How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making

Infrared study of carbon deposits on bimetallic catalysts. Annual progress report, December 1, 1989--November 30, 1990

Catalytic reforming of low octane gasoline is carried out on dual function catalysts, e.g. Pt/alumina, Pt-Re/alumina, Pt-Sn/alumina. Carboxylates are a constituent of coke on alumina; Re lowers this. 3 wt% Sn lowers both carboxylate and coke by 40% compared to alumina. 3% loadings of both Sn and Pt showed a strong synergistic effect: total coke is increased by 300% and carboxylate production is doubled. At 3% loadings of both metals, the ability of Pt to chemisorb CO is decreased, which parallels the excess coke. At 0.3%, both effects are not detectable. In order to understand the effects of second metals added with Pt on carboxylate production, a study of the mechanism of the production of carbon-oxygen species under reducing conditions of coke deposition is needed

THE INFRARED SPECTRUM OF ACETYLENE CHEMISORBED ON NICKEL

Author Institution: Beacon Laboratories, The Texas CompanyThe infrared spectrum of acetylene chemisorbed on silica-supported nickel (9.2 wt. %) has been obtained. As in chemisorbed ethylene the absorption due to C-H stretching was essentially in the region characteristic of saturated hydrocarbons. But unlike chemisorbed ethylene, the chemisorbed acetylene spectrum shows evidence of the existence of $-CH_{3}$ groups by a sharp absorption band at 7.25 microns. Attempts were made to rule out effects due to residual surface hydrogen by chemisorbing acetylene on a de-hydrogenated surface and also on a deuterated surface. However in both cases the presence of $CH_{2}$ and $CH_{3}$ groups was indicated in the spectra of the chemisorbed acetylene. It was therefore concluded that self-hydrogenation takes place with some acetylene molecules giving up hydrogen atoms to others to form chemisorbed ethyl groups, $C^{*}H_{2}CH_{3}$, and a surface carbide

THE INFRARED SPECTRA OF OLEFINS CHEMISORBED ON NICKEL

Author Institution: Beacon Laboratories, The Texas CompanyThe infrared spectra of ethylene and propylene chemisorbed on silica-supported nickel (9.2 wt. %) have been obtained. Interpretation of the spectra is based on analogy with the spectra of hydrocarbons of known structure neglecting any possible effects of strain on the spectra of of the adsorbed hydrocarbons. In the case of chemisorbed ethylene the position of the absorption due to C-H stretching was essentially in the region characteristic of saturated hydrocarbons. In addition a band attributed to $CH_{2}$ deformation was observed at 6.91 microns. On the basis of these data it was concluded that the chemisorbed species consists mainly of $H_{2}C^{*}-C^{*}H_{2}$ (asterisk indicates bonding to the nickel surface). Evidence was obtained for the existence of a half-hydrogenated state, $C^{*}H_{2}CH_{3}$, by exposing the chemisorbed ethylene to hydrogen. Infrared spectra of chemisorbed propylene and hydrogen exposed chemisorbed propylene were also obtained

INFRARED STUDY OF THE HYDROGENATION AND DEHYDROGENATION OF CHEMISORBED OLEFINS AND ACETYLENE

Author Institution: Texaco Research Center, Beacon“Various unsaturated hydrocarbons were chemisorbed on Cabosil-supported nickel and then exposed to hydrogen to form adsorbed alkyl groups. Infrared spectra show that these chemisorbed alkyl groups can be dehydrogenated by evacuation to form a surface carbide type chemisorbed species. By reexposure to hydrogen at room temperature, the surface carbide is easily rehydrogenated to form adsorbed alkyl groups. The spectra show that some polymerization can occur during this procedure. This is especially interesting in the case of acetylene which on chemisorption forms both adsorbed ethyl groups and an appreciable quantity of surface carbide. Subsequent hydrogen exposure results in an infrared spectrum indicating mainly adsorbed butyl groups, consistent with the fact that hydrogenation of acetylene produces a product containing a high percentage of butane.