Discussing uncertainty and risk in primary care: recommendations of a multi-disciplinary panel regarding communication around prostate cancer screening.

BackgroundShared decision making improves value-concordant decision-making around prostate cancer screening (PrCS). Yet, PrCS discussions remain complex, challenging and often emotional for physicians and average-risk men.ObjectiveIn July 2011, the Centers for Disease Control and Prevention convened a multidisciplinary expert panel to identify priorities for funding agencies and development groups to promote evidence-based, value-concordant decisions between men at average risk for prostate cancer and their physicians.DesignTwo-day multidisciplinary expert panel in Atlanta, Georgia, with structured discussions and formal consensus processes.ParticipantsSixteen panelists represented diverse specialties (primary care, medical oncology, urology), disciplines (sociology, communication, medical education, clinical epidemiology) and market sectors (patient advocacy groups, Federal funding agencies, guideline-development organizations).Main measuresPanelists used guiding interactional and evaluation models to identify and rate strategies that might improve PrCS discussions and decisions for physicians, patients and health systems/society. Efficacy was defined as the likelihood of each strategy to impact outcomes. Effort was defined as the relative amount of effort to develop, implement and sustain the strategy. Each strategy was rated (1-7 scale; 7 = maximum) using group process software (ThinkTank(TM)). For each group, intervention strategies were grouped as financial/regulatory, educational, communication or attitudinal levers. For each strategy, barriers were identified.Key resultsHighly ranked strategies to improve value-concordant shared decision-making (SDM) included: changing outpatient clinic visit reimbursement to reward SDM; development of evidence-based, technology-assisted, point-of-service tools for physicians and patients; reframing confusing prostate cancer screening messages; providing pre-visit decision support interventions; utilizing electronic health records to promote benchmarking/best practices; providing additional training for physicians around value-concordant decision-making; and using re-accreditation to promote training.ConclusionsConference outcomes present an expert consensus of strategies likely to improve value-concordant prostate cancer screening decisions. In addition, the methodology used to obtain agreement provides a model of successful collaboration around this and future controversial cancer screening issues, which may be of interest to funding agencies, educators and policy makers

Investigating design features of a computer-mediated communication system

Computer-mediated communication (CMC) is increasingly used in higher education, but it is not without problems. The effectiveness of CMC depends on many factors, including the characteristics of CMC systems themselves. The research reported here therefore aimed to investigate how an educational CMC system might be improved, in order to support learning more effectively. The main context for the research was distance learning at the UK Open University (OU). A two-stage, mixed methods research approach was adopted. In the first stage, interviews and observations were carried out to explore the benefits and problems experienced by users. This revealed two major issues: information overload and lack of social presence. Information overload relates to users’ problems dealing with large numbers of messages. Social presence relates to the need for users to feel connected with each other. The second stage investigated system features aimed at addressing these issues, implemented in a prototype computer conferencing system. Features to address overload included branched message threading and user recommendations. Features to address social presence were ‘résumés’ and instant messaging. These features were evaluated using questionnaires, with several cohorts of students in an OU course. Students expressed approval of the features, although some features were not widely used. Students preferred branched threading to chronological threading because branching helped them to follow ‘conversations’. Students were uncomfortable recommending messages, feeling that the value of a message would vary between people. They were also uncomfortable using instant messaging to contact others whom they did not know. However, the awareness aspect of instant messaging provided a sense of solidarity. The research demonstrated that the problems of overload and lack of social presence are significant, and each has social aspects which must be addressed. Students’ relationships with each other affect whether and how they use the features of CMC systems. We can conclude that particular attention must be paid to the social aspects of online communication, both when designing educational CMC systems and when considering how they are used. To maximise the benefits for learning, students need to feel comfortable with each other online, and there are few short cuts to achieving this

Targeted, structured text messaging to improve dietary and lifestyle behaviours for people on maintenance haemodialysis (KIDNEYTEXT): Study protocol for a randomised controlled trial

Introduction Managing nutrition is critical for reducing morbidity and mortality in patients on haemodialysis but adherence to the complex dietary restrictions remains problematic. Innovative interventions to enhance the delivery of nutritional care are needed. The aim of this phase II trial is to evaluate the feasibility and effectiveness of a targeted mobile phone text messaging system to improve dietary and lifestyle behaviours in patients on long-term haemodialysis. Methods and analysis Single-blinded randomised controlled trial with 6 months of follow-up in 130 patients on haemodialysis who will be randomised to either standard care or KIDNEYTEXT. The KIDNEYTEXT intervention group will receive three text messages per week for 6 months. The text messages provide customised dietary information and advice based on renal dietary guidelines and general healthy eating dietary guidelines, and motivation and support to improve behaviours. The primary outcome is feasibility including recruitment rate, drop-out rate, adherence to renal dietary recommendations, participant satisfaction and a process evaluation using semistructured interviews with a subset of purposively sampled participants. Secondary and exploratory outcomes include a range of clinical and behavioural outcomes and a healthcare utilisation cost analysis will be undertaken. Ethics and dissemination The study has been approved by the Western Sydney Local Health District Human Research Ethics Committee-Westmead. Results will be presented at scientific meetings and published in peer-reviewed publications. Trial registration number ACTRN12617001084370; Pre-results

The memory space: Exploring future uses of Web 2.0 and mobile internet through design interventions.

The QuVis Quantum Mechanics Visualization project aims to address challenges of quantum mechanics instruction through the development of interactive simulations for the learning and teaching of quantum mechanics. In this article, we describe evaluation of simulations focusing on two-level systems developed as part of the Institute of Physics Quantum Physics resources. Simulations are research-based and have been iteratively refined using student feedback in individual observation sessions and in-class trials. We give evidence that these simulations are helping students learn quantum mechanics concepts at both the introductory and advanced undergraduate level, and that students perceive simulations to be beneficial to their learning.Comment: 15 pages, 5 figures, 1 table; accepted for publication in the American Journal of Physic

Passenger Flows in Underground Railway Stations and Platforms, MTI Report 12-43

Urban rail systems are designed to carry large volumes of people into and out of major activity centers. As a result, the stations at these major activity centers are often crowded with boarding and alighting passengers, resulting in passenger inconvenience, delays, and at times danger. This study examines the planning and analysis of station passenger queuing and flows to offer rail transit station designers and transit system operators guidance on how to best accommodate and manage their rail passengers. The objectives of the study are to: 1) Understand the particular infrastructural, operational, behavioral, and spatial factors that affect and may constrain passenger queuing and flows in different types of rail transit stations; 2) Identify, compare, and evaluate practices for efficient, expedient, and safe passenger flows in different types of station environments and during typical (rush hour) and atypical (evacuations, station maintenance/ refurbishment) situations; and 3) Compile short-, medium-, and long-term recommendations for optimizing passenger flows in different station environments