bluuebunny/crossref_metadata_2025 huggingface dataset:
Administration of Mycobacterium phlei cell wall-nucleic acid complex in the immediate postoperative period for the treatment of nonmuscle- invasive bladder cancer
Authors: Morales Álvaro
Published: October 2016

Introduction: This review sought to investigate the safety of intravesical administration of Mycobacterium phlei cell wall-nucleic acid (MCNA) in the immediate postoperative period after biopsy/ resection for non-muscle-invasive bladder cancer (NMIBC).Methods: Patients with NMIBC who failed bacillus Calmette-Guérin (BCG) therapy and at high risk of recurrence and progression participated in this study. Treatment involved an induction phase of six weeks and maintenance of three weekly instillations every six months for two years. Biopsies were mandatory at six months and resections/biopsies as indicated. Of the 129 patients enrolled, 18 (14%) received one or more instillations of MCNA within 24 hours of an endoscopic procedure for a total of 32 instillations.Results: Fourteen patients (78%) received MCNA in the immediate postoperative period. Two (11%) received treatment the day after surgery, but a second treatment immediately after a transurethral resection of the bladder tumour (TURBT). The remaining two patients received an instillation each the day after surgery. Adverse events (AEs) occurred in 31.3% of those treated immediately after the procedure; they were mild, limited to the lower urinary tract, and not drug-related. Only one patient experienced systemic symptoms of moderate severity. None of the AEs resulted in postponement of treatment. There were no AEs among those receiving MCNA the day after surgery.Conclusions: The dual mechanism of action of MCNA suggests that early treatment would take advantage of its chemotherapeutic (pro-apoptotic) activity. Concerns about early administration due to the presence of live bacteria are circumvented with this sterile preparation. These preliminary results warrant further investigation to confirm the safety of perioperative administration of MCNA.
Appendix for: "A proposed solution to a urological tightrope walk: The challenge of transition of spina bifida patients from pediatric to adult care in Ontario"n
Authors: Koyle Martin A. , Golda Nicole , Hillis Christopher , Oldershaw Betty , DeMelo Margaret , Uyeno Jennifer
Published: October 2016

N/A
Appendix for: The uptake of active surveillance for the management of prostate cancer: A population-based analysis
Authors: Richard Patrick O. , Alibhai Shabbir M.H. , Panzarella Tony , Klotz Laurence , Komisarenko Maria , Fleshner Neil E. , Urbach David , Finelli Antonio
Published: October 2016

N/A
Entrepreneurial Orientation of Mexican Small Business Managers
Authors: De la Garza Carranza María Teresa , Soria Eugenio Guzmán , Estrada Cecilia Ramos
Published: October 2016

In small businesses, management skills, entrepreneurial orientation, social responsibility and closely related issues are very important. In this paper, the results of a study of the relationship between management skills, social responsibility and entrepreneurial orientation of small Mexican entrepreneurs are presented. The study was carried out using quantitative methods and included the design of a survey applied to 140 small entrepreneurs in the central region of Mexico. Findings reveal that there is a positive and significant relationship between these three variables, considering the mediation of demographic variables. A model evaluated through regression analysis models is also presented, which proves to be significant and explains these relationships in all their dimensions.
Drying Kinetics of Microwave-Dried Vegetable Amaranth (Amaranthus dubius) Leaves
Authors: Mujaffar Saheeda , Loy Alex Lee
Published: October 2016

The effect of microwave power level (200, 500, 700 and 1000W) on the drying behaviour of amaranth (Amaranthus dubius) leaves was investigated. Higher microwave power levels effected faster drying and there was an increase in drying rate constant (k) as microwave power level increased from 200 to 1000W and an increase in diffusivity (Deff) values from 3.04 x 10-10 to 2.82 x 10-9 m2/s. Leaves dried at 1000W power level however showed noticeable scorching after 540s of drying. Drying at the lower microwave power levels occurred in the constant and falling rate period, while at the higher power levels drying occurred in the falling rate period after an initial warm-up phase. Amaranth leaves could be dried at 700W power from an initial moisture content of 6.00 g H2O/g DM (85.7% wb) to 0.08 g H2O/g DM (7.6% wb) in 11.5 min. Overall, of the twenty-two thin layer models applied to the MR data, the Alibas model gave the best fit in terms of both the root mean square error (RMSE) and the chi-square statistic (c2).
Interval Enclosures for Reliability Metrics
Authors: Campos Marcilia Andrade , Mendonça André Feitoza
Published: October 2016

The computation of reliability metrics involves real numbers. Therefore, numerical problems are generated due to the limitation of representing and operating with real numbers in computers. This paper proposes interval functions for controlling numeric errors in the computation of reliability metrics values of complex systems, based on interval mathematics and high accuracy arithmetic. The interval functions calculate interval enclosures, using Intlab toolbox, for real values of reliability metrics and the SHARPE software was used to validate the results. Analysis of the numerical results obtained with the proposed functions showed that the intervals really enclose the real numbers calculated by the software SHARPE, indicating that these functions, in fact, are an alternative for auto-validating representation of these reliability values of complex systems.
Finite Element Method with Spectral Green's Function in Slab Geometry for Neutron Diffusion in Multiplying Media and One Energy Group
Authors: Rocha Rogério Vinícius Matos , Dominguez Dany Sanchez , Iglesias Susana Marrero , Barros Ricardo Carvalho de
Published: October 2016

The physical phenomenon of neutrons transport associated with eigenvalue problems appears in the criticality calculations of nuclear reactors and can be treated as a diffusion process. This paper presents a new method to solve eigenvalue problems of neutron diffusion in slab geometry and one energy group. This formulation combines the Finite Element Method, considered an intermediate mesh method, with the Spectral Green's Function Method, which is free of truncation errors, and it is considered a coarse mesh method. The novelty of this formulation is to approach the spatial moments of the neutron flux distribution by the first-order polynomials obtained from the spectral analysis of diffusion equation. The approximations provided by the new formulation allow obtaining accurate results in coarse mesh calculations. To validate the method, we compare the results obtained with the methods described in the literature, specifically the Diamond Difference method. The accuracy and the computational performance of the proposed formulation were characterized by solving benchmarks problems with a high degree of heterogeneity.
Multi-fractal Analysis for Riemann Serie and Mandelbrot Binomial Measure with (min,+)-Wavelets.
Authors: Gondran Michel , Kenoufi Abdelouahab , Lehner Thierry
Published: October 2016

One introduces first the so-called (min, +)-wavelets which are lower and upper hulls build from (min, +) analysis in order to perform multi-fractal analysis. In a second step it is applied to functions such as the Riemann serie and binomial Mandelbrot measure for numerical computations of their singularities spectrum, and comparisons with well-known theoretical and to WTMM method results.
The perceived effects of psycho-spiritual integrative therapy and community support groups on coping with breast cancer: a qualitative analysis
Authors: McDonald Cynthia , Wall Kathleen , Corwin Diana , Brooks Christine , Koopman Cheryl
Published: October 2016

Background: Few studies have assessed the efficacy of interventions that specifically address the unmet spiritual needs of cancer patients. This exploratory qualitative study sought to address this gap by comparing the subjective effects of Psycho-Spiritual Integrative Therapy (PSIT) groups and community-based support groups on coping and post-traumatic growth among women diagnosed with breast cancer. Community-based breast cancer support groups generally emphasize social support, emotional expression and problem solving, whereas PSIT emphasizes spiritual as well as psychological and existential development. PSIT offers a patient-centered approach in which this personal growth can be tailored to the participant’s beliefs and values.Methods: The study sample consisted of 24 participants; 12 from PSIT groups and 12 from community-based cancer support groups. Thematic analysis and grounded theory were used to analyze interview data.Results: The qualitative analysis identified four phases of coping with breast cancer. Women attributed positive effects of both PSIT groups and community-based support groups on coping and post-traumatic growth in the following areas: self-acceptance, body image, life purpose and meaning, spirituality, reassessment of values and priorities and interpersonal relationships. However, women participating in PSIT reported more positive effects on spiritual and existential development and coping than did community sample participants.Conclusion: Because of its inherent focus on spiritual and existential development, PSIT may both appeal to and help some women to better adapt to breast cancer survivorship.
Developing a research framework to inform an evidence base for person-centered medicine: keeping the person at the centre
Authors: Reid Corinne
Published: October 2016

Person-centered medicine exists at the intersect of science and humanism and has the dual goals of relational and evidence-based practice. In the operationalization of humanistic medicine the development of a sympathetic and facilitative research framework is, then, a priority. The person-centric research framework is proffered as one such model and will be described in this paper with a view to eliciting discussion about the essential qualities of a person-centered approach to evidence generation. This framework has been emergent from the clinical practice of the author and builds upon other pioneering work in this field. It is operationalized as a practitioner-informed philosophy of the conceptualisation, practice and interpretation of research.
Health information technology use and the decisions of altruistic physicians
Authors: Tsang Sandro
Published: October 2016

Rationale, aims and objectives: Knowledge is the basis and mediator of medical care. Health information technology (HIT) can help in improving care only if physicians faithfully apply their knowledge during its use. A measure of judicious HIT use has recently been proposed. Behavioural research and the oft-cited technology acceptance model suggest that beliefs/perceptions may also represent decision factors. This paper proposes a perception scale and an alternative measure of judicious HIT use.Methods: Statistical analyses were performed on a subset of survey data collected for developing an eHealth success model. This paper focuses on deriving a structural equation model that can explain the associations among intent to use HIT, professional concerns and perceptions about the impacts of HIT on care benefits.Results: The statistical results show that altruism, autonomy, the physician-patient relationship, (subconscious) autonomy, efficiency and efficacy significantly associate with each other to different extents. Only altruism and efficacy appear to be significant determinants of intent to use at p<0.01 and p<0.05, respectively. The scaled χ2 difference test shows that this model is not significantly different from Tsang’s model.Conclusion: Physician performance cannot be reliably evaluated and monitored when based purely on direct observations. The statistical results indicate that professional concerns associate with physicians’ perceptions about the impacts of HIT and influence intent to use HIT. This paper shows a tendency of physicians to internalise factors that cannot be directly observed in the evaluation of HIT use. The study is advanced as of use in deriving policies that aim at coalescing evidence-based medical practice with humanism and thus as a significant contribution to the advancement of person-centered medicine.
Translation and application of G-MHLC-C scales in academic and non-academic nursing staff
Authors: Van Eckert Sandra , Gaidys Uta , Martin Colin
Published: October 2016

To date, studies on the health locus of control have focused on chronically ill and pregnant patients and have not included staff working in health services. Following the translation of the MHLC-C into German and its pre-testing by Wallston et al. [1], the G-MHLC-C was completed by 212 academic and non-academic nurses and the results of the respective groups were compared. With a Cronbachs of α=0.70, the internal consistency of the G-MHLC-C was within acceptable limits. Two of the sub-scales showed poor consistency. When comparing the scores of both groups, only the G-MHLC-C ‘chance’ subscale showed a significant difference (p=0.01). Before recommending the general use of G-MHLC-C, further studies on the translation and validation should be conducted. In addition, it should be explored to what extent the G-MHLC-C for nursing staff represents a suitable tool despite their professional experiences and nursing education.
Use of participatory design in the development of person-centred web-based support for persons with long-term illness
Authors: Sparud-Lundin Carina , Josefsson Ulrika , Berg Marie , Hellstrom Anna-Lena , Koinberg Ingalill , Nolbris Margaretha Jenholt , Ranerup Agneta , Skarsater Ingela
Published: October 2016

Background: E-health solutions are increasingly being developed to meet patients’ preferences and promote their participation in healthcare. Few studies have explored the participatory design process from the perspective of person-centeredness, including how it becomes materialized in technology. This paper explores how applied participatory approaches and the design of 4 web-based interventions directed towards long-term illness correspond to key areas of person-centeredness. Methods: Data were collected during 2009 to 2012, from 4 Swedish research projects. The analysis followed an inductive approach involving a step-wise cross-case analysis. The purpose was to create shared knowledge and understanding of each separate case and to generate relevant categories.Results: A number of question areas describe the dialogue with the case participants. Results of the dialogue are categorized into 4 support areas: psychological/emotional, personal, information and technical. Person-centeredness becomes visible in the participatory design process as the approach promotes the development of a holistic view of the person and the illness and a partnership between patients and carers. The use of communication technology exemplifies concrete materialization of person-centeredness in the design of the web-based supports. The purpose of the web supports and the shaping of the actual use of the functionalities are more abstract forms of materialization.Conclusions: Our results contribute to a central development area within eHealth involving increased opportunities for patients to contribute actively in real time, obtaining access to information and sometimes interacting with carers. However, neither participatory approaches nor technology for online information and communication, can guarantee person-centeredness in isolation.
Ladd, P.D. and Churchill, A.M. (2012). Person-Centred Diagnosis and Treatment in Mental Health: A Model for Empowering Clients, London: Jessica Kingsley Publishers. ISBN 9781849058865
Authors: Lindsay Margot
Published: October 2016

No abstract
A task-fit measure of health information technology use
Authors: Tsang Sandro
Published: October 2016

Rationale, aims and objectives: Introducing profession concerns into the evaluation of health information technology (HIT) use is an important and developing practice. A comprehensive evaluation should include the intellect elements of HIT use. This paper proposes a task-fit measure of HIT that integrates an information/knowledge quality scale into a validated judicious HIT use measure. It also presents some statistics that have implications for policy-making and curriculum development.Methods: Statistical analyses were performed on a subset of survey data. A structural equation modelling technique was applied to examine the associations among intent to use HIT, professional concerns and information/knowledge quality.Results: The statistical results show that altruism, autonomy, physician-patient relationship, (subconscious) autonomy, digestible information and medical history associate with each other to different extents. Only altruism and medical history show to be significant determinants of intent to use at P<0.001 and P<0.05 respectively. The scaled χ2 difference test shows that this model is not significantly different from the judicious HIT use model.Conclusion: The statistical results suggest that professional concerns, digestible information and person-related information are HIT use decision factors. Perhaps physicians may prefer HITs considered to be compatible with practising the science, humanism and ethics of medicine simultaneously. This research direction will potentially contribute to identifying the task-fit HITs and the corresponding policies for re-orientating medicine to be a science-using and compassionate practice in this eHealth era, thereby promoting the development of person-centered healthcare.
Cultivating person-centered medicine in future physicians
Authors: Garneau Kevin , Hutchinson Thomas , Zhao Qinyi , Dobkin Patricia
Published: October 2016

Person-centered medicine, while valued implicitly, is not always taught explicitly in medical schools or during residency programs. Threats to educating and practicing person-centered medicine include perceived lack of time, stress, burnout and a paucity of mentors with a systematic approach to modeling and teaching students how to relate to patients in a way that addresses them as whole persons. Herein we review how trainee stress and burnout negatively impact patient care and outline a program designed to teach mindful medical practice that may be an antidote to these problems. Moreover, we present quantitative data and a student’s narrative to highlight how to cultivate person-centered medicine in trainees.Fifty-eight 4th year medical students completed questionnaires pertaining to: depression, burnout, stress, wellbeing, self-compassion and mindfulness before and after taking a 4-week elective entitled, Mindful Medical Practice. Statistically significant improvements were found on emotional exhaustion, depression, self-compassion and mindfulness. One student’s experiences highlighted how what he learned in the elective guided him during his family medicine residency. We conclude with a discussion of how the culture of medicine and the training of future physicians in particular, need to take the whole persons of both the physician and patient into account in order for all to be satisfied with and benefit from medical care.
What Person-Centred Medicine is and isn't: temptations for the ‘soul’ of PCM
Authors: Loughlin Michael
Published: October 2016

In their important discussion paper presenting person-centred medicine (PCM) as ‘an emergent model of modern clinical practice’ [1], Miles and Mezzich note a rather obvious comparison between the rhetoric of their own favoured ‘model’ and the rhetoric of the evidence-based medicine (EBM) movement. For all their differences, PCM and EBM have something in common. While we may disagree about what evidence is or indeed just not be sure what it is, we are generally agreed that we are in favour of it. A movement that is all about promoting the use of evidence in medicine sounds about as uncontroversial as it gets. I might be oblivious to scientific debates about the nature of evidence and have no idea how to define the term, but I know that I want anyone treating me to use evidence, all the same. I may wonder what else medical decisions should be based on, if not evidence? [2]. Similarly, it would make very little sense to be ‘against’ persons. I may have never given a moment’s thought to philosophical disputes about the nature of persons, but I know that however one defines persons, I am one of them and in reply to the question: ‘Should medicine care for persons or not?’ few would answer in the negative. Again, I might wonder: if medicine is not about caring for ‘the person’, then what is it about?
Partnership or paternalistic model of physician care for older patients? Perspectives of a 76-year-old woman and a 75-year-old man
Authors: Marcinowicz Ludmila
Published: October 2016

Older patients see their doctors relatively often and so recognition of their healthcare preferences can lead to improved quality of care. Knowledge of older patients’ views and preferences is still relatively unexplored, especially the kind of model of care they prefer - partnership or paternalistic. This paper presents results of part of a qualitative research project on the experience of patients over 65-years-old who are consumers of family physicians’ care in Poland. The aim of this study was to explore the type of physician care relationship preferred by elderly patients - partnership or paternalistic. In-depth interviews were conducted, encouraging the participants to speak freely about the care they received from family physicians. The interviews were recorded and then fully transcribed. The content of the transcripts was analyzed thematically. Two elderly patients, male and female, with chronic illnesses, were interviewed about their experiences during visits to the doctor, including their expectations about physician care and what they considered to be the most important aspects of visiting a doctor. Descriptions of the above two cases prove that there is no simple answer to the question of a family doctor care model type which is better for older patients. One subject preferred the paternalistic approach, whereas the other preferred a partnership model based on cooperation. Both patients emphasized the need for acquiring information on the disease, treatments and outcomes regardless of the preferred care model.
Person-centered medicine - a complementary approach to coping with burnout prodromes in medical students. A commentary on Garneau, K., Hutchinson, T., Zhao Q., Dobkin P.L. The European Journal of Person Centered Health Care
Authors: Zaharieva Polina , Kazakov Dimitar , Stoyanov Drozdstoj
Published: October 2016

No abstract
Modern healthcare: a technical giant, yet an ethical child?
Authors: Miles Andrew , Asbridge Jonathan Elliott
Published: October 2016

Within our healthcare systems, avoidable error rates and medico-legal bills are soaring, care home and hospital scandals are frequent and patient-reported consternation and even frank distress with the inhuman way they are routinely ‘dealt with’ are all now so commonplace as to be almost normative. All of these things - and more - vividly illustrate that much is wrong within modern medicine and healthcare and that much, therefore, needs to be put right. If Society continues to tolerate this crisis of disregard and neglect and if it does not urgently take the time to consider why and how we have arrived at where we currently are - in order to take corrective actions - then we will have reached a very sad point in human history indeed.
The Balancing Person: an innovative approach to person-centred education in chronic illness
Authors: Hansen Ulla Moller , Engelund Gitte , A Rogvi Sofie , Willaing Ingrid
Published: October 2016

Rationale, aims and objective: Most patient education is based on a professional understanding of patients’ needs for learning, rather than a patient perspective. This generates a risk of neglecting issues that are important to patients, but unrecognised by educators. The aim of this study was to develop a health educational model for group-based patient education in chronic illness based on patient-perceived challenges.Methods: Design Thinking was used as a method of inquiry. Four interactive workshops with 25 Danish patients with Type 2 diabetes, heart disease and chronic obstructive pulmonary disease provided data on patient-perceived challenges. Workshops with 28 educators informed the development of the model. A constant comparative method was used for analyses.Results: Patients with chronic illness experience a constant need to balance their lives, which imposes new challenges in their everyday life. We identified 4 main challenges: Bodily Infirmities, Lowered Expectations, Challenging Relations and Changeable Moods. In response to these challenges, researchers and educators developed The Balancing Person, a health educational model with 4 interconnected meta-needs for the education process: Wholeness, Clarity, Timeliness and Connectedness.
Co- and multimorbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT Study and theoretical reflections concerning basic medical models
Authors: Tomasdottir Margret Olafia , Getz Linn , Sigurdsson Johann A , Petursson Halfdan , Kirkengen Anna Luise , Krokstad Steinar , McEwan Bruce , Hetlevik Irene
Published: October 2016

Rationale and aims: Accumulating evidence shows that diseases tend to cluster in diseased individuals, so-called multimorbidity. The aim of this study was to analyze multimorbidity patterns, empirically and theoretically, to better understand the phenomenon. Population and methods: The Norwegian population-based Nord-Trøndelag Health Study HUNT 3 (2006-8), with 47,959 individuals aged 20-79 years. A total of 21 relevant, longstanding diseases/malfunctions were eligible for counting in each participant. Multimorbidity was defined as two or more chronic conditions.Results: Multimorbidity was found in 18% of individuals aged 20 years. The prevalence increased with age in both sexes. The overall age-standardized prevalence was 42% (39% for men, 46% for women). ‘Musculoskeletal disorders’ was the disease-group most frequently associated with multimorbidity. Three conditions, strategically selected to represent different diagnostic domains according to biomedical tradition; gastro-esophageal reflux, thyroid disease and dental problems, were all associated with both mental and somatic comorbid conditions. Conclusions and implications: Multimorbidity appears to be prevalent in both genders and across age-groups, even in the affluent and relatively equitable Norwegian society. The disease clusters typically transcend biomedicine’s traditional demarcations between mental and somatic diseases and between diagnostic categories within each of these domains. A new theoretical approach to disease development and recovery is warranted, in order to adequately tackle ‘the challenge of multimorbidity’, both empirically and clinically. We think the concept allostatic load can be systematically developed to “capture” the interrelatedness of biography and biology and to address the fundamental significance of “that, which gains” versus “that, which drains” any given human being.
Evaluation of a four-week Rehabilitation Assessment program introduced at an Australian Community Care Units setting: mental health consumers and clinicians perspectives
Authors: Nguy Jodie , Petrakis Melissa , Wilson Michael
Published: October 2016

Background: Community Care Units (CCUs) are purpose built residential accommodation for adults with severe and enduring mental illness. The CCUs are staffed by clinical mental health staff 24 hours per day and there are consistent guidelines as to the process these programs utilise to prioritise who would most benefit from them. A CCU based in the Inner East of Melbourne, Australia, has utilised one bed as a ‘review program’ to assess patients’ functional livings skills and potential for engagement with the long-term rehabilitation program as part of a general more person-centered healthcare approach.  Aims: The purpose was to evaluate: (1) patient perception of the program and if this benefits their rehabilitation, (2) the perception of clinicians who refer to the program and (3) the perception of clinicians of the CCU multidisciplinary team (MDT).  Method: A purposive sample of patients and clinicians was employed. Semi-structured interviews were conducted with 7 patients who had participated in the review program between January 2010 - April 2012 and an online survey was conducted with responses from 5 case managers who had referred patients and 9 clinicians in the CCU MDT team who had participated in conducting the review. Results: Our results indicated that patients found the process somewhat overwhelming and an adjustment to their daily routine; they were generally unclear as to the rationale for referral to the program. Clinicians found the program to be a useful process in assisting a more in-depth understanding of their patients’ needs.  Conclusion: Results suggest that review and modification to program delivery could enhance patient benefits and enhance more person-centered approaches to care.
A 30-month follow-up of generalized anxiety disorder: Status after metacognitive therapy and intolerance of uncertainty-therapy
Authors: Van der Heiden Colin , Melchior Kim
Published: October 2016

Objectives: Although metacognitive therapy and intolerance-of-uncertainty therapy are considered efficacious treatments for generalized anxiety disorder, little is known about the long-term course in patients who engaged in treatment studies. Method: We conducted a continuation study of patients with GAD who had participated in a randomized, delayed treatment controlled trial in which the relative efficacy of MCT and IUT were compared.Results: Of the original 85 patients who completed the study, 34 were available for assessment of worry severity at 30-month follow-up. Both treatment groups showed maintenance of treatment gains from 6-month to 30-month follow-up assesment. However, MCT produced better results at long-term follow-up, which was reflected in statistically and clinically significant differences, and in terms of sustained efficacy (i.e., the degree in which patients who improved with treatment remained improved).Conclusion: Both MCT and IUT may be associated with long-term benefits for patients diagnosed with GAD, with MCT performing significantly better than IUT, and showing greater sustained efficacy.
Physician Styles of Decision Making for a Complex Condition: Type 2 Diabetes with Comorbid Mental Illness
Authors: Trachtenberg Felicia , Pober David , Welch Lisa , McKinlay John
Published: October 2016

Rationale, aims, and objectives: Variation in physician decisions may reflect personal styles of decision making, as opposed to singular clinical actions, and these styles may be applied differently depending on patient complexity. The objective of this study is to examine clusters of physician decision making for type 2 diabetes, overall and in the presence of a mental health comorbidity. Method: This randomized balanced factorial experiment presented video vignettes of a “patient” with diagnosed but uncontrolled type 2 diabetes. “Patients” were systematically varied by age, sex, race, and comorbidity (depression, schizophrenia with normal or bizarre affect, eczema as control).  256 primary care physicians, balanced by gender and experience level, completed a structured interview about clinical management.  Results: Cluster analysis identified three styles of diabetes management.  “Minimalists” (N=84) performed fewer exams or tests compared to “middle of the road” physicians (N=84).  “Interventionists” (N=88) suggested more medications and referrals.  A second cluster analysis, without control for comorbidities, identified an additional cluster of “information seekers” (N=15) who requested more additional information and referrals.  Physicians ranking schizophrenia higher than diabetes on their problem list were more likely “minimalists” and none were “interventionists” or “information seekers”. Conclusions: Variations in clinical management encompass multiple clinical actions, and physicians subtly shift these decision making styles depending on patient comorbidities. Physicians’ practice styles may help explain persistent differences in patient care. Training and continuing education efforts to encourage physicians to implement evidence-based clinical practice should account for general styles of decision making and for how physicians process complicating comorbidities.
Carers – vital partners in increasing the person-centeredness of health and social care systems
Authors: Miles Andrew , Asbridge Jonathan Elliot
Published: October 2016

No abstract
Ongoing problems with the E of EBM and on the need for person-centered healthcare. A commentary on Steurer et al. (2014). “Are clinically heterogenous studies synthesized in systematic reviews?”
Authors: Miles Andrew
Published: October 2016

No abstract
A Description of Nurse Practitioners’ Self-Report Implementation of Patient-Centered Care
Authors: Sidani Souraya , Collins Laura , Harbman Patti , Hurlock- Chorostecki Christina , MacMillan Kathleen , Reeves Scott , Donald Faith , Van Soeren Mary , Staples Patti
Published: October 2016

This study aimed to describe the nurse practitioners’ self-reported implementation of patient-centered care (PCC) and factors that influence their delivery of PCC. It was guided by a conceptualization of PCC that identified three components that distinguish PCC (i.e. holistic, collaborative, and responsive care) and respective activities that operationalize them. A sample of 149 nurse practitioners employed in acute and long term care settings, in Ontario Canada, completed a valid and reliable measure of the extent to which they implemented the three PCC components. The results indicated that the majority of respondents reported engagement in most activities reflective of the PCC components, most of the time, and that experienced nurse practitioners performed a large number of these activities. Further research should examine the contribution of each PCC component, as implemented by nurse practitioners and other members of the healthcare team, to patient-oriented outcomes.
Evaluating a person-centred chronic pain service using indices of reliable and clinically significant change
Authors: Macey Katherine , Clarke Simon , Golijani-Moghaddam Nima , Das Nair Roshan
Published: October 2016

Background: Psychological interventions for chronic pain often require substantial individualisation, which can undermine links with the research evidence on which treatment is based. To ensure clients receive effective therapy, evaluation is needed. This paper demonstrates the use of individual level change indices, which may be more appropriate for assessing effectiveness of person-centred treatment than traditional group-level statistics.Aims: To evaluate the efficacy of a psychological chronic pain service at individual level and to recommend improvements for future service evaluation.Method: Indices of reliable and clinically significant change were used to assess outcomes on the HADS, CORE-10, and PSEQ.Results: 56 out of 83 clients had usable outcome data. On the most widely administered outcome measure, the CORE-10, n=15 met reliable change and n=22 met clinically significant change criteria. 18 showed no reliable change. Only one person deteriorated.Conclusions: The person-centred treatment provided by this service was effective and achieved outcomes similar to published data from a structured group programme. However, missing data reduces the reliability of these conclusions and led to reduced usefulness of the evaluation for service planning. Recommendations for future evaluation are made.
ASSESSMENT AND MANAGEMENT TECHNIQUE OF PRACTITIONERS: EXPLORING CLINICAL REASONING IN THE CONTEXT OF THE INDIVIDUAL PATIENT
Authors: Rehman Amir Ur , Siddiqui Muhammad A , Ashraff Suhel , Sajjad Abdul Ghafoor , Darain Haider
Published: October 2016

This paper aims to describe the clinical reasoning behind the diagnosis and management process used by a physiotherapist working in a musculoskeletal outpatient department. The therapist was videotaped while attending to a patient having osteoarthritis of left knee, which he came across in his initial phase of musculoskeletal practice. In the analysis, the therapist was trying to reflect on his practice describing the thoughts and consideration on which he had diagnosed the condition of patient as osteoarthritis of knee. The model called hypothetico deductive reasoning served as the mainframe work for the reflection of practice employed by this physiotherapist. This paper explores these findings and relating them to the research in the field of reasoning.
AUSTRALIAN PATIENTS USING A CARDIAC-DIABETES WEB-BASED INTERVENTION PROGRAM: CONTRIBUTIONS TO PERSON-CENTERED CLINICAL PRACTICE
Authors: Wu Chiung-Jung (Jo) , Atherton John J , Chang Anne M , Courtney Mary , Strodl Esben , Clark Alexander M , Thompson David R , Ramis Mary-Anne , McPhail Steven M
Published: October 2016

Rationale, aims and objectives: Patients with both cardiac disease and diabetes have poorer health outcomes than patients with only one chronic condition. While evidence indicates that internet based interventions may improve health outcomes for patients with a chronic disease, there is no literature on internet programs specific to cardiac patients with comorbid diabetes. Therefore this study aimed to develop a specific web-based program, then to explore patients’ perspectives on the usefulness of a new program.Methods: The interpretive approach using semi-structured interviews on a purposive sample of eligible patients with type 2 diabetes and a cardiac condition in a metropolitan hospital in Brisbane, Australia. Thematic analysis was undertaken to describe the perceived usefulness of a newly developed Heart2heart webpage.Results: Themes identified included confidence in hospital health professionals and reliance on doctors to manage conditions. Patients found the webpage useful for managing their conditions at home.Conclusions: The new Heart2heart webpage provided a positive and useful resource.  Further research on to determine the potential influence of this resource on patients’ self-management behaviours is paramount. Implications for practice include using multimedia strategies for providing information to patients’ comorbidities of cardiac disease and type 2 diabetes, and further development on enhancement of such strategies.
HEALTH - ILLNESS - DISEASE. A PERSON-CENTERED PERSPECTIVE
Authors: Sturmberg Joachim
Published: October 2016

Health, illness and disease are terms that appear to be used interchangeably amongst health professionals when describing their roles and responsibilities. However, health, illness and disease are distinctively different entities. Health, illness and dis-ease, the original meaning of the term disease, are subjective states, whereas disease now defines an objective pathologic/patho-physiologic state. Health, illness and dis-ease are experienced as much in the presence as absence of identifiable “pathology” and result from the experiential dynamics that define complex adaptive states. These states result from the dynamic interactions between the somatic, psychological, social and semiotic or cognitive domains that characterize a person’s integrity. These insights are the basis for a proposed re-definition of health.
The case of case reports: A decade of publications by staff at a major university hospital
Authors: Wynn Rolf , Nissen Trygve , Bergvik Svein
Published: October 2016

Rationale: The place of case reports in the medical literature has been much debated in recent years. This study was undertaken to gain knowledge about the publication practice of case reports and case series from a major university hospital.Method: We decided to conduct a retrospective, bibliographic, descriptive study of published case reports and case series from a university hospital in a period of 10 years. The following variables were studied: number of reports, authorship characteristics, collaboration practices, titles, medical specialities represented, educational versus non-educational purpose and number of citations.The data were extracted from the national research information system database in Norway.Results: 2.2%of all the publications were case reports. Multiple authorship was common. Male authors outnumbered female authors. Collaboration across hospitals and nations occurred for one third of the articles. 43%of the titles did not contain information that identified them as case reports or case series. The most frequently represented specialties were neurology, rheumatology, plastic surgery and medical genetics. Nine out of  10 articles were non- educational. A third of the articles had not been cited.Conclusions: The case report seems to be a minor, although viable, genre. The proportion of case reports and case series was low. A plausible hypothesis could be that clinician-researchers at the study hospital prioritized controlled clinical and paraclinical/laboratory studies that rank higher on the evidence hierarchy. Since case reports document the presentations of individual patients and their treatment, a declining interest in their publication has a significant implication for person-centered healthcare education and training.
TALES FROM A MEDICAL APPRENTICESHIP: REFLECTIONS ON SUPPORTING EMPATHY
Authors: Davies Elizabeth
Published: October 2016

This article brings together and uses some tales describing experiences from my medical training to draw out a number of themes that seem relevant to person –centred health care in England. First, is the suffering and disability which doctors deal with every day in their work. Second, there is the privilege of practice, and the risk it brings of practitioners becoming immune to suffering. Third, is the complexity of health care and the effect of government efforts to sort out some of these problems, and the attempts of managers to implement new policies. The glib adoption of ‘in’ phrases, however, belies an ignorance of the complexity of patients’ problems that makes delivering person-centred care so important and sometimes so difficult. Hopefully these tales show how far things have moved towards developing care that truly centres around the person with the illness. I offer some reflections from a long journey now to argue that the task of new structures should be to support staff to do their job better, not to manage them into carrying out an entirely different administrative function.
PATIENT PREFERENCES FOR THE PHARMACOLOGICAL TREATMENT OF OSTEOARTHRITIS: A FEASIBILITY STUDY USING ADAPTIVE CHOICE-BASED CONJOINT ANALYSIS (ACBCA)
Authors: Al-Omari Basem , Sim Julius , Croft Peter , Frisher Martin
Published: October 2016

Rationale, aims and objectives Patient preferences are an important part of optimizing the pharmacological treatment of osteoarthritis (OA). Recent choice experiments have explored this issue using two types of conjoint analysis: choice-based conjoint analysis (CBCA) and adaptive conjoint analysis (ACA). The aim of this study was to examine the feasibility of using adaptive choice-based conjoint analysis (ACBCA) methods to determine patient preferences for pharmacological treatment of OA. The specific outcomes were patient evaluations of a) eight attributes in an ACBCA task, b) the computer skills required to complete the task, and c) the perceived utility of the results. Method Participants were drawn from members of a Research Users’ Group (RUG) who had been diagnosed with osteoarthritis. Participants took part in two feasibility studies. In the first feasibility study, four RUG members critically examined the implementation of a computerized ACBCA task. In the second feasibility study, 11 RUG members completed an ACBCA task on medication preferences for osteoarthritis. The ACBCA task was evaluated by a set of self-completed questions and through semi-structured interviews. ResultsThe first feasibility study helped to shape the design and contents of the ACBCA task. In the second feasibility study, no participants reported the ACBCA task to be hard to read or understand. Most participants agreed that the task was adjusting appropriately as the session proceeded and that it helped them in making decisions about preferences. Older patients and patients with little computer experience appeared to find no substantial challenges in using this interactive computer-based technique. ConclusionsThese studies indicate that, with the involvement of patients, face and content validity of an ACBCA task can be achieved through a developmental process taking account of participants’ requirements.
Caring for the caregiver: factors associated with the quality of life of family caregivers to palliative care patients
Authors: Quesada Macarena , Madrigal Manuel , Luna Aurelio , Perez-Carceles Maria D
Published: October 2016

Purpose: The aim was to investigate the factors associated with the quality of life (QoL) of family caregivers to palliative care patients. Methods: A cross-sectional survey was conducted of 125 family caregivers of patients in the terminal phase of their illness and included in palliative care programs. Data were collected using WHOQOL-BREF, the socio-demographic characteristics of both caregiver and patient, clinical questions and information about caregiving. Results: The QoL of caregivers was lower than that of the national average for healthy people. Significantly lower QoL scores were obtained in the case of caregivers if they were women, over 55 years, uneducated, unemployed or the patient’s spouse. Cancer diagnosis and patients who were dependent for their Activities of Daily Living also lower caregiver QoL. The factors associated with higher caregiver QoL in each domain differed: being employed in the physical domain (OR:3.3; 95% CI:1.47-7.4), the patient receiving palliative care in hospital in the psychological domain (OR:3.05; 95% CI:1.19-7.7), a higher level of caregiver´s education in the social domain (OR:3.3; 95% CI:1.4-9.8) and caregivers between 45-55 years in the environmental domain (OR:5.4; 95% CI:1.6-9.2).Conclusion: Family caregivers of palliative care patients are highly burdened during caregiving. Characteristics of the patient and caregiver and the conditions under which care is performed, significantly affect QoL. We consider it essential to increase health professionals’ awareness of the importance of the role of the caregiver in providing services to the terminally ill, given the impact of the caregiver’s QoL on the QoL of the palliative care patient and its importance for the delivery of person-centered care at the end of life.
Long-term engagement with a practice-based exercise referral scheme: Patients’ perceptions of effectiveness
Authors: Queen Martyn , Crone Diane , Parker Andrew
Published: October 2016

Objectives Limited and contradictory evidence exists on the long-term effectiveness of exercise referral schemes (ERS) for physical activity promotion and its impact on perceived health status. The intention of this study was to investigate patients’ views of a physical activity intervention on their self-assessed health status.Methods A longitudinal qualitative study design was employed with 12 patients aged 55 – 74, attending a primary care physical activity intervention. Semi-structured interviews took place on three occasions over a 12 month period in a Primary Care Health Centre. Transcripts of recorded interviews were coded and thematically analysed using grounded theory techniques.Results The majority of patients believed that their engagement with the Scheme and resultant long-term increase in physical activity behaviour, helped to improve their health status. This was evident through improved perceptions of medical conditions, through stabilisation or reductions in medication and visits to medical services.Conclusion The findings show the value of a long-term physical activity intervention in a Primary Care setting, through increases in physical activity levels and patients self-assessed health status. These findings can serve as guide for future service commissioners of ERS.