A discursive exploration of public perspectives on placebos and their effects.

There is increasing evidence that placebos could be effective in clinical practice. However, knowledge of public perspectives on placebos is underdeveloped. We conducted a discourse analysis of internet comments on news articles related to placebos, aiming to improve this knowledge for clinicians and researchers. We developed two discursive constructs of the placebo. The dominant construct of the 'placebo pill' informs a paradoxical understanding of placebos that closes down treatment. The less-prevalent counter-discursive construct of the 'treatment process' frames placebos as potentially viable within modern evidence-based medicine. We discuss the opportunities and challenges of this alternative understanding of placebos

Aplikasi konsep berbasis perpindahan pada perencanaan pilar beton bertulang untuk struktur jembatan

Akhir-akhir ini sedang dikembangkan metode perencanaan seismik struktur dengan konsep berbasis perpindahan. Dengan konsep ini, struktur direncanakan berdasarkan target perpindahan yang dikehendaki. Dalam penelitian ini, dilakukan aplikasi perencanaan dengan konsep berbasis perpindahan terhadap pilar kantilever jembatan beton bertulang dengan ketinggian 3, 5, 7, 9, 11, dan 13 m. Hasil perencanaan kemudian dianalisis dengan analisis inelastik riwayat waktu dengan menggunakan program komputer Ruaumoko. Hasil dari analisis inelastik riwayat waktu, pada pilar dengan ketinggian 7m atau lebih menunjukkan drift yang cukup bersesuaian dengan drift yang direncanakan, sedangkan untuk pilar dengan ketinggian 3m dan 5m, drift yang teijadi relatif jauh lebih kecil daiipada drift yang direncanakan

Proceedings of the 25th Americas Conference on Information Systems (AMCIS 2019)

© 2019 Association for Information Systems. All rights reserved. Project start-up is defined as a short-term systematic process leading to project execution. Literature to date lacks emphasis on a definition of the project startup phase and the tasks conducted during this phase. Whilst studies have explored causes of project failure to derive from the early stages of a project, limited studies have explored the impacts of project start-up tasks to a project’s execution and outcome. Using semi-structured interviews from 17 participants across 7 organizations, this study identifies the project start-up tasks and its impact to project delivery and outcomes from the perspective of in-house and outsourced projects. The start-up phase of each organization was then displayed in a comprehensive model depicting the substages within this phase, its corresponding tasks, and the ultimate outcome of each substage. Commonalities and variations within and across organizations are further highlighted

Career after successful medical board examination in general practice - a cross-sectional survey

QUESTION UNDER STUDY: Switzerland is facing a shortage of general practitioners (GPs). Knowledge of the factors influencing career choice is crucial for increasing the attractiveness of general practice. The aim of our study was to report the working conditions of recently certified GPs and the effect of vocational training in general practice on GP skills and knowledge, and economic skills. Furthermore, we recorded when GPs chose general practice as a career, as well as potential barriers to and facilitators of their decision. METHODS: Study design: Cross-sectional survey with an online-based questionnaire. Study group: 1,133 physicians certified in general practice between the years 2000 and 2010. RESULTS: The response rate was 40.6% (456); 426 (44.1% females) were included in further analysis. A total of 341 (80.0%) were currently working in general practice. Female GPs were significantly more often employed (rather than working independently), working part-time and in group practices. Fifty-two (12.2%) of the participants did not work in general practice although they had intended to earlier. The majority (54.3%) of the participants working as GPs decided to become a GP during their residency. Overall, 60.6% of all participants completed vocational training in a general practice, which significantly improved self-perceived general practice skills compared with their colleagues without such training. CONCLUSIONS: Residency is a more important time-period than medical school for career decisions to become a GP. Attractive residency programmes must be developed to engage physicians in this vulnerable phase. The workplace settings of female GPs were significantly different from those ofmale GPs. Vocational training in general practice had a positive effect on self-perceived GP skills

From chronic conditions to relevance in multimorbidity: a four-step study in family medicine.

Chronic conditions and multimorbidity (MM) are major concerns in family medicine (FM). Based on the International Classification of Primary Care, Second Edition (ICPC-2), this study aimed to list (i)the chronic conditions and (ii)those most relevant to MM in FM. A panel of FM experts used a four-step process to identify chronic conditions among ICPC-2 items and list chronic conditions most relevant in MM. They also evaluated the importance of eight criteria, previously identified in the literature, for characterizing chronic conditions. Step one involved a focus group of five experts. Steps two, three and four involved 10, 25 and 25 experts, respectively. They rated ICPC-2 items via an online questionnaire using a Likert scale from 1 (never chronic/irrelevant in MM) to 9 (always chronic/always relevant in MM). A median value cut-off was used to evaluate appropriateness of each item and the inter-percentile range adjusted for symmetry to determine the agreement/disagreement between experts. In parallel, in steps two and three, experts rated the importance of eight criteria to characterize chronic conditions, using a Likert scale from 1 (strongly disagree) to 9 (strongly agree). Of the ICPC-2's 686 items, experts identified 139 chronic conditions, of which 75 were deemed most relevant in the context of MM. Four of the eight criteria were retained as important to define chronic conditions: duration, sequelae, recurrence/pattern and the diagnosis itself. Using this list of 75 chronic conditions most relevant in the context of MM should enhance the validity of studies of MM in FM

Value of the SYNTAX score for periprocedural myocardial infarction according to WHO and the third universal definition of myocardial infarction: insights from the TWENTE trial

Aims: The SYNTAX score is a tool to quantify the complexity of coronary artery disease. We investigated the relation between the SYNTAX score and the occurrence of a periprocedural myocardial infarction (PMI) according to the historical definition of the World Health Organization (WHO) and the recently updated universal definition of MI. Methods and results: The SYNTAX score was calculated in 1,243 patients enrolled in TWENTE, a randomised trial which assessed second-generation drug-eluting stents. PMI was defined by the WHO definition and the third universal definition of MI. Patients were divided into tertiles of the SYNTAX score: ≤7 (n=430); >7 and <15 (n=390); ≥15 (n=423). PMI according to the WHO definition occurred more frequently in patients in the highest SYNTAX score tertile (7.3% vs. 3.1% vs. 1.6%, p<0.001) compared to the mid and lowest tertile. Similar findings were seen for universal PMI (9.9% vs. 7.7% vs. 3.7%, p<0.01). After multivariate analysis, SYNTAX score was a significant independent correlate of PMI for both definitions: the highest SYNTAX score tertile had an almost five times higher risk for WHO PMI, and a three times higher risk for universal PMI. Conclusions: In a broad patient population treated with second-generation DES, the SYNTAX score was able to stratify the risk of PM

Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis

BACKGROUND: Physicians' shortage in many countries and demands of high-quality and affordable care make physician-nurse substitution an appealing workforce strategy. The objective of this study is to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the impact of physician-nurse substitution in primary care on clinical parameters. METHODS: We systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected peer-reviewed RCTs comparing physician-led care with nurse-led care on changes in clinical parameters. Study selection and data extraction were performed in duplicate by independent reviewers. We assessed the individual study risk of bias; calculated the study-specific and pooled relative risks (RR) or weighted mean differences (WMD); and performed fixed-effects meta-analyses. RESULTS: 11 RCTs (N = 30,247) were included; most were from Europe, generally small with higher risk of bias. In all studies, nurses provided care for complex conditions including HIV, hypertension, heart failure, cerebrovascular diseases, diabetes, asthma, Parkinson's disease and incontinence. Meta-analyses showed greater reductions in systolic blood pressure (SBP) in favour of nurse-led care (WMD -4.27 mmHg, 95% CI -6.31 to -2.23) but no statistically significant differences between groups in the reduction of diastolic blood pressure (DBP) (WMD -1.48 mmHg, 95%CI -3.05 to -0.09), total cholesterol (TC) (WMD -0.08 mmol/l, 95%CI -0.22 to 0.07) or glycosylated haemoglobin (WMD 0.12%HbAc1, 95%CI -0.13 to 0.37). Of other 32 clinical parameters identified, less than a fifth favoured nurse-led care while 25 showed no significant differences between groups. LIMITATIONS: disease-specific interventions from a small selection of healthcare systems, insufficient quantity and quality of studies, many different parameters. CONCLUSIONS: trained nurses appeared to be better than physicians at lowering SBP but similar at lowering DBP, TC or HbA1c. There is insufficient evidence that nurse-led care leads to better outcomes of other clinical parameters than physician-led care

Who cares when you close down? The effects of primary care practice closures on patients

This paper investigates the consequences that patients face when their regular general practitioner (GP) closes down her practice, typically due to retirement. We estimate the causal impact of closures on patients' utilization patterns, healthcare expenditures, hospitalizations, mortality, and health plan choices. Employing a difference-in-difference framework, we find that patients who experience a discontinuity of care persistently adjust their ambulatory utilization pattern by shifting visits away from GPs (−12%) toward specialists (+11%) and hospital outpatient facilities (+6%). In contrast, we find no evidence on adverse health effects as measured by hospitalizations and mortality. The impact on utilization is heterogeneous along several dimensions. In particular, we find geographic disparities between regions with high and low availability of primary care. We also observe that patients with chronic conditions substitute more strongly toward other providers. Our results have potential implications for health policy in at least two dimensions: first, practice closures lead to more fragmented care which may entail inefficiencies, and second, closures deteriorate access to primary care in regions with low physician density