Character evolution and missing (morphological) data across Asteridae

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The development of a multidisciplinary system to understand causal factors in road crashes

The persistent lack of crash causation data to help inform and monitor road and vehicle safety policy is a major obstacle. Data are needed to assess the performance of road and vehicle safety stakeholders and is needed to support the development of further actions. A recent analysis conducted by the European Transport Safety Council identified that there was no single system in place that could meet all of the needs and that there were major gaps including in-depth crash causation information. This paper describes the process of developing a data collection and analysis system designed to fill these gaps. A project team with members from 7 countries was set up to devise appropriate variable lists to collect crash causation information under the following topic levels: accident, road environment, vehicle, and road user, using two quite different sets of resources: retrospective detailed police reports (n=1300) and prospective, independent, on-scene accident research investigations (n=1000). Data categorisation and human factors analysis methods based on Cognitive Reliability and Error Analysis Method (Hollnagel, 1998) were developed to enable the causal factors to be recorded, linked and understood. A harmonised, prospective “on-scene” method for recording the root causes and critical events of road crashes was developed. Where appropriate, this includes interviewing road users in collaboration with more routine accident investigation techniques. The typical level of detail recorded is a minimum of 150 variables for each accident. The project will enable multidisciplinary information on the circumstances of crashes to be interpreted to provide information on the causal factors. This has major applications in the areas of active safety systems, infrastructure and road safety, as well as for tailoring behavioural interventions. There is no direct model available internationally that uses such a systems based approach

The development of a multidisciplinary system to understand causal factors in road crashes

The persistent lack of crash causation data to help inform and monitor road and vehicle safety policy is a major obstacle. Data are needed to assess the performance of road and vehicle safety stakeholders and is needed to support the development of further actions. A recent analysis conducted by the European Transport Safety Council identified that there was no single system in place that could meet all of the needs and that there were major gaps including in-depth crash causation information. This paper describes the process of developing a data collection and analysis system designed to fill these gaps. A project team with members from 7 countries was set up to devise appropriate variable lists to collect crash causation information under the following topic levels: accident, road environment, vehicle, and road user, using two quite different sets of resources: retrospective detailed police reports (n=1300) and prospective, independent, on-scene accident research investigations (n=1000). Data categorisation and human factors analysis methods based on Cognitive Reliability and Error Analysis Method (Hollnagel, 1998) were developed to enable the causal factors to be recorded, linked and understood. A harmonised, prospective “on-scene” method for recording the root causes and critical events of road crashes was developed. Where appropriate, this includes interviewing road users in collaboration with more routine accident investigation techniques. The typical level of detail recorded is a minimum of 150 variables for each accident. The project will enable multidisciplinary information on the circumstances of crashes to be interpreted to provide information on the causal factors. This has major applications in the areas of active safety systems, infrastructure and road safety, as well as for tailoring behavioural interventions. There is no direct model available internationally that uses such a systems based approach

The usefulness and feasibility of a screening instrument to identify psychosocial problems in patients receiving curative radiotherapy: a process evaluation

<p>Abstract</p> <p>Background</p> <p>Psychosocial problems in cancer patients are often unrecognized and untreated due to the low awareness of the existence of these problems or pressures of time. The awareness of the need to identify psychosocial problems in cancer patients is growing and has affected the development of screening instruments. This study explored the usefulness and feasibility of using a screening instrument (SIPP: Screening Inventory of Psychosocial Problems) to identify psychosocial problems in cancer patients receiving curative radiotherapy treatment (RT).</p> <p>Methods</p> <p>The study was conducted in a radiation oncology department in the Netherlands. Several methods were used to document the usefulness and feasibility of the SIPP. Data were collected using self-report questionnaires completed by seven radiotherapists and 268 cancer patients.</p> <p>Results</p> <p>Regarding the screening procedure 33 patients were offered to consult a psychosocial care provider (e.g. social worker, psychologist) during the first consultation with their radiotherapist. Of these patients, 31 patients suffered from at least sub-clinical symptoms and two patients hardly suffered from any symptoms. Patients' acceptance rate 63.6% (21/33) was high. Patients were positive about the content of the SIPP (mean scores vary from 8.00 to 8.88, out of a range between 0 and 10) and about the importance of discussing items of the SIPP with their radiotherapist (mean score = 7.42). Radiotherapists' perspectives about the contribution of the SIPP to discuss the different psychosocial problems were mixed (mean scores varied from 3.17 to 4.67). Patients were more positive about discussing items of the SIPP if the radiotherapists had positive attitudes towards screening and discussing psychosocial problems.</p> <p>Conclusions</p> <p>The screening procedure appeared to be feasible in a radiotherapy department. In general, patients' perspectives were at least moderate. Radiotherapists considered the usefulness and feasibility of the SIPP generally to be lower, but their evaluations were mixed. A positive attitude to using screening instruments like the SIPP needs to be encouraged among radiotherapists, as this may not only improve the usefulness of a screening instrument, but also patients' satisfaction with care.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00859768">NCT00859768</a></p

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