15 research outputs found

    Barriers and Facilitators to Use of a Clinical Evidence Technology for Management of Skin Problems in Primary Care: Insights from Mixed Methods

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    Background: A previous cluster-randomized controlled trial tested the effectiveness of a clinical evidence technology (CET), VisualDx, for skin problems seen by Primary Care Providers (PCPs). Based on patient report, there was no effect on time to problem resolution or return appointments. Objective: To explain, from the provider perspective, why the CET did not make a difference in the clinical trial and to identify barriers and facilitators to use. Methods: Mixed methods study design. Providers from both arms completed a survey about their use of VisualDx and information-seeking during and after the trial. Active arm providers participated in interviews to explore their opinions and experiences using VisualDx. Behavioral steps of the evidence-based medicine (EBM) paradigm informed the 6 step model. Results: PCPs found VisualDx easy to use (median 3 on a 1-4 scale), but found it only somewhat useful (median 2 on a 1-4 scale). PCPs with fewer years in practice used it more often and found it easier to use. Interviews identified facilitators and barriers to using VisualDx. Facilitators included diagnostic uncertainty, positive attitude, easy access, utility for diagnosis and therapy decisions, and utility for patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulty, and retrieval of irrelevant diagnoses and images. Some PCPs reported positive impacts on patient treatment and fewer referrals; others saw no difference. PCPs found VisualDx easy to access, but some found the interface difficult to use. They found it useful and relevant at times, but also frustrating and time-consuming. They used other sources in addition to, or instead of, VisualDx. Conclusion: PCPs did not perceive VisualDx as “useful” often enough for them to use it frequently or exclusively, thereby reducing the likelihood of its making a difference in patient-level outcomes such as problem resolution and return appointments

    Barriers and Facilitators to Use of a Clinical Evidence Technology in the Management of Skin Problems in Primary Care: Insights from Mixed Methods

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    Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. Methods: Using a convergent mixed methods design, PCPs completed a post-trial survey and participated in interviews about using the CET for the management of patients’ skin problems. Data from both methods were integrated. Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management

    Examining the generalizability of research findings from archival data

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    This initiative examined systematically the extent to which a large set of archival research findings generalizes across contexts. We repeated the key analyses for 29 original strategic management effects in the same context (direct reproduction) as well as in 52 novel time periods and geographies; 45% of the reproductions returned results matching the original reports together with 55% of tests in different spans of years and 40% of tests in novel geographies. Some original findings were associated with multiple new tests. Reproducibility was the best predictor of generalizability—for the findings that proved directly reproducible, 84% emerged in other available time periods and 57% emerged in other geographies. Overall, only limited empirical evidence emerged for context sensitivity. In a forecasting survey, independent scientists were able to anticipate which effects would find support in tests in new samples

    MUC1, MUC2, MUC4, MUC5AC and MUC6 expression in the progression of prostate cancer

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    Molecular changes are vital for the development of prognostic markers and therapeutic modalities of prostate cancer (CaP). There is growing interest in mucins as treatment targets in human malignancies, including CaP. The role of their expression in the progression of CaP is however unclear. We examined the expressions MUC1, MUC2, MUC4, MUC5AC and MUC6 in CaP tissues using tissue microarrays (TMAs) to look for tumor-associated antigens (TAAs) for targeted therapy. In this study, 120 paraffin-embedded specimens were selected from patients who underwent radical retro-pubic prostatectomy (RRP) or trans-urethral-resection of the prostate (TURP) for primary, untreated CaP and 10 matched lymph node metastases. A series of MUC monoclonal antibodies (mAbs) was used on TMAs by standard immunohistochemistry. Our results indicate that the over-expression of MUC1 was detected in 58% of primary CaP tissues and 90% of lymph node metastases but not in normal prostate or benign tissues, while the expression of MUC2, MUC4, MUC5AC and MUC6 was found to be negative in both normal and cancer tissues. Of the MUC1 positive tumors 86% were Gleason grade 7 or higher. Over-expression of MUC1 was found in late stage CaP while MUC2, 4, 5AC and 6 were negative in CaP. MUC1 is a TAA that is highly related to tumor progression in CaP patients. This antigen is ideal for targeted therapy to control micrometastases and hormone refractory disease but additional studies are necessary to assess its usefulness in patient biopsies and CaP bone metastases before clinical trial

    Desarrollando un marco para el liderazgo Ă©tico

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    Interest in ethical leadership from academics and practitioners has grown enormously in recent years. This article addresses this literature through a framework that identifies three interlocking questions. First, who are ethical leaders and what are their characteristics? Second, how do ethical leaders do what they do? Third, why do leaders do as they do and what are the outcomes of ethical leadership? Different dimensions to ethical leadership are examined and presented as three interlocking circles; Virtues, Purposes and Practices. This framework presents an integrated approach to ethical leadership and argues that future research take this holistic framework and apply it to different sectors or contexts

    New high statistics measurement of K-e4 decay form factors and pi pi scattering phase shifts

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    We report results from a new measurement of the K-e4 decay K-+/- -> pi(+)pi(-)e(+/-)nu by the NA48/2 collaboration at the CERN SPS, based on a partial sample of more than 670 000 K-e4 decays in both charged modes collected in 2003. The form factors of the hadronic current (F,G,H) and pi pi phase difference (delta=delta(s)-delta(p)) have been measured in ten independent bins of the pi pi mass spectrum to investigate their variation. A sizeable acceptance at large pi pi mass, a low background and a very good resolution contribute to an improved experimental accuracy, a factor two better than in the previous measurement, when extracting the pi pi scattering lengths a(0) (0) and a(0) (2). Under the assumption of isospin symmetry and using numerical solutions of the Roy equations, the following values are obtained in the plane (a(0) (0),a(0) (2)): a(0) (0)=0.233 +/- 0.016(stat)+/- 0.007(syst),a(0) (2)=-0.0471 +/- 0.011(stat)+/- 0.004syst. The presence of potentially large isospin effects is also considered and will allow comparison with precise predictions from Chiral Perturbation Theory

    Search for the dark photon in pi(0) decays

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    A sample of 1.69 x 10(7) fully reconstructed pi(0) -> gamma e(+)e(-) decay candidates collected by the NA48/2 experiment at CERN in 2003-2004 is analyzed to search for the dark photon (A') production in the pi(0) -> gamma A' decay followed by the prompt A' -> e(+)e(-) decay. No signal is observed, and an exclusion region in the plane of the dark photon mass m(A') and mixing parameter epsilon(2) is established. The obtained upper limits on epsilon(2) are more stringent than the previous limits in the mass range 9 MeV/c(2) pi(+/-)A' decay is also evaluated. (C) 2015 The Authors. Published by Elsevier B.V
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