, method of delivery, and regimen. Concordance between clinical trials and guidelines was assessed by comparing the number of trials that found a statistically significant treatment effect for an intervention that included a specific advice topic with the number of guidelines recommending that topic. The median (interquartile range) completeness of reporting for clinical trials and guidelines was 8 (7-9) and 3 (2-4) out of nine items on the Template for Intervention Description and Replication checklist, respectively. Guideline recommendations were discordant with clinical trials for 50% of the advice topics identified. Completeness of reporting was less than ideal for randomized controlled trials and extremely poor for guidelines. The recommendations made in guidelines of advice for acute LBP were often not concordant with the results of clinical trials. Taken together, these findings mean that the potential clinical value of advice interventions for patients with acute LBP is probably not being realized. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Ancient advice for modern mariners

    NASA Astrophysics Data System (ADS)

    Brooks, David A.

    Some unusual preparations may be advised for persons anticipating voyages in sailing research vessels. For example, cooking facilities on sailing ships tend to be of modest means, and a scientist embarking on such a vessel may wonder whether he should bring his own essential provisions. Casting about for ideas, I happened on some relevant advice from Benjamin Franklin, who was seldom reluctant to sermonize on matters at hand. In spite of his numerous Atlantic crossings, Franklin was humble about offering advice to mariners, who he realized were generally suspicious of landlubbers.

  20. PhysioDirect: Supporting physiotherapists to deliver telephone assessment and advice services within the context of a randomised trial

    PubMed Central

    Bishop, Annette; Gamlin, Jill; Hall, Jeanette; Hopper, Cherida; Foster, Nadine E.

    2013-01-01

    Physiotherapy-led telephone assessment and advice services for patients with musculoskeletal problems have been developed in many services in the UK, but high quality trial data on clinical and cost effectiveness has been lacking. In order to address this ‘The PhysioDirect trial’ (ISRCTN55666618), was a pragmatic randomised trial of a PhysioDirect telephone assessment and advice service. This paper describes the PhysioDirect system used in the trial and how physiotherapists were trained and supported to use the system and deliver the PhysioDirect service. The PhysioDirect system used in the trial was developed in Huntingdon and now serves a population of 350,000 people. When initiating or providing physiotherapy-led telephone assessment and advice services training and support for physiotherapists delivering care in this way is essential. An enhanced skill set is required for telephone assessment and advice particularly in listening and communication skills. In addition to an initial training programme, even experienced physiotherapists benefit from a period of skill consolidation to become proficient and confident in assessing patients and delivering care using the telephone. A computer-based system assists the delivery of a physiotherapy-led musculoskeletal assessment and advice service. Clinical Trials Registration Number (ISRCTN55666618). PMID:23219629

  1. Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis.

    PubMed

    Fernandez, Matt; Hartvigsen, Jan; Ferreira, Manuela L; Refshauge, Kathryn M; Machado, Aryane F; Lemes, Ítalo R; Maher, Chris G; Ferreira, Paulo H

    2015-09-15

    A systematic review and meta-analysis. To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica. Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches. Data Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence. Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71-22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, -2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes. There is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term. 1.

  2. Content and Style of Advice in Iran and Canada

    ERIC Educational Resources Information Center

    Tavakoli, Mahin

    2013-01-01

    The content and nature of nonprofessional advice in Iran, a hierarchical and collectivist culture, was compared to the same type of advice in Canada, an egalitarian and individualist culture. A researcher developed a questionnaire that consisted of 10 letters, each describing a writer's problem and asking for advice. The responses of participants…

  3. The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice.

    PubMed

    Mogensen, Mette; Jemec, Gregor Be

    2010-10-28

    In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers.

  4. The potential carcinogenic risk of tanning beds: clinical guidelines and patient safety advice

    PubMed Central

    Mogensen, Mette; Jemec, Gregor BE

    2010-01-01

    Introduction: In 2009, the WHO listed ultraviolet (UV) radiation as a group 1 carcinogen. In spite of this, each year, millions of people tan indoor in Western countries. The aim of this review is to summarize evidence of tanning bed carcinogenesis and to present guidelines for use of tanning beds and patient safety advice. Methods: A narrative review of the literature was conducted based on both PubMed and Medline searches and on literature review of the retrieved papers. Results: Use of indoor tanning beds represents a significant and avoidable risk factor for the development of both melanoma and nonmelanoma skin cancers. Frequent tanners are more often adolescent females. Tanning beds have additional potential adverse effects such as burns, solar skin damage, infection, and possibly also addictive behavior. Discussion: The effort in preventing UV light-induced carcinogenesis should currently be aimed at developing new strategies for public health information. Tanning beds are one preventable source of UV radiation. In the majority of people solar UV radiation continues to be the major factor and therefore anti-tanning campaigns must always include sunbathers. PMID:21188119

  5. Improving support for heart failure patients: a systematic review to understand patients' perspectives on self-care.

    PubMed

    Spaling, Melisa A; Currie, Kay; Strachan, Patricia H; Harkness, Karen; Clark, Alexander M

    2015-11-01

    This systematic review aimed to generate patient-focussed recommendations to enhance support of heart failure self-care by examining patients' experiences, perspectives and self-care behaviours. Despite increased recognition of the importance of heart failure self-care, patients' knowledge and practices around this self-care and interventions to improve it are inconsistent. Consequently, current guidelines focus on what the domains of heart failure self-care are, more so than the ways to improve this care. Systematic review and qualitative interpretive synthesis. A systematic, comprehensive and detailed search of 11 databases was conducted until March, 2012 for papers published 1995-2012: 37 studies were included (1343 patients, 75 caregivers, 63 health care professionals) that contained a qualitative research component and data on adult patients' heart failure self-care. This interpretive synthesis used a recognized approach consisting of a multi-stage analytic process; in addition, the included studies underwent quality appraisal. Findings indicate that while patients could often recall health professionals' self-care advice, they were unable to integrate this knowledge into daily life. Attempts to manage HF were based on how patients 'felt' rather than clinical indicators of worsening symptoms. Self-efficacy and learning from past management experiences facilitated favourable outcomes - these enabled patients and caregivers to adeptly apply self-care strategies into daily activities. Addressing common but basic knowledge misconceptions regarding the domains of HF self-care is insufficient to increase effective HF self-care; this should be supplemented with strategies with patients and family members to promote self-efficacy, learning and adaptation/application of recommendations to daily life. © 2015 John Wiley & Sons Ltd.

  6. ADVICE--Educational System for Teaching Database Courses

    ERIC Educational Resources Information Center

    Cvetanovic, M.; Radivojevic, Z.; Blagojevic, V.; Bojovic, M.

    2011-01-01

    This paper presents a Web-based educational system, ADVICE, that helps students to bridge the gap between database management system (DBMS) theory and practice. The usage of ADVICE is presented through a set of laboratory exercises developed to teach students conceptual and logical modeling, SQL, formal query languages, and normalization. While…

  7. Young Children's Trust in Overtly Misleading Advice

    ERIC Educational Resources Information Center

    Heyman, Gail D.; Sritanyaratana, Lalida; Vanderbilt, Kimberly E.

    2013-01-01

    The ability of 3- and 4-year-old children to disregard advice from an overtly misleading informant was investigated across five studies (total "n" =212). Previous studies have documented limitations in young children's ability to reject misleading advice. This study was designed to test the hypothesis that these limitations are primarily…

  8. 'PhysioDirect' telephone assessment and advice services for physiotherapy: protocol for a pragmatic randomised controlled trial

    PubMed Central

    Salisbury, Chris; Foster, Nadine E; Bishop, Annette; Calnan, Michael; Coast, Jo; Hall, Jeanette; Hay, Elaine; Hollinghurst, Sandra; Hopper, Cherida; Grove, Sean; Kaur, Surinder; Montgomery, Alan

    2009-01-01

    Background Providing timely access to physiotherapy has long been a problem for the National Health Service in the United Kingdom. In an attempt to improve access some physiotherapy services have introduced a new treatment pathway known as PhysioDirect. Physiotherapists offer initial assessment and advice by telephone, supported by computerised algorithms, and patients are sent written self-management and exercise advice by post. They are invited for face-to-face treatment only when necessary. Although several such services have been developed, there is no robust evidence regarding clinical and cost-effectiveness, nor the acceptability of PhysioDirect. Methods/Design This protocol describes a multi-centre pragmatic individually randomised trial, with nested qualitative research. The aim is to determine the effectiveness, cost-effectiveness, and acceptability of PhysioDirect compared with usual models of physiotherapy based on patients going onto a waiting list and receiving face-to-face care. PhysioDirect services will be established in four areas in England. Adult patients in these areas with musculoskeletal problems who refer themselves or are referred by a primary care practitioner for physiotherapy will be invited to participate in the trial. About 1875 consenting patients will be randomised in a 2:1 ratio to PhysioDirect or usual care. Data about outcome measures will be collected at baseline and 6 weeks and 6 months after randomisation. The primary outcome is clinical improvement at 6 months; secondary outcomes include cost, waiting times, time lost from work and usual activities, patient satisfaction and preference. The impact of PhysioDirect on patients in different age-groups and with different conditions will also be examined. Incremental cost-effectiveness will be assessed in terms of quality adjusted life years in relation to cost. Qualitative methods will be used to explore factors associated with the success or failure of the service, the

  9. 19 CFR 111.39 - Advice to client.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Advice to client. 111.39 Section 111.39 Customs... CUSTOMS BROKERS Duties and Responsibilities of Customs Brokers § 111.39 Advice to client. (a) Withheld or false information. A broker must not withhold information relative to any customs business from a client...

  10. Toward advocacy in cancer care for older adults: survivors have cautious personal actions but bold advice for others.

    PubMed

    Kahana, Eva; Kahana, Boaz; Kelley-Moore, Jessica; Adams, Scott A; Hammel, Rachel; Kulle, Diana; Brown, Jane A; King, Cathie

    2009-11-01

    To examine narratives of personal coping with the cancer experience and compare them with narratives of advice offered to other cancer patients by community-dwelling elderly cancer survivors. Qualitative and quantitative mixed methods. Community. Interviews were conducted with 100 elderly adults who had reported cancer diagnosis from among participants of a panel study of 1,107 community-dwelling elderly adults. Mean age of the sample was 78.7+/-6.8; 62% were female, and 62% were married. Three raters identified consistent themes through content analyses of interviews using a staged content analysis process. Themes reporting personal coping were coded separately from advice respondents would offer to others. Respondents reported themes of personal coping that corresponded well to previously established modes of problem-focused and emotion-focused coping. Themes for personal coping primarily reflected reframing, normalizing, and obtaining social support. Assertive healthcare consumerism and self-care were seldom reported as personal coping strategies but emerged as important coping approaches, along with positive attitude maintenance, in advice offered to others. Length of survivorship was unrelated to coping strategies. Elderly cancer survivors use passive modes of coping and rely on physicians, family, or cognitive acceptance in coping with cancer, but they offer far more proactive advice to other cancer patients. These findings underscore the importance of physician encouragement of older cancer patient initiative and proactivity in expressing views and preferences. Physicians should offer reassurance that elderly patients' questions and initiatives are welcomed.

  11. Advice-Implicative Interrogatives: Building "Client-Centered" Support in a Children's Helpline

    ERIC Educational Resources Information Center

    Butler, Carly W.; Potter, Jonathan; Danby, Susan; Emmison, Michael; Hepburn, Alexa

    2010-01-01

    Interactional research on advice giving has described advice as normative and asymmetric. In this paper we examine how these dimensions of advice are softened by counselors on a helpline for children and young people through the use of questions. Through what we term "advice-implicative interrogatives," counselors ask clients about the…

  12. Consumer satisfaction with telehealth advice-nursing.

    PubMed

    Chang, B L; Mayo, A; Omery, A

    2001-01-01

    An increase in interest in the establishment of telephone advice services has resulted in the proliferation of call centers. Despite their wide usage, research for the most part has not addressed the quality of care in relation to consumer satisfaction. This paper examines consumer outcomes of satisfaction, and follow-up with recommendations, within a framework of the nursing process and its associated components of assessment (including problem identification), care planning, intervention, and evaluation. The data for the study were obtained from seven after-hours call centers operating under the auspices of health maintenance organizations, preferred provider organizations, and private insurance companies. A sample of 157 non-redundant telephone calls from adults with medical-surgical problems were audiotaped with providers' and callers' consent. Sociodemographic information of the advice nurses, and chief complaints of the callers were obtained. The quality of nursing of the audiotaped calls was rated through an implicit review method by registered nurse raters using an advice nurse structured implicit review (AN-SIR) form developed for the study. Follow-up information was obtained through telephone calls to ascertain the consumers' perceptions of satisfaction, helpfulness, and follow-through with recommendations. Results indicated that consumers calling with a variety of general complaints contacted 32 nurses in advice nurse call centers. The quality of nursing process was found to be the best in the area of intervention. Evaluation was also well above the midpoint on a transformed scale of zero to 100. Assessment, although slightly above midpoint, was the lowest of the three components of the nursing process examined. Consumer satisfaction was high with 95.4 percent of the consumers rating the calls as completely or at least somewhat satisfied, and 93.2 percent, stating the advice was very or somewhat helpful. Exploratory regression analysis showed that the

  13. Patient Smoking Cessation Advice by Health Care Providers: The Role of Ethnicity, Socioeconomic Status, and Health

    PubMed Central

    Houston, Thomas K.; Scarinci, Isabel C.; Person, Sharina D.; Greene, Paul G.

    2005-01-01

    Objectives. We assessed differences by ethnicity in ever receiving advice from providers to quit smoking. We evaluated whether socioeconomic status and health status were moderators of the association. Methods. We used 2000 Behavioral Risk Factor Surveillance Survey data, a population-based cross-sectional survey. Results. After adjusting for complex survey design, 69% of the 14089 current smokers reported ever being advised to quit by a provider. Hispanics (50%) and African Americans (61%) reported receiving smoking counseling less frequently compared with Whites (72%, P<.01 for each). Ethnic minority status, lower education, and poorer health status remained significantly associated with lower rates of advice to quit after adjustment for number of cigarettes, time from last provider visit, income, comorbidities, health insurance, gender, and age. Smoking counseling differences between African Americans and Whites were greater among those with lower income and those without health insurance. Compared with Whites, differences for both Hispanics and African Americans were also greater among those with lower education. Conclusion. We found lower rates of smoking cessation advice among ethnic minorities. However, we also found complex interactions of ethnicity with socioeconomic factors. PMID:15914833

  14. 'How to stop a nosebleed': an assessment of the quality of epistaxis treatment advice on YouTube.

    PubMed

    Haymes, A T; Harries, V

    2016-08-01

    Video hosting websites are increasingly being used to disseminate health education messages. This study aimed to assess the quality of advice contained within YouTube videos on the conservative management of epistaxis. YouTube.com was searched using the phrase 'how to stop a nosebleed'. The first 50 videos were screened. Objective advice scores and subjective production quality scores were attributed by independent raters. Forty-five videos were analysed. The mean advice score was 2.0 out of 8 and the mean production quality score was 1.6 out of 3. There were no correlations between a video's advice score and its search results rank (ρ = -0.28, p = 0.068), its view count (ρ = 0.20, p = 0.19) or its number of 'likes' (ρ = 0.21, p = 0.18). The quality of information on conservative epistaxis management within YouTube videos is extremely variable. A high search rank is no indication of video quality. Many videos proffer inappropriate and dangerous 'alternative' advice. We do not recommend YouTube as a source for patient information.

  15. Western Australian women's perceptions of conflicting advice around breast feeding.

    PubMed

    Hauck, Yvonne L; Graham-Smith, Catherine; McInerney, Justine; Kay, Sue

    2011-10-01

    to explore women's perceptions of conflicting advice around breast feeding from formal support networks, specifically health professionals involved in postnatal support. a qualitative exploratory design was employed using the critical incident technique. Data were obtained from 62 Western Australian women who responded to an invitation to share incidents of receiving conflicting advice. Women who had breast fed a child within the past 12 months shared their experience through a telephone interview (n = 50) or completing a brief questionnaire (n = 12) addressing the following questions: Describe a situation in detail where you felt you received conflicting advice about breast feeding from a health professional. How did this situation affect you and/or your breast feeding? a modified constant comparison method was used to analyse the critical incidents revealing commonalities under who offered conflicting advice; what contributed to advice being perceived as conflicting; topic areas more inclined to being regarded as conflicting; what protected against advice being perceived as conflicting; the consequences of receiving conflicting advice; and strategies that women used to manage these incidents. advice that was viewed as conflicting extended beyond the provision of information that was inconsistent or directly contradictory, and included issues around information overload and disparities between the mother's and health professional's expectations. The manner of presenting information or advice, the skills of using effective communication, demonstration of a caring attitude with an empathic approach and focusing upon the woman as an individual were seen to be important to minimise these incidents. Attention to women's perceptions and the consequences of conflicting advice must be addressed, otherwise the credibility and confidence in health professionals' knowledge and ability to support breast feeding is questioned, resulting in a valuable support network being

  16. Making a Difference: Lessons Learned, Advice Given

    ERIC Educational Resources Information Center

    Kramer, Gary L.

    2011-01-01

    When it comes to giving advice, the author agrees with colleagues who have stated that although they might give advice to aspiring professionals, it would be better yet if they would write or apply it to themselves! So within that context, the author, like his colleagues, does not claim to possess superior wisdom in student services. Rather, he…

  17. Weight Advice Associated With Male Firefighter Weight Perception and Behavior

    PubMed Central

    Brown, Austin L.; Poston, Walker S.C.; Jahnke, Sara A.; Haddock, C. Keith; Luo, Sheng; Delclos, George L.; Day, R. Sue

    2016-01-01

    Introduction The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters. Methods A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011–2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity. Results Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders. Conclusions Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters. PMID:26141913

  18. Power in telephone-advice nursing.

    PubMed

    Leppänen, Vesa

    2010-03-01

    Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.

  19. Perceived threat and corroboration: key factors that improve a predictive model of trust in internet-based health information and advice.

    PubMed

    Harris, Peter R; Sillence, Elizabeth; Briggs, Pam

    2011-07-27

    How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ(2) (5) = 10.8 (P = .21), comparative fit

  20. Perceived Threat and Corroboration: Key Factors That Improve a Predictive Model of Trust in Internet-based Health Information and Advice

    PubMed Central

    Harris, Peter R; Briggs, Pam

    2011-01-01

    Background How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. Objective The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. Methods Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. Results We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ2 5 = 10

  1. Compliance With Referral Advice After Treatment With Prereferral Rectal Artesunate: A Study in 3 Sub-Saharan African Countries.

    PubMed

    Siribié, Mohamadou; Ajayi, IkeOluwapo O; Nsungwa-Sabiiti, Jesca; Sanou, Armande K; Jegede, Ayodele S; Afonne, Chinenye; Falade, Catherine O; Gomes, Melba

    2016-12-15

     Children aged <5 years were enrolled in a large study in 3 countries of sub-Saharan Africa because they had danger signs preventing them from being able to take oral medications. We examined compliance and factors associated with compliance with referral advice for those who were treated with rectal artesunate.  Patient demographic data, speed of accessing treatment after danger signs were recognized, clinical symptoms, malaria microscopy, treatment-seeking behavior, and compliance with referral advice were obtained from case record forms of 179 children treated with prereferral rectal artesunate in a multicountry study. We held focus group discussions and key informant interviews with parents, community health workers (CHWs), and facility staff to understand the factors that deterred or facilitated compliance with referral advice.  There was a very high level of compliance (90%) among patients treated with prereferral rectal artesunate. Age, symptoms at baseline (prostration, impaired consciousness, convulsions, coma), and malaria status were not related to referral compliance in the analysis.  Teaching CHWs to diagnose and treat young children with prereferral rectal artesunate is feasible in remote communities of Africa, and high compliance with referral advice can be achieved. © 2016 World Health Organization; licensee Oxford Journals.

  2. [Pre-travel advice and patient education of Hungarian travellers].

    PubMed

    Lengyel, Ingrid; Felkai, Péter

    2018-03-01

    According to international surveys, over half of the travellers face some kind of health issue when travelling. The overwhelming majority of travel-related illnesses can be prevented with pre-travel medical consultations, but the syllabus and content of the consultation have to match the travel habits and culture of the given society. This publication explores the specificities and travel habits of Hungarian travellers. One hundred participants of a travel exhibition completed a survey about their international travel. As the survey was not representative, the data could only be processed through simple statistical methods. However, since the exhibition was presumably attended by those wishing to travel, the conclusions drawn from the results are worth publishing, since no similar survey in Hungary has been published before. Based on the suitable classification of age groups in travel medicine, 11% of the participants were adolescents / young adults (aged 15-24), 81% adults (25-59) and 8% elderly (60-74). Twenty-eight percent of the participants travel multiple times a year, 40% yearly and 32% of them less frequently; 16% of the adults, 8% of the adolescents and 4% of the elderly age group travel multiple times a year. The travel destinations of Hungarian travellers have remained practically unchanged since a study was conducted 13 years ago: the vast majority (95%) travelled within Europe, 2% to the United States, and 11% of them elsewhere. Since Hungarians do not travel to endemic areas, only 5% consulted their general practitioners (GPs) prior to travelling, and 29% did when they had to be vaccinated. Forty-two percent of those wishing to travel never consult their GPs, even though 29% of them are aware of some chronic illness. Instead, 51% gather their health information from the internet and only 6% from their doctors. By the contradiction between the poor health status of the majority of Hungarian travellers and the negligence of seeking pre-travel advice

  3. Advice for windpower users

    NASA Astrophysics Data System (ADS)

    Stephenson, W.

    1982-01-01

    Advice for private users of windpower energy is given. Type of energy needed; amount of energy expected from windpower systems; cost effectiveness; autonomous operation versus connection to the national grid; and high and low speed systems are discussed.

  4. Testing an Integrated Model of Advice Giving in Supportive Interactions

    ERIC Educational Resources Information Center

    Feng, Bo

    2009-01-01

    Viewing supportive communication as a multistage process, the present study proposed and tested an integrated model of advice giving, which specifies three sequential moves in supportive interactions involving advice: emotional support, problem inquiry and analysis, and advice. Seven hundred and fifty-two participants read and responded to a…

  5. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture.

    PubMed

    Armour, Michael; Dahlen, Hannah G; Smith, Caroline A

    2016-01-01

    Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of "more than needles" for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial.

  6. More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture

    PubMed Central

    2016-01-01

    Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial. PMID:27242909

  7. Gender differences in medical advice and health behavior of obese African Americans with and without type 2 diabetes.

    PubMed

    Vaccaro, Joan A; Huffman, Fatma G

    2012-09-01

    This study examined gender differences in medical advice related to diet and physical activity for obese African American adults (N = 470) with and without diabetes. Data from the 2007-2008 National Health and Nutrition Examination Survey were analyzed using logistic regression analyses. Even after sociodemographic adjustments, men were less likely to report receiving medical advice as compared with women. Both men and women given dietary and physical activity advice were more likely to follow it. Men were less likely to report currently reducing fat or calories, yet men with diabetes were 5 times more likely to state that they were reducing fat and calories as compared with women with diabetes. Gender- and disease state-specific interventions are needed comparing standard care with enhanced patient education. Moreover, these findings necessitate studies that characterize the role of the health care professional in the diagnosis and treatment of obesity and underscore patient-provider relationships.

  8. Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus.

    PubMed

    Barakatun Nisak, Mohd Yusof; Ruzita, Abd Talib; Norimah, A Karim; Gilbertson, Heather; Nor Azmi, Kamaruddin

    2010-06-01

    This randomized controlled study was conducted to determine the effect of low glycemic index (GI) dietary advice on eating patterns and dietary quality in Asian patients with type 2 diabetes (T2DM). Asian patients with T2DM (N  =  104) were randomized into 2 groups that received either low GI or conventional carbohydrate exchange (CCE) dietary advice for 12 weeks. Nutritional prescriptions were based on the medical nutrition therapy for T2DM, with the difference being in the GI component of the carbohydrates. Dietary intake and food choices were assessed with the use of a 3-day food record. At week 12, both groups achieved the recommendations for carbohydrate (52 ± 4% and 54 ± 4% of energy) and fat (30 ± 4% and 28 ± 5% of energy) intake. There were no significant differences in the reported macronutrient intake in both groups. With the low GI diet, crude fiber and dietary calcium intake increased, while the dietary GI reduced. Subjects in the lowest dietary glycemic index/glycemic load (GI/GL) quartile consumed more parboiled/basmati rice, pasta, milk/dairy products, fruits, and dough, which are foods from the low GI category. There was a significant reduction in the hemoglobin A(1c) level at week 12 for patients in the lowest GI/GL quartile (Δ  =  -0.7 ± 0.1%) compared with those in the highest GI/GL quartile (Δ  =  -0.1 ± 0.2%). These results demonstrate the ability of low GI dietary advice to improve the dietary quality of Asian patients with T2DM.

  9. Comparison of office visit and nurse advice hotline data for syndromic surveillance--Baltimore-Washington, D.C., metropolitan area, 2002.

    PubMed

    Henry, Jade Vu; Magruder, S; Snyder, M

    2004-09-24

    Kaiser Permanente of the Mid-Atlantic States (KPMAS) is collaborating with the Electronic Surveillance System for Early Notification of Community-Based Epidemics II (ESSENCE II) program to understand how managed-care data can be effectively used for syndromic surveillance. This study examined whether KPMAS nurse advice hotline data would be able to predict the syndrome diagnoses made during subsequent KPMAS office visits. All nurse advice hotline calls during 2002 that were linked to an outpatient office visit were identified. By using International Classification of Diseases, Ninth Revision (ICD-9) codes, outpatient visits were categorized into seven ESSENCE II syndrome groups (coma, gastrointestinal, respiratory, neurologic, hemorrhagic, infectious dermatologic, and fever). Nurse advice hotline calls were categorized into ESSENCE II syndrome groups on the basis of the advice guidelines assigned. For each syndrome group, the sensitivity, specificity, and positive predictive value of hotline calls were calculated by using office visits as a diagnostic standard. For matching syndrome call-visit pairs, the lag (i.e., the number of hours that elapsed between the date and time the patient spoke to an advice nurse and the date and time the patient made an office visit) was calculated. Of all syndrome groups, the sensitivity of hotline calls for respiratory syndrome was highest (74.7%), followed by hotline calls for gastrointestinal syndrome (72.0%). The specificity of all nurse advice syndrome groups ranged from 88.9% to 99.9%. The mean lag between hotline calls and office visits ranged from 8.3 to 50 hours, depending on the syndrome group. The timeliness of hotline data capture compared with office visit data capture, as well as the sensitivity and specificity of hotline calls for detecting respiratory and gastrointestinal syndromes, indicate that KPMAS nurse advice hotline data can be used to predict KPMAS syndromic outpatient office visits.

  10. Efficacy of paracetamol, diclofenac and advice for acute low back pain in general practice: design of a randomized controlled trial (PACE Plus).

    PubMed

    Schreijenberg, M; Luijsterburg, P A J; Van Trier, Y D M; Rizopoulos, D; Koopmanschap, M A; Voogt, L; Maher, C G; Koes, B W

    2017-02-01

    Low back pain is common and associated with a considerable burden to patients and society. There is uncertainty regarding the relative benefit of paracetamol and diclofenac and regarding the additional effect of pain medication compared with advice only in patients with acute low back pain. This trial will assess the effectiveness of paracetamol, diclofenac and placebo for acute low back pain over a period of 4 weeks. Furthermore, this trial will assess the additional effectiveness of paracetamol, diclofenac and placebo compared with advice only for acute low back pain over a period of 4 weeks. The PACE Plus trial is a multi-center, placebo-blinded, superiority randomized controlled trial in primary care, with a follow-up of 12 weeks. Patients with acute low back pain aged 18-60 years presenting in general practice will be included. Patients are randomized into four groups: 1) Advice only (usual care conforming with the clinical guideline of the Dutch College of General Practitioners); 2) Advice and paracetamol; 3) Advice and diclofenac; 4) Advice and placebo. The primary outcome is low back pain intensity measured with a numerical rating scale (0-10). Secondary outcomes include compliance to treatment, disability, perceived recovery, costs, adverse reactions, satisfaction, sleep quality, co-interventions and adequacy of blinding. Between group differences for low back pain intensity will be evaluated using a repeated measurements analysis with linear effects models. An economic evaluation will be performed using a cost-effectiveness analysis with low back pain intensity and a cost-utility analysis with quality of life. Explorative analyses will be performed to assess effect modification by predefined variables. Ethical approval has been granted. Trial results will be released to an appropriate peer-viewed journal. This paper presents the design of the PACE Plus trial: a multi-center, placebo-blinded, superiority randomized controlled trial in primary care that

  11. The impact of mass media health communication on health decision-making and medical advice-seeking behavior of u.s. Hispanic population.

    PubMed

    De Jesus, Maria

    2013-01-01

    Mass media health communication has enormous potential to drastically alter how health-related information is disseminated and obtained by different populations. However, there is little evidence regarding the influence of media channels on health decision-making and medical advice-seeking behaviors among the Hispanic population. The Pew 2007 Hispanic Healthcare Survey was used to test the hypothesis that the amount of mass media health communication (i.e., quantity of media-based health information received) is more likely to influence Hispanic adults' health decision-making and medical advice-seeking behavior compared to health literacy and language proficiency variables. Results indicated that quantity of media-based health information is positively associated with health decision-making and medical advice-seeking behavior above and beyond the influence of health literacy and English and Spanish language proficiency. In a context where physician-patient dynamics are increasingly shifting from a passive patient role model to a more active patient role model, media-based health information can serve as an influential cue to action, prompting Hispanic individuals to make certain health-related decisions and to seek more health advice and information from a health provider. Study implications are discussed.

  12. Designing a Method with Physician Participation to Assess and Improve Quality of Healthcare in Otolaryngology.

    PubMed

    Arce, José M; Martín Cleary, Catalina; Cenjor, Carlos; Ramos, Ángel; Ortiz, Alberto

    2017-04-01

    Patient choice of healthcare centers to be treated for specific diseases is compromised by the low accessibility of understandable information. Physicians are rarely involved in healthcare quality assessment, despite their potentially valuable input. The purpose of this study was to develop a methodology for evaluating the quality of care that specifically incorporates advice from medical specialists and provides accessible information for patients in search of high-quality healthcare. A pilot Delphi study was conducted among 28 Spanish otolaryngology experts, seeking their opinion on the quality-of-care indicators and on their ability to recommend the most suitable department for the treatment of specific otolaryngologic diseases. The average acceptance rate was 91.9% for quality-of-care indicator and 96.5% for the resources needed for improving the quality of care. Furthermore, 93% experts reported that patients frequently ask for physician advice on which center provides better care for a specific disease, 92.6% experts believe they could recommend the best centers for specific otolaryngologic diseases, and 80% experts agreed that expert opinion on the quality of care offered by different centers would be a valuable addition to quality-of-care assessment. The incorporation of physician advice into healthcare quality assessment may improve the usefulness of healthcare quality indicators for patients. Assessment tools incorporating physician advice should be developed and validated.

  13. No Effect of Writing Advice on Reading Comprehension

    ERIC Educational Resources Information Center

    Balling, Laura Winther

    2018-01-01

    This article considers text comprehension through the integrated perspectives of language processing research and practical writing advice as expressed in writing guides and language policies. Such guides for instance include advice to use active constructions instead of passives and sentences instead of nominalizations. These recommended and…

  14. Weight Advice Associated With Male Firefighter Weight Perception and Behavior.

    PubMed

    Brown, Austin L; Poston, Walker S C; Jahnke, Sara A; Haddock, C Keith; Luo, Sheng; Delclos, George L; Day, R Sue

    2015-10-01

    The high prevalence of overweight and obesity threatens the health and safety of the fire service. Healthcare professionals may play an important role in helping firefighters achieve a healthy weight by providing weight loss counseling to at-risk firefighters. This study characterizes the impact of healthcare professional weight loss advice on firefighter weight perceptions and weight loss behaviors among overweight and obese male firefighters. A national sample of 763 overweight and obese male firefighters who recalled visiting a healthcare provider in the past 12 months reported information regarding healthcare visits, weight perceptions, current weight loss behaviors, and other covariates in 2011-2012. Analyzed in 2013, four unique multilevel logistic regression models estimated the association between healthcare professional weight loss advice and the outcomes of firefighter-reported weight perceptions, intentions to lose weight, reduced caloric intake, and increased physical activity. Healthcare professional weight loss advice was significantly associated with self-perception as overweight (OR=4.78, 95% CI=2.16, 10.57) and attempted weight loss (OR=2.06, 95% CI=1.25, 3.38), but not significantly associated with reduced caloric intake (OR=1.26, 95% CI=0.82, 1.95) and increased physical activity (OR=1.51, 95% CI=0.89, 2.61), after adjusting for confounders. Healthcare professional weight loss advice appears to increase the accuracy of firefighter weight perceptions, promote weight loss attempts, and may encourage dieting and physical activity behaviors among overweight firefighters. Healthcare providers should acknowledge their ability to influence the health behaviors of overweight and obese patients and make efforts to increase the quality and frequency of weight loss recommendations for all firefighters. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Resources available to help family physicians provide advice to travellers.

    PubMed Central

    Lechky, O

    1995-01-01

    Because many Canadians are travelling to exotic destinations, family physicians may be asked for advice on immunization and health tips to prevent illnesses such as malaria, altitude disease, meningitis and schistosomiasis. A Toronto family physician who is on staff at a travel clinic says a few guiding principles and good resources can help family physicians ensure that their patients are healthy when they return from a trip. PMID:7553504

  16. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall provide...

  17. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall provide...

  18. 14 CFR 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Legal advice and assistance. 1209.305 Section 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA shall provide...

  19. 29 CFR 1912a.5 - Advice and recommendations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 7 2013-07-01 2013-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and...

  20. 29 CFR 1912a.5 - Advice and recommendations.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 7 2014-07-01 2014-07-01 false Advice and recommendations. 1912a.5 Section 1912a.5 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) NATIONAL ADVISORY COMMITTEE ON OCCUPATIONAL SAFETY AND HEALTH § 1912a.5 Advice and...

  1. Marriage Advice for Parents of Children With Special Needs

    MedlinePlus

    ... Staying Safe Videos for Educators Search English Español Marriage Advice for Parents of Children With Special Needs KidsHealth / For Parents / Marriage Advice for Parents of Children With Special Needs ...

  2. Communicating effectively with deaf patients.

    PubMed

    McAleer, Monica

    This article explores the communication needs of deaf patients who use British Sign Language as their first or preferred language. It would appear that these needs are not being met, particularly in acute hospital settings. Practical advice is provided for nurses to improve the quality of care that deaf patients receive.

  3. Student giving health advice to family and friends.

    PubMed

    Tso, Simon; Yousuf, Asim

    2016-06-01

    This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends. This was a descriptive thematic analysis study involving a convenience sample of medical students from the University of Warwick 4-year MB ChB graduate-entry medicine programme. Each participating student attended a one-to-one semi-structured interview. Audio recordings of the interviews were transcribed verbatim and analysed thematically. Data saturation of the main themes was achieved following 14 interviews. Of the 14 students, eight (57%) were males and six (43%) were females. Students were asked to advise on a range of human and veterinary health issues. They were prepared to offer advice on health issues that they felt competent to manage: for example, first-aid scenarios that a 'reasonable layperson' or a first-aider would be able to help with. The nature of health advice given by students became increasingly complex as they progressed through their degree programme; however, they generally refrained from giving advice on complex health issues and chose to refer the individual to seek help from competent professionals instead. Previous research highlighted inappropriate advice could delay individuals seeking help from competent professionals, resulting in adverse clinical outcomes; however, we recommend that students should not be discouraged to act as good Samaritans. Instead, educators could help them to explore the professionalism and ethical issues raised by these requests, and the practical ways of handling these requests sensitively through discussion of case scenarios with acceptable and inappropriate behaviours. This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends. © 2015 John Wiley & Sons Ltd.

  4. Knowledge, Attitude and Advice-Giving Behaviour of Community Pharmacists Regarding Topical Corticosteroids

    PubMed Central

    Lau, Wing Man

    2017-01-01

    This study examines the relationship between community pharmacists’ knowledge, attitudes to information provision and self-reported counselling behaviours in relation to topical corticosteroids and adjunct therapy in atopic eczema. A mixed-methods approach was used whereby data from interviews with community pharmacists were used to design a structured questionnaire that a larger sample of community pharmacists completed anonymously. The questionnaire was completed and returned by 105 pharmacists (36% response rate). Pharmacists showed gaps in their knowledge on the use of topical corticosteroids in atopic eczema but had good understanding on the use of emollients. There was a significant correlation between pharmacists’ attitudes to information provision and their self-reported counselling behaviour for most themes except in relation to corticosteroid safety where less advice was given. Improving attitudes to information provision should correlate with increased counselling behaviour. However, for the theme of corticosteroid safety, further studies are needed to examine why in practice pharmacists are not providing patient counselling on this topic even though most agreed this is a topic patients should know about. PMID:28970453

  5. Knowledge, Attitude and Advice-Giving Behaviour of Community Pharmacists Regarding Topical Corticosteroids.

    PubMed

    Lau, Wing Man; Donyai, Parastou

    2017-07-25

    This study examines the relationship between community pharmacists' knowledge, attitudes to information provision and self-reported counselling behaviours in relation to topical corticosteroids and adjunct therapy in atopic eczema. A mixed-methods approach was used whereby data from interviews with community pharmacists were used to design a structured questionnaire that a larger sample of community pharmacists completed anonymously. The questionnaire was completed and returned by 105 pharmacists (36% response rate). Pharmacists showed gaps in their knowledge on the use of topical corticosteroids in atopic eczema but had good understanding on the use of emollients. There was a significant correlation between pharmacists' attitudes to information provision and their self-reported counselling behaviour for most themes except in relation to corticosteroid safety where less advice was given. Improving attitudes to information provision should correlate with increased counselling behaviour. However, for the theme of corticosteroid safety, further studies are needed to examine why in practice pharmacists are not providing patient counselling on this topic even though most agreed this is a topic patients should know about.

  6. Written advice can provide a safe and acceptable alternative to new patient assessment for selected referrals to haematologists.

    PubMed

    Ganly, Peter S; Keeman, Helen; Spearing, Ruth L; Smith, Mark P; Patton, Nigel; Merriman, Eileen G; Gibbons, Steve S

    2008-01-07

    To measure the safety and acceptability of providing written advice (WA) for selected patients referred to a haematology service, as an alternative to inpatient or outpatient assessment. Review of the initial management and subsequent course of patients newly referred to a tertiary referral hospital in Christchurch, New Zealand, between 16 October 2003 and 8 June 2006. Structured questionnaires were sent to all referring doctors and patients recently managed with WA. Numbers and diagnoses of patients managed with WA, early assessment or delayed assessment; re-referral and treatment details; characteristics of WA letters; and opinions of referring doctors and their patients on the WA process. 26% of new referrals (714/2785) were managed with prompt WA, while 16% (455/2785) received the alternative of delayed assessment. After a median follow-up of 23 months (range, 8-40 months), 13% of those managed with WA (91/714) were re-referred back to the same haematologists; 7% (52/714) were assessed in hospital and 2% (15/714) eventually required treatment. There were no deaths due to haematological causes. Over 90% of responding referring doctors said the WA process was rapid and effective, and 77% of recently managed patients were pleased to be treated by their own doctors. Using WA to manage a substantial minority of patients referred to haematologists can be rapid and safe. It is widely accepted by referring doctors.

  7. A phenomenologic investigation of pediatric residents' experiences being parented and giving parenting advice.

    PubMed

    Bax, A C; Shawler, P M; Blackmon, D L; DeGrace, E W; Wolraich, M L

    2016-09-01

    Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The primary purpose of this study was to examine pediatric residents' self-reported experiences giving parenting advice and explore the relationship between parenting advice given and types of parenting residents received as children. Thirteen OUHSC pediatric residents were individually interviewed to examine experiences being parented and giving parenting advice. Phenomenological methods were used to explicate themes and secondary analyses explored relationships of findings based upon Baumrind's parenting styles (authoritative, authoritarian, permissive). While childhood experiences were not specifically correlated to the parenting advice style of pediatric residents interviewed, virtually all reported relying upon childhood experiences to generate their advice. Those describing authoritative parents reported giving more authoritative advice while others reported more variable advice. Core interview themes related to residents' parenting advice included anxiety about not being a parent, varying advice based on families' needs, and emphasis of positive interactions and consistency. Themes related to how residents were parented included discipline being a learning process for their parents and recalling that their parents always had expectations, yet always loved them. Pediatric residents interviewed reported giving family centered parenting advice with elements of positive interactions and consistency, but interviews highlighted many areas of apprehension residents have around giving parenting advice. Our study suggests that pediatric residents may benefit from more general educational opportunities to develop the content of their parenting advice, including reflecting on any impact from their own upbringing.

  8. Community forum. 1. Family planning. Palaces of advice.

    PubMed

    Bunting, J

    1983-01-19

    Completed questionnaires were collected from 130 respondents attending child health clinics (CHCs) in Corringham, Stanford, East Tilbury, and Billericay to investigate the source chosen by patients using CHCs for family planning information and materials, and why they made this choice. Criteria for inclusion were that all subjects were attending a CHC and by definition had at least 1 child; all subjects were female and of reproductive age; and all were at that time using some family planning method. 23 respondents indicated that they went to more than 1 source for advice. No respondents went to their midwife and only 4% sought the advice of their health visitor. Approximately equal proportions of respondents indicated that they went to their general practitioner and to family planning clinics, these 2 groups together forming 4/5 of all answers. 8% of respondents indicated they were dissatisfied with the advice given or obtained. 24 respondents (partners) used the condom, 56 oral contraceptives, 5 the IUD, 9 the diaphragm, 2 the condom and rhythm, 1 the condom and withdrawal, 1 withdrawal, and 2 partners had had a vasectomy. In the Essex statistics, in addition 5% were not using any method of contraception and 1% were using chemicals only. The most interesting variation between this study and the Essex Family Planning Center statistics are: almost twice as many study respondents use the condom and 3 times as many Essex clients as survey patients use the IUD. 1/5 expressed dissatisfaction with their method of contraception. Respondents obtained their supplies free in equal numbers from the Family Planning Center and family doctor, but 19% chose or were forced by circumstances to pay for their supplies. 73% reported no problems in getting supplies; 7% indicated problems and 20% did not respond to this question. Criticism can be divided into 3 categories: variation in cost of supplies between sources of service; clinic too far away; and occasionally an overnight wait

  9. The Perceived Impact of Agricultural Advice in Ethiopia

    ERIC Educational Resources Information Center

    Hamilton, Alexander; Hudson, John

    2017-01-01

    Purpose: We examine the impact of advice given by extension agents to Ethiopian farmers, as perceived by the farmers themselves. Design/methodology/approach: Using survey data from 2014, we analyze the perceived impact of advice on farmers' incomes and crop yields. We use a bootstrapped instrumental variable (IV) estimator and the conditional…

  10. Expert Financial Advice Neurobiologically “Offloads” Financial Decision-Making under Risk

    PubMed Central

    Engelmann, Jan B.; Capra, C. Monica; Noussair, Charles; Berns, Gregory S.

    2009-01-01

    Background Financial advice from experts is commonly sought during times of uncertainty. While the field of neuroeconomics has made considerable progress in understanding the neurobiological basis of risky decision-making, the neural mechanisms through which external information, such as advice, is integrated during decision-making are poorly understood. In the current experiment, we investigated the neurobiological basis of the influence of expert advice on financial decisions under risk. Methodology/Principal Findings While undergoing fMRI scanning, participants made a series of financial choices between a certain payment and a lottery. Choices were made in two conditions: 1) advice from a financial expert about which choice to make was displayed (MES condition); and 2) no advice was displayed (NOM condition). Behavioral results showed a significant effect of expert advice. Specifically, probability weighting functions changed in the direction of the expert's advice. This was paralleled by neural activation patterns. Brain activations showing significant correlations with valuation (parametric modulation by value of lottery/sure win) were obtained in the absence of the expert's advice (NOM) in intraparietal sulcus, posterior cingulate cortex, cuneus, precuneus, inferior frontal gyrus and middle temporal gyrus. Notably, no significant correlations with value were obtained in the presence of advice (MES). These findings were corroborated by region of interest analyses. Neural equivalents of probability weighting functions showed significant flattening in the MES compared to the NOM condition in regions associated with probability weighting, including anterior cingulate cortex, dorsolateral PFC, thalamus, medial occipital gyrus and anterior insula. Finally, during the MES condition, significant activations in temporoparietal junction and medial PFC were obtained. Conclusions/Significance These results support the hypothesis that one effect of expert advice is to

  11. Family Practitioners' Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks.

    PubMed

    Godycki-Cwirko, Maciek; Nocun, Marek; Butler, Christopher C; Little, Paul; Verheij, Theo; Hood, Kerenza; Fleten, Nils; Kowalczyk, Anna; Melbye, Hasse

    2016-01-01

    Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours. to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries. Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression. 324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs' advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; P<0.001), fever (2.49; P<0.001), patients feeling generally unwell (2.21; P<0.001), antibiotic prescribing (1.51; P = 0.025) and auscultation abnormality (1.50; P = 0.029). Advice to take time off was not associated with patient reported recovery. There is large variation in FPs' advice given to patients with LRTIs in Europe about taking time off work, which is not explained by differences in patients' reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed.

  12. 5 CFR 2634.402 - Special notice for advice-and-consent nominees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... trust after the Senate has given its advice and consent to a nomination. ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special notice for advice-and-consent... § 2634.402 Special notice for advice-and-consent nominees. (a) In general. In any case in which the...

  13. 5 CFR 2634.402 - Special notice for advice-and-consent nominees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... trust after the Senate has given its advice and consent to a nomination. ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Special notice for advice-and-consent... § 2634.402 Special notice for advice-and-consent nominees. (a) In general. In any case in which the...

  14. The role of the psychiatrist in improving patient compliance.

    PubMed

    Hotujac, Ljubomir

    2007-02-01

    Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid.

  15. The Readability of Electronic Cigarette Health Information and Advice: A Quantitative Analysis of Web-Based Information.

    PubMed

    Park, Albert; Zhu, Shu-Hong; Conway, Mike

    2017-01-06

    The popularity and use of electronic cigarettes (e-cigarettes) has increased across all demographic groups in recent years. However, little is currently known about the readability of health information and advice aimed at the general public regarding the use of e-cigarettes. The objective of our study was to examine the readability of publicly available health information as well as advice on e-cigarettes. We compared information and advice available from US government agencies, nongovernment organizations, English speaking government agencies outside the United States, and for-profit entities. A systematic search for health information and advice on e-cigarettes was conducted using search engines. We manually verified search results and converted to plain text for analysis. We then assessed readability of the collected documents using 4 readability metrics followed by pairwise comparisons of groups with adjustment for multiple comparisons. A total of 54 documents were collected for this study. All 4 readability metrics indicate that all information and advice on e-cigarette use is written at a level higher than that recommended for the general public by National Institutes of Health (NIH) communication guidelines. However, health information and advice written by for-profit entities, many of which were promoting e-cigarettes, were significantly easier to read. A substantial proportion of potential and current e-cigarette users are likely to have difficulty in fully comprehending Web-based health information regarding e-cigarettes, potentially hindering effective health-seeking behaviors. To comply with NIH communication guidelines, government entities and nongovernment organizations would benefit from improving the readability of e-cigarettes information and advice. ©Albert Park, Shu-Hong Zhu, Mike Conway. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 06.01.2017.

  16. Improving Patient Safety: Improving Communication.

    PubMed

    Bittner-Fagan, Heather; Davis, Joshua; Savoy, Margot

    2017-12-01

    Communication among physicians, staff, and patients is a critical element in patient safety. Effective communication skills can be taught and improved through training and awareness. The practice of family medicine allows for long-term relationships with patients, which affords opportunities for ongoing, high-quality communication. There are many barriers to effective communication, including patient factors, clinician factors, and system factors, but tools and strategies exist to address these barriers, improve communication, and engage patients in their care. Use of universal precautions for health literacy, appropriate medical interpreters, and shared decision-making are evidence-based tools that improve communication and increase patient safety. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  17. Financial Advice: Who Pays

    ERIC Educational Resources Information Center

    Finke, Michael S.; Huston, Sandra J.; Winchester, Danielle D.

    2011-01-01

    Using a cost-benefit framework for financial planning services and proprietary data collected in the summer of 2008, the client characteristics that are associated with the likelihood of paying for professional financial advice, as well as the type of financial services purchased, are identified. Results indicate that respondents who pay for…

  18. The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain

    PubMed Central

    2010-01-01

    Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active. Methods/Design The proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled

  19. 43 CFR 2203.5 - Action on advice of the Attorney General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... record of decision on the proposed exchange, discuss the consideration given any advice received from the... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Action on advice of the Attorney General... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.5 Action on advice of the Attorney General...

  20. Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools.

    PubMed

    Mondain, Véronique; Lieutier, Florence; Pulcini, Céline; Degand, Nicolas; Landraud, Luce; Ruimy, Raymond; Fosse, Thierry; Roger, Pierre Marie

    2018-05-01

    The increasing incidence of ESBL-producing Enterobacteriaceae (ESBL-E) in France prompted the publication of national recommendations in 2010. Based on these, we developed a toolkit and a warning system to optimise management of ESBL-E infected or colonised patients in both community and hospital settings. The impact of this initiative on quality of care was assessed in a teaching hospital. The ESBL toolkit was developed in 2011 during multidisciplinary meetings involving a regional network of hospital, private clinic and laboratory staff in Southeastern France. It includes antibiotic treatment protocols, a check list, mail templates and a patient information sheet focusing on infection control. Upon identification of ESBL-E, the warning system involves alerting the attending physician and the infectious disease (ID) advisor, with immediate, advice-based implementation of the toolkit. The procedure and toolkit were tested in our teaching hospital. Patient management was compared before and after implementation of the toolkit over two 3-month periods (July-October 2010 and 2012). Implementation of the ESBL-E warning system and ESBL-E toolkit was tested for 87 patients in 2010 and 92 patients in 2012, resulting in improved patient management: expert advice sought and followed (16 vs 97%), information provided to the patient's general practitioner (18 vs 63%) and coding of the condition in the patient's medical file (17 vs 59%), respectively. Our multidisciplinary strategy improved quality of care for in-patients infected or colonised with ESBL-E, increasing compliance with national recommendations.

  1. [Social counseling in outpatient cancer counseling centers : Offers and use by advice-seekers].

    PubMed

    Ernst, Jochen; Mehnert, Anja; Weis, Joachim; Faust, Tanja; Giesler, Jürgen M; Roick, Julia

    2016-11-01

    Outpatient psychosocial cancer care has gained importance in recent years and psychosocial counselling services (PCS) offer a broad spectrum of counselling interventions. Yet there is no published research on PCS legal counselling services. This study investigated the range of issues addressed by legal counselling and their relationship with characteristics of advice seekers and counsellors. We analyzed the records of 21 PCS funded by the German Cancer Aid (DKH) including 5203 advice seekers (80 % patients, 20 % others including friends and family; age ∅ 54 years; 24 % male) in 20,947 counselling sessions. We calculated descriptive statistics and binary logistic regression analyses (legal counselling: yes/no). Fifty-five percent of counselling seekers received legal counselling and 28 % approached the PCS exclusively for legal counselling. The proportion of people seeking legal advice ranged from 15 to 87 % between counselling centers. The most common topics during legal counselling were medical rehabilitation programs (57 %) and disability law (43 %). Counselling occurred in a single session in 68 % of cases and was mostly sought by older and unemployed persons with a recent diagnosis. Legal counselling made up 18 % of counselling time. Legal advice was mostly given by social workers (71 %). Legal counselling is a major part of psychosocial care services. Our results reveal large differences between counselling centers. Further research on quality of care and efficacy of legal counseling is needed.

  2. 5 CFR 1304.4607 - Advice to former Government employees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Advice to former Government employees. 1304.4607 Section 1304.4607 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET ADMINISTRATIVE PROCEDURES POST EMPLOYMENT CONFLICT OF INTEREST § 1304.4607 Advice to former Government employees. The Office...

  3. Factors affecting the acceptance of expert advice.

    PubMed

    Van Swol, Lyn M; Sniezek, Janet A

    2005-09-01

    This paper expands research on the judge advisor system (JAS) by examining advice utilization and trust. Experiment 1 examined five factors that could increase utilization of expert advice: judge's trust in the advisor, advisor confidence, advisor accuracy, judge's prior relationship with the advisor, and judge's power to set payment to the advisor. While judge's trust and advisor confidence correlated with the judge matching the advisor's advice, a stepwise regression found that of the five variables, advisor confidence was the only significant predictor of the judge matching the advisor. Experiment 2 examined trust without the role assignment to judge or advisor. While trust expressed in partner was not higher for the judge than the advisor in Experiment 1, in Experiment 2 trust in partner expressed by the low-expertise dyad member was higher than trust expressed by the high-expertise dyad member. Results from the two experiments are discussed in the context of Sniezek and Van Swol (2001).

  4. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 4 2012-07-01 2012-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling service...

  5. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling service...

  6. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 4 2013-07-01 2013-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling service...

  7. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 4 2014-07-01 2014-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling service...

  8. 29 CFR 1400.735-3 - Advice and counseling service.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 4 2011-07-01 2011-07-01 false Advice and counseling service. 1400.735-3 Section 1400.735-3 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE STANDARDS OF CONDUCT, RESPONSIBILITIES, AND DISCIPLINE General § 1400.735-3 Advice and counseling service...

  9. Aspects of Recipient Design in Expert Advice-giving on Call-in Radio.

    ERIC Educational Resources Information Center

    Hutchby, Ian

    1995-01-01

    Investigates the management of expertise in advice-giving in the calls to a radio advice line. Analyzes how the expert's talk handles the tension between the personal and public dimensions of advice-giving in such a public forum. (HB)

  10. Advice Taking from Humans and Machines: An fMRI and Effective Connectivity Study.

    PubMed

    Goodyear, Kimberly; Parasuraman, Raja; Chernyak, Sergey; Madhavan, Poornima; Deshpande, Gopikrishna; Krueger, Frank

    2016-01-01

    With new technological advances, advice can come from different sources such as machines or humans, but how individuals respond to such advice and the neural correlates involved need to be better understood. We combined functional MRI and multivariate Granger causality analysis with an X-ray luggage-screening task to investigate the neural basis and corresponding effective connectivity involved with advice utilization from agents framed as experts. Participants were asked to accept or reject good or bad advice from a human or machine agent with low reliability (high false alarm rate). We showed that unreliable advice decreased performance overall and participants interacting with the human agent had a greater depreciation of advice utilization during bad advice compared to the machine agent. These differences in advice utilization can be perceivably due to reevaluation of expectations arising from association of dispositional credibility for each agent. We demonstrated that differences in advice utilization engaged brain regions that may be associated with evaluation of personal characteristics and traits (precuneus, posterior cingulate cortex, temporoparietal junction) and interoception (posterior insula). We found that the right posterior insula and left precuneus were the drivers of the advice utilization network that were reciprocally connected to each other and also projected to all other regions. Our behavioral and neuroimaging results have significant implications for society because of progressions in technology and increased interactions with machines.

  11. Advice Taking from Humans and Machines: An fMRI and Effective Connectivity Study

    PubMed Central

    Goodyear, Kimberly; Parasuraman, Raja; Chernyak, Sergey; Madhavan, Poornima; Deshpande, Gopikrishna; Krueger, Frank

    2016-01-01

    With new technological advances, advice can come from different sources such as machines or humans, but how individuals respond to such advice and the neural correlates involved need to be better understood. We combined functional MRI and multivariate Granger causality analysis with an X-ray luggage-screening task to investigate the neural basis and corresponding effective connectivity involved with advice utilization from agents framed as experts. Participants were asked to accept or reject good or bad advice from a human or machine agent with low reliability (high false alarm rate). We showed that unreliable advice decreased performance overall and participants interacting with the human agent had a greater depreciation of advice utilization during bad advice compared to the machine agent. These differences in advice utilization can be perceivably due to reevaluation of expectations arising from association of dispositional credibility for each agent. We demonstrated that differences in advice utilization engaged brain regions that may be associated with evaluation of personal characteristics and traits (precuneus, posterior cingulate cortex, temporoparietal junction) and interoception (posterior insula). We found that the right posterior insula and left precuneus were the drivers of the advice utilization network that were reciprocally connected to each other and also projected to all other regions. Our behavioral and neuroimaging results have significant implications for society because of progressions in technology and increased interactions with machines. PMID:27867351

  12. Assessment of producers' response to Salmonella biosecurity issues and uptake of advice on laying hen farms in England and Wales.

    PubMed

    Gosling, R J; Martelli, F; Wintrip, A; Sayers, A R; Wheeler, K; Davies, R H

    2014-01-01

    High standards of biosecurity are known to reduce the risk of disease outbreaks; however, uptake of advice and implementation of biosecurity measures are dependent on many factors. This study assessed the uptake of targeted biosecurity advice by 60 laying hen farms provided during biosecurity audit visits. Advice was provided as bullet point cards focusing on specific areas identified as benefitting from improvement. These covered site entrance, site tidiness, vaccination, boot hygiene, hand hygiene, house tidiness, rodent control, fly control, red mite control and cleaning and disinfection between flocks. Background knowledge of Salmonella and biosecurity and farmers' willingness and intent to implement additional measures were assessed. About 50% of the principal decision-makers had basic background knowledge of Salmonella, with 22% considered well informed; almost all agreed that biosecurity could impact on Salmonella control and many appeared willing to implement additional biosecurity measures. Sixty-three per cent of study farms were categorised using the Defra Farmer Segmentation Model as Modern Family Businesses (MFBs), with 7-11% of farms being categorised as Custodian, Lifestyle Choice, Pragmatist or Challenged Enterprise; however, categorisation, did not determine uptake of advice. The most frequently used advice cards were boot hygiene, red mite control, hand hygiene, site entrance and cleaning and disinfection; uptake of advice ranged from 54 to 80% depending on the advice card. Uptake of advice by the farmers was encouraging, especially considering it was being provided by people other than their usual source of biosecurity information. Those who did not implement the recommended measures cited cost, difficulty of enforcement and practicality as the main reasons. However, the positive uptake of advice and implementation of recommended measures by many farmers demonstrates that targeted advice, discussed face to face with farmers, on a small number of

  13. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults

    PubMed Central

    Desroches, Sophie; Lapointe, Annie; Ratté, Stéphane; Gravel, Karine; Légaré, France; Turcotte, Stéphane

    2016-01-01

    Background It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients, and greater adherence to dietary advice is a critical component in preventing and managing chronic diseases. Objectives To assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Search methods We searched the following electronic databases up to 29 September 2010: The Cochrane Library (issue 9 2010), PubMed, EMBASE (Embase.com), CINAHL (Ebsco) and PsycINFO (PsycNET) with no language restrictions. We also reviewed: a) recent years of relevant conferences, symposium and colloquium proceedings and abstracts; b) web-based registries of clinical trials; and c) the bibliographies of included studies. Selection criteria We included randomized controlled trials that evaluated interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. Studies were eligible if the primary outcome was the client’s adherence to dietary advice. We defined ‘client’ as an adult participating in a chronic disease prevention or chronic disease management study involving dietary advice. Data collection and analysis Two review authors independently assessed the eligibility of the studies. They also assessed the risk of bias and extracted data using a modified version of the Cochrane Consumers and Communication Review Group data extraction template. Any discrepancies in judgement were resolved by discussion and consensus, or with a third review author. Because the studies differed widely with respect to interventions, measures of diet adherence, dietary advice, nature of the chronic diseases and duration of interventions and follow-up, we conducted a qualitative analysis. We classified included studies according to the function of the intervention and present results in a narrative table using vote counting for each category of intervention. Main results

  14. Does providing written dietary advice improve the ingestion of non-allergic nuts in children with existing nut allergies? - A randomized controlled trial.

    PubMed

    Norman, M; South, C; Quinn, P; Chan, D; Palmer, S; Netting, M; Gold, M

    2016-05-01

    Allergy to one or more nuts is common in children and often complete nut avoidance is advised. More recently, introduction of non-allergic nuts into the diet is advised by some allergists. This study aims to determine whether the provision of additional written dietary advice increases the ingestion of non-allergic nuts by children with nut allergy. Secondary aims include determining which factors facilitate or prevent successful inclusion of non-allergic nuts in the diet, and how inclusion influences quality of life, sensitization and the rate of nut reactions. This is a randomized, double-blinded, controlled trial of children with nut allergy who were asked to ingest one or more non-allergic nuts. Participants were 75 children aged 2-16 years (Intervention=36, Control=39), recruited in Adelaide, Australia. Randomized participants were supplied with the intervention (recipe booklet and monthly reminder text messages) or provided standard verbal dietary advice. After 6 months participants were assessed by a blinded investigator with regard to nut ingestion, quality of life, sensitization and nut reactions. The intervention did not increase the ingestion of non-allergic nuts. A negative hospital challenge was a predictor of successful introduction. Parental report of child concern about a reaction was the greatest barrier. Ingestion of non-allergic nuts did not improve quality of life or change nut sensitization. Few nut reactions occurred during the study. Ingestion of non-allergic nuts by children with nut allergy was not improved by additional dietary intervention. Selective introduction of non-allergic nuts is difficult to achieve when the child is anxious about introduction and challenges cannot be done in a medically supervised setting. This dietary intervention did not improve non-allergic nut ingestion by nut allergic children. Hospital challenge increased introduction rates, whilst parentally reported child concern about a reaction reduced success. Non

  15. Pectus patient information website has improved access to care and patient reported outcomes.

    PubMed

    Tikka, Theofano; Webb, Joanne; Agostini, Paula; Kerr, Amy; Mannion, Glenn; Steyn, Richard S; Bishay, Ehab; Kalkat, Maninder S; Rajesh, Pala B; Naidu, Babu

    2016-04-26

    Pectus is the most common congenital disorder. Awareness amongst primary care physicians and the general public is poor. NHS commissioning bodies plan to withdraw funding for this surgery because they deem a lack of sufficient evidence of benefit. The purpose of this study is to assess the effects of introducing a patient information website on referral and activity patterns and on patients reported outcomes. We produced an innovative information website, www.pectus.co.uk , accessible to the general public, providing information about pectus deformities; management options and advice about surgery. Referral patterns and number of cases where studied before and after the introduction of the website in 2010. Patients' satisfaction post-op was assessed using the Brompton's single step questionnaire (SSQ). The website had considerable traffic with 2179 hits in 2012, 4983 in 2013 and 7416 in 2014. This has led to 1421 contacts and 372 email enquiries. These emails have resulted in an increased number of patients who have been assessed and go on to have surgery. We asked 59 pectus excavatum patients who were operated from 2008 to 2014 to complete the SSQ. We received 32 replies. Eighty-four percent (16/19) of patients who visited the website and then underwent surgery, found the website useful. All patients scored satisfactorily in SSQ. Even though those who visited the website tended to be more satisfied with the surgical outcomes this did not reach statistical significance. This group of patients said that would have the operation again given the option compared to 76.9 % of the group who did not visit the website before surgery (p=0.031). Despite the fact that patients who visited the website experienced more post-operative complications were equally or more satisfied with post-operative outcomes. The overall SSQ obtainable score was not different for the two subgroups, being more widespread in the group that did not visit the website. The introduction of a pectus

  16. Early scientific advice obtained simultaneously from regulators and payers: findings from a pilot study in Australia.

    PubMed

    Wonder, Michael; Backhouse, Martin E; Hornby, Edward

    2013-01-01

    There is scope for better interaction between regulators, payers/HTA agencies, and medicines developers in their common objective of getting new medicines to patients. This paper reports on a tripartite early scientific advice pilot conducted by a pharmaceutical company (developer), the Therapeutic Goods Administration (TGA: regulator) and the Pharmaceutical Benefit Advisory Committee (PBAC) Secretariat (HTA agency) in Australia. The objective was to explore the practicality, feasibility, and sustainability of means of obtaining simultaneous scientific advice from both a regulatory and reimbursement perspective. Advice was sought for two development compounds in different disease areas. The focus was on matters of common interest to the TGA and the PBAC (i.e. the clinical evidence). Briefing books were prepared by the developer and supplied eight weeks prior to the meeting and only verbal advice was provided. The pilot meeting took place in 2009. Each session lasted for approximately two hours and was structured around the questions in the briefing books. The representatives from the TGA and PBAC Secretariat provided well-informed, considered and careful advice for both compounds, which was predominantly actionable and practical. The sessions proved highly informative and permitted better alignment of the possible positioning of new medicines with the clinical evidence that regulators and HTA agencies might subsequently require for favorable assessment. The process provided early and clear signals to inform major development investments and the probability of successful market access. A number of challenges need to be addressed before tripartite scientific advice can be provided on continual basis. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

  17. Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial.

    PubMed

    Hosseinpour-Niazi, S; Mirmiran, P; Hedayati, M; Azizi, F

    2015-05-01

    The objective of this study was to determine the effects of substitution of red meat with legumes in the Therapeutic Lifestyle Change (TLC) diet on cardiometabolic risk factors in type 2 diabetes patients based on dietary education. This study was a randomized, controlled, cross-over trial. Thirty-one participants (24 women and 7 men; age: 58.1 ± 6.0 years) with type 2 diabetes were randomly assigned to consume a control diet (legume-free TLC diet) and legume-based TLC diet for 8 weeks. Legume-based TLC diet was the same as the control diet, but the legume-based TLC group was advised to replace two servings of red meat with legumes, 3 days per week. After the interventional period, a washout period was conducted for 4 weeks. The groups were then advised to follow the alternate treatment for 8 weeks. Cardiometabolic risk factors were measured. Compared with the legume-free TLC diet, the legume-based TLC diet significantly decreased fasting blood glucose (P=0.04), fasting insulin (P=0.04), triglyceride concentrations (P=0.04) and low-density lipoprotein cholesterol (P=0.02). Total cholesterol concentrations decreased after consumption of both TLC diet and legume TLC diet; however, the data did not differ significantly between the two diets. body mass index (BMI), waist circumference, systolic and diastolic blood pressures did not change significantly after consumption of either the legume-free TLC diet or the legume-based TLC diet. Dietary advice given for substitution of red meat with legume intakes within a TLC diet-improved lipid profiles and glycemic control among diabetes patients, which were independent from BMI change. This trial was registered in the Iranian Registry of Clinical Trials (http://www.irct.ir) as IRCT201202251640N7.

  18. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Examination, counseling and staff advice. 1... and staff advice. The Commission maintains a staff to carry out on-the-scene examination of records... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to the...

  19. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Examination, counseling and staff advice. 1... and staff advice. The Commission maintains a staff to carry out on-the-scene examination of records... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to the...

  20. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Examination, counseling and staff advice. 1... and staff advice. The Commission maintains a staff to carry out on-the-scene examination of records... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to the...

  1. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Examination, counseling and staff advice. 1... and staff advice. The Commission maintains a staff to carry out on-the-scene examination of records... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to the...

  2. 16 CFR 1.72 - Examination, counseling and staff advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Examination, counseling and staff advice. 1... and staff advice. The Commission maintains a staff to carry out on-the-scene examination of records... counseling. Requests for staff interpretation of the Fair Credit Reporting Act should be directed to the...

  3. Getting started on your research: practical advice for medical educators.

    PubMed

    Markert, Ronald J

    2010-10-01

    Guidance and mentorship benefit faculty who having little or no background conducting research in medical education. From his experience the author suggests three characteristics that distinguish medical educators who are especially productive in their scholarly activities: intrinsic rather than extrinsic motivation, collaboration with colleagues, and the personal qualities of patience and organization. He then expands on these characteristics by offering practical advice in the form of eight tips for faculty seeking to acquire or improve their medical education research skills.

  4. Racial disparities in reported prenatal care advice from health care providers.

    PubMed Central

    Kogan, M D; Kotelchuck, M; Alexander, G R; Johnson, W E

    1994-01-01

    OBJECTIVES. The relationship between certain maternal behaviors and adverse pregnancy outcomes has been well documented. One method to alter these behaviors is through the advice of women's health care providers. Advice from providers may be particularly important in minority populations, who have higher rates of infant mortality and prematurity. This study examines racial disparities according to women's self-report of advice received from health care providers during pregnancy in four areas: tobacco use, alcohol consumption, drug use, and breast-feeding. METHODS. Health care providers' advice to 8310 White non-Hispanic and Black women was obtained from the National Maternal and Infant Health Survey. RESULTS. After controlling for sociodemographic, utilization, and medical factors, Black women were more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. The difference between Blacks and Whites also approached significance for breast-feeding. No overall difference was noted in advice regarding cessation of drug use, although there was a significant interaction between race and marital status. CONCLUSIONS. These data suggest that Black women may be at greater risk for not receiving information that could reduce their chances of having an adverse pregnancy outcome. PMID:8279618

  5. Evaluation of a Web-based intervention providing tailored advice for self-management of minor respiratory symptoms: exploratory randomized controlled trial.

    PubMed

    Yardley, Lucy; Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

    2010-12-15

    There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. This study was designed as an evaluation of the usage and effects of the "Internet Doctor" website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline

  6. Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial

    PubMed Central

    Joseph, Judith; Michie, Susan; Weal, Mark; Wills, Gary; Little, Paul

    2010-01-01

    Background There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. Objective This study was designed as an evaluation of the usage and effects of the “Internet Doctor” website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Methods Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. Results The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and

  7. 14 CFR § 1209.305 - Legal advice and assistance.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Legal advice and assistance. § 1209.305 Section § 1209.305 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.305 Legal advice and assistance. The General Counsel of NASA...

  8. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus.

    PubMed

    Tieu, Joanna; Shepherd, Emily; Middleton, Philippa; Crowther, Caroline A

    2017-01-03

    Gestational diabetes mellitus (GDM) is a form of diabetes occurring during pregnancy which can result in short- and long-term adverse outcomes for women and babies. With an increasing prevalence worldwide, there is a need to assess strategies, including dietary advice interventions, that might prevent GDM. To assess the effects of dietary advice interventions for preventing GDM and associated adverse health outcomes for women and their babies. We searched Cochrane Pregnancy and Childbirth's Trials Register (3 January 2016) and reference lists of retrieved studies. Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of dietary advice interventions compared with no intervention (standard care), or to different dietary advice interventions. Cluster-RCTs were eligible for inclusion but none were identified. Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. We included 11 trials involving 2786 women and their babies, with an overall unclear to moderate risk of bias. Six trials compared dietary advice interventions with standard care; four compared low glycaemic index (GI) with moderate- to high-GI dietary advice; one compared specific (high-fibre focused) with standard dietary advice. Dietary advice interventions versus standard care (six trials) Considering primary outcomes, a trend towards a reduction in GDM was observed for women receiving dietary advice compared with standard care (average risk ratio (RR) 0.60, 95% confidence interval (CI) 0.35 to 1.04; five trials, 1279 women; Tau² = 0.20; I² = 56%; P = 0.07; GRADE: very low-quality evidence); subgroup analysis suggested a greater treatment effect for overweight and obese women receiving dietary advice. While no clear difference was observed for pre-eclampsia (RR 0.61, 95% CI 0.25 to 1.46; two trials, 282 women

  9. Behavior Modification of Studying Through Study Skills Advice and Self-Control Procedures

    ERIC Educational Resources Information Center

    Richards, C. Steven

    1975-01-01

    Investigates the efficacy of two behavioral self-control procedures as additions to the typical treatment for college students' study behavior--study skills advice. Predicted self-monitoring would be an effective treatment addition to study skills advice and study skills advice would be superior to the control groups. Results supported…

  10. [Pre travel advice - a study among Swiss general practitioners].

    PubMed

    Walz, Alexander; Tschudi, Peter; Badertscher, Nina; Hatz, Christoph

    2013-06-01

    Up to 65 % of travellers seek pre-travel advice at their general practitioner. Professionals should inform about the most common and most dangerous health threats, requiring up-to-date knowledge about epidemiology of respective disorders. The aim of the present study was to investigate the content of pre-travel advice given by general practitioners in order to provide them with better expert support from travel medicine specialists. One third of them perform pre-travel advice weekly, and some two thirds do so at least monthly. The most frequently discussed topics are malaria, immunisation, insect bite prevention and travellers' diarrhoea. Less than half of the advice sessions included talking about the risk of accidents. Apart from the need for yellow fever vaccination, referral to travel medicine experts was highest for immunocompromised and pregnant travellers, and for trips to "high risk" countries. A considerable number of practitioners do not comply with the Swiss recommendations, continuously updated in the Bulletin of the Federal Office of Public Health, possibly because only 21 % consult them at regular intervals.

  11. Competing infant feeding information in mothers' networks: advice that supports v. undermines clinical recommendations.

    PubMed

    Ashida, Sato; Lynn, Freda B; Williams, Natalie A; Schafer, Ellen J

    2016-05-01

    To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas. Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices. Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA. Eighty-one low-income mothers of infants between 0 and 12 months old. Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95% CI 1·2, 38·1) and not adding cereal in the infant's bottle (OR=15·9; 95% CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours. Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers' networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers' social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers' infant care career may be beneficial.

  12. 31 CFR 248.3 - Advice of nonreceipt or loss.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Advice of nonreceipt or loss. 248.3... § 248.3 Advice of nonreceipt or loss. The payee or owner of a depositary check which is not received, or..., giving information as to the circumstances of the loss, theft or destruction of the check and whether it...

  13. 31 CFR 245.4 - Advice of nonreceipt or loss.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Advice of nonreceipt or loss. 245.4... § 245.4 Advice of nonreceipt or loss. (a) In the event of the nonreceipt, loss or destruction of a check... of such check, describing the check, stating the purpose for which it was issued and giving, if...

  14. 31 CFR 245.4 - Advice of nonreceipt or loss.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Advice of nonreceipt or loss. 245.4... § 245.4 Advice of nonreceipt or loss. (a) In the event of the nonreceipt, loss or destruction of a check... of such check, describing the check, stating the purpose for which it was issued and giving, if...

  15. 31 CFR 248.3 - Advice of nonreceipt or loss.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Advice of nonreceipt or loss. 248.3... § 248.3 Advice of nonreceipt or loss. The payee or owner of a depositary check which is not received, or..., giving information as to the circumstances of the loss, theft or destruction of the check and whether it...

  16. 5 CFR 2641.105 - Advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Administrative Personnel OFFICE OF GOVERNMENT ETHICS GOVERNMENT ETHICS POST-EMPLOYMENT CONFLICT OF INTEREST RESTRICTIONS General Provisions § 2641.105 Advice. (a) Agency ethics officials.Current or former employees or... designated agency ethics official or another agency ethics official. The agency in which an individual...

  17. Nutrigenomics-based personalised nutritional advice: in search of a business model?

    PubMed

    Ronteltap, Amber; van Trijp, Hans; Berezowska, Aleksandra; Goossens, Jo

    2013-03-01

    Nutritional advice has mainly focused on population-level recommendations. Recent developments in nutrition, communication, and marketing sciences have enabled potential deviations from this dominant business model in the direction of personalisation of nutrition advice. Such personalisation efforts can take on many forms, but these have in common that they can only be effective if they are supported by a viable business model. The present paper takes an inventory of approaches to personalised nutrition currently available in the market place as its starting point to arrive at an identification of their underlying business models. This analysis is presented as a unifying framework against which the potential of nutrigenomics-based personalised advice can be assessed. It has uncovered nine archetypical approaches to personalised nutrition advice in terms of their dominant underlying business models. Differentiating features among such business models are the type of information that is used as a basis for personalisation, the definition of the target group, the communication channels that are being adopted, and the partnerships that are built as a part of the business model. Future research should explore the consumer responses to the diversity of "archetypical" business models for personalised nutrition advice as a source of market information on which the delivery of nutrigenomics-based personalised nutrition advice may further build.

  18. Rheumatology telephone advice line - experience of a Portuguese department.

    PubMed

    Ferreira, R; Marques, A; Mendes, A; da Silva, J A

    2015-01-01

    Telephone helplines for patients are tool for information and advice. They can contribute to patient's satisfaction with care and to the effectiveness and safety of treatments. In order to achieve this, they need to be adequately adapted to the target populations, as to incorporate their abilities and expectations. a) Evaluate the adherence of patients to a telephone helpline managed by nurses in a Portuguese Rheumatology Department, b) Analyse the profile of users and their major needs, c) Analyse the management of calls by the nurses. The target population of this phone service are the patients treated at Day Care Hospital and Early Arthritis Clinic of our department. Nurses answered phone calls immediately between 8am and 4pm of working days. In the remaining hours messages were recorded on voice mail and answered as soon as possible. Details of the calls were registered in a dedicated sheet and patients were requested permission to use data to improve the service, with respect for their rights of confidentiality, anonymity and freedom of decision. In 18 months 173 calls were made by 79 patients, with a mean age of 47.9 years (sd=9.13). Considering the proportions of men and women in the target population, it was found that men called more frequently (M= 32.7% vs F= 20.4%, p=.016). The reasons for these calls can be divided into three categories: instrumental help, such as the request for results of complementary tests or rescheduling appointments (43.9% of calls); counselling on side effects or worsening of the disease/pain (31.2 %); counselling on therapy management (24.9%). Neither sex nor patient age were significantly related to these reasons for calling. Nurses resolved autonomously half (50.3%) of the calls and in 79.8% of the cases there was no need for patient referral to other health services. About a quarter of patients adhered to the telephone helpline.. Patients called to obtain support in the management of disease and therapy or to report side

  19. A parent advice package for family shopping trips: development and evaluation1

    PubMed Central

    Clark, Hewitt B.; Greene, Brandon F.; Macrae, John W.; McNees, M. Patrick; Davis, Jerry L.; Risley, Todd R.

    1977-01-01

    This article reports on the primary steps in the development of parent advice for popular dissemination: (a) developing advice for one specific problem situation, family shopping trips; (b) testing the advice program for benefit to children and convenience to adults; and (c) packaging the advice so it can be used successfully by interested parents. Systematic observation of 12 families using the written advice package on shopping trips revealed its effectiveness in reducing child disruptions and increasing positive interactions between parents and children. These findings, along with interview information from families, showed that the package is usable, effective, and popular with both parents and children, and thus is ready for dissemination to a wide audience of parents—a step that in itself should involve research and evaluation. PMID:16795570

  20. Regulatory Scientific Advice on Non-Inferiority Drug Trials

    PubMed Central

    Knol, Mirjam J.; Klungel, Olaf H.; Gispen-De Wied, Christine C.; de Boer, Antonius; Hoes, Arno W.; Leufkens, Hubert G.; Mantel-Teeuwisse, Aukje K.

    2013-01-01

    The active-controlled trial with a non-inferiority design has gained popularity in recent years. However, non-inferiority trials present some methodological challenges, especially in determining the non-inferiority margin. Regulatory guidelines provide some general statements on how a non-inferiority trial should be conducted. Moreover, in a scientific advice procedure, regulators give companies the opportunity to discuss critical trial issues prior to the start of the trial. The aim of this study was to identify potential issues that may benefit from more explicit guidance by regulators. To achieve this, we collected and analyzed questions about non-inferiority trials posed by applicants for scientific advice in Europe in 2008 and 2009, as well as the responses given by the European Medicines Agency (EMA). In our analysis we included 156 final letters of advice from 2008 and 2009, addressed to 94 different applicants (manufacturers). Our analysis yielded two major findings: (1) applicants frequently asked questions ‘whether’ and ‘how’ to conduct a non-inferiority trial, 26% and 74%, respectively, and (2) the EMA regulators seem mainly concerned about the choice of the non-inferiority margin in non-inferiority trials (36% of total regulatory answers). In 40% of the answers, the EMA recommended using a stricter margin, and in 10% of the answers regarding non-inferiority margins, the EMA questioned the justification of the proposed non-inferiority margin. We conclude that there are still difficulties in selecting the appropriate methodology for non-inferiority trials. Straightforward and harmonized guidance regarding non-inferiority trials is required, for example on whether it is necessary to conduct such a trial and how the non-inferiority margin is determined. It is unlikely that regulatory guidelines can cover all therapeutic areas; therefore, in some cases regulatory scientific advice may be used as an opportunity for tailored advice. PMID:24040346

  1. Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines.

    PubMed

    Stark, Renee; Kirchberger, Inge; Hunger, Matthias; Heier, Margit; Leidl, Reiner; von Scheidt, Wolfgang; Meisinger, Christa; Holle, Rolf

    2014-03-01

    Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.

  2. Relationships between physician advice and tobacco and alcohol use during pregnancy.

    PubMed

    Jones-Webb, R; McKiver, M; Pirie, P; Miner, K

    1999-04-01

    We sought to examine relationships between physician advice and use of tobacco and alcohol during pregnancy among 683 women in the upper Midwest. Data on risk of substance use during pregnancy were analyzed using logistic regression analysis. A higher proportion of women used tobacco (34%) than alcohol (25%) during their most recent pregnancy. Women who received advice from a physician to abstain from alcohol reported a lower risk of smoking and drinking during pregnancy than women who did not receive such advice. Risk of smoking and drinking during pregnancy was also common among women who reported early onset of alcohol use. Results suggest that physician advice regarding alcohol use during pregnancy is protective against maternal smoking and drinking during pregnancy.

  3. Caught in the middle? How women deal with conflicting pregnancy-advice from health professionals and their social networks.

    PubMed

    Schölmerich, Vera L N; Ghorashi, Halleh; Denktaş, Semiha; Groenewegen, Peter

    2016-04-01

    to investigate how pregnant women deal with conflicting advice from their social networks and their caregivers and how this influenced their pregnancy-related behaviours. a qualitative study based on face-to-face interviews and focus-groups. We applied an inductive analysis technique closely following the 'Gioia method'. impoverished neighbourhoods in Rotterdam, the Netherlands. 40 women who were pregnant, or had given birth within the last 12 months. 12 women were Native Dutch, 16 had a Moroccan background, and 12 had a Turkish background. all women faced a misalignment of advice by health professionals and social networks. For the native Dutch respondents, this misalignment did not seem to present a challenge. They had a strongly articulated preference for the advice of health professionals, and did not fear any social consequences for openly following their advice. For the women with a Turkish/Moroccan background, however, this discrepancy in advice presented a dilemma. Following one piece of advice seemed to exclude also following the other one, which would possibly entail social consequences. These women employed one of the three strategies to deal with this dilemma: a) avoiding the dilemma (secretly not following the advice of one side), b) embracing the dilemma (combining conflicting advice), and c) resolving the dilemma (communicating between both sides). we argue that the currently popular interventions geared towards increasing the health literacy of non-Western ethnic minority pregnant women and improving communication between ethnic minority clients and caregivers are not sufficient, and might even exacerbate the dilemma some pregnant women face. As an alternative, we recommend involving not only caregivers but also women's social network in intervention efforts. Interventions could aim to increase the negotiation capacity of the target group, but also to increase the health literacy of the members of their social network to enable the circulation of

  4. Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds.

    PubMed

    Rawlins, Matthew D M; Sanfilippo, Frank M; Ingram, Paul R; McLellan, Duncan G J; Crawford, Colin; D'Orsogna, Luca; Dyer, John

    2018-02-01

    We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p < 0.0001, relative risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p < 0.0001). These findings may be explained by regular, direct engagement of the antimicrobial stewardship team with the rehabilitation service clinical team, a model potentially applicable to other settings.

  5. Low Income Women and Physician Breastfeeding Advice: A Regional Assessment

    ERIC Educational Resources Information Center

    Stolzer, J; Zeece, Pauline

    2006-01-01

    Objectives: The aims of the pilot study presented here were to determine whether low income women were receiving compendious breastfeeding advice from their attending physicians. Design: This study assessed low income women's reports of physician breastfeeding advice using a newly designed Likert scaled survey based on the American Surgeon…

  6. Family planning advice and postpartum contraceptive use among low-income women in Mexico.

    PubMed

    Barber, Sarah L

    2007-03-01

    In Mexico, family planning advice has been incorporated into the clinical guidelines for prenatal care. However, the relationship between women's receipt of family planning advice during prenatal care and subsequent contraceptive use has not been evaluated. Data were collected in 2003 and 2004 in 17 Mexican states from 2,238 urban low-income women postpartum. Participating women reported on prenatal services received and contraceptive use. Logistic and multinomial logistic regression models evaluated whether receiving family planning advice during prenatal care predicted current contraceptive use, after quality of care in the community, service utilization, delivery characteristics, household socioeconomic characteristics, and maternal and infant characteristics were controlled for. Overall, 47% of women used a modern contraceptive method. Women who received family planning advice during prenatal care were more likely to use a contraceptive than were those who did not receive such advice (odds ratio, 2.2). Women who received family planning advice had a higher probability of using condoms (relative risk ratio, 2.3) and IUDs (5.2), and of undergoing sterilization (1.4), than of using no method. Integrating family planning advice into prenatal care may be an important strategy for reaching women when their demand for contraception is high.

  7. A novel pen-based Bluetooth-enabled insulin delivery system with insulin dose tracking and advice.

    PubMed

    Bailey, Timothy S; Stone, Jenine Y

    2017-05-01

    Diabetes is growing in prevalence internationally. As more individuals require insulin as part of their treatment, technology evolves to optimize delivery, improve adherence, and reduce dosing errors. Insulin pens outperform vial and syringe in simplicity, dosing accuracy, and user preference. Bolus advisors improve dosing confidence and treatment adherence. The InPen System offers a novel approach to treatment via a wireless pen that syncs to a mobile application featuring a bolus advisor, enabling convenient insulin dose tracking and more accurate bolus advice among other features. Areas covered: Existing technology for insulin delivery and bolus advice are reviewed. The mechanics and functionality of the InPen device are delineated. Findings from formative testing and usability studies of the InPen system are reported. Future directions for the InPen system in the treatment of diabetes are discussed. Expert opinion: Diabetes management is complex and largely data-driven. The InPen System offers a promising new opportunity to avail insulin pen-users of features known to improve treatment efficacy, which have otherwise primarily been available to those using pumps. Given that the majority of insulin users do not use insulin pumps, the InPen System is poised to improve glucose control in a significant portion of the diabetes population.

  8. Auditing a court assessment and advice service for defendants with mental health difficulties: utilizing electronic patient records.

    PubMed

    Gough, Karen; Magness, Laura; Winstanley, Julia

    2012-07-01

    This study is an audit of the Somerset Court Advice and Assessment Service (CAAS) throughout its first year of implementation. It reports that the service successfully met the six desired objectives as set out in its Service Level Agreement. Further to this, it reports that the use of National Health Service electronic patient records within a court setting facilitated the provision of apposite and timely information to the court. Specific findings were that deliberate self-harm/suicidal ideation and mood disorders were the primary reasons for a person requiring CAAS involvement. Violence against the person, breach of orders and theft were the most prevalent categories of offending within this referred group. The prevalence of previous psychiatric history was significantly higher than found in comparable audits. It is likely that this is due to the efficacy of proactive and in vivo utilization of electronic patient records. Conclusions include the need to work in partnership with drug and alcohol agencies and the importance of recognizing that these services have significant clinical benefits for defendants with mental health problems, and the court system in terms of financial savings. We suggest ongoing audit is necessary to guide the development of other schemes in this pioneering service area.

  9. Smoking Cessation Advice: Knowledge, Attitude, and Practice among Clinical Dental Students’

    PubMed Central

    Prabhu, Allama; Jain, Jayesh Kumar; Sakeenabhi, B.; Kumar, P. G. Naveen; Imranulla, Mohamed; Ragher, Mallikarjuna

    2017-01-01

    Background: Smoking is the single most important public health challenge facing the National Health Service. The detrimental effects on the general health of tobacco smoking are well documented. Smoking is a primary risk factor for oral cancer and many oral diseases. Dental professional scan plays an important role in preventing adverse health effects by promoting smoking cessation. Objective: To assess the knowledge, attitude, and practice among clinical dental students in giving smoking cessation advice and to explore the barriers to this activity. Materials and Methods: A total of 262 clinical dental trainee of two dental colleges (College of Dental Sciences and Bapuji Dental College) of Davangere city were included in the survey. A self-administered questionnaire was administered to assess the knowledge, attitude, and practice toward Tobacco Cessation Advise. Results: Among the 262 participants in the study, around 51% said they know about Nicotine Replacement Therapy, and among them, only 4.6% were aware of the options available in the market. When asked about 5A's of tobacco cessation, only 35.5% were aware of it. Similarly, when asked about 5R's of tobacco cessation, 48.5% were unaware of it. Conclusions: The respondents did not have sufficient knowledge regarding tobacco cessation advice. With patient's disinterest and lack of time being quoted as the important barriers in providing tobacco cessation advice, it is highly recommended that there is need to incorporate few chapters on tobacco, its effect and cessation of habit in the undergraduate dental curriculum with simultaneous application of the same in clinical practice. PMID:29284949

  10. The personal shopper--a pilot randomized trial of grocery store-based dietary advice.

    PubMed

    Lewis, K H; Roblin, D W; Leo, M; Block, J P

    2015-06-01

    The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index--2005 [0-100 points]), and nutritional knowledge (0-65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. © 2015 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

  11. A double-blind, randomized trial, including frequent patient-physician contacts and Ramadan-focused advice, assessing vildagliptin and gliclazide in patients with type 2 diabetes fasting during Ramadan: the STEADFAST study.

    PubMed

    Hassanein, Mohamed; Abdallah, Khalifa; Schweizer, Anja

    2014-01-01

    Several observational studies were conducted with vildagliptin in patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan, showing significantly lower incidences of hypoglycemia with vildagliptin versus sulfonylureas, including gliclazide. It was of interest to complement the existing real-life evidence with data from a randomized, double-blind, clinical trial. NCT01758380. This multiregional, double-blind study randomized 557 patients with T2DM (mean glycated hemoglobin [HbA1c], 6.9%), previously treated with metformin and any sulfonylurea to receive either vildagliptin (50 mg twice daily) or gliclazide plus metformin. The study included four office visits (three pre-Ramadan) and multiple telephone contacts, as well as Ramadan-focused advice. Hypoglycemic events were assessed during Ramadan; HbA(1c) and weight were analyzed before and after Ramadan. The proportion of patients reporting confirmed (<3.9 mmol/L and/or severe) hypoglycemic events during Ramadan was 3.0% with vildagliptin and 7.0% with gliclazide (P=0.039; one-sided test), and this was 6.0% and 8.7%, respectively, for any hypoglycemic events (P=0.173). The adjusted mean change pre- to post-Ramadan in HbA(1c) was 0.05%±0.04% with vildagliptin and -0.03%±0.04% with gliclazide, from baselines of 6.84% and 6.79%, respectively (P=0.165). In both groups, the adjusted mean decrease in weight was -1.1±0.2 kg (P=0.987). Overall safety was similar between the treatments. In line with the results from previous observational studies, vildagliptin was shown in this interventional study to be an effective, safe, and well-tolerated treatment in patients with T2DM fasting during Ramadan, with a consistently low incidence of hypoglycemia across studies, accompanied by good glycemic and weight control. In contrast, gliclazide showed a lower incidence of hypoglycemia in the present interventional than the previous observational studies. This is suggested to be linked to the specific circumstances of this

  12. Sociality Mental Modes Modulate the Processing of Advice-Giving: An Event-Related Potentials Study

    PubMed Central

    Li, Jin; Zhan, Youlong; Fan, Wei; Liu, Lei; Li, Mei; Sun, Yu; Zhong, Yiping

    2018-01-01

    People have different motivations to get along with others in different sociality mental modes (i.e., communal mode and market mode), which might affect social decision-making. The present study examined how these two types of sociality mental modes affect the processing of advice-giving using the event-related potentials (ERPs). After primed with the communal mode and market mode, participants were instructed to decide whether or not give an advice (profitable or damnous) to a stranger without any feedback. The behavioral results showed that participants preferred to give the profitable advice to the stranger more slowly compared with the damnous advice, but this difference was only observed in the market mode condition. The ERP results indicated that participants demonstrated more negative N1 amplitude for the damnous advice compared with the profitable advice, and larger P300 was elicited in the market mode relative to both the communal mode and the control group. More importantly, participants in the market mode demonstrated larger P300 for the profitable advice than the damnous advice, whereas this difference was not observed at the communal mode and the control group. These findings are consistent with the dual-process system during decision-making and suggest that market mode may lead to deliberate calculation for costs and benefits when giving the profitable advice to others. PMID:29467689

  13. "What Advice Would You Give to Students Starting Your Course?"

    ERIC Educational Resources Information Center

    Meedin, Aneeqa

    2007-01-01

    In this essay, the author, a Biomedical Sciences student at the University of Sheffield, presents an atypical way of addressing the question "What advice would you give to students starting your course?" by transcribing the much-evoked and revered Ten Commandments, the original guide to life, into advice for new and bewildered Biomedical…

  14. Listen to Your Heart? Calling and Receptivity to Career Advice

    ERIC Educational Resources Information Center

    Dobrow, Shoshana R.; Tosti-Kharas, Jennifer

    2012-01-01

    This study explores calling in the context of career decision making. Specifically, the authors examine receptivity to advice that discourages individuals from pursuing a professional path in their calling's domain. The authors hypothesize that people with a strong calling will be more likely to ignore negative career advice. In Study 1, a…

  15. A quantitative analysis of the quality and content of the health advice in popular Australian magazines.

    PubMed

    Wilson, Amanda; Smith, David; Peel, Roseanne; Robertson, Jane; Kypri, Kypros

    2017-06-01

    To examine how health advice is provided in popular magazines and the quality of that advice. A prospective quantitative analysis of the quality of health advice provided in Australian magazines between July and December 2011 was conducted. A rating instrument was adapted from the Media Doctor Australia rating tool used to assess quality of health news reporting. Criteria included: recommends seeing a doctor; advice based on reliable evidence; advice clear and easily applied; benefits presented meaningfully; potential harms mentioned; evidence of disease mongering; availability and cost of treatments; obvious advertising; vested interest, and anecdotal evidence. 163 health advice articles were rated showing a wide variation in the quality of advice presented between magazines. Magazines with 'health' in the title, rated most poorly with only 36% (26/73) of these articles presenting clear and meaningful advice and 52% (38/73) giving advice based on reliable evidence. Australian magazines, especially those with health in the title, generally presented poor quality, unreliable health advice. Teen magazine Dolly provided the highest quality advice. Consumers need to be aware of this when making health choices. © 2016 Public Health Association of Australia.

  16. Advice on lifestyle changes (diet, red wine and physical activity) does not affect internal carotid and middle cerebral artery blood flow velocity in patients with carotid arteriosclerosis in a randomized controlled trial.

    PubMed

    Droste, Dirk W; Iliescu, Catalina; Vaillant, Michel; Gantenbein, Manon; De Bremaeker, Nancy; Lieunard, Charlotte; Velez, Telma; Meyer, Michèle; Guth, Tessy; Kuemmerle, Andrea; Chioti, Anna

    2014-01-01

    A Mediterranean diet, with and without small daily amounts of red wine, and physical activity reduce the risk of cerebrovascular disease and improve cognition. An increase in cerebral blood flow may be the underlying mechanism. Under normal conditions, cerebral blood flow velocity changes in the internal carotid arteries and in large basal cerebral arteries correlate closely with cerebral blood flow changes, as the diameter of these vessels hardly changes and only the smaller vessels downstream change their diameter. A prospective randomized controlled trial was performed in 108 patients with carotid atherosclerosis (mean age 64 years, 67% men, 66% on statin therapy). Half of them were advised to follow a polyphenol-rich modified Mediterranean diet including 1-2 tomatoes, 3-5 walnuts and a bar of dark chocolate (25 g) a day and to perform moderate physical exercise for 30 min/day (lifestyle changes). Within these two groups, half of the patients were randomized either to avoid any alcohol or to drink 100 ml of red wine (women) or 200 ml of red wine (men) daily. Bilateral middle cerebral and internal carotid blood flow velocity (peak systolic, peak end-diastolic and mean) was measured at baseline and after 4 and 20 weeks using colour-coded duplex ultrasound. Insonation depth and insonation angle were used to identically place the sample volume during follow-up investigations. A general linear model with Tukey-Kramer adjustment for multiple comparisons was used to assess the primary end points. For the analysis we used the mean values of the right and left artery. Neither lifestyle changes nor red wine had an effect on peak systolic, peak end-diastolic or mean cerebral blood flow velocity. Advice on lifestyle changes, including a modified polyphenol-rich Mediterranean diet, a glass of red wine daily and physical exercise, did not affect middle cerebral and internal carotid blood flow velocity in our patient group with carotid atherosclerosis. An increase in cerebral

  17. Citizens advice in primary care: a qualitative study of the views and experiences of service users and staff.

    PubMed

    Burrows, J; Baxter, S; Baird, W; Hirst, J; Goyder, E

    2011-10-01

    To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention's effectiveness. A qualitative study in an urban and rural primary care setting in the UK. Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users. Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner's (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time. Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  18. Health professionals' advice for breastfeeding problems: Not good enough!

    PubMed Central

    Amir, Lisa H; Ingram, Jennifer

    2008-01-01

    Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women. PMID:18786249

  19. Health professionals' advice for breastfeeding problems: not good enough!

    PubMed

    Amir, Lisa H; Ingram, Jennifer

    2008-09-11

    Jane Scott and colleagues have recently published a paper in the International Breastfeeding Journal showing that health professionals are still giving harmful advice to women with mastitis. We see the management of mastitis as an illustration of health professionals' management of wider breastfeeding issues. If health professionals don't know how to manage this common problem, how can they be expected to manage less common conditions such as a breast abscess or nipple/breast candidiasis? There is an urgent need for more clinical research into breastfeeding problems and to improve the education of health professionals to enable them to promote breastfeeding and support breastfeeding women.

  20. Giving and Receiving Advice in Computer-Mediated Peer Response Activities

    ERIC Educational Resources Information Center

    Tsai, Mei-Hsing; Kinginger, Celeste

    2015-01-01

    In synchronous computer-mediated contexts, peer-to-peer interaction at the microlevel has received little scrutiny. In applying a conversation analysis approach, this study scrutinizes the precise nature of peer-to-peer advice giving and receiving. In this process, an advice giver can be viewed at certain moments as more competent to evaluate a…

  1. For the sake of whom: conversation analysis of advice giving in offender counseling.

    PubMed

    Jing-ying, Guo

    2013-08-01

    Regarded as beneficial and preferable to the clients, advice delivery has been an integral part of counseling; however, there are controversies over the suitability of giving advice in counseling services, including counseling conducted in the context of prisons. Based on conversation analysis, this article tries to explore when and how police counselors in two Chinese prisons give advice and how inmate clients respond to and seek advice in offender counseling. It is found that advice delivery, supposed to be for the inmate clients' sake, only serves a phatic function in the context of prisons in which security is a priority, and transforming inmates into law-abiding citizen is the overall goal of prison rehabilitation and correction. Hence, offender counselors, intending to alleviate depression and anxiety in inmate clients, are caught in a dilemma.

  2. Smoking cessation advice: the self-reported attitudes and practice of primary health care physicians in a military community, central Saudi Arabia.

    PubMed

    AlAteeq, Mohammed; Alrashoud, Abdulaziz M; Khair, Mohammed; Salam, Mahmoud

    2016-01-01

    .012) and physicians with a negative attitude (adj. P=0.008). Provision of smoking cessation advice by primary health care physicians serving a military community is significantly associated with their attitude and years of experience. Patients who are seeking smoking cessation advice should be referred to physicians with higher levels of education. Routinely scheduled training on proper delivery of smoking cessation advice may increase physicians' confidence; improve their attitude, and subsequently, their practice.

  3. What are colorectal cancer survivors' preferences for dietary advice? A best-worst discrete choice experiment.

    PubMed

    Wright, Stuart J; Gibson, Debbie; Eden, Martin; Lal, Simon; Todd, Chris; Ness, Andy; Burden, Sorrel

    2017-12-01

    Studies on healthy lifestyle interventions in survivors of colorectal cancer have been disappointing, demonstrating only modest changes. This study aims to quantify people's preferences for different aspects of dietary intervention. A best-worst discrete choice experiment was designed and incorporated into a questionnaire including participants' characteristics and a self-assessment of lifestyle. The response rate was 68% and 179 questionnaires were analysed. When analysing aggregate preferences, the modes of information provision selected as the most preferred were "face-to-face" (willingness to pay (WTP) £63.97, p ≤ 0.001) and "telephone" (WTP £62.36, p < 0.001) discussions whereas group discussions were preferred least (WTP -£118.96, p ≤ 0.001). Scenarios that included hospitals were most preferred (WTP £17.94, p = 0.031), and the favoured provider was bowel cancer nurses (WTP £75.11, p ≤ 0.001). When investigating preference heterogeneity, three sub-groups were identified: Firstly, "technophiles" preferring email (WTP £239.60, p ≤ 0.001) were male, were younger and had fewer risk factors. Secondly, a "one-to-one" group had strong preference for interventions over the telephone or at their local doctors and were older (WTP £642.13, p ≤ 0.001). Finally, a "person-centred" group preferred face-to-face individual or group sessions (WTP £358.79, p < 0.001) and had a high risk lifestyle. For survivors of colorectal cancer, there is not one approach that suits all when it comes to providing dietary advice. This is important information to consider when planning healthy lifestyle interventions which include dietary advice for survivors of colorectal cancer. Aligning services to individuals' preferences has the potential to improve patient experience and outcomes by increasing uptake of healthy lifestyle advice services and promoting a more tailored approach to dietary modifications, acknowledging sub-groups of people within the total

  4. 29 CFR 2550.408g-1 - Investment advice-participants and beneficiaries.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...)(A) Any investment advice is based on generally accepted investment theories that take into account... theories that take into account additional considerations; (B) Any investment advice takes into account... to— (A) Apply generally accepted investment theories that take into account the historic risks and...

  5. 29 CFR 2550.408g-1 - Investment advice-participants and beneficiaries.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...)(A) Any investment advice is based on generally accepted investment theories that take into account... theories that take into account additional considerations; (B) Any investment advice takes into account... to— (A) Apply generally accepted investment theories that take into account the historic risks and...

  6. 29 CFR 2550.408g-1 - Investment advice-participants and beneficiaries.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...)(A) Any investment advice is based on generally accepted investment theories that take into account... theories that take into account additional considerations; (B) Any investment advice takes into account... to— (A) Apply generally accepted investment theories that take into account the historic risks and...

  7. A qualitative investigation of alcohol use advice during pregnancy: experiences of Dutch midwives, pregnant women and their partners.

    PubMed

    van der Wulp, Nickie Y; Hoving, Ciska; de Vries, Hein

    2013-11-01

    two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy. study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model. study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands. 10 midwives in Study 1; 25 pregnant women and nine partners in Study 2. study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals. midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy. training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media

  8. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital.

    PubMed

    Pages, K P; Russo, J E; Wingerson, D K; Ries, R K; Roy-Byrne, P P; Cowley, D S

    1998-09-01

    The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.

  9. Parents’ professional sources of advice regarding child discipline and their use of corporal punishment

    PubMed Central

    Taylor, Catherine A.; Moeller, William; Hamvas, Lauren; Rice, Janet C.

    2014-01-01

    Parents (n=500) were surveyed about which professional groups they were most likely to seek and follow advice from regarding child discipline as well as their use of corporal punishment (CP). Nearly half of parents reported that they were most likely to seek child discipline advice from pediatricians (48%), followed by religious leaders (21%) and mental health professionals (18%). Parents that sought advice from religious leaders (vs. pediatricians) had nearly 4 times the odds of reporting use of CP. Parents reported they were more likely to follow the advice of pediatricians than any other professional; however, Black parents were as likely to follow the advice of religious leaders as that of pediatricians. Pediatricians play a central role in advising parents about child discipline. Efforts to engage pediatricians in providing violence prevention counseling should continue. Increased efforts are needed to engage other professionals, especially religious leaders, in providing such advice to parents. PMID:23185082

  10. Parents' professional sources of advice regarding child discipline and their use of corporal punishment.

    PubMed

    Taylor, Catherine A; Moeller, William; Hamvas, Lauren; Rice, Janet C

    2013-02-01

    Parents (n = 500) were surveyed about which professional groups they were most likely to seek and follow advice from regarding child discipline as well as their use of corporal punishment (CP). Nearly half of the parents reported that they were most likely to seek child discipline advice from pediatricians (48%), followed by religious leaders (21%) and mental health professionals (18%). Parents who sought advice from religious leaders (vs pediatricians) had nearly 4 times the odds of reporting use of CP. Parents reported that they were more likely to follow the advice of pediatricians than any other professional; however, black parents were as likely to follow the advice of religious leaders as that of pediatricians. Pediatricians play a central role in advising parents about child discipline. Efforts to engage pediatricians in providing violence prevention counseling should continue. Increased efforts are needed to engage other professionals, especially religious leaders, in providing such advice to parents.

  11. The personal shopper – a pilot randomized trial of grocery store-based dietary advice

    PubMed Central

    Lewis, K H; Roblin, D W; Leo, M; Block, J P

    2015-01-01

    The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index – 2005 [0–100 points] ), and nutritional knowledge (0–65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. PMID:25873139

  12. Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

    PubMed

    Gagneux-Brunon, Amandine; Andrillat, Carole; Fouilloux, Pascale; Daoud, Fatiha; Defontaine, Christiane; Charles, Rodolphe; Lucht, Frédéric; Botelho-Nevers, Elisabeth

    2016-03-01

    Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic. A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France. During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96). Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  13. Advice on drug safety in pregnancy: are there differences between commonly used sources of information?

    PubMed

    Frost Widnes, Sofia K; Schjøtt, Jan

    2008-01-01

    Safety regarding use in pregnancy is not established for many drugs. Inconsistencies between sources providing drug information can give rise to confusion with possible therapeutic consequences. Therefore, it is important to measure clinically important differences between drug information sources. The objective of this study was to compare two easily accessible Norwegian sources providing advice on drug safety in pregnancy - the product monographs in the Felleskatalog (FK), published by the pharmaceutical companies, and the five regional Drug Information Centres (DICs) in Norway - in addition to assessing the frequency of questions regarding drug safety in pregnancy made to the DICs according to the Anatomical Therapeutic Chemical (ATC) classification system. Advice on drug use in pregnancy provided by the DICs in 2003 and 2005 were compared with advice in the product monographs for the respective drugs in the FK. Comparison of advice was based on categorization to one of four categories: can be used, benefit-risk assessment, should not be used, or no available information. A total of 443 drug advice were categorized. Seven out of ten of drugs frequently enquired about, according to the ATC system, were drugs acting on the nervous system (group N). For 208 (47%) of the drugs, advice differed between the DICs and FK. Advice from the FK was significantly (p < 0.01) more restrictive than advice from the DICs. There were no differences in the level of consistency of advice between drugs that were newly introduced and those that had been on the market for a longer time, advice regarding use of drugs in the first trimester and advice regarding use of drugs in the second or third trimester, or between advice provided during 2003 and during 2005. The results of this study show considerable differences between two Norwegian sources providing advice on the use of drugs in pregnancy. Based on the knowledge that healthcare providers choose sources of information in a random

  14. Variability in the quality of overdose advice in Summary of Product Characteristics (SPC) documents: gut decontamination recommendations for CNS drugs.

    PubMed

    Wall, Andrew J B; Bateman, D N; Waring, W S

    2009-01-01

    Deliberate self-poisoning is a major cause of morbidity and mortality. The Summary of Product Characteristics (SPC) document is a legal requirement for all drugs, and Section 4.9 addresses the features of toxicity and clinical advice on management of overdose. The quality and appropriateness of this advice have received comparatively little attention. Section 4.9 of the SPC was examined for all drugs in the central nervous system (CNS) category of the British National Formulary. Advice concerning gut decontamination was examined with respect to specific interventions: induced vomiting, oral activated charcoal, gastric lavage, and other interventions. Data were compared with standard reference sources for clinical management advice in poisoning. These were graded 'A' if no important differences existed, 'B' if differences were noted but not thought clinically important, and 'C' if differences were thought to be clinically significant. SPC documents were examined for 258 medications from 67 manufacturers. The overall agreement was 'A' in 23 (8.9%), 'B' in 28 (10.9%) and 'C' in 207 (80.2%). Discrepancies were due to inappropriate recommendation of induced emesis in 21.7% (95% confidence interval 17.1, 27.1), gastric lavage in 38.4% (32.7, 44.4), other gut decontamination in 5.8% (3.6, 9.4) and failure to recommend oral activated charcoal in 57.4% (51.1, 63.4). Gut decontamination advice in SPC documents with respect to CNS drugs was inadequate. Possible reasons for the observed discrepancies and ways of improving the consistency of advice are proposed.

  15. Provision of travel medicine advice through community pharmacies: assessment of knowledge, attitudes and practices of pharmacists in Malaysia.

    PubMed

    Taha, Nur Akmar; See, Yee Lian

    2016-10-01

    The risk for travel-related illnesses has increased with significant growth in international travel, but very few travellers seek travel advice. Community pharmacists can play a vital role in the provision of travel medicine advice due to their accessibility. This study aimed to assess travel medicine knowledge, attitudes and practices (KAP) among community pharmacists in Kuala Lumpur, Malaysia. A self-administered KAP questionnaire was distributed to a convenience sample of pharmacists in Kuala Lumpur identified from the list of licensed community pharmacists in Malaysia year 2014. Questionnaires were returned by 111 pharmacists of 143 distributed (response rate, 78%). Most of the respondents (82%) were not trained in travel medicine. Overall, mean knowledge score was 4.4 ( ± 1.7), indicating a moderate level of knowledge on a variety of travel-related health issues. Community pharmacists who graduated from foreign universities possessed significantly higher knowledge scores than did those who graduated locally (P < 0.05). The majority had a positive attitude towards travel medicine. A vast majority provided travel medicine advice mainly to adults who travel as tourists, and the primary travel advice given was on traveller's diarrhoea. There are gaps in the knowledge and practice of travel medicine among Malaysian pharmacists. Positive attitudes of pharmacists towards travel medicine and appropriate interventions, such as incorporation of travel medicine in local pharmacy curricula, continuous pharmacy education or certified training may improve the quality of travel advice given and allow pharmacists to be recognised as a credible source of information on travel medicine. © 2016 Royal Pharmaceutical Society.

  16. Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669)

    PubMed Central

    2014-01-01

    Background Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. Methods/Design This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. Discussion This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Trial registration Current Controlled Trials ISRCTN52269669. PMID:25012813

  17. Rationale, design and methods of the Study of Work and Pain (SWAP): a cluster randomised controlled trial testing the addition of a vocational advice service to best current primary care for patients with musculoskeletal pain (ISRCTN 52269669).

    PubMed

    Bishop, Annette; Wynne-Jones, Gwenllian; Lawton, Sarah A; van der Windt, Danielle; Main, Chris; Sowden, Gail; Burton, A Kim; Lewis, Martyn; Jowett, Sue; Sanders, Tom; Hay, Elaine M; Foster, Nadine E

    2014-07-10

    Musculoskeletal pain is a major contributor to short and long term work absence. Patients seek care from their general practitioner (GP) and yet GPs often feel ill-equipped to deal with work issues. Providing a vocational case management service in primary care, to support patients with musculoskeletal problems to remain at or return to work, is one potential solution but requires robust evaluation to test clinical and cost-effectiveness. This protocol describes a cluster randomised controlled trial, with linked qualitative interviews, to investigate the effect of introducing a vocational advice service into general practice, to provide a structured approach to managing work related issues in primary care patients with musculoskeletal pain who are absent from work or struggling to remain in work. General practices (n = 6) will be randomised to offer best current care or best current care plus a vocational advice service. Adults of working age who are absent from or struggling to remain in work due to a musculoskeletal pain problem will be invited to participate and 330 participants will be recruited. Data collection will be through patient completed questionnaires at baseline, 4 and 12 months. The primary outcome is self-reported work absence at 4 months. Incremental cost-utility analysis will be undertaken to calculate the cost per additional QALY gained and incremental net benefits. A linked interview study will explore the experiences of the vocational advice service from the perspectives of GPs, nurse practitioners (NPs), patients and vocational advisors. This paper presents the rationale, design, and methods of the Study of Work And Pain (SWAP) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for musculoskeletal pain patients with work-related issues. Current Controlled Trials ISRCTN52269669.

  18. Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

    PubMed Central

    Csémy, Ladislav; Sherritt, Lon; Starostova, Olga; Van Hook, Shari; Johnson, Julie; Boulter, Suzanne; Brooks, Traci; Carey, Peggy; Kossack, Robert; Kulig, John W.; Van Vranken, Nancy; Knight, John R.

    2012-01-01

    OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS: We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and “talking points” designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS: Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38–0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57–0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17–0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32–0.71). CONCLUSIONS: Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients. PMID:22566420

  19. 43 CFR 2203.5 - Action on advice of the Attorney General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.5 Action on advice of the Attorney General... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Action on advice of the Attorney General. 2203.5 Section 2203.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  20. 43 CFR 2203.5 - Action on advice of the Attorney General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.5 Action on advice of the Attorney General... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Action on advice of the Attorney General. 2203.5 Section 2203.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  1. 43 CFR 2203.5 - Action on advice of the Attorney General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... PROCEDURES Exchanges Involving Fee Federal Coal Deposits § 2203.5 Action on advice of the Attorney General... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Action on advice of the Attorney General. 2203.5 Section 2203.5 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF...

  2. 45 CFR 73.735-805 - Advice and guidance on conflicts matters.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Advice and guidance on conflicts matters. 73.735... STANDARDS OF CONDUCT Financial Interest § 73.735-805 Advice and guidance on conflicts matters. (a) Whenever... should include a description of: (1) The activity, relationship, or interest giving rise to the question...

  3. 45 CFR 73.735-805 - Advice and guidance on conflicts matters.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Advice and guidance on conflicts matters. 73.735... STANDARDS OF CONDUCT Financial Interest § 73.735-805 Advice and guidance on conflicts matters. (a) Whenever... should include a description of: (1) The activity, relationship, or interest giving rise to the question...

  4. Advice from working women with retired partners.

    PubMed

    Cooley, Eileen L; Adorno, Gail

    2016-01-01

    in the 21st century, as more women are employed full-time and couples increasingly share egalitarian values, more women continue employment after their partners have voluntarily retired. However, we know very little about the experiences of this growing population of women. We asked working women with retired partners to share their advice for other women who may face this developmental transition. Open-ended responses from 97 women were analyzed to identify pertinent issues and themes. Four primary content areas were identified: time management, division of household labor, financial planning, and communication. Communication between partners was both a topic of concern as well as the solution suggested to resolve conflicts or differences that may arise when women live with a retired partner. It is expected that future changes in the workforce and improvements in the gender balance within relationships will continue to impact experiences for working women with retired partners.

  5. How nurses can use social enterprise to improve services in health care.

    PubMed

    Dawes, David

    This article describes the concept of social enterprise in nursing, and outlines how this model can help to improve care delivered to patients. It provides advice for nurses interested in pursuing this entrepreneurial route and also offers case studies demonstrating how the social enterprise model has been implemented in practice.

  6. Managing Your Aging Patient Population

    PubMed Central

    McNary, Ann L.

    2017-01-01

    This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so “clinician” is used to indicate all treatment team members. PMID:28584697

  7. Advice as a smoking cessation strategy: a systematic review and implications for physical therapists.

    PubMed

    Bodner, Michael E; Dean, Elizabeth

    2009-07-01

    Although identified as a clinical priority, smoking cessation has been addressed minimally in the literature in the context of physical therapy practice. Smoking cessation advice delivered by a health professional can help smokers quit. The salient components of such advice however warranted elucidation to enable physical therapists to integrate this clinical competence into their practices. Therefore, we conducted a systematic review to elucidate the effectiveness of advice by a health professional and its components to optimize smoking cessation instituted in the context of physical therapy practice. Thirty source articles were identified. A random-effects model meta-analysis was used to assess the effectiveness of the advice parameters. Risk ratios (RRs) were used to estimate pooled treatment effects. RRs for brief, intermediate, and intensive advice were 1.74 (95% CI=1.37, 2.22), 1.71 (95% CI=1.39, 2.09), and 1.60 (95% CI=1.13, 2.27), respectively. Self-help materials, follow-up, and interventions based on psychological or motivational frameworks were particularly effective components of intermediate and intensive advice interventions. Advice can be readily integrated into physical therapy practice and used to initiate or support ongoing smoking cessation in clients irrespective of reason for referral. Incorporating smoking cessation as a physical therapy goal is consistent with the contemporary definition of the profession and the mandates of physical therapy professional associations to promote health and wellness, including smoking cessation for both primary health benefit and to minimize secondary effects (e.g., delayed healing and recovery, and medical and surgical complications). Thus, advice is an evidence-based strategy to effect smoking cessation that can be exploited in physical therapy practice. Further research to refine how best to assess smokers and, in turn, individualize brief smoking cessation advice could augment positive smoking cessation

  8. The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews.

    PubMed

    Lake, Rebecca; Georgiou, Andrew; Li, Julie; Li, Ling; Byrne, Mary; Robinson, Maureen; Westbrook, Johanna I

    2017-08-30

    Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care

  9. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.

    PubMed

    Hofstede, Stefanie N; Marang-van de Mheen, Perla J; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M; Nelissen, Rob G H H; van Bodegom-Vos, Leti

    2016-01-01

    International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA) recommend to start with (a combination of) non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands. We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments. Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA), and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice). For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice), "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy). Also the belief in the efficacy of these treatments was associated with increased prescription. Strategies to improve non-surgical treatment use in orthopaedic practice

  10. Advice given by community members to pregnant women: a mixed methods study.

    PubMed

    Verma, Bianca A; Nichols, Lauren P; Plegue, Melissa A; Moniz, Michelle H; Rai, Manisha; Chang, Tammy

    2016-11-09

    Smoking and excess weight gain during pregnancy have been shown to have serious health consequences for both mothers and their infants. Advice from friends and family on these topics influences pregnant women's behaviors. The purpose of our study was to compare the advice that community members give pregnant women about smoking versus the advice they give about pregnancy weight gain. A survey was sent via text messaging to adults in a diverse, low-income primary care clinic in 2015. Respondents were asked what advice (if any) they have given pregnant women about smoking or gestational weight gain and their comfort-level discussing the topics. Descriptive statistics were used to characterize the sample population and to determine response rates. Open-ended responses were analyzed qualitatively using grounded theory analysis with an overall convergent parallel mixed methods design. Respondents (n = 370) were 77 % female, 40 % black, and 25 % reported education of high school or less. More respondents had spoken to pregnant women about smoking (40 %, n = 147) than weight gain (20 %, n = 73). Among individuals who had not discussed either topic (n = 181), more reported discomfort in talking about weight gain (65 %) compared to smoking (34 %; p < 0.0001). Advice about smoking during pregnancy (n = 148) was frequently negative, recommending abstinence and identifying smoking as harmful for baby and/or mother. Advice about weight gain in pregnancy (n = 74) revealed a breadth of messages, from reassurance about all weight gain ("Eat away" or "It's ok if you are gaining weight"), to specific warnings against excess weight gain ("Too much was dangerous for her and the baby."). Many community members give advice to pregnant women. Their advice reveals varied perspectives on the effects of pregnancy weight gain. Compared to a nearly ubiquitous understanding of the harms of smoking during pregnancy, community members demonstrated less

  11. Does Expert Advice Improve Educational Choice?

    PubMed Central

    2015-01-01

    This paper reports evidence that an individual meeting with a study counselor at high school significantly improves the quality of choice of tertiary educational field, as self-assessed 18 months after graduation from college. To address endogeneity, we explore the variation in study counseling practices between schools as an instrumental variable (IV). Following careful scrutiny of the validity of the IV, our results indicate a significant and positive influence of study counseling on the quality of educational choice, foremost among males and those with low educated parents. The overall result is stable across a number of robustness checks. PMID:26692388

  12. Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation.

    PubMed

    Yardley, Lucy; Nyman, Samuel R

    2007-06-01

    Falls are very common in older persons and can result in substantial disability and distress. By undertaking strength and balance training (SBT) exercises, older people can reduce their risk of falling. The Internet offers a potentially cost-effective means of disseminating information about SBT to older people and their carers. A particular advantage of using the Internet for this purpose is that the advice given can be 'tailored' to the needs of the individual. This study used a randomized controlled design to evaluate an interactive web-based program that tailored advice about undertaking SBT activities. The participants were 280 people with an age range of 65-97 years recruited by advertising the website by email and the Internet. Those randomized to the tailored advice were presented with advice tailored to their personal self-rated balance capabilities, health problems and activity preferences. Those in the control group were presented with all the advice from which the tailored advice was selected. After reading the advice, those in the tailored advice group (n = 144) had more positive attitudes (p < 0.01) than those in the control group (n = 136), reporting greater perceived relevance of the SBT activities, greater confidence in the ability to carry them out, and hence stronger intentions to undertake the activities. This study provides an initial indication that an interactive website might offer a cost-effective way to provide personalized advice to some older people. Further research is required to determine whether website-based advice on falls prevention changes behavior as well as intentions and whether the advice needs to be supplemented by other forms of support.

  13. Kosmo's Farewell Advice

    NASA Technical Reports Server (NTRS)

    Kosmo, Joe; Ross, Amy

    2012-01-01

    Joe Kosmo shared some final words and advice for his teammates in the Spacesuit and Crew Survival Systems Branch (EC5) and the Crew and Thermal Systems Division (CTSD (EC)) upon his retirement. He knew nothing about spacesuits when he started working for NASA in 1961, but neither did anyone else. He summed up the best lessons learned during his 50 years of developing U.S. spacesuits and encouraged the next generation s space industry workers to challenge what they hear and decide what is right. Topics include and oral history of early NASA manned flights by Richard S. Johnston, U.S. human spaceflight chronology, a history of advanced EVA project funding, and a discussion of NASA's innovative spirit.

  14. Empowering Girls through Sport? Sports Advice Books for Young Female Readers

    ERIC Educational Resources Information Center

    Heinecken, Dawn

    2016-01-01

    Advice books by female athletes are among the top selling sports books for young readers in the US. Though they have received little attention to date, sports advice books are important to examine because of how they function as a form of conduct manual instructing girls in specific understandings of female identity. Implying that girls face…

  15. Electronic cigarettes: a survey of perceived patient use and attitudes among members of the British thoracic oncology group.

    PubMed

    Sherratt, Frances C; Newson, Lisa; Field, John K

    2016-05-17

    Smoking cessation following lung cancer diagnosis has been found to improve several patient outcomes. Electronic cigarette (e-cigarette) use is now prevalent within Great Britain, however, use and practice among patients with lung cancer has not as yet been explored. The current study aims to explore e-cigarette use among patients and examine current practice among clinicians. The results have important implications for future policy and practice. Members of The British Thoracic Oncology Group (BTOG) were contacted via several e-circulations (N = 2,009), requesting them to complete an online survey. Of these, 7.7 % (N = 154) completed the survey, which explored participant demographics and smoking history, perceptions of patient e-cigarette use, practitioner knowledge regarding sources of guidance pertaining to e-cigarettes, and practitioner advice. Practitioners frequently observed e-cigarette use among patients with lung cancer. The majority of practitioners (81.4 %) reported responding to patient queries pertaining to e-cigarettes within the past year; however, far fewer (21.0 %) felt confident providing patients with e-cigarette advice. Practitioner confidence was found to differentiate by gender (p = 0.012) and employment speciality (p = 0.030), with nurses reporting particularly low levels of confidence in advising. The results also demonstrate extensive variability regarding the practitioner advice content. The results demonstrate that patients refer to practitioners as a source of e-cigarette guidance, yet few practitioners feel confident advising. The absence of evidence-based guidance may have contributed towards the exhibited inconsistencies in practitioner advice. The findings highlight that training should be delivered to equip practitioners with the knowledge and confidence to advise patients effectively; this could subsequently improve smoking cessation rates and patient outcomes.

  16. Smoking cessation advice: the self-reported attitudes and practice of primary health care physicians in a military community, central Saudi Arabia

    PubMed Central

    AlAteeq, Mohammed; Alrashoud, Abdulaziz M; Khair, Mohammed; Salam, Mahmoud

    2016-01-01

    to the less experienced (adj. P=0.012) and physicians with a negative attitude (adj. P=0.008). Conclusion Provision of smoking cessation advice by primary health care physicians serving a military community is significantly associated with their attitude and years of experience. Patients who are seeking smoking cessation advice should be referred to physicians with higher levels of education. Routinely scheduled training on proper delivery of smoking cessation advice may increase physicians’ confidence; improve their attitude, and subsequently, their practice. PMID:27175065

  17. Association of gestational weight gain expectations with advice on actual weight gain

    USDA-ARS?s Scientific Manuscript database

    To examine pregnant women's gestational weight gain expectations/advice from various sources (i.e., self, family/friends, physician) and the impact of these sources of expectations/advice on actual measured gestational weight gain. Pregnant women (n=230, 87.4% Caucasian, second pregnancy) in a cohor...

  18. Reinforcement learning agents providing advice in complex video games

    NASA Astrophysics Data System (ADS)

    Taylor, Matthew E.; Carboni, Nicholas; Fachantidis, Anestis; Vlahavas, Ioannis; Torrey, Lisa

    2014-01-01

    This article introduces a teacher-student framework for reinforcement learning, synthesising and extending material that appeared in conference proceedings [Torrey, L., & Taylor, M. E. (2013)]. Teaching on a budget: Agents advising agents in reinforcement learning. {Proceedings of the international conference on autonomous agents and multiagent systems}] and in a non-archival workshop paper [Carboni, N., &Taylor, M. E. (2013, May)]. Preliminary results for 1 vs. 1 tactics in StarCraft. {Proceedings of the adaptive and learning agents workshop (at AAMAS-13)}]. In this framework, a teacher agent instructs a student agent by suggesting actions the student should take as it learns. However, the teacher may only give such advice a limited number of times. We present several novel algorithms that teachers can use to budget their advice effectively, and we evaluate them in two complex video games: StarCraft and Pac-Man. Our results show that the same amount of advice, given at different moments, can have different effects on student learning, and that teachers can significantly affect student learning even when students use different learning methods and state representations.

  19. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial.

    PubMed

    Dodd, Jodie M; Turnbull, Deborah; McPhee, Andrew J; Deussen, Andrea R; Grivell, Rosalie M; Yelland, Lisa N; Crowther, Caroline A; Wittert, Gary; Owens, Julie A; Robinson, Jeffrey S

    2014-02-10

    To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women. Multicentre randomised trial. We utilised a central telephone randomisation server, with computer generated schedule, balanced variable blocks, and stratification for parity, body mass index (BMI) category, and hospital. Three public maternity hospitals across South Australia. 2212 women with a singleton pregnancy, between 10+0 and 20+0 weeks' gestation, and BMI ≥ 25. 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information. Incidence of infants born large for gestational age (birth weight ≥ 90th centile for gestation and sex). Prespecified secondary outcomes included birth weight >4000 g, hypertension, pre-eclampsia, and gestational diabetes. Analyses used intention to treat principles. 2152 women and 2142 liveborn infants were included in the analyses. The risk of the infant being large for gestational age was not significantly different in the two groups (lifestyle advice 203/1075 (19%) v standard care 224/1067 (21%); adjusted relative risk 0.90, 95% confidence interval 0.77 to 1.07; P=0.24). Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g (lifestyle advice 164/1075 (15%) v standard care 201/1067 (19%); 0.82, 0.68 to 0.99; number needed to treat (NNT) 28, 15 to 263; P=0.04). There were no differences in maternal pregnancy and birth outcomes between the two treatment groups. For women who were overweight or obese, the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes. Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

  20. Learners Need Face-to-Face Advice

    ERIC Educational Resources Information Center

    Sedgmore, Lynne

    2012-01-01

    In January the 157 Group launched a policy paper making the case for professional careers guidance. With the launch of the National Careers Service in April, information, advice and guidance is a hot topic within the education and skills sector and one that is regularly debated. The combination of policy changes, including the introduction of…

  1. [Pharmaceutical advice concerning different pharmaceutical dosage forms].

    PubMed

    Szakonyi, Gergely; Zelkó, Romána

    2010-01-01

    The present paper summarizes the commonly applied types of drug uptake and the pharmacists' advice concerning a certain dosage form. The manuscript also deals with the modified release dosage forms and their abbreviations in the name of the marketing authorized products.

  2. Parenting an overweight or obese teen: issues and advice from parents.

    PubMed

    Boutelle, Kerri N; Feldman, Shira; Neumark-Sztainer, Dianne

    2012-01-01

    This qualitative study addresses: (1) what challenges parents of overweight adolescents face and (2) what advice parents of overweight adolescents have for other parents. One-on-one interviews were conducted with parents of overweight or previously overweight adolescents. Medical clinic at the University of Minnesota. Twenty-seven parents of adolescents (12-19 years) who were either currently or previously overweight recruited from the community. Qualitative interviews related to parenting overweight adolescents. Content analysis was used to identify themes regarding parental experiences. Issues most frequently mentioned were (1) uncertainty regarding effective communication with adolescent about weight-related topics; (2) inability to control adolescents' decisions related to healthful eating and activity behaviors; (3) concern for adolescents' well-being; and (4) parental feeling of responsibility/guilt. Parental advice most often provided included: (1) setting up a healthful home environment; (2) parental role modeling of healthful behaviors; and (3) providing support/encouragement for positive efforts. Topics for potential intervention development include communication and motivation of adolescents regarding weight-related topics, appropriate autonomy, and addressing negative emotions concerning the adolescent's weight status. Targeting these topics could potentially improve acceptability and outcomes for treatments. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  3. Parenting an overweight or obese teen; issues and advice from parents

    PubMed Central

    Boutelle, Kerri N.; Feldman, Shira; Neumark-Sztainer, Dianne

    2013-01-01

    Objective This qualitative study addresses: 1) What challenges do parents of overweight adolescents face? 2) What advice do parents of overweight adolescents have for other parents? Design One-on-one interviews were conducted with 27 parents of overweight or previously overweight adolescents Setting Medical clinic at the University of Minnesota Participants 27 parents of adolescents (12-19 years) who were either currently or previously overweight recruited from the community Main Outcome Measures. Qualitative interviews related to parenting overweight adolescents Analysis Content analysis was used to identify themes regarding parental experiences. Results Issues most frequently mentioned: 1) uncertainty regarding effective communication with adolescent about weight-related topics, 2) inability to control adolescent’s decisions around healthy eating and activity behaviors, 3) concern for adolescent’s well-being, 4) parental feeling of responsibility/guilt. Parental advice most often provided included: 1) setting up healthy home environment, 2) parental role modeling of healthy behaviors, and 3) providing support/encouragement for positive efforts. Conclusions Topics for potential intervention development include communication and motivation of adolescents regarding weight-related topics, appropriate autonomy, and addressing negative emotions concerning the adolescent’s weight status. Targeting these topics could potentially improve acceptability and outcomes for treatments. PMID:22770833

  4. Researchers' Roles in Patient Safety Improvement.

    PubMed

    Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

    2016-03-01

    In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

  5. 4 CFR 28.8 - Informal procedural advice.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 4 Accounts 1 2010-01-01 2010-01-01 false Informal procedural advice. 28.8 Section 28.8 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL APPEALS BOARD; PROCEDURES APPLICABLE TO CLAIMS CONCERNING EMPLOYMENT PRACTICES AT THE GOVERNMENT ACCOUNTABILITY OFFICE...

  6. Dietary advice for muscularity, leanness and weight control in Men's Health magazine: a content analysis.

    PubMed

    Cook, Toni M; Russell, Jean M; Barker, Margo E

    2014-10-11

    The dietary content of advice in men's lifestyle magazines has not been closely scrutinised. We carried out an analysis of such content in all 2009 issues (n = 11) of Men's Health (MH) focusing on muscularity, leanness and weight control. Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets.Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines' support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns.Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on

  7. Dietitians’ Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults

    PubMed Central

    DESROCHES, SOPHIE; LAPOINTE, ANNIE; DESCHÊNES, SARAH-MAUDE; BISSONNETTE-MAHEUX, VÉRONIQUE; GRAVEL, KARINE; THIRSK, JAYNE; LÉGARÉ, FRANCE

    2016-01-01

    Purpose To assess dietitians’ perspectives on the importance and applicability of interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults in the Canadian context. Methods Based on a Cochrane systematic review, we identified 8 promising interventions for enhancing adherence to dietary advice: behavioural contracts, exchange lists, feedback based on self-monitoring, individualized menu suggestions, multiple interventions, portion size awareness, telephone follow-up, and videos. Thirty-two dietitians then completed a 3-round Delphi study by responding to an electronic questionnaire asking them to rate the importance and applicability in their practice of the 8 interventions on a 7-point Likert scale. Results Using a ≥75% level of agreement, 4 interventions showed strong consensus: multiple interventions, feedback based on self-monitoring, portion size awareness, and videos. Among these, the most significant were (means ± SD for importance and applicability, respectively) feedback based on self-monitoring (6.97 ± 0.18 and 6.72 ± 0.46), portion size awareness (6.69 ± 0.54 and 6.75 ± 0.51), and multiple interventions (6.94 ± 0.25 and 6.81 ± 0.40). Conclusions These findings can guide the development of educational training sessions for dietitians to help them provide practice-relevant interventions that will increase the likelihood that patients adhere to their advice regarding prevention and management of chronic diseases. PMID:26280789

  8. A qualitative study to identify reasons for discharges against medical advice in the cardiovascular setting

    PubMed Central

    Saunders, Elijah; Mullins, C Daniel; Pradel, Françoise G; Zuckerman, Marni; Loh, F Ellen; Weir, Matthew R

    2012-01-01

    Background Cardiovascular disease (CVD) is responsible for the largest number of discharges against medical advice (AMA). However, there is limited information regarding the reasons for discharges AMA in the CVD setting. Objective To identify reasons for discharges AMA among patients with CVD. Design Qualitative study using focus group interviews (FGIs). Participants A convenience sample of patients with a CVD-related discharge diagnosis who left AMA and providers (physicians, nurses and social workers) whose patients have left AMA. Primary and secondary outcomes To identify patients' reasons for discharges AMA as identified by patients and providers. To identify strategies to reduce discharges AMA. Approach FGIs were grouped according to patients, physicians and nurses/social workers. A content analysis was performed independently by three coauthors to identify the nature and range of the participants' viewpoints on the reasons for discharges AMA. The content analysis involved specific categories of reasons as motivated by the Health Belief Model as well as reasons (ie, themes) that emerged from the interview data. Results 9 patients, 10 physicians and 23 nurses/social workers were recruited for the FGIs. Patients and providers reported the same three reasons for discharges AMA: (1) patient's preference for their own doctor, (2) long wait time and (3) factors outside the hospital. Patients identified an unmet expectation to be involved in setting the treatment plan as a reason to leave AMA. Participants identified improved communication as a solution for reducing discharges AMA. Conclusions Patients wanted more involvement in their care, exhibited a strong preference for their own primary physician, felt that they spent a long time waiting in the hospital and were motivated to leave AMA by factors outside the hospital. Providers identified similar reasons except the patients' desire for involvement. Additional research is needed to determine the applicability of

  9. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†

    PubMed Central

    Heywood, Anita E.; Nothdurft, Hans; Tessier, Dominique; Moodley, Melissa; Rombo, Lars; Marano, Cinzia; De Moerlooze, Laurence

    2017-01-01

    Background: Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries. Methods: An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18–65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed. Results: Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses. Conclusions: HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller

  10. Pre-travel advice, attitudes and hepatitis A and B vaccination rates among travellers from seven countries†.

    PubMed

    Heywood, Anita E; Nothdurft, Hans; Tessier, Dominique; Moodley, Melissa; Rombo, Lars; Marano, Cinzia; De Moerlooze, Laurence

    2016-07-01

    Knowledge about the travel-associated risks of hepatitis A and B, and the extent of pre-travel health-advice being sought may vary between countries. An online survey was undertaken to assess the awareness, advice-seeking behaviour, rates of vaccination against hepatitis A and B and adherence rates in Australia, Finland, Germany, Norway, Sweden, the UK and Canada between August and October 2014. Individuals aged 18-65 years were screened for eligibility based on: travel to hepatitis A and B endemic countries within the past 3 years, awareness of hepatitis A, and/or combined hepatitis A&B vaccines; awareness of their self-reported vaccination status and if vaccinated, vaccination within the last 3 years. Awareness and receipt of the vaccines, sources of advice, reasons for non-vaccination, adherence to recommended doses and the value of immunization reminders were analysed. Of 27 386 screened travellers, 19 817 (72%) were aware of monovalent hepatitis A or combined A&B vaccines. Of these 13 857 (70%) had sought advice from a healthcare provider (HCP) regarding combined hepatitis A&B or monovalent hepatitis A vaccination, and 9328 (67%) were vaccinated. Of 5225 individuals eligible for the main survey (recently vaccinated = 3576; unvaccinated = 1649), 27% (841/3111) and 37% (174/465) of vaccinated travellers had adhered to the 3-dose combined hepatitis A&B or 2-dose monovalent hepatitis A vaccination schedules, respectively. Of travellers partially vaccinated against combined hepatitis A&B or hepatitis A, 84% and 61%, respectively, believed that they had received the recommended number of doses. HCPs remain the main source of pre-travel health advice. The majority of travellers who received monovalent hepatitis A or combined hepatitis A&B vaccines did not complete the recommended course. These findings highlight the need for further training of HCPs and the provision of reminder services to improve traveller awareness and adherence to vaccination

  11. Daughter-initiated health advice to mothers: perceptions of African–American and Latina daughters

    PubMed Central

    Mosavel, M.; Thomas, T.

    2009-01-01

    The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents’ health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African–American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African–American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family. PMID:19339373

  12. Integrating advice and experience: learning and decision making with social and nonsocial cues.

    PubMed

    Collins, Elizabeth C; Percy, Elise J; Smith, Eliot R; Kruschke, John K

    2011-06-01

    When making decisions, people typically gather information from both social and nonsocial sources, such as advice from others and direct experience. This research adapted a cognitive learning paradigm to examine the process by which people learn what sources of information are credible. When participants relied on advice alone to make decisions, their learning of source reliability proceeded in a manner analogous to traditional cue learning processes and replicated the established learning phenomena. However, when advice and nonsocial cues were encountered together as an established phenomenon, blocking (ignoring redundant information) did not occur. Our results suggest that extant cognitive learning models can accommodate either advice or nonsocial cues in isolation. However, the combination of advice and nonsocial cues (a context more typically encountered in daily life) leads to different patterns of learning, in which mutually supportive information from different types of sources is not regarded as redundant and may be particularly compelling. For these situations, cognitive learning models still constitute a promising explanatory tool but one that must be expanded. As such, these findings have important implications for social psychological theory and for cognitive models of learning. 2011 APA, all rights reserved

  13. Evidence-based first aid advice for paediatric burns in the United Kingdom.

    PubMed

    Varley, Alice; Sarginson, Julia; Young, Amber

    2016-05-01

    Burn and scald injuries are common in children. First aid advice for paediatric burns is offered by a range of health organisations and charities in the UK. Despite this, children still present to emergency departments and burn services having received little or inadequate first aid. A survey was undertaken regarding the content and consistency of the advice given by a cross-section of UK health organisations involved in first aid prevention and education. The advice was subsequently examined to determine if it was evidence-based. Our study has demonstrated inconsistencies in the content of the first aid advice provided by the 21 organisations included in the study. Seventy-one percent of the information was only available online. The temperature, method and duration of cooling varied substantially, as did the advice recommended for the removal of clothing and jewellery and methods for covering the burn immediately after injury. Results from the literature review concluded the following based on available evidence; cool the burn with running tap water for 20min, remove clothing and jewellery and cover the burn with cling film or a clean non-adhesive dressing. This study highlights the lack of consistency between first aid guidance provided by health organisations and charities in the UK. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  14. Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden.

    PubMed

    Bjelkmar, Pär; Hansen, Anette; Schönning, Caroline; Bergström, Jakob; Löfdahl, Margareta; Lebbad, Marianne; Wallensten, Anders; Allestam, Görel; Stenmark, Stephan; Lindh, Johan

    2017-04-18

    In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skellefteå municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s) and the potential for earlier detection using calls to a health advice line. The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skellefteå in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

  15. Peer Tutoring in a Graduate Writing Centre: Identity, Expertise, and Advice Resisting

    ERIC Educational Resources Information Center

    Waring, Hansun Zhang

    2005-01-01

    Compared to research on the giving of advice (e.g. Hutchby 1995), relatively less work has been conducted on the receiving or resisting of advice, where the interactionally problematic nature of advising is crystallized (e.g. Heritage and Sefi 1992). Moreover, the notion of advising in education settings has predominantly concerned procedural…

  16. Repaglinide/metformin fixed-dose combination to improve glycemic control in patients with type 2 diabetes: an update

    PubMed Central

    Moses, Robert G

    2010-01-01

    Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC) therapy (PrandiMet®; Novo Nordisk, Bagsværd, Denmark) has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control. PMID:21437084

  17. Repaglinide/metformin fixed-dose combination to improve glycemic control in patients with type 2 diabetes: an update.

    PubMed

    Moses, Robert G

    2010-05-10

    Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC) therapy (PrandiMet(®); Novo Nordisk, Bagsværd, Denmark) has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control.

  18. Inequalities in advice provided by public health workers to women during antenatal sessions in rural India.

    PubMed

    Singh, Abhishek; Pallikadavath, Saseendran; Ram, Faujdar; Ogollah, Reuben

    2012-01-01

    Studies have widely documented the socioeconomic inequalities in maternal and child health related outcomes in developing countries including India. However, there is limited research on the inequalities in advice provided by public health workers on maternal and child health during antenatal visits. This paper investigates the inequalities in advice provided by public health workers to women during antenatal visits in rural India. The District Level Household Survey (2007-08) was used to compute rich-poor ratios and concentration indices. Binary logistic regressions were used to investigate inequalities in advice provided by public health workers. The dependent variables comprised the advice provided on seven essential components of maternal and child health care. A significant proportion of pregnant women who attended at least four ANC sessions were not advised on these components during their antenatal sessions. Only 51%-72% of the pregnant women were advised on at least one of the components. Moreover, socioeconomic inequalities in providing advice were significant and the provision of advice concentrated disproportionately among the rich. Inequalities were highest in the case of advice on family planning methods. Advice on breastfeeding was least unequal. Public health workers working in lower level health facilities were significantly less likely than their counterparts in the higher level health facilities to provide specific advice. A significant proportion of women were not advised on recommended components of maternal and child health in rural India. Moreover, there were enormous socioeconomic inequalities. The findings of this study raise questions about the capacity of the public health care system in providing equitable services in India. The Government of India must focus on training and capacity building of the public health workers in communication skills so that they can deliver appropriate and recommended advice to all clients, irrespective of

  19. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  20. Training Patient and Family Storytellers and Patient and Family Faculty

    PubMed Central

    Morrise, Lisa; Stevens, Katy Jo

    2013-01-01

    Narrative medicine has become a prominent method of developing more empathetic relationships between medical clinicians and patients, on the basis of a deeper understanding of the patient experience. Beyond its usefulness during clinical encounters, patient storytelling can inform processes and procedures in Advisory Councils, Committee Meetings, and Family as Faculty settings, leading to improved quality and safety in health care. Armed with a better understanding of the patient experience, clinicians and administrators can make decisions, hopefully in collaboration with patients, that will enrich the patient experience and increase satisfaction among patients, families, and staff. Patient and family storytelling is a key component of the collaboration that is ideal when an organization seeks to deliver patient- and family-centered care. Providing patients and families with training will make the narratives they share more powerful. Health care organizations will find that purposeful storytelling can be an invaluable aspect of a patient- and family-centered culture. Well-delivered storytelling will support quality- and safety-improvement efforts and contribute to improved patient satisfaction. This article provides instruction for teaching patients and families how to tell stories with purpose and offers advice about how to support patients, families, and clinicians participating in this effort. PMID:24355906

  1. 77 FR 48169 - The Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 1...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-13

    ... Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 1; The Information Technology Agreement: Advice and Information on the Proposed Expansion: Part 2 AGENCY: United States... Technology Agreement: Advice and Information on the Proposed Expansion: Part 1, and investigation No. 332-536...

  2. Assessing the feasibility of screening and providing brief advice for alcohol misuse in general dental practice: a clustered randomised control trial protocol for the DART study

    PubMed Central

    Ntouva, Antiopi; Porter, Jessie; Crawford, Mike J; Britton, Annie; Gratus, Christine; Newton, Tim; Tsakos, Georgios; Heilmann, Anja; Pikhart, Hynek; Watt, Richard G

    2015-01-01

    Introduction Alcohol misuse is a significant public health problem with major health, social and economic consequences. Systematic reviews have reported that brief advice interventions delivered in various health service settings can reduce harmful drinking. Although the links between alcohol and oral health are well established and dentists come into contact with large numbers of otherwise healthy patients regularly, no studies have been conducted in the UK to test the feasibility of delivering brief advice about alcohol in general dental settings. Methods and analysis The Dental Alcohol Reduction Trial (DART) aims to assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice in patients attending National Health Service (NHS) general dental practices in North London. DART is a cluster randomised control feasibility trial and uses a mixed methods approach throughout the development, design, delivery and evaluation of the intervention. It will be conducted in 12 NHS general dental practices across North London and will include dental patients who drink above the recommended guidance, as measured by the Alcohol Use Disorders Identification Test (AUDIT-C) screening tool. The intervention involves 5 min of tailored brief advice delivered by dental practitioners during the patient's appointment. Feasibility and acceptability measures as well as suitability of proposed primary outcomes of alcohol consumption will be assessed. Initial economic evaluation will be undertaken. Recruitment and retention rates as well as acceptability of the study procedures from screening to follow-up will be measured. Ethics and dissemination Ethical approval was obtained from the Camden and Islington Research Ethics Committee. Study outputs will be disseminated via scientific publications, newsletters, reports and conference presentations to a range of professional and patient groups and stakeholders. Based on the results of the trial

  3. Randomised clinical trial: yoga vs written self-care advice for ulcerative colitis.

    PubMed

    Cramer, H; Schäfer, M; Schöls, M; Köcke, J; Elsenbruch, S; Lauche, R; Engler, H; Dobos, G; Langhorst, J

    2017-06-01

    Perceived stress seems to be a risk factor for exacerbation of ulcerative colitis. Yoga has been shown to reduce perceived stress. To assess the efficacy and safety of yoga for improving quality of life in patients with ulcerative colitis. A total of 77 patients (75% women; 45.5 ± 11.9 years) with ulcerative colitis in clinical remission but impaired quality of life were randomly assigned to yoga (12 supervised weekly sessions of 90 min; n = 39) or written self-care advice (n = 38). Primary outcome was disease-specific quality of life (Inflammatory Bowel Disease Questionnaire). Secondary outcomes included disease activity (Rachmilewitz clinical activity index) and safety. Outcomes were assessed at weeks 12 and 24 by blinded outcome assessors. The yoga group had significantly higher disease-specific quality of life compared to the self-care group after 12 weeks (Δ = 14.6; 95% confidence interval=2.6-26.7; P = 0.018) and after 24 weeks (Δ = 16.4; 95% confidence interval=2.5-30.3; P = 0.022). Twenty-one and 12 patients in the yoga group and in the self-care group, respectively, reached a clinical relevant increase in quality of life at week 12 (P = 0.048); and 27 and 17 patients at week 24 (P = 0.030). Disease activity was lower in the yoga group compared to the self-care group after 24 weeks (Δ = -1.2; 95% confidence interval=-0.1-[-2.3]; P = 0.029). Three and one patient in the yoga group and in the self-care group, respectively, experienced serious adverse events (P = 0.317); and seven and eight patients experienced nonserious adverse events (P = 0.731). Yoga can be considered as a safe and effective ancillary intervention for patients with ulcerative colitis and impaired quality of life. ClinicalTrials.gov identifier: NCT02043600. © 2017 John Wiley & Sons Ltd.

  4. 7 CFR 1450.5 - Performance based on advice or action of USDA.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Performance based on advice or action of USDA. 1450.5... (BCAP) Common Provisions § 1450.5 Performance based on advice or action of USDA. (a) The provisions of... representative of USDA apply to this part, and may be considered as a basis to provide relief to persons subject...

  5. 7 CFR 12.11 - Action based upon advice or action of USDA.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 1 2014-01-01 2014-01-01 false Action based upon advice or action of USDA. 12.11... CONSERVATION General Provisions § 12.11 Action based upon advice or action of USDA. The provisions of part 718... it is determined by the appropriate USDA agency that the action of a person which would form the...

  6. 7 CFR 12.11 - Action based upon advice or action of USDA.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 1 2011-01-01 2011-01-01 false Action based upon advice or action of USDA. 12.11... CONSERVATION General Provisions § 12.11 Action based upon advice or action of USDA. The provisions of part 718... it is determined by the appropriate USDA agency that the action of a person which would form the...

  7. 7 CFR 1450.5 - Performance based on advice or action of USDA.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Performance based on advice or action of USDA. 1450.5... (BCAP) Common Provisions § 1450.5 Performance based on advice or action of USDA. (a) The provisions of... representative of USDA apply to this part, and may be considered as a basis to provide relief to persons subject...

  8. 7 CFR 12.11 - Action based upon advice or action of USDA.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 1 2012-01-01 2012-01-01 false Action based upon advice or action of USDA. 12.11... CONSERVATION General Provisions § 12.11 Action based upon advice or action of USDA. The provisions of part 718... it is determined by the appropriate USDA agency that the action of a person which would form the...

  9. 7 CFR 1450.5 - Performance based on advice or action of USDA.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Performance based on advice or action of USDA. 1450.5... (BCAP) Common Provisions § 1450.5 Performance based on advice or action of USDA. (a) The provisions of... representative of USDA applies to this part, and may be considered as a basis to provide relief to persons...

  10. 7 CFR 1450.5 - Performance based on advice or action of USDA.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Performance based on advice or action of USDA. 1450.5... (BCAP) Common Provisions § 1450.5 Performance based on advice or action of USDA. (a) The provisions of... representative of USDA apply to this part, and may be considered as a basis to provide relief to persons subject...

  11. 7 CFR 12.11 - Action based upon advice or action of USDA.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Action based upon advice or action of USDA. 12.11... CONSERVATION General Provisions § 12.11 Action based upon advice or action of USDA. The provisions of part 718... it is determined by the appropriate USDA agency that the action of a person which would form the...

  12. 7 CFR 12.11 - Action based upon advice or action of USDA.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Action based upon advice or action of USDA. 12.11... CONSERVATION General Provisions § 12.11 Action based upon advice or action of USDA. The provisions of part 718... it is determined by the appropriate USDA agency that the action of a person which would form the...

  13. Prospective audit of postoperative instructions to patients undergoing root canal treatment in the DDUH and re-audit following introduction of a written patient information sheet.

    PubMed

    Moorthy, A; Alkadhimi, A F; Stassen, Leo F; Duncan, H F

    2016-01-01

    Concerns were expressed that postoperative written instructions following endodontic treatment are not available in the Dublin Dental University Hospital. Data was collected in three phases: retrospective analysis of clinical notes for evidence of the delivery of postoperative instructions; a randomly distributed questionnaire to patients undergoing root canal treatment prior to the introduction of a written postoperative advice sheet; and, another survey following introduction of the advice sheet. Some 56% of patients' charts documented that postoperative advice was given. Analysis of phase two revealed that patients were not consistently informed of any key postoperative messages. In phase 3 analysis, the proposed benchmarks were met in four out of six categories. Postoperative advice after root canal treatment in the DDUH is both poorly recorded and inconsistently delivered. A combination of oral postoperative instructions and written postoperative advice provided the most effective delivery of patient information.

  14. Implementation of dietary and general lifestyle advice among women with polycystic ovarian syndrome.

    PubMed

    Humphreys, Laura; Costarelli, Vassiliki

    2008-07-01

    Central obesity and insulin resistance are strongly implicated in the etiology of polycystic ovarian syndrome (PCOS) and their reduction is therefore a central treatment focus. Weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility in women with PCOS. The purpose of the current study is to investigate the general attitudes towards dieting and exercise in women with PCOS, together with the extent of implementation of the dietary and lifestyle advice that these women are given as part of their treatment. General knowledge of patients about their condition (PCOS) has also been assessed. Fifty three pre-menopausal women, over the age of 18 years, with a confirmed diagnosis of PCOS, were recruited from the Endocrinology Department, Middlesex Hospital, London. Subjects were interviewed individually using an interview-guided questionnaire. Sixty four per cent of the subjects were overweight (BMI > 25 kg/m2) and 55% of those were obese (BMI > 30 kg/m2). All subjects identified the importance of weight control in the management of their condition. However, only nine out of the 35 overweight women had actually been referred to a dietician and only 22 reported taking moderate exercise at least once a week in order to improve their health. The main sources of information on weight management were the internet and their consultant endocrinologist, who they normally see only twice a year. In spite of the fact that weight loss and weight maintenance are absolutely vital in the treatment of PCOS, our study has shown that the support given to PCOS patients to help reduce and control their weight is inadequate and needs to be improved.

  15. Advice networks in teams: the role of transformational leadership and members' core self-evaluations.

    PubMed

    Zhang, Zhen; Peterson, Suzanne J

    2011-09-01

    This article examines the team-level factors promoting advice exchange networks in teams. Drawing upon theory and research on transformational leadership, team diversity, and social networks, we hypothesized that transformational leadership positively influences advice network density in teams and that advice network density serves as a mediating mechanism linking transformational leadership to team performance. We further hypothesized a 3-way interaction in which members' mean core self-evaluation (CSE) and diversity in CSE jointly moderate the transformational leadership-advice network density relationship, such that the relationship is positive and stronger for teams with low diversity in CSE and high mean CSE. In addition, we expected that advice network centralization attenuates the positive influence of network density on team performance. Results based on multisource data from 79 business unit management teams showed support for these hypotheses. The results highlight the pivotal role played by transformational leadership and team members' CSEs in enhancing team social networks and, ultimately, team effectiveness. PsycINFO Database Record (c) 2011 APA, all rights reserved

  16. ADVICE for a healthier life: Adult Vaccination Campaign in Europe.

    PubMed

    Ozisik, Lale; Tanriover, Mine Durusu; Rigby, Shirley; Unal, Serhat

    2016-09-01

    Immunization is one of the most effective public health measures to prevent disease. Despite relatively good vaccination rates in childhood in many parts of the world, vaccines to prevent diseases are underused in the adult population and adult vaccination rates are still far below the target. The European Federation of Internal Medicine (EFIM), declared that 'internal medicine must focus on better care for individuals, better health care for populations and lower costs'. Adult vaccination is a good example of a public health initiative aimed at reducing morbidity and mortality, but awareness of the need for adult vaccination and uptake of the programs across Europe is variable. The Adult Vaccination Campaign in Europe (ADVICE) was developed with an aim to raise awareness for adult vaccination and to understand the dynamics of the vaccination practices and the possible barriers against achieving targeted vaccination rates in Europe. In order to reach vaccination targets, we need evidence based, up to date guidelines; recommendations at national and international levels; surveillance for vaccination rates; and opportunities to provide vaccines more readily. Leadership at a European level and a firm research and action agenda are crucial. The European Federation of Internal Medicine can take the lead as it declared its interest on 'better care for individuals, better health care for populations'. Hence, we consider ADVICE a very timely and very valuable initiative to draw a roadmap to improve adult vaccination rates in Europe. Copyright © 2016. Published by Elsevier B.V.

  17. What advice is given to newly qualified doctors on Twitter? An analysis of #TipsForNewDocs tweets.

    PubMed

    Rashid, Mohammed Ahmed; McKechnie, Doug; Gill, Deborah

    2018-07-01

    Twitter is a social media platform on which users post very brief messages that can be rapidly communicated across wide geographical areas and audiences. Many doctors use Twitter for personal as well as professional communications and networking. The #TipsForNewDocs hashtag is used on Twitter to give advice to newly qualified doctors as they commence their careers. This study explores the nature and focus of such advice. An analysis of Twitter activity containing the #TipsForNewDocs hashtag was performed using Symplur health care analytics software. Tweets sent during a peak 48-hour period in 2016 (immediately preceding the first day of work for newly qualified UK doctors) were studied. The geographical locations and professional backgrounds of participants were categorised and the content of tweets was subjected to thematic analysis. During 1 and 2 August 2016, 661 unique #TipsForNewDocs tweets were posted. A total of 621 (94.0%) were posted by people in the UK; 522 (79.0%) were posted by doctors, and the remainder by allied health care professionals and patients. The majority of included tweets focused on aspects of professional development, improving personal or professional knowledge, particularly tacit knowledge, and developing 'know-how'. These aspects of professional knowledge have previously been described as fundamental to professional education and training. However, a significant subset of tweets focused on accelerating socialisation into the profession, an essential step in joining a professional community. The tweets relating to socialisation were often humorous and colloquial in nature. Despite their brief and often jocular nature, #TipsForNewDocs tweets provided meaningful advice for newcomers to the profession, often focusing on tacit learning and professional socialisation. Hashtag-driven enquiries can be a valuable and time-efficient way of accessing and sharing tacitly held knowledge. Social media content analysis can provide valuable insights

  18. Communication of Science Advice to Government.

    PubMed

    Hutchings, Jeffrey A; Stenseth, Nils Chr

    2016-01-01

    There are various ways to construct good processes for soliciting and understanding science. Our critique of advisory models finds that a well-supported chief science advisor (CSA) best ensures the provision of deliberative, informal, and emergency advice to government. Alternatively, bias, increasingly manifest as science-based advocacy, can hinder communication, diminish credibility, and distort scientific evidence. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Decision Making and Confidence Given Uncertain Advice

    ERIC Educational Resources Information Center

    Lee, Michael D.; Dry, Matthew J.

    2006-01-01

    We study human decision making in a simple forced-choice task that manipulates the frequency and accuracy of available information. Empirically, we find that people make decisions consistent with the advice provided, but that their subjective confidence in their decisions shows 2 interesting properties. First, people's confidence does not depend…

  20. Evaluation of a smartphone nutrition and physical activity application to provide lifestyle advice to pregnant women: The SNAPP randomised trial.

    PubMed

    Dodd, Jodie M; Louise, Jennie; Cramp, Courtney; Grivell, Rosalie M; Moran, Lisa J; Deussen, Andrea R

    2018-01-01

    Our objective was to evaluate the impact of a smartphone application as an adjunct to face-to-face consultations in facilitating dietary and physical activity change among pregnant women. This multicentre, nested randomised trial involved pregnant women with a body mass index ≥18.5 kg/m 2 , with a singleton pregnancy between 10 and 20 weeks' gestation, and participating in 2 pregnancy nutrition-based randomised trials across metropolitan Adelaide, South Australia. All women participating in the SNAPP trial received a comprehensive dietary, physical activity, and behavioural intervention, as part of the GRoW or OPTIMISE randomised trials. Women were subsequently randomised to either the "Lifestyle Advice Only Group," where women received the above intervention, or the "Lifestyle Advice plus Smartphone Application Group," where women were additionally provided access to the smartphone application. The primary outcome was healthy eating index (HEI) assessed by maternal food frequency questionnaire completed at trial entry, and 28 and 36 weeks' gestation. Analyses were performed using intention-to-treat principles, with statistical significance at p = .05. One hundred sixty-two women participated: 77 allocated to the Lifestyle Advice plus Smartphone Application Group and 85 to the Lifestyle Advice Only Group. Mean difference in HEI score at 28 weeks of pregnancy was 0.01 (CI [-2.29, 2.62]) and at 36 weeks of pregnancy -1.16 (CI [-4.60, 2.28]). There was no significant additional benefit from the provision of the smartphone application in improving HEI score (p = .452). Although all women improved dietary quality across pregnancy, use of the smartphone application was poor. Our findings do not support addition of the smartphone application. © 2017 John Wiley & Sons Ltd.

  1. The stage of change approach for implementing ergonomics advice - Translating research into practice.

    PubMed

    Rothmore, Paul; Aylward, Paul; Oakman, Jodi; Tappin, David; Gray, Jodi; Karnon, Jonathan

    2017-03-01

    The Stage of Change (SOC) approach has been proposed as a method to improve the implementation of ergonomics advice. However, despite evidence for its efficacy there is little evidence to suggest it has been adopted by ergonomics consultants. This paper investigates barriers and facilitators to the implementation, monitoring and effectiveness of ergonomics advice and the adoption of the SOC approach in a series of focus groups and a subsequent survey of members of the Human Factors Societies of Australia and New Zealand. A proposed SOC assessment tool developed for use by ergonomics practitioners is presented. Findings from this study suggest the limited application of a SOC based approach to work-related musculoskeletal injury prevention by ergonomics practitioners is due to the absence of a suitable tool in the ergonomists' repertoire, the need for training in this approach, and their limited access to relevant research findings. The final translation of the SOC assessment tool into professional ergonomics practice will require accessible demonstration of its real-world usability to practitioners and the training of ergonomics practitioners in its application. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Whose Expertise?: An Analysis of Advice Giving in Early Childhood Parent-Teacher Conferences

    ERIC Educational Resources Information Center

    Cheatham, Gregory A.; Ostrosky, Michaelene M.

    2011-01-01

    Early childhood and early childhood special education programs have a focus on parent-educator partnerships. Parent-teacher conferences are a context for these partnerships, and advice giving is one type of exchange occurring within conferences. Parent-teacher conference advice was investigated through participant interviews and the methodology of…

  3. Quality of Extension Advice: A Gendered Case Study from Ghana and Sri Lanka

    ERIC Educational Resources Information Center

    Lamontagne-Godwin, Julien; Williams, Frances; Bandara, Willoru Mudiyansele Palitha Thilakasiri; Appiah-Kubi, Ziporah

    2017-01-01

    Purpose: Women farmers have less access to extension services than male farmers, even though they make up almost half of the global agricultural workforce. Gender-focused international development programmes have focused on how ensuring women receive better access to advice. However, the quality of the technical advice and the service women…

  4. National and Governmental Advisory Committee Advice Letters for 2014

    EPA Pesticide Factsheets

    Advice Letters produced for and/or by the National Advisory Committee and Governmental Advisory Committee to the United States Representative to the North American Commission for Environmental Cooperation

  5. National and Governmental Advisory Committee Advice Letters for 2015

    EPA Pesticide Factsheets

    Advice Letters produced for and/or by the National Advisory Committee and Governmental Advisory Committee to the United States Representative to the North American Commission for Environmental Cooperation

  6. Advising Beef-Cattle Farmers: Problem-Finding Rather than Problem-Solving. Characterization of Advice Practices in Creuse

    ERIC Educational Resources Information Center

    Magne, Marie-Angelina; Ingrand, Stephane

    2004-01-01

    French farms have to adapt quickly in an economic and social context that is in profound change. For this, advice procedures must themselves be reconsidered. The aim of this work was to characterize the advice practices in beef-cattle systems in Creuse and define farmers' and advisers' requirements according to future methods of providing advice.…

  7. Effect of Connective Tissue Manipulation on Symptoms and Quality of Life in Patients With Chronic Constipation: A Randomized Controlled Trial.

    PubMed

    Gürsen, Ceren; Kerem Günel, Mintaze; Kaya, Serap; Kav, Taylan; Akbayrak, Türkan

    2015-06-01

    The purpose of this study was to examine the effects of connective tissue manipulation (CTM) on the severity of constipation and health-related quality of life in individuals diagnosed with chronic constipation. Fifty patients with a diagnosis of chronic constipation according to Rome III criteria were recruited and randomized to an intervention (n = 25) or control group (n = 25). The intervention group received CTM in addition to the lifestyle advice, whereas the control group was given only lifestyle advice for constipation. All assessments were performed at baseline and at the end of 4 weeks. The primary outcome measure was the Constipation Severity Instrument. Secondary outcomes included Patient Assessment of Constipation Quality of Life Questionnaire, Bristol Stool Scale, and 7-day bowel diary. Differences between groups were analyzed with t tests, Mann-Whitney U test and χ(2) test. Compared with the control group, subjects in the intervention group reported significantly greater improvement in total and subscale scores of the Constipation Severity Instrument and Patient Assessment of Constipation Quality of Life Questionnaire (P < .05). Based on the results from bowel diaries, the improvements in the number of bowel movements, duration of defecation, stool consistency, and the feeling of incomplete evacuation in the intervention group were also significantly more than the control group (P < .05). This study showed that CTM and lifestyle advice were superior to reducing symptoms of constipation and quality of life compared with lifestyle advice alone for patients with chronic constipation. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  8. Differential neurobiological effects of expert advice on risky choice in adolescents and adults.

    PubMed

    Engelmann, Jan B; Moore, Sara; Monica Capra, C; Berns, Gregory S

    2012-06-01

    We investigated behavioral and neurobiological mechanisms by which risk-averse advice, provided by an expert, affected risky decisions across three developmental groups [early adolescents (12-14 years), late adolescents (15-17 years), adults (18+ years)]. Using cumulative prospect theory, we modeled choice behavior during a risky-choice task. Results indicate that advice had a significantly greater impact on risky choice in both adolescent groups than in adults. Using functional magnetic resonance imaging, we investigated the neural correlates of this behavioral effect. Developmental effects on correlations between brain activity and valuation parameters were obtained in regions that can be classified into (i) cognitive control regions, such as dorsolateral prefrontal cortex (DLPFC) and ventrolateral PFC; (ii) social cognition regions, such as posterior temporoparietal junction; and (iii) reward-related regions, such as ventromedial PFC (vmPFC) and ventral striatum. Within these regions, differential effects of advice on neural correlates of valuation were observed across development. Specifically, advice increased the correlation strength between brain activity and parameters reflective of safe choice options in adolescent DLPFC and decreased correlation strength between activity and parameters reflective of risky choice options in adult vmPFC. Taken together, results indicate that, across development, distinct brain systems involved in cognitive control and valuation mediate the risk-reducing effect of advice during decision making under risk via specific enhancements and reductions of the correlation strength between brain activity and valuation parameters.

  9. Use of deodorants during adjuvant breast radiotherapy: a survey of compliance with standard advice, impact on patients and a literature review on safety.

    PubMed

    Graham, P H; Graham, J L

    2009-12-01

    Proscription of antiperspirant or deodorant use during adjuvant breast radiotherapy is common. The investigators were seeking an information base to facilitate design of an appropriate controlled trial of the use of deodorants during radiotherapy. The first component consisted of a survey of women after adjuvant breast radiotherapy seeking information about routine deodorant use and potential concern if deodorants were not permitted during radiotherapy. The second component comprised a literature search for any existing controlled evidence regarding harm from deodorant use during radiotherapy. Four hundred fourteen women completed surveys. Two hundred eighty recalled advice against deodorants. Two hundred ninety-nine women routinely used deodorants, 70% of whom used roll-on products. Forty-five continued deodorant use during radiation, 20 of these despite recalling advice not to wear a deodorant. Of the 233 women who routinely wore a deodorant but abstained during radiotherapy, 19% expressed a lot of concern about body odour and 45% were slightly concerned. Three controlled studies totalling 310 patients report specific deodorants versus no deodorant use which did not show statistically significantly increased skin reactions, but had only a small subset with axillary irradiation. The proscription of deodorant use during radiotherapy is of unproven benefit and causes body odour concern to the majority of women who are usual deodorant users. The next most appropriate trial would compare use of the usual deodorant versus no deodorant, would encompass a significant number of women with radiotherapy to the axilla or application of deodorant to irradiated skin areas, and include endpoints other than skin reaction alone.

  10. Dietary Advice for Airline Travel.

    PubMed

    Leggat; Nowak

    1997-03-01

    In addition to their regular meal service, most of the major domestic and international airlines offer special meals. It should be noted that regular meal services on international flights often give a choice of meals, even in economy class, and often include a salad and or fruit dish, which could be consumed by most people. More airlines also seem to be moving towards having at least one more culturally appropriate meal on the menu, particularly for relevant flight sectors. However, these meals may be inappropriate for some passengers, and there is a need for this special meals service. Meals services on airlines have improved greatly in recent years, particularly with the employment of consultant dietitians to the catering staff of airlines and advances in chef training. Special meal services are designed to cater to the most common variations of meals required by most passengers for medical, religious, or other reasons. The special requirements for these meals are described elsewhere.1 It is important to realize that the meals are designed and the ingredients interpreted by that airline, and may not necessarily reflect what the traveler might eat at home. So it is important to advise travelers not to have high expectations of this special meal service. This paper aims to provide some basic practical advice for selection of special diets for airline travelers.

  11. 31 CFR 10.37 - Requirements for written advice.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...' professional knowledge on Federal tax matters are not considered written advice on a Federal tax matter for... representations, statements, findings, or agreements (including projections, financial forecasts, or appraisals... on representations, statements, findings, or agreements is unreasonable if the practitioner knows or...

  12. National and Governmental Advisory Committee Advice Letters for 2016

    EPA Pesticide Factsheets

    Advice Letters and produced by the National Advisory Committee and Governmental Advisory Committee to the United States Representative to the North American Commission for Environmental Cooperation, and EPA responses

  13. 45 CFR 162.1602 - Standards for health care payment and remittance advice transaction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Standards for health care payment and remittance advice transaction. 162.1602 Section 162.1602 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1602 Standards for...

  14. 45 CFR 162.1602 - Standards for health care payment and remittance advice transaction.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standards for health care payment and remittance advice transaction. 162.1602 Section 162.1602 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Payment and Remittance Advice § 162.1602 Standards for...

  15. 39 CFR 762.41 - Advice of non-receipt or loss, destruction, or mutilation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Advice of non-receipt or loss, destruction, or..., Mutilated, and Defaced Disbursement Postal Money Orders § 762.41 Advice of non-receipt or loss, destruction... purpose for which it was issued, giving, if possible, its date, number, and amount, and requesting that...

  16. 39 CFR 762.41 - Advice of non-receipt or loss, destruction, or mutilation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Advice of non-receipt or loss, destruction, or..., Mutilated, and Defaced Disbursement Postal Money Orders § 762.41 Advice of non-receipt or loss, destruction... purpose for which it was issued, giving, if possible, its date, number, and amount, and requesting that...

  17. Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India.

    PubMed

    Devpura, Bhanu; Bhadesia, Pranav; Nimbalkar, Somashekhar; Desai, Sandeep; Phatak, Ajay

    2016-01-01

    Objective . We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods . Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results . The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions . The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.

  18. The pattern of clinical advice sought by general practitioners from a medical consultant in clinical biochemistry.

    PubMed Central

    Bhatnagar, D

    1997-01-01

    Clinical biochemistry departments can be a valuable source of clinical advice for further investigations and the need for referral to specialist clinics. This paper outlines the pattern of clinical advice sought by general practitioners in a district hospital setting, and addresses some of the issues regarding seeking such advice and the implications for continuing medical education and training. PMID:9196966

  19. Comparative trial of the WHO ASSIST-linked brief intervention and simple advice for substance abuse in primary care.

    PubMed

    Assanangkornchai, Sawitri; Nima, Patimoh; McNeil, Edward B; Edwards, J Guy

    2015-12-01

    To help decrease the burden of substance-related problems, the World Health Organization developed the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) - a sensitive screening questionnaire to help identify misuse of alcohol and other substances - linked to Brief Intervention (BI). This paper compares the effectiveness of the ASSIST followed either by its linked BI or by simple advice (SA). The trial was conducted in southern Thailand. The ASSIST was used to screen patients attending primary care units and categorise them into 'low-risk', 'moderate-risk' and 'high-risk' groups. Patients at 'moderate-risk' were randomised to receive ASSIST-linked BI (n=120) or SA (n=116). The outcome measures were changes in the ASSIST-Specific Substance Involvement Scores (ASSIST-SSIS), ASSIST-Total Substance Involvement Scores (ASSIST-TSIS) and proportions of patients whose scores at three and six months had decreased from the 'moderate-risk' to 'low-risk' category. 147 patients (72 BI; 75 SA) completed the six-month trial. There were significant reductions in both ASSIST-SSIS and ASSIST-TSIS, with no significant difference between groups. The percentages of patients converted to the 'low-risk' category were 36.7% and 38.8% at month 3, and 53.3% and 53.4% at month 6, for the BI and SA groups, respectively. In conclusion, in primary care administering the ASSIST and telling patients their score, followed either by formal brief intervention or simple advice, are equally effective in decreasing substance use for up to six months. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Evaluation of infection control advice for patients at risk of chemotherapy-induced neutropenia in 2 pediatric oncology centers: Cape Town, South Africa, and Newcastle-Upon-Tyne, UK.

    PubMed

    Woolner, Andrea Forman; Davidson, Alan; Skinner, Rod; King, Derek

    2012-02-01

    Childhood cancers are treated with myelotoxic chemotherapy. Resultant neutropenia can lead to life-threatening infections. There is no consistent guidance on infection control precautions for neutropenic patients who are not yet febrile or infected. Although it is not possible to eradicate infection risk, it is conceivable that the risk could be reduced by effective infection prevention. This study compared infection control measures advised to pediatric and adolescent oncology patients receiving chemotherapy in 2 centers (Cape Town, South Africa, and Newcastle, UK). Prospective, observational, cross-sectional surveys of staff and patients/parents were undertaken using standardized, study-specific questionnaires. Seventy-eight staff and 56 patients/parents participated. Precautions advised in Newcastle were significantly different to Cape Town (all P < .05), except both agreed inpatient isolation was unnecessary. Over 40% of patients/parents felt isolation was important (P < .01). In Cape Town, staff and patients had similar views. In Newcastle, patients/parents had stricter opinions on particular precautions than staff, for example, attending school, playing outside and avoiding busy places (P < .01). Patient/parent responses were similar between centers. Over 90% of staff felt advising patients/parents about hand washing was important. Currently infection prevention advice is inconsistent. Further research is needed to elucidate effective guidance for infection prevention in pediatric neutropenic patients.

  1. Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results—A Service Quality Improvement Study

    PubMed Central

    Bowman, Brent; Smith, Scott

    2010-01-01

    Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation

  2. Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results-A Service Quality Improvement Study.

    PubMed

    Bowman, Brent; Smith, Scott

    2010-01-01

    Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff.DirectConnect-the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone-focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time.How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is "one-number" convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times.The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation-making no

  3. Localized prostate cancer treatment decision-making information online: improving its effectiveness and dissemination for nonprofit and government-supported organizations.

    PubMed

    Silk, Kami J; Perrault, Evan K; Nazione, Samantha; Pace, Kristin; Hager, Polly; Springer, Steven

    2013-12-01

    The current study reports findings from evaluation research conducted to identify how online prostate cancer treatment decision-making information can be both improved and more effectively disseminated to those who need it most. A multi-method, multi-target approach was used and guided by McGuire's Communication Matrix Model. Focus groups (n = 31) with prostate cancer patients and their family members, and in-depth interviews with physicians (n = 8), helped inform a web survey (n = 89). Results indicated that physicians remain a key information source for medical advice and the Internet is a primary channel used to help make informed prostate cancer treatment decisions. Participants reported a need for more accessible information related to treatment options and treatment side effects. Additionally, physicians indicated that the best way for agencies to reach them with new information to deliver to patients is by contacting them directly and meeting with them one-on-one. Advice for organizations to improve their current prostate cancer web offerings and further ways to improve information dissemination are discussed.

  4. [The role of science in policy making--EuSANH-ISA project, framework for science advice for health].

    PubMed

    Cianciara, Dorota; Piotrowicz, Maria; Bielska-Lasota, Magdalena; Wysocki, Mirosław J

    2012-01-01

    Governments and other authorities (including MPs) should be well informed on issues of science and technology. This is particularly important in the era of evidence-based practice. This implies the need to get expert advice. The process by which scientific knowledge is transmitted, along with proposals how to solve the problem, is called science advice. The main aim of the article is to discuss the issue of science advice--definitions, interaction between science and policymaking, and its position in contemporary policies. The second aim is to present European Science Advisory Network for Health (EuSANH), EuSANH-ISA project, and framework for science advice for health which was developed by participants. Furthermore, the role of civil society in decision-making process and science advice is also discussed. Interaction between scientists and policy-makers are described in terms of science-push approach (technocratic model), policy-pull (decisionistic) and simultaneous push-pull approach (pragmatic). The position of science advice is described in historical perspective from the 50s, especially in the last two decades. Description relies to USA, Canada and UK. Principles of scientific advice to government (Government Office for Science, UK) are quoted. Some important documents related to science advice in EU and UN are mentioned. EuSANH network is described as well as EuSANH-ISA project, with its objectives and outcomes. According to findings of this project, the process of science advice for health should follow some steps: framing the issue to be covered; planning entire process leading to the conclusion; drafting the report; reviewing the report and revision; publishing report and assessing the impact on policy.

  5. Teachable moments for health behavior change and intermediate patient outcomes.

    PubMed

    Flocke, Susan A; Clark, Elizabeth; Antognoli, Elizabeth; Mason, Mary Jane; Lawson, Peter J; Smith, Samantha; Cohen, Deborah J

    2014-07-01

    Teachable moments (TM) are opportunities created through physician-patient interaction and used to encourage patients to change unhealthy behaviors. We examine the effectiveness of TMs to increase patients' recall of advice, motivation to modify behavior, and behavior change. A mixed-method observational study of 811 patient visits to 28 primary care clinicians used audio-recordings of visits to identify TMs and other types of advice in health behavior change talk. Patient surveys assessed smoking, exercise, fruit/vegetable consumption, height, weight, and readiness for change prior to the observed visit and 6-weeks post-visit. Compared to other identified categories of advice (i.e. missed opportunities or teachable moment attempts), recall was greatest after TMs occurred (83% vs. 49-74%). TMs had the greatest proportion of patients change in importance and confidence and increase readiness to change; however differences were small. TMs had greater positive behavior change scores than other categories of advice; however, this pattern was statistically non-significant and was not observed for BMI change. TMs have a greater positive influence on several intermediate markers of patient behavior change compared to other categories of advice. TMs show promise as an approach for clinicians to discuss behavior change with patients efficiently and effectively. Copyright © 2014. Published by Elsevier Ireland Ltd.

  6. An fMRI and effective connectivity study investigating miss errors during advice utilization from human and machine agents.

    PubMed

    Goodyear, Kimberly; Parasuraman, Raja; Chernyak, Sergey; de Visser, Ewart; Madhavan, Poornima; Deshpande, Gopikrishna; Krueger, Frank

    2017-10-01

    As society becomes more reliant on machines and automation, understanding how people utilize advice is a necessary endeavor. Our objective was to reveal the underlying neural associations during advice utilization from expert human and machine agents with fMRI and multivariate Granger causality analysis. During an X-ray luggage-screening task, participants accepted or rejected good or bad advice from either the human or machine agent framed as experts with manipulated reliability (high miss rate). We showed that the machine-agent group decreased their advice utilization compared to the human-agent group and these differences in behaviors during advice utilization could be accounted for by high expectations of reliable advice and changes in attention allocation due to miss errors. Brain areas involved with the salience and mentalizing networks, as well as sensory processing involved with attention, were recruited during the task and the advice utilization network consisted of attentional modulation of sensory information with the lingual gyrus as the driver during the decision phase and the fusiform gyrus as the driver during the feedback phase. Our findings expand on the existing literature by showing that misses degrade advice utilization, which is represented in a neural network involving salience detection and self-processing with perceptual integration.

  7. Development of an integrated electronic platform for patient self-report and management of adverse events during cancer treatment.

    PubMed

    Holch, P; Warrington, L; Bamforth, L C A; Keding, A; Ziegler, L E; Absolom, K; Hector, C; Harley, C; Johnson, O; Hall, G; Morris, C; Velikova, G

    2017-09-01

    Significant adverse events (AE) during cancer therapy disrupt treatment and escalate to emergency admissions. Approaches to improve the timeliness and accuracy of AE reporting may improve safety and reduce health service costs. Reporting AE via patient reported outcomes (PROs), can improve clinician-patient communication and making data available to clinicians in 'real-time' using electronic PROs (ePROs) could potentially transform clinical practice by providing easily accessible records to guide treatment decisions. This manuscript describes the development of eRAPID (electronic patient self-Reporting of Adverse-events: Patient Information and aDvice) is a National Institute for Health Research-funded programme, a system for patients to self-report and manage AE online during and after cancer treatment. A multidisciplinary team of IT experts, staff and patients developed using agile principles a secure web application interface (QStore) between an existing online questionnaire builder (QTool) displaying real-time ePRO data to clinicians in the electronic patient record at Leeds Teaching Hospitals NHS Trust. Hierarchical algorithms were developed corresponding to Common Terminology Criteria for Adverse Events grading using the QTool question dependency function. Patient advocates (N = 9), patients (N = 13), and staff (N = 19) usability tested the system reporting combinations of AE. The eRAPID system allows patients to report AE from home on PC, tablet or any web enabled device securely during treatment. The system generates immediate self-management advice for low or moderate AE and for severe AE advice to contact the hospital immediately. Clinicians can view patient AE data in the electronic patient record and receive email notifications when patients report severe AE. Evaluation of the system in a randomised controlled trial in breast, gynaecological and colorectal cancer patients undergoing systemic therapy is currently underway. To adapt eRAPID for

  8. Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study.

    PubMed

    Reynolds, Andrew N; Mann, Jim I; Williams, Sheila; Venn, Bernard J

    2016-12-01

    Regular physical activity is a cornerstone of diabetes management. We conducted a study to evaluate whether specifying the timing of walking in relation to meals enhances the benefits conferred by current physical activity guidelines. A total of 41 adults with type 2 diabetes mellitus (mean ± SD age 60 ± 9.9 years; mean diabetes duration 10 years) participated in this randomised, crossover study. Randomisation was by a computer-generated protocol. For periods of 2 weeks, advice to walk 30 min each day was compared with advice to walk for 10 min after each main meal. Both sets of advice met current physical activity guidelines for people with type 2 diabetes mellitus. Physical activity was measured by accelerometry over the full intervention, and glycaemia was measured using continuous glucose monitoring in 5 min intervals over 7 days. The primary outcome of postprandial glycaemia was assessed during the 3 h after a meal by the incremental area under the blood glucose curve (iAUC). The iAUC was significantly lower when participants walked after meals compared with on a single daily occasion (ratio of geometric means 0.88, 95% CI 0.78, 0.99). The improvement was particularly striking after the evening meal (0.78, 95% CI 0.67, 0.91) when the most carbohydrate was consumed and sedentary behaviours were highest. One participant died during the 30 day washout period between interventions, but participation in this study was not judged to contribute to this unfortunate event. The benefits relating to physical activity following meals suggest that current guidelines should be amended to specify post-meal activity, particularly when meals contain a substantial amount of carbohydrate. ACTRN12613000832774 FUNDING: : This study was supported by grants from the University of Otago and the New Zealand Artificial Limb Service. Glycated albumin reagents were provided by Asahi Kasei.

  9. [Scientific advice by the national and European approval authorities concerning advanced therapy medicinal products].

    PubMed

    Jost, Nils; Schüssler-Lenz, Martina; Ziegele, Bettina; Reinhardt, Jens

    2015-11-01

    The aim of scientific advice is to support pharmaceutical developers in regulatory and scientific questions, thus facilitating the development of safe and efficacious new medicinal products. Recent years have shown that the development of advanced therapy medicinal products (ATMPs) in particular needs a high degree of regulatory support. On one hand, this is related to the complexity and heterogeneity of this group of medicinal products and on the other hand due to the fact that mainly academic research institutions and small- and medium-sized enterprises (SMEs) are developing ATMPs. These often have limited regulatory experience and resources. In 2009 the Paul-Ehrlich-Institut (PEI) initiated the Innovation Office as a contact point for applicants developing ATMPs. The mandate of the Innovation Office is to provide support on regulatory questions and to coordinate national scientific advice meetings concerning ATMPs for every phase in drug development and especially with view to the preparation of clinical trial applications. On the European level, the Scientific Advice Working Party (SAWP) of the Committee for Medicinal Products for Human Use (CHMP) of the European Medicinal Agency (EMA) offers scientific advice. This article describes the concepts of national and EMA scientific advice concerning ATMPs and summarizes the experience of the last six years.

  10. THE GHOST IN THE MACHINE? THE VALUE OF EXPERT ADVICE IN THE PRODUCTION OF EVIDENCE-BASED GUIDANCE: A MIXED METHODS STUDY OF THE NICE INTERVENTIONAL PROCEDURES PROGRAMME.

    PubMed

    Oyebode, Oyinlola; Patrick, Hannah; Walker, Alexander; Campbell, Bruce; Powell, John

    2016-01-01

    The aim of this study was to determine the aspects of expert advice that decision makers find most useful in the development of evidence-based guidance and to identify the characteristics of experts providing the most useful advice. First, semi-structured interviews were conducted with seventeen members of the Interventional Procedures Advisory Committee of the UK's National Institute of Health and Care Excellence. Interviews examined the usefulness of expert advice during guidance development. Transcripts were analyzed inductively to identify themes. Second, data were extracted from 211 experts' questionnaires for forty-one consecutive procedures. Usefulness of advice was scored using an index developed through the qualitative work. Associations between usefulness score and characteristics of the expert advisor were investigated using univariate and multivariate analyses. Expert opinion was seen as a valued complement to empirical evidence, providing context and tacit knowledge unavailable in published literature, but helpful for interpreting it. Interviewees also valued advice on the training and experience required to perform a procedure, on patient selection criteria and the place of a procedure within a clinical management pathway. Limitations of bias in expert opinion were widely acknowledged and skepticism expressed regarding the anecdotal nature of advice on safety or efficacy outcomes. Quantitative analysis demonstrated that the most useful advice was given by clinical experts with direct personal experience of the procedure, particularly research experience. Evidence-based guidance production is often characterized as a rational, pipeline process. This ignores the valuable role that expert opinion plays in guidance development, complementing and supporting the interpretation of empirical data.

  11. Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial

    PubMed Central

    Cheng, Shi-Hui; Ismail, Amin; Anthony, Joseph; Ng, Ooi Chuan; Hamid, Azizah Abdul; Barakatun-Nisak, Mohd Yusof

    2015-01-01

    Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (−1.16 versus +3.91), reduced HOMA-IR (−1.09 versus +1.34), and increased QUICKI (+0.05 versus −0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (−0.76% versus −0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes. PMID:26713097

  12. Eight Weeks of Cosmos caudatus (Ulam Raja) Supplementation Improves Glycemic Status in Patients with Type 2 Diabetes: A Randomized Controlled Trial.

    PubMed

    Cheng, Shi-Hui; Ismail, Amin; Anthony, Joseph; Ng, Ooi Chuan; Hamid, Azizah Abdul; Barakatun-Nisak, Mohd Yusof

    2015-01-01

    Objectives. Optimizing glycemic control is crucial to prevent type 2 diabetes related complications. Cosmos caudatus is reported to have promising effect in improving plasma blood glucose in an animal model. However, its impact on human remains ambiguous. This study was carried out to evaluate the effectiveness of C. caudatus on glycemic status in patients with type 2 diabetes. Materials and Methods. In this randomized controlled trial with two-arm parallel-group design, a total of 101 subjects with type 2 diabetes were randomly allocated to diabetic-ulam or diabetic controls for eight weeks. Subjects in diabetic-ulam group consumed 15 g of C. caudatus daily for eight weeks while diabetic controls abstained from taking C. caudatus. Both groups received the standard lifestyle advice. Results. After 8 weeks of supplementation, C. caudatus significantly reduced serum insulin (-1.16 versus +3.91), reduced HOMA-IR (-1.09 versus +1.34), and increased QUICKI (+0.05 versus -0.03) in diabetic-ulam group compared with the diabetic controls. HbA1C level was improved although it is not statistically significant (-0.76% versus -0.37%). C. caudatus was safe to consume. Conclusions. C. caudatus supplementation significantly improves insulin resistance and insulin sensitivity in patients with type 2 diabetes.

  13. Function after spinal treatment, exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery.

    PubMed

    McGregor, A H; Doré, C J; Morris, T P; Morris, S; Jamrozik, K

    2010-01-26

    The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period. This trial will test the hypothesis that functional outcome following two common spinal operations can be improved by a programme of post-operative rehabilitation that combines professional support and advice with graded active exercise and/or an educational booklet based on evidence-based messages and advice. The study design is a multi-centre, factorial, randomised controlled trial with patients stratified by surgeon and operative procedure. The trial will compare the effectiveness and cost-effectiveness of a rehabilitation programme and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression, each compared with "usual care"using a 2 x 2 factorial design. The trial will create 4 sub-groups; rehabilitation-only, booklet-only, rehabilitation-plus-booklet, and usual care only. The trial aims to recruit 344 patients, which equates to 86 patients in each of the four sub-groups. All patients will be assessed for functional ability (through the Oswestry Disability Index - a disease specific functional questionnaire), pain (using visual analogue scales), and satisfaction pre-operatively and then at 6 weeks, 3, 6 and 9 months and 1 year post-operatively. This will be complemented by a formal analysis of cost-effectiveness. This trial will determine whether the outcome of spinal surgery can be enhanced by either a post-operative rehabilitation programme or an

  14. Smartphone Mobile Application Delivering Personalized, Real-Time Sun Protection Advice: A Randomized Clinical Trial

    PubMed Central

    Buller, David B.; Berwick, Marianne; Lantz, Kathy; Buller, Mary Klein; Shane, James; Kane, Ilima; Liu, Xia

    2014-01-01

    Importance Mobile smart phones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications, they can access remote databases, track time and location, and integrate user input to provide tailored health information. Objective A smart phone mobile application providing personalized, real-time sun protection advice was evaluated in a randomized trial. Design The trial was conducted in 2012 and had a randomized pretest-posttest controlled design with a 10-week follow-up. Setting Data was collected from a nationwide population-based survey panel. Participants The trial enrolled a sample of n=604 non-Hispanic and Hispanic adults from the Knowledge Panel® aged 18 or older who owned an Android smart phone. Intervention The mobile application provided advice on sun protection (i.e., protection practices and risk of sunburn) and alerts (to apply/reapply sunscreen and get out of the sun), hourly UV Index, and vitamin D production based on the forecast UV Index, phone's time and location, and user input. Main Outcomes and Measures Percent of days using sun protection and time spent outdoors (days and minutes) in the midday sun and number of sunburns in the past 3 months were collected. Results Individuals in the treatment group reported more shade use but less sunscreen use than controls. Those who used the mobile app reported spending less time in the sun and using all protection behaviors combined more. Conclusions and Relevance The mobile application improved some sun protection. Use of the mobile application was lower than expected but associated with increased sun protection. Providing personalized advice when and where people are in the sun may help reduce sun exposure. PMID:25629710

  15. Why do women not adhere to advice on maternal referral in rural Tanzania? Narratives of women and their family members.

    PubMed

    Pembe, Andrea B; Mbekenga, Columba K; Olsson, Pia; Darj, Elisabeth

    2017-01-01

    In most low-income countries, many women with high-risk pregnancies and complications do not reach the referral hospitals despite the provision of referral advice. To explore how antenatal maternal referral advice is understood and handled in a rural Tanzanian community. Individual in-depth interviews were conducted with six women who did not go to hospital and 13 people who were involved in the referral advice. Narrative analysis was used to describe and create meanings out of the decision-making process. In all interviews, not following the referral advice was greatly influenced by close family members. Three main traits of how referral advice was understood emerged: convinced referral is not necessary, accepting referral advice but delayed by others, and passive and moving with the wind. The main reasons given for declining the referral advice included discrediting midwives' advice, citing previous successful deliveries despite referral advice; being afraid of undergoing surgery; lack of support for care of siblings at home; and high costs incurred during referral. Declining maternal referral advice centred around the pregnant women's position and their dependence on the family members around them, with a decreased ability to show autonomy. If they were socially and economically empowered, women could positively influence decision making during maternal referrals.

  16. 77 FR 47880 - U.S.-Trans-Pacific Partnership Free Trade Agreement Including Canada and Mexico: Advice on the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-10

    ....S.-Trans-Pacific Partnership Free Trade Agreement Including Malaysia: Advice on Probable Economic... Partnership Free Trade Agreement Including Canada and Mexico: Advice on the Probable Economic Effect of... Mexico: Advice on the Probable Economic Effect of Providing Duty-Free Treatment for Imports. DATES...

  17. The Use of Living Organisms in Schools: Advice and Support from Science Inspectors.

    ERIC Educational Resources Information Center

    Lock, Roger

    1996-01-01

    Focuses on the advice and support from science inspectors or advisers with respect to the use of living organisms in schools. Reports that advice, support, and encouragement in the use of living organisms in teaching was widely available at the time of this study and schools have a great deal to lose from the shrinkage in the advisory service.…

  18. 76 FR 66135 - Investment Advice-Participants and Beneficiaries

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-25

    ... ``computer model'' requirement (requiring use of a certified computer model). Both types of arrangements also... that use fee-leveling] or paragraph (b)(4) [describing investment advice arrangements that use computer...-leveling and computer modeling provisions of the final rule. We note that, as also reflected in paragraph...

  19. Variations among Primary Care Physicians in Exercise Advice, Imaging, and Analgesics for Musculoskeletal Pain: Results from a Factorial Experiment

    PubMed Central

    Maserejian, Nancy N.; Fischer, Michael A.; Trachtenberg, Felicia L.; Yu, Jing; Marceau, Lisa D.; McKinlay, John B.; Katz, Jeffrey N.

    2014-01-01

    Objective To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider. Methods We conducted a balanced factorial experiment among primary care physicians in the U.S. Physicians (N=192) viewed two videos of different patients (actors) presenting with pain: (1) undiagnosed sciatica symptoms or (2) diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status (SES), race, physician gender and experience (<20 vs. ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the ACR, American Pain Society, and clinical expert consensus. Results Despite current recommendations, under one-third of physicians would provide exercise advice (30.2% for osteoarthritis, 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P<0.01), and to prescribe NSAIDs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment. Conclusion Physician education on disease management recommendations regarding exercise and analgesics, and implementation of quality measures may be useful, particularly for physicians with more years in practice. PMID:24376249

  20. The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse.

    PubMed

    Due, Ulla; Brostrøm, Søren; Lose, Gunnar

    2016-07-01

    We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. Nutritional advice and treatment by dietitians to patients with amyotrophic lateral sclerosis/motor neurone disease: a survey of current practice in England, Wales, Northern Ireland and Canada.

    PubMed

    Rio, A; Cawadias, E

    2007-02-01

    The management of amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) has shifted from an attitude of nihilism to treatments that prolong survival and offer hope. Nutrition is an integral component of ALS/MND care requiring coordination among acute and community multi-disciplinary teams (MDT). Evidence-based nutrition guidelines exist for this patient group but their use among dietitians is unknown. The aim of this study was to survey the knowledge, practice and guideline use of dietitians working in ALS/MND centres/clinics across England, Wales, Northern Ireland (EWNI) and Canada. Dietetic contact details were obtained from the Motor Neurone Disease Association (MNDA) and the ALS Society of Canada (ALSSC) websites. Telephone interviews were conducted with 23 dietitians using a standardized questionnaire. Multi-disciplinary team membership was high (78%). Only 22% dietitians had >4-years experience in ALS/MND care. Dietitians reported using body weight, percentage weight loss (PWL) and body mass index (BMI) to assess nutritional status. Equations used to estimate energy and protein requirements differed. Most frequent dietary advice was high calorie, texture modification and prescription nutritional supplements. Artificial nutrition and hydration (ANH) was discussed when patients developed dysphagia, energy intake was inadequate, weight loss of 10% or forced vital capacity (FVC) was reduced. A percutaneous endoscopic gastrostomy (PEG) service was available at all clinics/centres. Nutritional assessment techniques and dietary advice should be standardized. Dietetic collaboration at national and international level is recommended to reduce professional isolation. Training and support in ALS/MND nutrition should be made available as part of post-dietetic registration. Further dietetic research is required to stimulate nutritional care.

  2. Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial.

    PubMed

    Bourdel-Marchasson, Isabelle; Blanc-Bisson, Christelle; Doussau, Adélaïde; Germain, Christine; Blanc, Jean-Frédéric; Dauba, Jérôme; Lahmar, Cyril; Terrebonne, Eric; Lecaille, Cédric; Ceccaldi, Joël; Cany, Laurent; Lavau-Denes, Sandrine; Houede, Nadine; Chomy, François; Durrieu, Jessica; Soubeyran, Pierre; Senesse, Pierre; Chene, Geneviève; Fonck, Mariane

    2014-01-01

    We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17-23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (p<0.01). At the second visit, the energy target was achieved in 57 (40.4%) patients and the protein target in 66 (46.8%) with the intervention compared respectively to 13 (13.5%) and 20 (20.8%) in the controls. Death occurred during the first year in 143 patients (42.56%), without difference according to the intervention (p = 0.79). No difference in nutritional status changes was found. Response to chemotherapy was also similar between the groups. Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes. Cancer cachexia antianabolism may explain this lack of effect. ClinicalTrials.gov NCT

  3. Association between Precipitation Upstream of a Drinking Water Utility and Nurse Advice Calls Relating to Acute Gastrointestinal Illnesses

    PubMed Central

    Tornevi, Andreas; Axelsson, Gösta; Forsberg, Bertil

    2013-01-01

    Background The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation. Methods We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0–21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens. Results The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5–6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns. Conclusion An increase in nurse advice calls relating to gastrointestinal illnesses around 5–6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment. PMID:23875009

  4. Association between precipitation upstream of a drinking water utility and nurse advice calls relating to acute gastrointestinal illnesses.

    PubMed

    Tornevi, Andreas; Axelsson, Gösta; Forsberg, Bertil

    2013-01-01

    The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation. We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0-21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens. The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5-6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns. An increase in nurse advice calls relating to gastrointestinal illnesses around 5-6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment.

  5. 7 CFR 1468.33 - Performance based upon advice or action of representatives of CCC.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Performance based upon advice or action of representatives of CCC. 1468.33 Section 1468.33 Agriculture Regulations of the Department of Agriculture... representatives of CCC. If a participant relied upon the advice or action of any authorized representative of CCC...

  6. 7 CFR 1468.33 - Performance based upon advice or action of representatives of CCC.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Performance based upon advice or action of representatives of CCC. 1468.33 Section 1468.33 Agriculture Regulations of the Department of Agriculture... representatives of CCC. If a participant relied upon the advice or action of any authorized representative of CCC...

  7. 7 CFR 1468.33 - Performance based upon advice or action of representatives of CCC.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Performance based upon advice or action of representatives of CCC. 1468.33 Section 1468.33 Agriculture Regulations of the Department of Agriculture... representatives of CCC. If a participant relied upon the advice or action of any authorized representative of CCC...

  8. 7 CFR 1468.33 - Performance based upon advice or action of representatives of CCC.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Performance based upon advice or action of representatives of CCC. 1468.33 Section 1468.33 Agriculture Regulations of the Department of Agriculture... representatives of CCC. If a participant relied upon the advice or action of any authorized representative of CCC...

  9. 7 CFR 1468.33 - Performance based upon advice or action of representatives of CCC.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Performance based upon advice or action of representatives of CCC. 1468.33 Section 1468.33 Agriculture Regulations of the Department of Agriculture... representatives of CCC. If a participant relied upon the advice or action of any authorized representative of CCC...

  10. Physician Advice for e-Cigarette Use.

    PubMed

    Kollath-Cattano, Christy; Thrasher, James F; Osman, Amira; Andrews, Jeannette O; Strayer, Scott M

    To determine characteristics of smokers discussing e-cigarette use with their physician and receiving recommendations from their physician to use e-cigarettes for smoking cessation. US adult smokers who had visited a physician in the previous 12 months (n = 2671) were surveyed. Logistic generalized estimating equation models were used to assess the characteristics of smokers who (1) talked to a physician about e-cigarettes, and (2) received physician advice to use e-cigarettes for smoking cessation. 15% (n = 406) of smokers who visited a physician talked with their physician about e-cigarettes. Among those asked whether their physician recommend e-cigarettes for smoking cessation (n = 257), 61% responded affirmatively. Current e-cigarette users were more likely to talk to their physicians about e-cigarettes (nondaily users vs never users: OR, 2.70; 95% CI, 1.79-4.05; daily users vs never users: OR, 4.29; 95% CI, 2.34-7.84) and have their physician recommend e-cigarettes for smoking cessation (daily users vs never users: OR, 9.40; 95% CI, 2.54-34.71). The majority of smokers who talk to their physician about e-cigarettes report that they received advice to use e-cigarettes to quit smoking, despite limited evidence for their efficacy. More studies are needed to better understand e-cigarette recommendations in clinical settings. © Copyright 2016 by the American Board of Family Medicine.

  11. Developing leaflets to give dental health advice to Aboriginal families with young children.

    PubMed

    Blinkhorn, Fiona; Wallace, Janet; Smith, Leanne; Blinkhorn, Anthony S

    2014-08-01

    Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality. © 2014 FDI World Dental Federation.

  12. Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: a cross-sectional study

    PubMed Central

    Klemenc-Ketis, Zalika; Bulc, Mateja; Kersnik, Janko

    2011-01-01

    Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age  [± standard deviation] 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention. PMID:21495204

  13. Improving the use of pharmaceuticals through patient and community level interventions.

    PubMed

    Homedes, N; Ugalde, A

    2001-01-01

    Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients' compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations.

  14. Evaluating Health Advice in a Web 2.0 Environment: The Impact of Multiple User-Generated Factors on HIV Advice Perceptions.

    PubMed

    Walther, Joseph B; Jang, Jeong-Woo; Hanna Edwards, Ashley A

    2018-01-01

    Unlike traditional media, social media systems often present information of different types from different kinds of contributors within a single message pane, a juxtaposition of potential influences that challenges traditional health communication processing. One type of social media system, question-and-answer advice systems, provides peers' answers to health-related questions, which yet other peers read and rate. Responses may appear good or bad, responders may claim expertise, and others' aggregated evaluations of an answer's usefulness may affect readers' judgments. An experiment explored how answer feasibility, expertise claims, and user-generated ratings affected readers' assessments of advice about anonymous HIV testing. Results extend the heuristic-systematic model of persuasion (Chaiken, 1980) and warranting theory (Walther & Parks, 2002). Information that is generally associated with both systematic and heuristic processes influenced readers' evaluations. Moreover, content-level cues affected judgments about message sources unexpectedly. When conflicting cues were present, cues with greater warranting value (consensus user-generated ratings) had greater influence on outcomes than less warranted cues (self-promoted expertise). Findings present a challenge to health professionals' concerns about the reliability of online health information systems.

  15. Advice offered by practitioners of complementary/ alternative medicine: an important ethical issue.

    PubMed

    Ernst, E

    2009-12-01

    The current popularity of complementary/alternative medicine (CAM) generates many challenges to medical ethics. The one discussed here is the advice offered by CAM practitioners. Using selected examples, the author tries to demonstrate that some of the advice issued through the popular media or provided by acupuncturists, chiropractors, herbalists, homeopaths, pharmacists, and doctors is misleading or dangerous. This, the author argues, can impinge on the main principle of medical ethics: beneficence, nonmaleficence, and autonomy. We should work toward correcting this deplorable situation.

  16. Effects of yoga, strength training and advice on back pain: a randomized controlled trial.

    PubMed

    Brämberg, Elisabeth Björk; Bergström, Gunnar; Jensen, Irene; Hagberg, Jan; Kwak, Lydia

    2017-03-29

    Among the working population, non-specific low-back pain and neck pain are one of the most common reasons for sickness absenteeism. The aim was to evaluate the effects of an early intervention of yoga - compared with strength training or evidence-based advice - on sickness absenteeism, sickness presenteeism, back and neck pain and disability among a working population. A randomized controlled trial was conducted on 159 participants with predominantly (90%) chronic back and neck pain. After screening, the participants were randomized to kundalini yoga, strength training or evidence-based advice. Primary outcome was sickness absenteeism. Secondary outcomes were sickness presenteeism, back and neck pain and disability. Self-reported questionnaires and SMS text messages were completed at baseline, 6 weeks, 6 and 12 months. The results did not indicate that kundalini yoga and strength training had any statistically significant effects on the primary outcome compared with evidence-based advice. An interaction effect was found between adherence to recommendations and sickness absenteeism, indicating larger significant effects among the adherers to kundalini yoga versus evidence-based advice: RR = 0.47 (CI 0.30; 0.74, p = 0.001), strength training versus evidence-based advice: RR = 0.60 (CI 0.38; 0.96, p = 0.032). Some significant differences were also found for the secondary outcomes to the advantage of kundalini yoga and strength training. Guided exercise in the forms of kundalini yoga or strength training does not reduce sickness absenteeism more than evidence-based advice alone. However, secondary analyses reveal that among those who pursue kundalini yoga or strength training at least two times a week, a significantly reduction in sickness absenteeism was found. Methods to increase adherence to treatment recommendations should be further developed and applied in exercise interventions. Clinicaltrials.gov NCT01653782, date of registration: June, 28

  17. The effect of pre-travel advice on sexual risk behavior abroad: a systematic review.

    PubMed

    Croughs, Mieke; Remmen, Roy; Van den Ende, Jef

    2014-01-01

    Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad. In September 2012, a systematic analysis and meta-analysis of peer reviewed literature were performed on the relation between pre-travel STI advice for travelers and sexual risk behavior abroad. Primary outcome measure consisted of the number of travelers with a new sexual partner abroad; secondary outcome measure entailed the proportion of consistent condom use. Six studies were identified for inclusion in the review, of which three clinical trials on the effect of a motivational intervention compared to standard pre-travel STI advice qualified for the meta-analysis. Two of these trials were performed in US marines deployed abroad and one in visitors of a travel clinic. The extensive motivational training program of the marines led to a reduction in sexual risk behavior, while the brief motivational intervention in the travel clinic was not superior to standard advice. The meta-analysis established no overall effect on risk behavior abroad. No clinical trials on the effect of a standard pre-travel STI discussion were found, but a cohort study reported that no relation was found between the recall of a nonstructured pre-travel STI discussion and sexual risk behavior, while the recall of reading the STI information appeared to be related to more consistent condom use. Motivational pre-travel STI intervention was not found to be superior to standard STI advice, while no clinical trials on the effect of standard pre-travel STI advice were found. © 2013 International Society of Travel Medicine.

  18. Survey of Australian practitioners' provision of healthy lifestyle advice to clients who are obese.

    PubMed

    Ashby, Samantha; James, Carole; Plotnikoff, Ronald; Collins, Clare; Guest, Maya; Kable, Ashley; Snodgrass, Suzanne

    2012-06-01

    Obesity is a global issue, with healthcare practitioners increasingly involved in clinical interactions with people who are overweight or obese. These interactions are opportunities to provide evidence-based healthy lifestyle advice, and impact on public health. This study used a cross-sectional survey of Australian healthcare practitioners to investigate what influenced the provision of healthy lifestyle advice to obese and overweight clients. A modified theory of planned behavior was used to explore knowledge translation processes. Knowledge translation was linked to three factors: (i) a healthcare practitioner's education and confidence in the currency of their knowledge; (ii) personal characteristics - whether they accepted that providing this advice was within their domain of practice; and (iii) the existence of organizational support structures, such as access to education, and best practice guidelines. To fulfill the potential role healthcare practitioners can play in the provision of evidence-based health promotion advice requires organizations to provide access to practice guidelines and to instill a belief in their workforce that this is a shared professional domain. © 2012 Blackwell Publishing Asia Pty Ltd.

  19. The role of family nutritional support in Japanese patients with type 2 diabetes mellitus.

    PubMed

    Watanabe, Koin; Kurose, Takeshi; Kitatani, Naomi; Yabe, Daisuke; Hishizawa, Masahiro; Hyo, Takanori; Seino, Yutaka

    2010-01-01

    We investigated the role of family support in glycemic control by nutritional self-care behavior of Japanese patients with type 2 diabetes. One hundred twelve Japanese out-patients with type 2 diabetes were recruited for the study at Kansai Electric Power Hospital. Interviews were conducted and HbA1c and triglyceride levels were measured. HbA1c levels were significantly related to family nutritional support. Patients under 60 years old with family nutritional support showed significantly lower HbA1c than patients without family support (p<0.05). Female patients with family support showed significantly lower HbA1c than those without family support (p<0.05). In addition, male patients with family support showed significantly lower triglyceride levels than those without family support (p<0.05). In male patients, those who were supported by cooking or buying light meals showed significantly lower HbA1c than those who were supported by advice or encouragement (p<0.05). The frequency of support (every day, 2-3 days, 1 week) showed similar outcomes in glycemic control. Patients who appreciate the support and follow the advice showed lower HbA1c (6.88 +/- 0.22%) than (7.43 +/- 0.23%) patients who appreciate the advice but sometimes feel emotional barriers. Family nutritional support is useful in improving metabolic outcome of diabetic patients. Self-care practice in disease management should be carefully adjusted to the family setting of type 2 diabetic patients. Emotional barriers to family support may affect the metabolic consequences, especially in the Japanese elderly.

  20. "Advice to Writers": Students Discuss the Craft of Writing.

    ERIC Educational Resources Information Center

    Aversa, Nicholas J.; Tritt, Michael

    1988-01-01

    Asserts that the "Advice to Writers" project, encouraging students to articulate what they do when they write and to share those perceptions with fellow student writers, is an effective way for students to reflect on the writing process. (MM)

  1. Parents’ Primary Professional Sources of Parenting Advice Moderate Predictors of Parental Attitudes toward Corporal Punishment

    PubMed Central

    Taylor, Catherine A.; McKasson, Sarah; Hoy, Guenevere; DeJong, William

    2016-01-01

    Despite the risk it poses to children’s mental and physical health, approval and use of corporal punishment (CP) remains high in the United States. Informed by the Theory of Planned Behavior, we examined potential predictors of attitudes supportive of CP while assessing the moderating effects of parents’ (N=500) chosen primary professional source of advice regarding child discipline: pediatricians (47.8%), religious leaders (20.8%), mental health professionals (MHPs) (n=18.4%), or other identified professionals (13.0%). We conducted a random-digit-dial telephone survey among parents ages 18 and over within New Orleans, LA. The main outcome measure was derived from the Attitudes Toward Spanking scale (ATS). The main “predictors” were: perceived injunctive norms (i.e., perceived approval of CP by professionals; and by family and friends), perceived descriptive norms of family and friends regarding CP, and expected outcomes of CP use. We used multivariate OLS models to regress ATS scores on the predictor variables for each subset of parents based on their chosen professional source of advice. Perceived approval of CP by professionals was the strongest predictor of parental attitudes supportive of CP, except for those seeking advice from MHPs. Perceived injunctive and descriptive norms of family and friends were important, but only for those seeking advice from pediatricians or religious leaders. Positive expected outcomes of CP mattered, but only for those seeking advice from religious leaders or MHPs. In conclusion, the strength and relevance of variables predicting attitudes toward CP varied according to the professional from which the parent was most likely to seek advice. PMID:28529440

  2. Parents' Primary Professional Sources of Parenting Advice Moderate Predictors of Parental Attitudes toward Corporal Punishment.

    PubMed

    Taylor, Catherine A; McKasson, Sarah; Hoy, Guenevere; DeJong, William

    2017-02-01

    Despite the risk it poses to children's mental and physical health, approval and use of corporal punishment (CP) remains high in the United States. Informed by the Theory of Planned Behavior, we examined potential predictors of attitudes supportive of CP while assessing the moderating effects of parents' (N=500) chosen primary professional source of advice regarding child discipline: pediatricians (47.8%), religious leaders (20.8%), mental health professionals (MHPs) (n=18.4%), or other identified professionals (13.0%). We conducted a random-digit-dial telephone survey among parents ages 18 and over within New Orleans, LA. The main outcome measure was derived from the Attitudes Toward Spanking scale (ATS). The main "predictors" were: perceived injunctive norms (i.e., perceived approval of CP by professionals; and by family and friends), perceived descriptive norms of family and friends regarding CP, and expected outcomes of CP use. We used multivariate OLS models to regress ATS scores on the predictor variables for each subset of parents based on their chosen professional source of advice. Perceived approval of CP by professionals was the strongest predictor of parental attitudes supportive of CP, except for those seeking advice from MHPs. Perceived injunctive and descriptive norms of family and friends were important, but only for those seeking advice from pediatricians or religious leaders. Positive expected outcomes of CP mattered, but only for those seeking advice from religious leaders or MHPs. In conclusion, the strength and relevance of variables predicting attitudes toward CP varied according to the professional from which the parent was most likely to seek advice.

  3. [Evolution of the nutritional status of patients with HIV-AIDS. Effects of socioeconomic situation and dietetic counseling].

    PubMed

    Sánchez Alvarez, M C; Gómez Ramos, M J; Cano Sánchez, A; Pacheco Guevara, R; Nicolás Hernández, M; García Alberola, A

    1998-12-01

    To know HIV-AIDS patient's nutritional status in different infection's condition and their relation with the socioeconomic situation and, in that case, the nutritional condition improvement through the dietetic advice appropriated for each patient. Prospective study of 79 patients with HIV-AIDS diagnostic in any illness's condition and recopilation of anthropometrics and biochemical variables. At the beginning of the study we got data about socioeconomic situation of patient with a scale of 1 to 5 points each variable and an score top of 35. In the survivors we checked, after dietetic advice, the variables at 6 and 12 months by sanitary personal (physician and nurse) who weren't implicated in direct assistance. The study was analyzed by Student "T" for matched data and the simple correlation test. We have objectivated a lost of initial weight over their habitual's with a progressive impairment in different stage of evolution that weren't modified by dietetic advice. We didn't observed significant variations in the biochemical variables included in advances states and in parameters which are usually affected in malnutrition. In the analysis of relation between nutritional condition and socioeconomic factors, it was estimated a lesser score, that was statistically significative, in patients who had a work, family situation and an affective upset positive. The results obtained induce to think that the nutritional advices appropriated for each patient are not related, in our series, with progressive deterioration of anthropometrics variables, neither biochemical parameters fluctuations at 6, 12 months of follow-up. The patient's socioeconomic situation is not influenced by nutritional condition except for the work, affectivity and family environment.

  4. Oral health education (advice and training) for people with serious mental illness.

    PubMed

    Khokhar, Mariam A; Khokhar, Waqqas Ahmad; Clifton, Andrew V; Tosh, Graeme E

    2016-09-08

    . Oral health education compared with standard careWhen 'oral health education' was compared with 'standard care', there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95% CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health educationSimilarly, when 'motivational interview + oral health education' was compared with 'oral health education', there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoringFor this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the 'no monitoring' group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for 'no clinically important change in

  5. The Public Services Job Hunt: Observations and Advice

    ERIC Educational Resources Information Center

    Saunders, Laura

    2014-01-01

    The library science job market is competitive, and library and information science (LIS) students and new graduates often have questions and concerns about how to engage in a successful job hunt. Based on research with employers and interactions with students and alumni, the author offers advice for job-seekers looking for public services…

  6. The traditional food of migrants: Meat, water, and other challenges for dietary advice. An ethnography in Guanajuato, Mexico.

    PubMed

    Smith-Morris, Carolyn

    2016-10-01

    The term "traditional diet" is used variously in public health and nutrition literature to refer to a substantial variety of foodways. Yet it is difficult to draw generalities about dietary tradition for specific ethnic groups. Given the strong association between migration and dietary change, it is particularly important that dietary advice for migrants be both accurate and specific. In this article, I examine the cultural construct of "traditional foods" through mixed method research on diet and foodways among rural farmers in Guanajuato, MX and migrants from this community to other Mexican and U.S. destinations. Findings reveal first, that quantitatively salient terms may contain important variation, and second, that some "traditional" dietary items -like "refresco," "carne," and "agua" - may be used in nutritionally contradictory ways between clinicians and Mexican immigrant patients. Specifically, the term "traditional food" in nutritional advice for Mexican migrants may be intended to promote consumption of fresh produce or less meat; but it may also invoke other foods (e.g., meats or corn), inspire more regular consumption of formerly rare foods (e.g., meats, flavored waters), or set up financially impossible goals (e.g., leaner meats than can be afforded). Salience studies with ethnographic follow up in target populations can promote the most useful and accurate terms for dietary advice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Women and Heart Disease: Sharing Advice from the Heart

    MedlinePlus

    ... page please turn JavaScript on. Feature: Women and Heart Disease Sharing Advice From The Heart Past Issues / Spring 2016 Table of Contents This ... inspired you to get involved in the American Heart Association's Go Red For Women movement and Red ...

  8. Altitude-Related Illness: Advice to Travellers

    PubMed Central

    Crutcher, Rodney A.

    1990-01-01

    Altitude-related medical problems have received much attention in the recent medical literature. Family physicians must be knowledgeable about these problems so that they can give appropriate advice to travellers. The author, a practising family physician, discusses issues arising from both the modest cabin altitudes experienced in modern-day air travel and the greater altitudes experienced by skiers and trekkers, pilots and mountaineers, and lowland adventurers of all sorts. He reviews the process of acclimatization to altitude and the four principal forms of altitude illness. PMID:21233912

  9. Ethics seminars: a best-practice approach to navigating the against-medical-advice discharge.

    PubMed

    Clark, Mark A; Abbott, Jean T; Adyanthaya, Tara

    2014-09-01

    Patients who sign out or choose to leave the emergency department (ED) against medical advice (AMA) present important challenges. The current approach to the complex legal, ethical, and medical challenges that arise when adult patients decline medical care in the ED would benefit from a systematic best-practice strategy to maximize patient care outcomes, minimize legal risk, and reach the optimal ethical standard for this at-risk population. Professional responsibilities generated during an AMA encounter include determination of patient decision-making capacity, balancing protection of patient autonomy with prevention of harm, providing the best alternatives for patients who decline some or all of the proposed plan, negotiating to encourage patients to stay, planning for subsequent care, and documenting what transpired. We present two cases that illustrate key insights into a best-practice approach for emergency physicians (EPs) to address problems arising when patients want or need to leave the ED prior to completion of their care. We propose a practical, systematic framework, "AIMED" (assess, investigate, mitigate, explain, and document), that can be consistently applied in situations where patients consider leaving or do leave before their evaluations and urgent treatment are complete. Our goal is to maximize patient outcomes, minimize legal risk, and encourage a consistent and ethical approach to these vulnerable patients. © 2014 by the Society for Academic Emergency Medicine.

  10. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes.

  11. Institutional Image: How to Define, Improve, Market It.

    ERIC Educational Resources Information Center

    Topor, Robert S.

    Advice for colleges on how to identify, develop, and communicate a positive image for the institution is offered in this handbook. The use of market research techniques to measure image is discussed along with advice on how to improve an image so that it contributes to a unified marketing plan. The first objective is to create and communicate some…

  12. The complexity of patient safety reporting systems in UK dentistry.

    PubMed

    Renton, T; Master, S

    2016-10-21

    Since the 'Francis Report', UK regulation focusing on patient safety has significantly changed. Healthcare workers are increasingly involved in NHS England patient safety initiatives aimed at improving reporting and learning from patient safety incidents (PSIs). Unfortunately, dentistry remains 'isolated' from these main events and continues to have a poor record for reporting and learning from PSIs and other events, thus limiting improvement of patient safety in dentistry. The reasons for this situation are complex.This paper provides a review of the complexities of the existing systems and procedures in relation to patient safety in dentistry. It highlights the conflicting advice which is available and which further complicates an overly burdensome process. Recommendations are made to address these problems with systems and procedures supporting patient safety development in dentistry.

  13. Ostracism Reduces Reliance on Poor Advice from Others during Decision Making.

    PubMed

    Byrne, Kaileigh A; Tibbett, Thomas P; Laserna, Lauren N; Carter-Sowell, Adrienne R; Worthy, Darrell A

    2016-10-01

    Decision-making is rarely context-free, and often both social information and non-social information are weighed into one's decisions. Incorporating information into a decision can be influenced by previous experiences. Ostracism has extensive effects, including taxing cognitive resources and increasing social monitoring. In decision-making situations, individuals are often faced with both objective and social information and must choose which information to include or filter out. How will ostracism affect the reliance on objective and social information during decision-making? Participants ( N =245) in Experiment 1 were randomly assigned to be included or ostracized in a standardized, group task. They then performed a dynamic decision-making task that involved the presentation of either non-social (i.e. biased reward feedback) or social (i.e., poor advice from a previous participant) misleading information. In Experiment 2, participants ( N =105) completed either the ostracism non-social condition or social misleading information condition with explicit instructions stating that the advice given was from an individual who did not partake in the group task. Ostracized individuals relied more on non-social misleading information and performed worse than included individuals. However, ostracized individuals discounted misleading social information and outperformed included individuals. Results of Experiment 2 replicated the findings of Experiment 1. Across two experiments, ostracized individuals were more critical of advice from others, both individuals who may have ostracized them and unrelated individuals. In other words, compared to included individuals, ostracized individuals underweighted advice from another individual, but overweighted non-social information during decision-making. We conclude that when deceptive objective information is present, ostracism results in disadvantageous decision-making.

  14. Ostracism Reduces Reliance on Poor Advice from Others during Decision Making

    PubMed Central

    Byrne, Kaileigh A.; Tibbett, Thomas P.; Laserna, Lauren N.; Carter-Sowell, Adrienne R.; Worthy, Darrell A.

    2016-01-01

    Decision-making is rarely context-free, and often both social information and non-social information are weighed into one’s decisions. Incorporating information into a decision can be influenced by previous experiences. Ostracism has extensive effects, including taxing cognitive resources and increasing social monitoring. In decision-making situations, individuals are often faced with both objective and social information and must choose which information to include or filter out. How will ostracism affect the reliance on objective and social information during decision-making? Participants (N=245) in Experiment 1 were randomly assigned to be included or ostracized in a standardized, group task. They then performed a dynamic decision-making task that involved the presentation of either non-social (i.e. biased reward feedback) or social (i.e., poor advice from a previous participant) misleading information. In Experiment 2, participants (N=105) completed either the ostracism non-social condition or social misleading information condition with explicit instructions stating that the advice given was from an individual who did not partake in the group task. Ostracized individuals relied more on non-social misleading information and performed worse than included individuals. However, ostracized individuals discounted misleading social information and outperformed included individuals. Results of Experiment 2 replicated the findings of Experiment 1. Across two experiments, ostracized individuals were more critical of advice from others, both individuals who may have ostracized them and unrelated individuals. In other words, compared to included individuals, ostracized individuals underweighted advice from another individual, but overweighted non-social information during decision-making. We conclude that when deceptive objective information is present, ostracism results in disadvantageous decision-making. PMID:28469290

  15. Time Advice and Learning Questions in Computer Simulations

    ERIC Educational Resources Information Center

    Rey, Gunter Daniel

    2011-01-01

    Students (N = 101) used an introductory text and a computer simulation to learn fundamental concepts about statistical analyses (e.g., analysis of variance, regression analysis and General Linear Model). Each learner was randomly assigned to one cell of a 2 (with or without time advice) x 3 (with learning questions and corrective feedback, with…

  16. The Impact of Advice Seekers' Need Salience and Doctors' Communication Style on Attitude and Decision Making: A Web-Based Mammography Consultation Role Play.

    PubMed

    Fissler, Tim; Bientzle, Martina; Cress, Ulrike; Kimmerle, Joachim

    2015-09-08

    Patients and advice seekers come to a medical consultation with typical needs, and physicians require adequate communication skills in order to address those needs effectively. It is largely unclear, however, to what extent advice seekers' attitudes toward a medical procedure or their resulting decisions are influenced by a physician's communication that ignores or explicitly takes these needs into account. This experimental study tested how advice seekers' salient needs and doctor's communication styles influenced advice seekers' attitudes toward mammography screening and their decision whether or not to participate in this procedure. One hundred women (age range 20-47 years, mean 25.22, SD 4.71) participated in an interactive role play of an online consultation. During the consultation, a fictitious, program-controlled physician provided information about advantages and disadvantages of mammography screening. The physician either merely communicated factual medical information or made additional comments using a communication style oriented toward advice seekers' typical needs for clarity and well-being. Orthogonal to this experimental treatment, participants' personal needs for clarity and for well-being were either made salient before or after the consultation with a needs questionnaire. We also measured all participants' attitudes toward mammography screening and their hypothetical decisions whether or not to participate before and after the experiment. As assumed, the participants expressed strong needs for clarity (mean 4.57, SD 0.42) and for well-being (mean 4.21, SD 0.54) on 5-point Likert scales. Making these needs salient or not revealed significant interaction effects with the physician's communication style regarding participants' attitude change (F 1,92 =7.23, P=.009, η 2 =.073) and decision making (F 1,92 =4.43, P=.038, η 2 =.046). Those participants whose needs were made salient before the consultation responded to the physician's communication

  17. Motivational Interviewing versus Brief Advice for Cigarette Smokers in Residential Alcohol Treatment

    PubMed Central

    Rohsenow, Damaris J.; Martin, Rosemarie A.; Monti, Peter M.; Colby, Suzanne M.; Day, Anne M.; Abrams, David B.; Sirota, Alan D.; Swift, Robert M.

    2013-01-01

    Residential treatment for substance use disorders (SUD) provides opportunity for smoking intervention. A randomized controlled trial compared: (1) Motivational Interviewing (MI) to Brief Advice (BA), (2) in one session or with two booster sessions, for 165 alcoholics in SUD treatment. All received nicotine replacement (NRT). MI and BA produced equivalent confirmed abstinence, averaging 10% at 1 month, 2% at 3, 6 and 12 months. However, patients with more drug use pretreatment (>22 days in 6 months) given BA had more abstinence at 12 months (7%) than patients in MI or with less drug use (all 0%). Boosters produced 16-31% fewer cigarettes per day after BA than MI. Substance use was unaffected by treatment condition or smoking cessation. Motivation to quit was higher after BA than MI. Thus, BA plus NRT may be a cost-effective way to reduce smoking for alcoholics with comorbid substance use who are not seeking smoking cessation. PMID:24210533

  18. Pragmatic Variations in Giving Advice in L2 by Malaysian Postgraduate Students: The Situational Effects

    ERIC Educational Resources Information Center

    Farashaiyan, Atieh; Muthusamy, Paramasivam

    2016-01-01

    The present study attempted to describe the giving advice strategies utilized by Malaysian postgraduate students in confronting different situations. In addition, it examined the effects of the situational factors of social distance, power, and imposition on the students' choice of giving advice strategies. Another objective was to categorize the…

  19. Education and related support from medical specialists for Japanese patients with major skeletal dysplasias.

    PubMed

    Haga, Nobuhiko; Kosaki, Keisuke; Takikawa, Kazuharu; Tanaka, Hiroshi; Okada, Keita; Nakahara, Yasuo; Ogata, Naoshi

    2013-10-01

    Skeletal dysplasias manifest various clinical symptoms. Age at onset, severity, and progression of symptoms differ even among individuals with the same diagnosis. Though necessary support in education is presumed to differ among patients with different disorders, few articles report on education in patients with skeletal dysplasias. To clarify what types of schools children with major skeletal dysplasias attend, what kind of support they needed at schools, and how the advice on such support was conveyed from medical specialists to schools. Questionnaire study on patients with achondroplasia or hypochondroplasia (A/HCH), and osteogenesis imperfecta (OI). In A/HCH childhood locomotion ability was high and most patients had received general education, irrespective of their generation. Children with OI showed a lower level of locomotion ability; only about half of them had received general education. In selecting schools, the patients received advice from pediatricians, physiatrists, and orthopedic surgeons. The degree of necessity and content of support at the schools differed between A/HCH and OI. Remodeling of the lavatory, washbasin, and chair and support during swimming lessons were common in A/HCH patients. Support in school for OI patients was more frequent and included propelling wheelchairs, assisting in the use of the bathroom, and remodeling the lavatory. Most children were restricted from participating in physical education classes. Locomotion ability and the necessary support at school differed between A/HCH and OI. Support and advice from medical specialists who recognize disability of patients with skeletal dysplasias may improve patients' participation and education in schools. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. An Evaluation of an Occupational Health Advice Service

    ERIC Educational Resources Information Center

    Shearn, P.; Ford, Norma J.; Murphy, R. G.

    2010-01-01

    Objective: The objective of this article is to identify the profile of service users of an occupational health (OH) support service and establish areas of need, and to gather client feedback on the experience of participating in the support service and perceived outcomes and the impact of the advice received. Design and Setting: We carried out…

  1. Lay Evaluation of Financial Experts: The Action Advice Effect and Confirmation Bias.

    PubMed

    Zaleskiewicz, Tomasz; Gasiorowska, Agata; Stasiuk, Katarzyna; Maksymiuk, Renata; Bar-Tal, Yoram

    2016-01-01

    The goal of this experimental project was to investigate lay peoples' perceptions of epistemic authority (EA) in the field of finance. EA is defined as the extent to which a source of information is treated as evidence for judgments independently of its objective expertise and based on subjective beliefs. Previous research suggested that EA evaluations are biased and that lay people tend to ascribe higher EA to experts who advise action (in the case of medical experts) or confirm clients' expectations (in the case of politicians). However, there has been no research into biases in lay evaluations of financial experts and this project is aimed to fill this gap. Experiment 1 showed that lay people tended to ascribe greater authority to financial consultants who gave more active advice to clients considering taking out a mortgage. Experiment 2 confirmed the action advice effect found in Experiment 1. However, the outcomes of Experiments 2 and - particularly - 3 suggested that this bias might also be due to clients' desire to confirm their own opinions. Experiment 2 showed that the action advice effect was moderated by clients' own opinions on taking loans. Lay people ascribed the greatest EA to the advisor in the scenario in which he advised taking action and where this coincided with the client's positive opinion on the advisability of taking out a loan. In Experiment 3 only participants with a positive opinion on the financial product ascribed greater authority to experts who recommended it; participants whose opinion was negative tended to rate consultants who advised rejecting the product more highly. To conclude, these three experiments revealed that lay people ascribe higher EA to financial consultants who advise action rather than maintenance of the status quo , but this effect is limited by confirmation bias: when the client's a priori opinion is salient, greater authority is ascribed to experts whose advice confirms it. In this sense, results presented in the

  2. Lay Evaluation of Financial Experts: The Action Advice Effect and Confirmation Bias

    PubMed Central

    Zaleskiewicz, Tomasz; Gasiorowska, Agata; Stasiuk, Katarzyna; Maksymiuk, Renata; Bar-Tal, Yoram

    2016-01-01

    The goal of this experimental project was to investigate lay peoples’ perceptions of epistemic authority (EA) in the field of finance. EA is defined as the extent to which a source of information is treated as evidence for judgments independently of its objective expertise and based on subjective beliefs. Previous research suggested that EA evaluations are biased and that lay people tend to ascribe higher EA to experts who advise action (in the case of medical experts) or confirm clients’ expectations (in the case of politicians). However, there has been no research into biases in lay evaluations of financial experts and this project is aimed to fill this gap. Experiment 1 showed that lay people tended to ascribe greater authority to financial consultants who gave more active advice to clients considering taking out a mortgage. Experiment 2 confirmed the action advice effect found in Experiment 1. However, the outcomes of Experiments 2 and – particularly – 3 suggested that this bias might also be due to clients’ desire to confirm their own opinions. Experiment 2 showed that the action advice effect was moderated by clients’ own opinions on taking loans. Lay people ascribed the greatest EA to the advisor in the scenario in which he advised taking action and where this coincided with the client’s positive opinion on the advisability of taking out a loan. In Experiment 3 only participants with a positive opinion on the financial product ascribed greater authority to experts who recommended it; participants whose opinion was negative tended to rate consultants who advised rejecting the product more highly. To conclude, these three experiments revealed that lay people ascribe higher EA to financial consultants who advise action rather than maintenance of the status quo, but this effect is limited by confirmation bias: when the client’s a priori opinion is salient, greater authority is ascribed to experts whose advice confirms it. In this sense, results

  3. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial.

    PubMed

    Godycki-Cwirko, Maciek; Zakowska, Izabela; Kosiek, Katarzyna; Wensing, Michel; Krawczyk, Jaroslaw; Kowalczyk, Anna

    2014-04-04

    Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners' adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners' adherence to guidelines. A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians' adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients' records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care. The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care. This trial has been registered with Clinical Trials Protocol Registration System. NCT01893476.

  4. An Expert's Advice: What To Do If You Have Psoriasis

    MedlinePlus

    ... on. Feature: Living with Psoriasis An Expert's Advice: What To Do If You Have Psoriasis Past Issues / ... the Dermatology Foundation, and the American Skin Association. What is psoriasis? Psoriasis is a chronic (long-term) ...

  5. Feasibility, acceptability, and preliminary effectiveness of patient advocates for improving adult asthma outcomes

    PubMed Central

    Apter, Andrea J.; Wan, Fei; Reisine, Susan; Bogen, Daniel K.; Rand, Cynthia; Bender, Bruce; Bennett, Ian M.; Gonzalez, Rodalyn; Priolo, Chantel; Sonnad, Seema S.; Bryant-Stephens, Tyra; Ferguson, Monica; Boyd, Rhonda C.; Have, Thomas Ten; Roy, Jason

    2014-01-01

    Background Asthmatic adults from low-income urban neighborhoods have inferior health outcomes which in part may be due to barriers accessing care and with patient-provider communication. We adapted a patient advocate (PA) intervention to overcome these barriers. Objective To conduct a pilot study to assess feasibility, acceptability, and preliminary evidence of effectiveness. Methods A prospective randomized design was employed with mixed methods evaluation. Adults with moderate or severe asthma were randomized to 16 weeks of PA or a minimal intervention (MI) comparison condition. The PA, a nonprofessional, modeled preparations for a medical visit, attended the visit, and confirmed understanding. The PA facilitated scheduling, obtaining insurance coverage, and overcoming barriers to implementing medical advice. Outcomes included electronically-monitored inhaled corticosteroid adherence, asthma control, quality of life, FEV1, ED visits, and hospitalizations. Mixed-effects models guided an intention-to-treat analysis. Results 100 adults participated: age 47±14 years, 75% female, 71% African American, 16% white, baseline FEV1 69% ± 18%, 36% experiencing hospitalizations and 56% ED visits for asthma in the prior year. Ninety-three subjects completed all visits; 36 of 53 PA-assigned had a PA visit. Adherence declined significantly in the control (p= 0.001) but not significantly in the PA group (p=.30). Both PA and MI groups demonstrated improved asthma control (p=0.01 in both) and quality of life (p=0.001, p=0.004). Hospitalizations and ED visits for asthma did not differ between groups. The observed changes over time tended to favor the PA group, but this study was underpowered to detect differences between groups. Conclusion The PA intervention was feasible and acceptable and demonstrated potential for improving asthma control and quality of life. PMID:23800333

  6. Advice about diet and smoking for people with or at risk of age-related macular degeneration: a cross-sectional survey of eye care professionals in the UK.

    PubMed

    Lawrenson, John G; Evans, Jennifer R

    2013-06-10

    In the absence of a cure, there has been considerable interest in attempts to prevent or reduce the progression of age-related macular degeneration (AMD) by targeting particular modifiable risk factors. The aim of this study was to conduct a cross-sectional survey of the current practice of UK eye care professionals in relation to advice given on diet and other lifestyle modifications for patients with or at risk of AMD. Optometrists and ophthalmologists on the membership databases of professional organisations for the two professions were invited to participate in an online survey. The survey was open for 12 weeks between July and September 2012. A total of 1,468 responses were received (96.3% from optometrists and 3.7% from ophthalmologists). The response rate of those receiving the invitation was 16.2% (1,414/8735) for optometrists and 6% (54/1460) for ophthalmologists. A majority of respondents reported that they frequently provide dietary advice to patients with established AMD (67.9%) and those at risk of AMD (53.6%). Typical advice consisted of a recommendation to eat plenty of leafy green vegetables and eat more oily fish. The decision to recommend nutritional supplements was based on the risk of progression to advanced AMD, with approximately 93% of respondents recommending supplementation in a patient with advanced AMD in one eye. However for the majority, the type of supplement recommended did not comply with current best research evidence, based on the findings of the Age-related Eye Disease Study (AREDS). Only one in three optometrists regularly assessed smoking status and advised on smoking cessation. Within a large sample of eye care professionals, consisting predominantly of optometrists, who responded to a cross-sectional survey, there was active engagement in providing nutritional advice to patients with or at risk of AMD. However, the results demonstrate a need to raise awareness of the evidence underpinning the use of nutritional supplements

  7. Who Is and Who Is Not Willing to Use Online Employer-Provided Retirement Investment Advice

    ERIC Educational Resources Information Center

    Joo, So-Hyun; Grable, John E.; Choe, Hyuncha

    2007-01-01

    This study used classification tree analysis to examine who is and who is not willing to use online employer-provided retirement investment advice. Using data from the Retirement Confidence Survey (Employee Benefit Research Institute, 2004), the study focused on who was more likely to use online retirement investment advice when it was available…

  8. Improving patient safety incident reporting systems by focusing upon feedback - lessons from English and Welsh trusts.

    PubMed

    Wallace, Louise M; Spurgeon, Peter; Benn, Jonathan; Koutantji, Maria; Vincent, Charles

    2009-08-01

    This paper describes practical implications and learning from a multi-method study of feedback from patient safety incident reporting systems. The study was performed using the Safety Action and Information Feedback from Incident Reporting model, a model of the requirements of the feedback element of a patient safety incident reporting and learning system, derived from a scoping review of research and expert advice from world leaders in safety in high-risk industries. We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in general terms to health services worldwide.

  9. Improving Value for Patients with Eczema.

    PubMed

    Block, Julie

    2018-04-01

    Chronic diseases now represent a cost majority in the United States health care system. Contributing factors to rising costs include expensive novel and emerging therapies, under-treatment of disease, under-management of comorbidities, and patient dissatisfaction with care results. Critical to identifying replicable improvement methods is a reliable model to measure value. If we understand value within healthcare consumerism to be equal to a patient's health outcome improvement over costs associated with care (Value=Outcomes/Costs), we can use this equation to measure the improvement of value. Research and literature show that patient activation-the skills and confidence that equip patients to become actively engaged in their health care-impact health outcomes, costs, and patient experience. Reaching patient activation through engagement methods including shared decision-making (SDM) lead to improved value of care received. The National Eczema Association (NEA) Shared Decision-Making Resource Center can be a transformative strategy to measure and evaluate value of health care interventions for eczema patients to advance a value-driven health care system in the United States. Through this Resource Center, NEA will measure patient value through their own perceptions using validated PRO instruments and other patient-generated health data. Assessment of this data will reveal findings that can assist researchers in evaluating the impact this care framework on patient-perceived value across other chronic diseases. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. Nutrition and the brain: what advice should we give?

    PubMed

    Cooper, James K

    2014-09-01

    The knowledge base of nutrition and the brain is steadily expanding. Much of the research is aimed at ways to protect the brain from damage. In adults, the major causes of brain damage are aging and dementia. The most prominent dementia, and the condition that grabs the most public attention, is Alzheimer's disease. The assumption in the field is that possibly some change in nutrition could protect the brain and prevent, delay, or minimize Alzheimer's disease damage. Presented here is a framework for understanding the implications of this research. There is a gap between publishing research results and change in public nutrition behavior. Several influencing elements intervene. These include regulatory agencies and all the organizations and people who advise the public, all with their own perspectives. In considering what advice to give, advisors may consider effectiveness, research model, persuasiveness, and risks, among other factors. Advice about nutrition and Alzheimer's disease today requires several caveats. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Function after spinal treatment, exercise and rehabilitation (FASTER): improving the functional outcome of spinal surgery

    PubMed Central

    2010-01-01

    Background The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period. This trial will test the hypothesis that functional outcome following two common spinal operations can be improved by a programme of post-operative rehabilitation that combines professional support and advice with graded active exercise and/or an educational booklet based on evidence-based messages and advice. Methods/Design The study design is a multi-centre, factorial, randomised controlled trial with patients stratified by surgeon and operative procedure. The trial will compare the effectiveness and cost-effectiveness of a rehabilitation programme and an education booklet for the postoperative management of patients undergoing discectomy or lateral nerve root decompression, each compared with "usual care"using a 2 × 2 factorial design. The trial will create 4 sub-groups; rehabilitation-only, booklet-only, rehabilitation-plus-booklet, and usual care only. The trial aims to recruit 344 patients, which equates to 86 patients in each of the four sub-groups. All patients will be assessed for functional ability (through the Oswestry Disability Index - a disease specific functional questionnaire), pain (using visual analogue scales), and satisfaction pre-operatively and then at 6 weeks, 3, 6 and 9 months and 1 year post-operatively. This will be complemented by a formal analysis of cost-effectiveness. Discussion This trial will determine whether the outcome of spinal surgery can be enhanced by either a post

  12. Protecting Against Influenza (Flu): Advice for Caregivers of Young Children

    MedlinePlus

    ... Protecting Against Influenza (Flu): Advice for Caregivers of Young Children Language: English (US) Español Recommend on Facebook ... on How to Prevent Flu for Caregivers of Young Children 1. Take Time to Get a Vaccine ...

  13. [Demand for environmental medical advice at public health offices: experiences in the district aachen public health office].

    PubMed

    Wiesmüller, G A; Etschenberg, W; Koch, T; Konteye, C; Zahmel, J

    2002-03-01

    Since November, 1999 environmental medical advice is offered to interested citizens in the Aachen district at the District Aachen Public Health Office in cooperation with the outpatient unit of environmental medicine (UEM) of the Institute of Hygiene and Environmental Medicine of the University Hospital at Aachen, Germany. Advisory cases are documented in a data bank of Microsoft(R) Access 97. Until now, all advisory cases between November, 1999 and March, 2001 have been descriptively analysed. In this period, 34 personal and two telephonic advices were performed. The frequency of advisory activities is in the lower rang of published experiences in environmental medicine. Age distribution, more frequent advice utilization by women than by men and predominance of unspecific health disorders are comparable with published environmental medical experiences. However, in respect of suspected exposures, unspecific indoor-related environmental factors are predominant. In the past this was true for wood preservatives. Judgement about possible relationships between suspected environmental factors and health disorders or diseases was positive among 11.8 % of the persons seeking advice. This percentage is higher than published experiences which mostly show values below 10 %. It must be considered that this judgement depends primarily on the physician. Other reasons may be the too small number of advice seeking persons and selective influences. Furthermore, a definite judgement can be made only after environmental medical diagnostics (biological monitoring, local inspection, ambient monitoring) and differential diagnostics. Conspicuously, 76.5 % of the advisory cases had no contact to environmental medicine prior to the environmental medical advice at the Aachen District Public Health Office. This points to an information deficit about possibilities to clarify questions concerning environmental medicine in the population. In this context a regional guide on environmental

  14. Advice for prevention from HIV-positive African-American women: 'My story is not just a story'.

    PubMed

    Robillard, Alyssa; Padi, Akhila; Lewis, Kaleea; Julious, Carmen; Troutman, Jamie

    2017-05-01

    Large disparities in HIV incidence, prevalence and mortality exist for African-American women, especially in the southern region of the USA. Based on the culture-centric health promotion model, HIV-positive African American women can use their stories to support primary prevention. The purpose of this study was to document advice from HIV-positive African-American women (n = 25) to young African-American women, as described in their own cultural narratives collected through qualitative interviews. Content analysis of women's advice identified five common themes revolving broadly around: (1) advice for prevention, (2) support systems for prevention, (3) education, (4) empowerment/self-care and (5) potential barriers to prevention. Advice reflected recommendations based on personal experience and highlighted social determinants linked to HIV, such as stigma, access to education and healthcare, social support, and gender and power dynamics. Women also offered advice for coping with an HIV-positive diagnosis. Communication with parents, family and friends regarding education and social support emerged as an important interpersonal factor for participants, as were interactions with sexual/romantic partners. Stigma, at the community level, was consistently discussed as a hindrance to prevention. Narratives of HIV-positive women as community health agents of change can enhance the effectiveness of HIV prevention interventions for young US African-American women.

  15. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  16. Anticipatory guidance in type 2 diabetes to improve disease management; next steps after basal insulin.

    PubMed

    Johnson, Eric L; Frias, Juan P; Trujillo, Jennifer M

    2018-05-01

    The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues. Anticipatory guidance is an individualized, proactive approach to patient education and counseling by a health-care professional to support patients in better coping with problems before they arise. It has been shown to improve disease outcomes in a variety of chronic conditions, including diabetes. While important at all stages, anticipatory guidance may be of particular importance during changes in treatment regimens, and especially during transition to, and escalation of, insulin-based regimens. The aim of this article is to provide advice to physicians on anticipatory guidance for basal-insulin dosing, focusing on appropriate basal-insulin-dose increase and prevention of potentially deleterious basal-insulin doses, so called overbasalization. It also provides an overview of new treatment options for patients with T2D who are not well controlled on basal-insulin therapy, fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists, and advice on the type of anticipatory guidance needed to ensure safe and appropriate switching to these therapies.

  17. Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial.

    PubMed

    Rona, Roberto J; Burdett, Howard; Khondoker, Mizanur; Chesnokov, Melanie; Green, Kevin; Pernet, David; Jones, Norman; Greenberg, Neil; Wessely, Simon; Fear, Nicola T

    2017-04-08

    The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and

  18. Healthcare students' perceptions about their role, confidence and competence to deliver brief public health interventions and advice.

    PubMed

    McLean, Sionnadh; Charlesworth, Laura; May, Stephen; Pollard, Nick

    2018-05-24

    Public health improvement has long been an important focus for the United Kingdom Department of Health. The Allied Health Professions (AHP) Federation has 84,000 members, such a large number of AHP professionals should play a role in public health initiatives, but it is not clear if they or the AHP students who will be the future healthcare workforce feel themselves equipped to do so. Our aim was to understand the perceptions of AHP students about their role in delivering public health advice. AHP students were recruited in one teaching university from different departments. Participants were final year AHP students who had completed all clinical placements related to their course. All students were emailed an invitation to participate, and those interested were asked to contact the researchers to participate in one of several focus groups. Data were recorded, transcribed, and analysed using framework analysis by two independent researchers. Nineteen students were recruited and participated in four focus groups. The main themes produced by the data analysis were: understanding of public health issues, perceptions of their role in this, challenges and opportunities to develop a public health role, and preparation for a public health role. AHP students felt that they had a role in public health advice-giving, but barriers to providing this advice included their own lack of confidence and knowledge, time, and the environment of the clinical placement. They considered that there should be more teaching on public health issues, and that these should feature in both the curriculum and on clinical placement.

  19. CVMP advice on injection-site fibrosarcomas in cats.

    PubMed

    2003-03-29

    In response to increasing concern, the Committee for Veterinary Medicinal Products (CVMP) has produced this advisory notice for veterinary surgeons on the development in cats of fibrosarcomas at sites of administration of veterinary medicinal products. The advice relates principally, but not exclusively, to the subcutaneous injection of vaccines. The issue is of relevance only to cats and no extrapolation should be made to other species or to man. At the current state of knowledge, it is not possible to provide specific advice on the risk that any product, or any type of product, might represent in terms of inducing a fibrosarcoma at the site of administration. However, following the precautionary principle, the CVMP considers that information on this issue should be made available to veterinary surgeons in order that they can have an informed discussion with owners of the benefits and risks of therapeutic interventions in cats, particularly in relation to vaccination and re-vaccination. The CVMP wishes to emphasise that modern vaccines continue to represent the only safe and effective means of protecting cats against serious infectious diseases and this should be taken fully into account in any discussion between veterinary surgeons and owners of cats.

  20. Less is (sometimes) more in cognitive engineering: the role of automation technology in improving patient safety

    PubMed Central

    Vicente, K

    2003-01-01

    

 There is a tendency to assume that medical error can be stamped out by automation. Technology may improve patient safety, but cognitive engineering research findings in several complex safety critical systems, including both aviation and health care, show that more is not always better. Less sophisticated technological systems can sometimes lead to better performance than more sophisticated systems. This "less is more" effect arises because safety critical systems are open systems where unanticipated events are bound to occur. In these contexts, decision support provided by a technological aid will be less than perfect because there will always be situations that the technology cannot accommodate. Designing sophisticated automation that suggests an uncertain course of action seems to encourage people to accept the imperfect advice, even though information to decide independently on a better course of action is available. It may be preferable to create more modest designs that merely provide feedback about the current state of affairs or that critique human generated solutions than to rush to automate by creating sophisticated technological systems that recommend (fallible) courses of action. PMID:12897363

  1. Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

    PubMed Central

    Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

    2015-01-01

    Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

  2. Development of a novel remote patient monitoring system: the advanced symptom management system for radiotherapy to improve the symptom experience of patients with lung cancer receiving radiotherapy.

    PubMed

    Maguire, Roma; Ream, Emma; Richardson, Alison; Connaghan, John; Johnston, Bridget; Kotronoulas, Grigorios; Pedersen, Vibe; McPhelim, John; Pattison, Natalie; Smith, Allison; Webster, Lorraine; Taylor, Anne; Kearney, Nora

    2015-01-01

    The use of technology-enhanced patient-reported outcome measures to monitor the symptoms experienced by people with cancer is an effective way to offer timely care. This study aimed to (a) explore the feasibility and acceptability of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy and clinicians involved in their care and (b) assess changes in patient outcomes during implementation of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy in clinical practice. A repeated-measures, single-arm, mixed-methods study design was used involving poststudy interviews and completion of patient-reported outcome measures at baseline and end of treatment with 16 patients with lung cancer and 13 clinicians who used this mobile phone-based symptom monitoring system. Only rarely did patients report problems in using the handset and they felt that the system covered all relevant symptoms and helped them to manage their symptoms and effectively communicate with clinicians. Clinical improvements in patient anxiety, drowsiness, and self-care self-efficacy were also observed. Clinicians perceived the use of "real-time" risk algorithms and automated self-care advice provided to patients as positively contributing to clinical care. Reducing the complexity of the system was seen as important to promote its utility. Although preliminary, these results suggest that monitoring patient symptoms using mobile technology in the context of radiotherapy for lung cancer is feasible and acceptable in clinical practice. Future research would be most beneficial if the use of this technology was focused on the postradiotherapy phase and expanded the scope of the system to encompass a wider range of supportive care needs.

  3. Self-discharge against medical advice from tertiary health institution: A call for concern.

    PubMed

    Yusuf, Moruf Babatunde; Ogunlusi, Johnson Dare; Popoola, Sunday Ogunsuyi; Ogunlayi, Sheriff Olawale; Babalola, Waheed Olaide; Oluwadiya, Kehinde Sunday

    2017-01-01

    Self-discharge by patients without completing their treatment is a problematic issue in healthcare and is strongly associated with readmission and poor treatment outcome. A descriptive study of the rate and reasons why patients with limb injuries took self-discharge against medical advice (DAMA) from our facility, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, a tertiary health institution between May 2011 and April 2014. One hundred and thirty-one (16.2%) patients took DAMA out of 810 patients seen with limb injuries. Age ranges from 3 to 95 years with a mean of 36.31 ± 19.34 years. Road traffic crash accounted for 110 (84%) of the injuries. One hundred and sixteen (88.5%) had fractures and 9 (6.9%) had soft tissue injuries. Fifty-eight (44.3%) of the patients were referred cases, 128 (97.7%) signed DAMA form while 3 (2.3%) absconded from the hospital. Reasons for DAMA were mainly; belief more in traditional bone setters (TBSs) (36.6%); pressure from relations (22.9%) and high cost of hospital care (19.8%). One hundred and one (77.1%) of the patients volunteered that they were going to TBS for continued care. High percentage of patients DAMA from our facility and majority of them were in favour of unorthodox form of treatment.

  4. A double-blind, randomized trial, including frequent patient–physician contacts and Ramadan-focused advice, assessing vildagliptin and gliclazide in patients with type 2 diabetes fasting during Ramadan: the STEADFAST study

    PubMed Central

    Hassanein, Mohamed; Abdallah, Khalifa; Schweizer, Anja

    2014-01-01

    Background Several observational studies were conducted with vildagliptin in patients with type 2 diabetes mellitus (T2DM) fasting during Ramadan, showing significantly lower incidences of hypoglycemia with vildagliptin versus sulfonylureas, including gliclazide. It was of interest to complement the existing real-life evidence with data from a randomized, double-blind, clinical trial. Clinical Trials Identifier NCT01758380. Methods This multiregional, double-blind study randomized 557 patients with T2DM (mean glycated hemoglobin [HbA1c], 6.9%), previously treated with metformin and any sulfonylurea to receive either vildagliptin (50 mg twice daily) or gliclazide plus metformin. The study included four office visits (three pre-Ramadan) and multiple telephone contacts, as well as Ramadan-focused advice. Hypoglycemic events were assessed during Ramadan; HbA1c and weight were analyzed before and after Ramadan. Results The proportion of patients reporting confirmed (<3.9 mmol/L and/or severe) hypoglycemic events during Ramadan was 3.0% with vildagliptin and 7.0% with gliclazide (P=0.039; one-sided test), and this was 6.0% and 8.7%, respectively, for any hypoglycemic events (P=0.173). The adjusted mean change pre- to post-Ramadan in HbA1c was 0.05%±0.04% with vildagliptin and −0.03%±0.04% with gliclazide, from baselines of 6.84% and 6.79%, respectively (P=0.165). In both groups, the adjusted mean decrease in weight was −1.1±0.2 kg (P=0.987). Overall safety was similar between the treatments. Conclusion In line with the results from previous observational studies, vildagliptin was shown in this interventional study to be an effective, safe, and well-tolerated treatment in patients with T2DM fasting during Ramadan, with a consistently low incidence of hypoglycemia across studies, accompanied by good glycemic and weight control. In contrast, gliclazide showed a lower incidence of hypoglycemia in the present interventional than the previous observational studies. This

  5. Library Students Are "Breaking Good" with Saul Goodman's Advice

    ERIC Educational Resources Information Center

    Turkewitz, Deborah

    2014-01-01

    Graduate students are taking big steps and stretching themselves, whether returning to school midpoint in their lives, taking classes on unfamiliar topics, or starting internships and trying to put theory into practice. Who better to offer advice to these graduate students than America's favorite hilarious, morally ambiguous, ambulance-chasing,…

  6. Sense about Sex: Media, Sex Advice, Education and Learning

    ERIC Educational Resources Information Center

    Attwood, Feona; Barker, Meg John; Boynton, Petra; Hancock, Justin

    2015-01-01

    The media are widely acknowledged as important in sex and relationship education, but they are usually associated with "bad" effects on young people in contrast to the "good" knowledge represented by more informational and educational formats. In this paper we look at sex advice giving in newspapers, magazines and television in…

  7. 18 CFR 388.104 - Informal advice from Commission staff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Commission staff. 388.104 Section 388.104 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Commission staff. (a) The Commission staff provides informal advice and assistance to the general public and... expressed by the staff do not represent the official views of the Commission, but are designed to aid the...

  8. 18 CFR 388.104 - Informal advice from Commission staff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Commission staff. 388.104 Section 388.104 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Commission staff. (a) The Commission staff provides informal advice and assistance to the general public and... expressed by the staff do not represent the official views of the Commission, but are designed to aid the...

  9. 18 CFR 388.104 - Informal advice from Commission staff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Commission staff. 388.104 Section 388.104 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Commission staff. (a) The Commission staff provides informal advice and assistance to the general public and... expressed by the staff do not represent the official views of the Commission, but are designed to aid the...

  10. 18 CFR 388.104 - Informal advice from Commission staff.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Commission staff. 388.104 Section 388.104 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Commission staff. (a) The Commission staff provides informal advice and assistance to the general public and... expressed by the staff do not represent the official views of the Commission, but are designed to aid the...

  11. 18 CFR 388.104 - Informal advice from Commission staff.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Commission staff. 388.104 Section 388.104 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Commission staff. (a) The Commission staff provides informal advice and assistance to the general public and... expressed by the staff do not represent the official views of the Commission, but are designed to aid the...

  12. Advice to White Allies: Insights from Faculty of Color

    ERIC Educational Resources Information Center

    Boutte, Gloria S.; Jackson, Tambra O.

    2014-01-01

    This article interweaves discussions of successes and tensions surrounding cross-racial collaborative social justice efforts in teacher education. It addresses frustrations that often occur for faculty of Color when working with White allies in P-12 settings and schools of education at Predominantly White Institutions. Advice is offered with the…

  13. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial

    PubMed Central

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners’ adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners’ adherence to guidelines. Methods/Design A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians’ adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients’ records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care. Discussion The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care. Trial registration This trial has been registered with Clinical Trials Protocol Registration

  14. The practitioner, the patient and resistance to change: recent ideas on compliance.

    PubMed Central

    Butler, C; Rollnick, S; Stott, N

    1996-01-01

    Despite the explosion of research into the effect of medical advice on patient behaviour, only about 50% of patients comply with long-term drug regimens. And when it comes to changes in lifestyle, the percentage of patients who comply with medical advice often falls to single figures. Review articles on compliance have traditionally concentrated on factors that make it easier for patients to adhere to medical advice. However, recent articles urge clinicians to be more understanding of the wider implications of compliance in their patients' lives. This article focuses on how clinicians' consulting methods can affect patients' behaviour. Specifically, the authors consider the patient-centred clinical method as well as insights from and consulting techniques pioneered in the addictions field that can help to bring ambivalent patients closer to decisions about change. Instead of seeing resistance to change as rooted entirely in the patient, the authors view it as stemming partly from the way clinicians talk to patients. An advice-giving approach is usually inadequate to motivate people to embark on major lifestyle changes. Instead, the authors propose a negotiation-based framework that harnesses patients' intrinsic motivation to make their own decisions. This approach also promotes clinicians' acceptance of patients' decisions, even if these decisions run counter to current medical wisdom. PMID:8616739

  15. Millennials at Work: The Advice of Great Leaders

    DTIC Science & Technology

    2015-04-01

    Millennials at Work The Advice of Great Leaders Carol Axten Axten has more than 30 years of experience in Defense Department engineering, program...management, and policy development. She has graduate degrees in business , engineering, international relations, and national security resource strategy...million members of the millennial generation will enter the workforce and by 2030 will make up 75 percent of all working professionals. As managers in the

  16. [Perception about the importance of feeding in a group of hematologic cancer patients].

    PubMed

    Rodríguez-Durán, D; Palma, S; Loria-Kohen, V; Villarino, M; Bermejo, L M; Gómez-Candela, C

    2012-01-01

    Oncohematologic patients usually present nutritional deficits associated with the disease, the treatments and side effects, etc. However, there are hardly any descriptive data about the dietary recommendations used and the patient's self-perception of its usefulness in their disease. To assess the self-perception of the nutritional importance in a group of oncohematologic patients. 111 oncohematologic patients self-reported a questionnaire containing items about socio-sanitary data and self-perception of the nutritional importance in their disease. The mean age was 40.0 ± 12.8 years (64.86% women). The most frequent diagnosis and treatment was lymphoma (83.78%) and chemotheraphy (92.80%). 75% considered "very important" relationship between oncohematologic disease and nutritional status. Only 54.1% received dietary advice. And 53.2% and 50.5% considered that the use of nutritional supplements improve quality of life and/or disease respectively. A significant percentage of patients had advanced stages of their disease. However, half the group had not received dietary advice despite high interest in receiving nutritional care. Therefore, the nutritional assessment and the personalized nutritional support implementation of the patient should be included in routine clinical practice.

  17. 45 CFR 162.1602 - Standards for health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Technical Report Type 3—Health Care Claim Payment/Advice (835), April 2006, ASC X12N/005010X221... for Electronic Data Interchange Technical Report Type 3, “Health Care Claim Payment/Advice (835... same transmission, the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3...

  18. 45 CFR 162.1602 - Standards for health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Technical Report Type 3—Health Care Claim Payment/Advice (835), April 2006, ASC X12N/005010X221... for Electronic Data Interchange Technical Report Type 3, “Health Care Claim Payment/Advice (835... same transmission, the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3...

  19. 45 CFR 162.1602 - Standards for health care electronic funds transfers (EFT) and remittance advice transaction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Technical Report Type 3—Health Care Claim Payment/Advice (835), April 2006, ASC X12N/005010X221... for Electronic Data Interchange Technical Report Type 3, “Health Care Claim Payment/Advice (835... same transmission, the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3...

  20. Do Students Listen to Advice from Their Experienced Peers?

    ERIC Educational Resources Information Center

    Finck, Joseph E.; DeLine, Amy D.

    2008-01-01

    Smith and Peterson (2007) recognize the impact between students seeking out advice and that student's academic performance. And Sallee and Tierney (2007) considered the ways in which students' peer networks facilitate or inhibit access to academic resources. In this paper the authors look at the students who receive suggestions from the previous…

  1. Inspiration from role models and advice for moving forward.

    PubMed

    Newman, Michelle G; McGinn, Lata K

    2012-12-01

    This Behavior Therapy series on overcoming the glass ceiling followed from a highly attended panel at ABCT on the same topic. The current paper summarizes the common themes across the various papers in this series with respect to obstacles prominent women have faced, and how we can learn from their stories to help inform the future. These themes include the importance of role models, messages from a supportive environment, difficulties balancing careers with children, coordinating careers with family, importance of taking charge of one's career, moving forward despite negative internal and external messages, and questions about whether things have changed substantially. In addition, this paper contains a summary of the helpful advice from accomplished women in academia for navigating the academic waters. It is our aspiration that going forward this series will stimulate other conversations as well as increase thought, behavior, solidarity, and awareness about this topic so that we can continue to work toward a future when things will continue to improve for women. Copyright © 2012. Published by Elsevier Ltd.

  2. Improving Efficiency While Improving Patient Care in a Student-Run Free Clinic.

    PubMed

    Lee, Jason S; Combs, Kristen; Pasarica, Magdalena

    2017-01-01

    Student-run free clinics (SRFCs) have the capacity to decrease health care inequity in underserved populations. These facilities can benefit from improved patient experience and outcomes. We implemented a series of quality improvement interventions with the objectives to decrease patient wait times and to increase the variety of services provided. A needs assessment was performed. Problems related to time management, communication between staff and providers, clinic resources, and methods for assessing clinic performance were identified as targets to reduce wait times and improve the variety of services provided. Seventeen interventions were designed and implemented over a 2-month period. The interventions resulted in improved efficiency for clinic operations and reduced patient wait times. The number of specialty providers, patient visits for specialty care, lifestyle education visits for disease prevention and treatment, free medications, and free laboratory investigations increased to achieve the goal of improving the availability and the variety of services provided. We demonstrated that it is feasible to implement successful quality improvement interventions in SRFCs to decrease patient wait times and to increase the variety of services provided. We believe that the changes we implemented can serve as a model for other SRFCs to improve their performance. © Copyright 2017 by the American Board of Family Medicine.

  3. Antenatal dietary advice and supplementation to increase energy and protein intake.

    PubMed

    Ota, Erika; Tobe-Gai, Ruoyan; Mori, Rintaro; Farrar, Diane

    2012-09-12

    significantly increased (random-effects MD +40.96 g, 95% CI 4.66 to 77.26 , Tau(2)= 1744, I(2) = 44%, 11 trials, 5385 women). There was also a significant reduction in the risk of small-for-gestational age (RR 0.79, 95% CI 0.69 to 0.90, I(2) = 16%, seven trials, 4408 women). No significant effect was detected for preterm birth or neonatal death.High-protein supplementation (one trial, 1051 women)High-protein supplementation (one trial, 505 women), was associated with a significantly increased risk of small-for-gestational age babies (RR 1.58, 95% CI 1.03 to 2.41).Isocaloric protein supplementation (two trials, 184 women)Isocaloric protein supplementation (two trials,184 women) had no significant effect on birthweight and weekly gestational weight gain. This review provides encouraging evidence that antenatal nutritional advice with the aim of increasing energy and protein intake in the general obstetric population appears to be effective in reducing the risk of preterm birth, increasing head circumference at birth and increasing protein intake, there was no evidence of benefit or adverse effect for any other outcome reported.Balanced energy and protein supplementation seems to improve fetal growth, and may reduce the risk of stillbirth and infants born small-for-gestational age. High-protein supplementation does not seem to be beneficial and may be harmful to the fetus. Balanced-protein supplementation alone had no significant effects on perinatal outcomes.The results of this review should be interpreted with caution, the risk of bias was either unclear or high for at least one category examined in several of the included trials and the quality of the evidence was low for several important outcomes. Also the anthropometric characteristics of the general obstetric population is changing, therefore, those developing interventions aimed at altering energy and protein intake should ensure that only those women likely to benefit are included. Large, well designed randomised trials

  4. Do physicians’ recommendations pull patients away from their preferred treatment options?

    PubMed Central

    Mendel, Rosmarie; Traut‐Mattausch, Eva; Frey, Dieter; Bühner, Markus; Berthele, Achim; Kissling, Werner; Hamann, Johannes

    2011-01-01

    Abstract Context and objective  Shared decision making is especially advocated for preference‐sensitive decisions. We investigated whether physicians’ recommendations pull patients away from their preferred treatment option when making a preference‐sensitive decision. Design, participants and methods  Inpatients (N = 102 with schizophrenia, N = 101 with multiple sclerosis) were presented with a hypothetical scenario (the choice between two drugs). They were first asked about their preferences concerning the two drugs and then they received a (fictitious) clinician’s recommendation that was contrary to their preferences. Subsequently they made a final choice between the two drugs. Main outcome measures  The main outcome measure was whether the patient followed the physician’s advice in the hypothetical scenario. Thereby patient’s (pre‐recommendation) preferences served as a baseline. Results  In the decision scenario, about 48% of the patients with schizophrenia and 26% of the patients with multiple sclerosis followed the advice of their physician and thus chose the treatment option that went against their initial preferences. Patients who followed their physician’s advice were less satisfied with their decision than patients not following their physician’s advice (schizophrenia: t = 2.61, P = 0.01; multiple sclerosis: t = 2.67, P = 0.009). Discussion and conclusions  When sharing decisions with patients, physicians should be aware that their advice might influence patients’ decisions away from their preferred treatment option. They should encourage their patients to identify their own preferences and help to find the treatment option most consistent with them. PMID:21323824

  5. A perspective on physiological studies supporting the provision of scientific advice for the management of Fraser River sockeye salmon (Oncorhynchus nerka)

    PubMed Central

    Patterson, David A.; Cooke, Steven J.; Hinch, Scott G.; Robinson, Kendra A.; Young, Nathan; Farrell, Anthony P.; Miller, Kristina M.

    2016-01-01

    The inability of physiologists to effect change in fisheries management has been the source of frustration for many decades. Close collaboration between fisheries managers and researchers has afforded our interdisciplinary team an unusual opportunity to evaluate the emerging impact that physiology can have in providing relevant and credible scientific advice to assist in management decisions. We categorize the quality of scientific advice given to management into five levels based on the type of scientific activity and resulting advice (notions, observations, descriptions, predictions and prescriptions). We argue that, ideally, both managers and researchers have concomitant but separate responsibilities for increasing the level of scientific advice provided. The responsibility of managers involves clear communication of management objectives to researchers, including exact descriptions of knowledge needs and researchable problems. The role of the researcher is to provide scientific advice based on the current state of scientific information and the level of integration with management. The examples of scientific advice discussed herein relate to physiological research on the impact of high discharge and water temperature, pathogens, sex and fisheries interactions on in-river migration success of adult Fraser River sockeye salmon (Oncorhynchus nerka) and the increased understanding and quality of scientific advice that emerges. We submit that success in increasing the quality of scientific advice is a function of political motivation linked to funding, legal clarity in management objectives, collaborative structures in government and academia, personal relationships, access to interdisciplinary experts and scientific peer acceptance. The major challenges with advancing scientific advice include uncertainty in results, lack of integration with management needs and institutional caution in adopting new research. We hope that conservation physiologists can learn from

  6. A perspective on physiological studies supporting the provision of scientific advice for the management of Fraser River sockeye salmon (Oncorhynchus nerka).

    PubMed

    Patterson, David A; Cooke, Steven J; Hinch, Scott G; Robinson, Kendra A; Young, Nathan; Farrell, Anthony P; Miller, Kristina M

    2016-01-01

    The inability of physiologists to effect change in fisheries management has been the source of frustration for many decades. Close collaboration between fisheries managers and researchers has afforded our interdisciplinary team an unusual opportunity to evaluate the emerging impact that physiology can have in providing relevant and credible scientific advice to assist in management decisions. We categorize the quality of scientific advice given to management into five levels based on the type of scientific activity and resulting advice (notions, observations, descriptions, predictions and prescriptions). We argue that, ideally, both managers and researchers have concomitant but separate responsibilities for increasing the level of scientific advice provided. The responsibility of managers involves clear communication of management objectives to researchers, including exact descriptions of knowledge needs and researchable problems. The role of the researcher is to provide scientific advice based on the current state of scientific information and the level of integration with management. The examples of scientific advice discussed herein relate to physiological research on the impact of high discharge and water temperature, pathogens, sex and fisheries interactions on in-river migration success of adult Fraser River sockeye salmon ( Oncorhynchus nerka ) and the increased understanding and quality of scientific advice that emerges. We submit that success in increasing the quality of scientific advice is a function of political motivation linked to funding, legal clarity in management objectives, collaborative structures in government and academia, personal relationships, access to interdisciplinary experts and scientific peer acceptance. The major challenges with advancing scientific advice include uncertainty in results, lack of integration with management needs and institutional caution in adopting new research. We hope that conservation physiologists can learn from

  7. Does Improving Patient-Practitioner Communication Improve Clinical Outcomes in Patients with Cardiovascular Diseases? A Systematic Review of the Evidence

    PubMed Central

    Schoenthaler, Antoinette; Kalet, Adina; Nicholson, Joseph; Lipkin, Mack

    2014-01-01

    Objective To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. Methods Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥ 18 years of age. Results Fifteen papers were reviewed: The primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients’ information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner’s general patient-centered communication or risk communication skills. Conclusions Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. Practice Implications Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes. Systematic Review Protocol Registration CRD42013006302 PMID:24795073

  8. Stress amongst nurses working in a healthcare telephone-advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance.

    PubMed

    Farquharson, Barbara; Allan, Julia; Johnston, Derek; Johnston, Marie; Choudhary, Carolyn; Jones, Martyn

    2012-07-01

    This paper is a report of a study, which assessed levels of stress amongst nurses working in a healthcare telephone-advice service. We explored whether stress related to performance, sickness absence, and intention to leave. Nurses report high levels of stress, as do call-centre workers. The emergence of telephone health advice services means many nurses now work in call-centres, doing work that differs markedly from traditional nursing roles. Stress associated with these roles could have implications for nurses, patients, and service provision. This paper reports cross-sectional survey results. The design of the overall study included longitudinal elements. A comprehensive study of stress was conducted amongst nurses working for a telephone-advice service in Scotland (2008-2010). All nurse-advisors were approached by letter and invited to participate. A total of 152 participants (33%) completed a questionnaire including General Health Questionnaire-12, Work Family Conflict Questionnaire, Job Satisfaction Scale and a measure of intention to leave the telephone-advice service and rated the perceived stress of 2 working shifts. Nurses' employers provided data on sickness absence and performance. Overall levels of psychological distress were similar to those found amongst Scottish women generally. In multiple regression, work-family conflict was identified as a significant predictor of job satisfaction and intention to leave, and significantly related to sickness absence. There were significant correlations between General Health Questionnaire scores and perceived stress of shifts and some performance measures. Work-family conflict is a significant predictor of job satisfaction, intention to leave, and sickness absence amongst telephone helpline nurses. Minimizing the impact of nurses' work on their home lives might reduce turnover and sickness absence. © 2012 Blackwell Publishing Ltd.

  9. A cluster randomised controlled trial of advice, exercise or multifactorial assessment to prevent falls and fractures in community-dwelling older adults: protocol for the prevention of falls injury trial (PreFIT)

    PubMed Central

    Lall, Ranjit; Withers, Emma J; Finnegan, Susanne; Underwood, Martin; Hulme, Claire; Sheridan, Ray; Skelton, Dawn A; Martin, Finbarr; Lamb, Sarah E

    2016-01-01

    Introduction Falls are the leading cause of accident-related mortality in older adults. Injurious falls are associated with functional decline, disability, healthcare utilisation and significant National Health Service (NHS)-related costs. The evidence base for multifactorial or exercise interventions reducing fractures in the general population is weak. This protocol describes a large-scale UK trial investigating the clinical and cost-effectiveness of alternative falls prevention interventions targeted at community dwelling older adults. Methods and analysis A three-arm, pragmatic, cluster randomised controlled trial, conducted within primary care in England, UK. Sixty-three general practices will be randomised to deliver one of three falls prevention interventions: (1) advice only; (2) advice with exercise; or (3) advice with multifactorial falls prevention (MFFP). We aim to recruit over 9000 community-dwelling adults aged 70 and above. Practices randomised to deliver advice will mail out advice booklets. Practices randomised to deliver ‘active’ interventions, either exercise or MFFP, send all trial participants the advice booklet and a screening survey to identify participants with a history of falling or balance problems. Onward referral to ‘active’ intervention will be based on falls risk determined from balance screen. The primary outcome is peripheral fracture; secondary outcomes include number with at least one fracture, falls, mortality, quality of life and health service resource use at 18 months, captured using self-report and routine healthcare activity data. Ethics and dissemination The study protocol has approval from the National Research Ethics Service (REC reference 10/H0401/36; Protocol V.3.1, 21/May/2013). User groups and patient representatives were consulted to inform trial design. Results will be reported at conferences and in peer-reviewed publications. A patient-friendly summary of trial findings will be published on the prevention

  10. A cluster randomised controlled trial of advice, exercise or multifactorial assessment to prevent falls and fractures in community-dwelling older adults: protocol for the prevention of falls injury trial (PreFIT).

    PubMed

    Bruce, Julie; Lall, Ranjit; Withers, Emma J; Finnegan, Susanne; Underwood, Martin; Hulme, Claire; Sheridan, Ray; Skelton, Dawn A; Martin, Finbarr; Lamb, Sarah E

    2016-01-18

    Falls are the leading cause of accident-related mortality in older adults. Injurious falls are associated with functional decline, disability, healthcare utilisation and significant National Health Service (NHS)-related costs. The evidence base for multifactorial or exercise interventions reducing fractures in the general population is weak. This protocol describes a large-scale UK trial investigating the clinical and cost-effectiveness of alternative falls prevention interventions targeted at community dwelling older adults. A three-arm, pragmatic, cluster randomised controlled trial, conducted within primary care in England, UK. Sixty-three general practices will be randomised to deliver one of three falls prevention interventions: (1) advice only; (2) advice with exercise; or (3) advice with multifactorial falls prevention (MFFP). We aim to recruit over 9000 community-dwelling adults aged 70 and above. Practices randomised to deliver advice will mail out advice booklets. Practices randomised to deliver 'active' interventions, either exercise or MFFP, send all trial participants the advice booklet and a screening survey to identify participants with a history of falling or balance problems. Onward referral to 'active' intervention will be based on falls risk determined from balance screen. The primary outcome is peripheral fracture; secondary outcomes include number with at least one fracture, falls, mortality, quality of life and health service resource use at 18 months, captured using self-report and routine healthcare activity data. The study protocol has approval from the National Research Ethics Service (REC reference 10/H0401/36; Protocol V.3.1, 21/May/2013). User groups and patient representatives were consulted to inform trial design. Results will be reported at conferences and in peer-reviewed publications. A patient-friendly summary of trial findings will be published on the prevention of falls injury trial (PreFIT) website. This protocol adheres to the

  11. Effectiveness of web-based tailored smoking cessation advice reports (iQuit): a randomized trial.

    PubMed

    Mason, Dan; Gilbert, Hazel; Sutton, Stephen

    2012-12-01

    To determine whether web-based tailored cessation advice, based on social cognitive theory and the perspectives on change model, was more effective in aiding a quit attempt than broadly similar web-based advice that was not tailored. Participants were allocated randomly to one of two groups, to receive either a cessation advice report and progress report that were tailored to individual-level characteristics or a cessation advice report that presented standardized (non-tailored) content. Tailoring was based on smoking-related beliefs, personal characteristics and smoking patterns, self-efficacy and outcome expectations. Participant enrolment and baseline assessments were conducted remotely online via the study website, with the advice reports presented by the same website. Participants (n = 1758) were visitors to the QUIT website who were based in the United Kingdom, aged 18 years or over and who smoked cigarettes or hand-rolled tobacco. Follow-up assessments were made at 6 months by telephone interview. The primary outcome measure was self-reported 3 months prolonged abstinence, and secondary outcomes were 1 month prolonged abstinence, 7-day and 24-hour point prevalence abstinence. The intervention group did not differ from the control group on the primary outcome (9.1% versus 9.3%; odds ratio = 1.02 95% confidence interval 0.73-1.42) or on any of the secondary outcomes. Intervention participants gave more positive evaluations of the materials than control participants. A web-based intervention that tailored content according to smoking-related beliefs, personal characteristics and smoking patterns, self-efficacy and outcome expectations, was not more effective than web-based materials presenting broadly similar non-tailored information. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  12. A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis.

    PubMed

    Paterson, Kade L; Wrigley, Tim V; Bennell, Kim L; Hinman, Rana S

    2014-01-01

    Expert opinion recommends cushioned and supportive footwear for people with knee osteoarthritis (OA). However, little is known about the footwear advice people receive from healthcare professionals, or the beliefs and footwear habits of people with knee OA. This study aimed to determine i) what types of shoes people are advised to wear for their knee OA and by whom; ii) establish which types of shoes people with knee OA believe are best for managing their knee OA symptoms and (iii) which shoes they wear most often. 204 people with symptomatic knee OA completed an online survey. The survey comprised 14 questions asking what footwear advice people had received for their knee OA and who they received it from, individual beliefs about optimal footwear styles for their knee OA symptoms and the types of footwear usually worn. Only one third (n = 69, 34%) of participants reported receiving footwear advice for their knee OA, and this was most frequently received from a podiatrist (n = 47, 68%). The most common advice was to wear sturdy/supportive shoes (n = 96, 47%) or shoes with arch supports (n = 84, 41%). These were also amongst the shoe styles that participants believed were best for their knee OA (n = 157 (77%) and n = 138 (68%) respectively). The type of shoes most frequently worn were athletic (n = 131, 64%) and sturdy/supportive shoes (n = 116, 57%). Most people with knee OA who completed our survey had not received advice about footwear for their knee OA symptoms. Our participants typically believed that sturdy/supportive shoes were best for their knee OA and this shoe style was most frequently worn, which is reflective of expert opinion. Future research is needed to confirm whether sturdy/supportive shoes are indeed optimal for managing symptoms of knee OA.

  13. Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus.

    PubMed

    Simon, Airin C R; Holleman, Frits; Gude, Wouter T; Hoekstra, Joost B L; Peute, Linda W; Jaspers, Monique W M; Peek, Niels

    2013-09-01

    The rising incidence of type 2 diabetes mellitus (T2DM) induces severe challenges for the health care system. Our research group developed a web-based system named PANDIT that provides T2DM patients with insulin dosing advice using state of the art clinical decision support technology. The PANDIT interface resembles a glucose diary and provides advice through pop-up messages. Diabetes nurses (DNs) also have access to the system, allowing them to intervene when needed. The objective of this study was to establish whether T2DM patients can safely use PANDIT at home. To this end, we assessed whether patients experience usability problems with a high risk of compromising patient safety when interacting with the system, and whether PANDIT's insulin dosing advice are clinically safe. The study population consisted of patients with T2DM (aged 18-80) who used a once daily basal insulin as well as DNs from a university hospital. The usability evaluation consisted of think-aloud sessions with four patients and three DNs. Video data, audio data and verbal utterances were analyzed for usability problems encountered during PANDIT interactions. Usability problems were rated by a physician and a usability expert according to their potential impact on patient safety. The usability evaluation was followed by an implementation with a duration of four weeks. This implementation took place at the patients' homes with ten patients to evaluate clinical safety of PANDIT advice. PANDIT advice were systematically compared with DN advice. Deviating advice were evaluated with respect to patient safety by a panel of experienced physicians, which specialized in diabetes care. We detected seventeen unique usability problems, none of which was judged to have a high risk of compromising patient safety. Most usability problems concerned the lay-out of the diary, which did not clearly indicate which data entry fields had to be entered in order to obtain an advice. 27 out of 74 (36.5%) PANDIT advice

  14. Patient satisfaction with out-of-hours GP cooperatives: a longitudinal study.

    PubMed

    Smits, Marleen; Huibers, Linda; Oude Bos, Anita; Giesen, Paul

    2012-12-01

    For over a decade, out-of-hours primary care in the Netherlands has been provided by general practitioner (GP) cooperatives. In the past years, quality improvements have been made and patients have become acquainted with the service. This may have increased patient satisfaction. The objective of this study was to examine changes in patient satisfaction with GP cooperatives over time. Longitudinal observational study. A validated patient satisfaction questionnaire was distributed in 2003-2004 (T1) and 2007-2008 (T2). Items were rated on a scale from 0 to 10 (1 = very bad; 10 = excellent). Eight GP cooperatives in the Netherlands. Stratified sample of 9600 patients. Response was 55% at T1 (n = 2634) and 51% at T2 (n = 2462). Expectations met; satisfaction with triage nurses, GPs, and organization. For most patients the care received at the GP cooperative met their expectations (T1: 86.1% and T2: 88.4%). Patients were satisfied with the triage nurses (overall grade T1: 7.73 and T2: 7.99), GPs (T1: 8.04 and T2: 8.25), and organization (overall grade T1: 7.60 and T2: 7.78). Satisfaction with triage nurses showed the largest increase over time. The quality and effectiveness of advice or treatment were given relatively low grades. Of all organizational aspects, the lowest grades were given for waiting times and information about the cooperative. In general, patients were initially satisfied with GP cooperatives and satisfaction had even increased four years later. However, there is room for improvement in the content of the advice, waiting times, and information supply. More research is needed into satisfaction of specific patient groups.

  15. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  16. 75 FR 65031 - U.S.-Trans-Pacific Partnership Free Trade Agreement Including Malaysia: Advice on the Probable...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-21

    ... Partnership Free Trade Agreement Including Malaysia: Advice on the Probable Economic Effect of Providing Duty...-2104-027, U.S.-Trans-Pacific Partnership Free Trade Agreement Including Malaysia: Advice on the Probable Economic Effect of Providing Duty-Free Treatment for Imports. DATES: November 10, 2010: Deadline...

  17. Computerized pediatric telephone triage and advice programs at children's hospitals: operating and financial characteristics.

    PubMed

    Melzer, S M; Poole, S R

    1999-08-01

    To describe the operating characteristics, financial performance, and perceived value of computerized children's hospital-based telephone triage and advice (TTA) programs. A written survey of all 32 children's hospital-based TTA programs in the United States that used the same proprietary pediatric TTA software product for at least 6 months. The expense, revenues, and perceived value of children's hospital-based TTA programs. Of 30 programs (94%) responding, 27 (90%) were eligible for the study and reported on their experience with nearly 1.3 million TTA calls over a 12-month period. Programs provided pediatric TTA services for 1560 physicians, serving an average of 82 physicians (range, 10-340 physicians) and answering 38880 calls (range, 8500-140000 calls) annually. The mean call duration was 11.3 minutes and the estimated mean total expense per call was $12.45. Of programs charging fees for TTA services, 16 (59%) used a per-call fee and 7 (26%) used a monthly service fee. All respondents indicated that fees did not cover all associated costs. Telephone triage and advice programs, when examined on a stand-alone basis, were all operating with annual deficits (mean, $447000; median, $325000; range, $74000-$1.3 million), supported by the sponsoring children's hospitals and their companion programs. Using a 3-point Likert scale, the TTA program managers rated the value of the TTA program very highly as a mechanism for marketing to physicians (2.85) and increasing physician (2.92) and patient (2.80) satisfaction. Children's hospital-based TTA programs operate at substantial financial deficits. Ongoing support of these programs may derive from the perception that they are a valuable mechanism for marketing and increase patient and physician satisfaction. Children's hospitals should develop strategies to ensure the long-term financial viability of TTA programs or they may have to discontinue these services.

  18. Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

    PubMed Central

    2011-01-01

    Background In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves. Method Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively. Results The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001). Conclusions MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. PMID:21871064

  19. Advice on Writing a Scientific Paper

    NASA Astrophysics Data System (ADS)

    Sterken, C.

    2006-04-01

    What makes one author a good communicator and another a poor one? What turns out one manuscript a swift editorial task, and another an editorial nightmare? Based on direct experience from the manuscripts of the lectures and papers presented during this school, advice is given on what to do and on what to avoid when writing a scientific paper. Some feedback recommendation is also provided on how to prepare manuscripts, handle copyright and permissions to reproduce, how to anticipate plagiarism, how to deal with editors and referees, and how to avoid common errors. A few illustrations of English grammar and style for the foreign author are given.

  20. 12 CFR 563g.15 - Requests for interpretive advice or waiver.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., Corporate and Securities Division; (b) The provisions of this part to which the request relates, the... SECURITIES OFFERINGS § 563g.15 Requests for interpretive advice or waiver. Any requests to the Office for...