485 research outputs found
BMQ
BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals
A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness
Importance Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking.
Observations Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior.
Conclusions Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care
Preferences and skills of Indian public sector teachers
With a sample of 700 future public sector primary teachers in India, a Discrete Choice Experiment is used to measure job preferences, particularly regarding location. General skills are also tested. Urban origin teachers and women are more averse to remote locations than rural origin teachers and men respectively. Women would require a 26-73 percent increase in salary for moving to a remote location. The results suggest that existing caste and gender quotas can be detrimental for hiring skilled teachers willing to work in remote locations. The most preferred location is home, which supports decentralised hiring, although this could compromise skills
An exploration of parentsâ preferences for foot care in juvenile idiopathic arthritis: a possible role for the discrete choice experiment
Background:
An increased awareness of patientsâ and parentsâ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parentsâ preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA).<p></p>
Methods:
A discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parentsâ monetary valuation of health and service improvements.<p></p>
Results:
Every attribute in the DCE was statistically significant (pâ<â0.01) except that of cost (pâ=â0.118), suggesting that all attributes, except cost, have an impact on parentsâ preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parentsâ estimated mean annual WTP for a multidisciplinary foot care service was ÂŁ1,119.05.<p></p>
Conclusions:
In terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parentsâ preferences.<p></p>
Health care professionals meeting with individuals with Type 2 diabetes and obesity: Balancing coaching and caution
The burden of diabetes and obesity is increasing worldwide, indicating a need to find the best standard for diabetes care. The aim of this study was to generate a theory grounded in empirical data derived from a deeper understanding of health care professionalsâ main concerns when they consult with individuals with diabetes and obesity and how they handle these concerns. Tape-recorded interviews were conducted with seven groups and three individual members of a diabetes team in an area of western Sweden. The grounded theory (GT) method was used to analyse the transcribed interviews. A core category, labelled Balancing coaching and caution and three categories (Coaching and supporting, Ambivalence and uncertainty, and Adjusting intentions) emerged. The core category and the three categories formed a substantive theory that explained and illuminated how health care professionals manage their main concern; their ambition to give professional individualised care; and find the right strategy for each individual with diabetes and obesity. The theory generated by this study can improve our understanding of how a lack of workable strategies limits caregiversâ abilities to reach their goals. It also helps identify the factors that contribute to the complexity of meetings between caregivers and individuals with diabetes
The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial
Determining Factors of the Level of Disclosure of Information on Business Combinations with the Entry into Force of the Accounting Standard CPC 15
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An Ultra Deep Field survey with WFIRST
Studying the formation and evolution of galaxies at the earliest cosmic
times, and their role in reionization, requires the deepest imaging possible.
Ultra-deep surveys like the HUDF and HFF have pushed to mag \mAB30,
revealing galaxies at the faint end of the LF to 911 and
constraining their role in reionization. However, a key limitation of these
fields is their size, only a few arcminutes (less than a Mpc at these
redshifts), too small to probe large-scale environments or clustering
properties of these galaxies, crucial for advancing our understanding of
reionization. Achieving HUDF-quality depth over areas 100 times larger
becomes possible with a mission like the Wide Field Infrared Survey Telescope
(WFIRST), a 2.4-m telescope with similar optical properties to HST, with a
field of view of 1000 arcmin, 100 the area of the
HST/ACS HUDF.
This whitepaper motivates an Ultra-Deep Field survey with WFIRST, covering
100300 the area of the HUDF, or up to 1 deg, to
\mAB30, potentially revealing thousands of galaxies and AGN at the
faint end of the LF, at or beyond \,\,910 in the epoch of
reionization, and tracing their LSS environments, dramatically increasing the
discovery potential at these redshifts.
(Note: This paper is a somewhat expanded version of one that was submitted as
input to the Astro2020 Decadal Survey, with this version including an Appendix
(which exceeded the Astro2020 page limits), describing how the science drivers
for a WFIRST Ultra Deep Field might map into a notional observing program,
including the filters used and exposure times needed to achieve these depths.
Contrasting effects of long term versus short-term nitrogen addition on photosynthesis and respiration in the Arctic
We examined the effects of short (<1â4 years) and long-term (22 years) nitrogen (N) and/or phosphorus (P) addition on the foliar CO2 exchange parameters of the Arctic species Betula nana and Eriophorum vaginatum in northern Alaska. Measured variables included: the carboxylation efficiency of Rubisco (Vcmax), electron transport capacity (Jmax), dark respiration (Rd), chlorophyll a and b content (Chl), and total foliar N (N). For both B. nana and E. vaginatum, foliar N increased by 20â50 % as a consequence of 1â22 years of fertilisation, respectively, and for B. nana foliar N increase was consistent throughout the whole canopy. However, despite this large increase in foliar N, no significant changes in Vcmax and Jmax were observed. In contrast, Rd was significantly higher (>25 %) in both species after 22 years of N addition, but not in the shorter-term treatments. Surprisingly, Chl only increased in both species the first year of fertilisation (i.e. the first season of nutrients applied), but not in the longer-term treatments. These results imply that: (1) under current (low) N availability, these Arctic species either already optimize their photosynthetic capacity per leaf area, or are limited by other nutrients; (2) observed increases in Arctic NEE and GPP with increased nutrient availability are caused by structural changes like increased leaf area index, rather than increased foliar photosynthetic capacity and (3) short-term effects (1â4 years) of nutrient addition cannot always be extrapolated to a larger time scale, which emphasizes the importance of long-term ecological experiments
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