bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline
Authors: Salerno Jennifer , Finelli Antonio , Morash Chris , Morgan Scott C. , Power Nicholas , Schieda Nichola , Haider Masoom A.
Published: October 2016

Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation.Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/ specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation.Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11‒85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases.Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.
Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study
Authors: Doiron R. Christopher , Jaeger Melanie , Booth Christopher M. , Wei Xuejiao , Siemens D. Robert
Published: October 2016

Introduction: Thoracic epidural analgesia (TEA) is commonly used to manage postoperative pain and facilitate early mobilization after major intra-abdominal surgery. Evidence also suggests that regional anesthesia/analgesia may be associated with improved survival after cancer surgery. Here, we describe factors associated with TEA at the time of radical cystectomy (RC) for bladder cancer and its association with both short- and long-term outcomes in routine clinical practice.Methods: All patients undergoing RC in the province of Ontario between 2004 and 2008 were identified using the Ontario Cancer Registry (OCR). Modified Poisson regression was used to describe factors associated with epidural use, while a Cox proportional hazards model describes associations between survival and TEA use.Results: Over the five-year study period, 1628 patients were identified as receiving RC, 54% (n=887) of whom received TEA. Greater anesthesiologist volume (lowest volume providers relative risk [RR] 0.85, 95% confidence interval [CI] 0.75‒0.96) and male sex (female sex RR 0.89, 95% CI 0.79‒0.99) were independently associated with greater use of TEA. TEA use was not associated with improved short-term outcomes. In multivariable analysis, TEA was not associated with cancer-specific survival (hazard ratio [HR] 1.02, 95% CI 0.87‒1.19; p=0.804) or overall survival (HR 0.91, 95% CI 0.80‒1.03; p=0.136).Conclusions: In routine clinical practice, 54% of RC patients received TEA and its use was associated with anesthesiologist provider volume. After controlling for patient, disease and provider variables, we were unable to demonstrate any effect on either short- or long-term outcomes at the time of RC.
Different Strokes for Different Folks: Gender and Emotions in an Environmental Game
Authors: Khachaturyan Marianna , Czap Natalia V.
Published: October 2016

Females are often expected to behave more environmentally-friendly than males, to be more sensitive to nuances in wording/framing, to be more emotionally expressive, and to be more likely to act on these emotions. Do they actually behave according to these expectations? Previous research found mixed evidence on gender effects. The purpose of our study is to examine whether there are gender differences in reaction to framing, expressing of emotions and acting in response to emotions in the environmental context and to determine whether these differences (if present) follow the “stereotypical” expectations. To investigate this, we conducted a framed laboratory experiment in the water quality context. Our findings show that there is a gender effect and it is highly context-dependent with respect to environmental decisions and with respect to the likelihood of expression of positive and negative emotions. Furthermore, we find that females sharing behavior is not sensitive to empathy vs. self-interest framing, while males sharing behavior is. Our results indicate that the payoff-relevant factors are, generally, more important than gender. We conclude that males and females are responding to different stimuli (“different strokes for different folks”), thus empirically testing behavior in a specific context is paramount when trying to predict responses by gender and designing environmental policies.
Openbaarheid: de regels en het spel
Authors: de Best Eva , Wallage Jacques
Published: October 2016

Openbaarheid: de regels en het spel

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
Gij zult beleefd glimlachen
Authors: Ramlal Munish
Published: October 2016

Gij zult beleefd glimlachen

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
Over kennislacunes en lokale mogelijkheden
Authors: Kruiter Albert-Jan , de Lange Sarah L.
Published: October 2016

Dossier

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
Discontinuïteit van discours als de motor van veranderingen
Authors: Achbab Samir
Published: October 2016

Discontinuity of discourse as the motor of change

In this article, based on a case study regarding the merger of boroughs within the municipality of Amsterdam, different perspectives are brought together to provide an overall analysis leading to insight into the change in the organizational culture. A particular research methodology is used to shed light on three elements of organizational culture: mindset (values), arena (group) and behavior. Through periodical measurements the effects of interventions and the progress in culture change is followed. It is argued that measurement instruments to explore the shifts in thinking and action are useful but limited. Policy makers and organizational actors from all hierarchical levels are shown to be influenced and disciplined by the actual existing change discourse to various degrees. Every organization nowadays must prove to the market that it is capable of change. Stories about organizational flexibility are embedded in more macro-stories of the changes in economic life. This article provides insight into the complexity of organizational discourse and the philosophical and sociological richness that it embodies. Therefore anthropological concepts are used which make the case more understandable in terms of rules and procedures that construct and legitimate the way we see things and talk about them.
Onder-wijsheid: hoe controlemechanismen het onderwijs overschaduwen
Authors: de Graaf Simon
Published: October 2016

Reflectie & Debat

Reflection and Debate initiates academically inspired discussions on issues that are on the current policy agenda.
Advies aan de regering: staatscommissies in Nederland tussen 1814 en 1970
Authors: Kerkhoff Toon , Martina Joshua
Published: October 2016

Advising the government: state committees in the Netherlands between 1814 and 1970

Continuing debate concerning the functioning of advisory boards to the Dutch central government seems hindered by lacking historical insight and insufficient empirical data. Especially the period until 1970 and so-called state committees (an important type of advisory board) have been neglected. This article therefore presents findings from historical research into Dutch state committees between 1814 and 1970. We provide a hitherto lacking overview of their origin, numbers, composition, functioning and topics. We also provide a first quantitative analysis to investigate the question what state committee activity tells us about continuity and change of the task perception of subsequent Dutch governments in this period. We argue that the so-called ‘night watchman state’ of the long 19th century (in which government did as least as possible) does become apparent from the number of state committees over time but that it seems never to have existed when we look at the topics they dealt with. Furthermore, the Dutch welfare state (said to have existed from the 1930s onwards) shows much less state committee activity then one would expect. We conclude with urgent questions for future research into advice and advisory boards in The Netherlands and introduce a digital database to facilitate such work.
Keuzemogelijkheden binnen en tussen pensioenregelingen: niet voor elk wat wils
Authors: Delsen Lei
Published: October 2016

Options within and between supplementary pension schemes: not for everyone

Surveys show that Dutch people want more options with regard to the own pension. Can freedom of choice be combined with collective organised solidarity within supplementary pension schemes? To answer this question the article discusses the pros and cons of options of workers and employers within and between pension schemes. The theoretical and empirical consequences of choices in the Dutch supplementary pension schemes are reviewed. The neo-classical economic theory, the neo-institutional theory and behavioral economic theory are applied to supplementary pensions. In addition, lessons are learned from the experience in the Netherlands with choices within pension schemes and with choices in other areas. Only a very small minority will use the new options in the supplementary pension schemes. Unlike the neoclassical economic theory, the neo-institutional theory and behavioral economic theory recommend to extend the compulsory supplementary pension to all employed persons. The welfare gain of more choices is questionable. Lifting the mandatory participation will affect the relative success of the Dutch pension system: large numbers of insured workers and relatively cheap and a relatively high pension as a result of this supplementary pension.
Pleidooi voor een basisinkomen?
Authors: Verbeek Bruno
Published: October 2016

Dossier

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
De slagkracht van populisme. Een onderzoek naar de houding tegenover populisme bij jongeren en jongvolwassenen in Vlaanderen
Authors: Keppens Gil , Siongers Jessy , Spruyt Bram , Vandenbossche Lauren , Van Droogenbroeck Filip
Published: October 2016

The power of populism. An investigation into the attitudes towards populism in adolescents and young adults in Flanders

Populism is usually studied by investigating the political discourses of parties considered to be populist. In contrast, this paper attempts to measure the support for a populist attitude among adolescents and young adults (age 14 to 30) in Flanders (N = 2618), the Dutch speaking part of Belgium. This paper answers two research questions: (1) Which adolescents and young adults support the populist attitude and which are the core elements of populism that get the most support? (2) To what extent are adolescents and young adults who support the core elements of populism willing to be politically engaged? The results show that: (1) the support for the populist attitude is widespread among young people in Flanders, and (2) the relationship between a support for populism and political engagement is nuanced. Implications of the support of the populist attitude for democratic participation are discussed.
Downloadverbod; einde illegaal downloadgenot? – Het arrest ACI Adam BV e.a. inzake de thuiskopievergoeding
Authors: Shahid Masuma
Published: October 2016

Downloadverbod; einde illegaal downloadgenot? – Het arrest ACI Adam BV e.a. inzake de thuiskopievergoeding

Het arrest ACI Adam BV e.a. is het eindresultaat van een jaren lang slepend conflict tussen een aantal elektronicaproducenten en Stichting de Thuiskopie omtrent de thuiskopievergoeding. In dit arrest verschaft het Hof van Justitie van Justitie duidelijkheid omtrent de (strikte) interpretatie en uitleg van de uitzonderingen en beperkingen van het reproductierecht uit de Auteursrechtrichtlijn. De lidstaten zijn vrij in het implementeren van de richtlijn, mits zij coherent zijn in het toepassen van de uitzonderingen. Een nationale wettelijke regeling die bij de toepassing van de privégebruikuitzondering geen onderscheid maakt tussen geoorloofde en ongeoorloofde bronnen is onverenigbaar met het Unierecht. Ook mag er in de thuiskopievergoeding geen rekening worden gehouden met schade ontstaan door reproducties uit ongeoorloofde bronnen.

HvJ EU 10 april 2014, zaak C-435/12, ACI Adam BV e.a./Stichting de Thuiskopie, Stichting Onderhandelingen Thuiskopie Vergoeding, ECLI:EU:C:2014:254
De Richtlijn betreffende schadevergoedingsacties wegens inbreuken op de mededingingsregels
Authors: Oude Elferink Edmon , Braat Bram
Published: October 2016

De Richtlijn betreffende schadevergoedingsacties wegens inbreuken op de mededingingsregels

Op 17 april 2014 heeft het Europees Parlement de Richtlijn betreffende bepaalde regels voor schadevorderingen volgens nationaal recht wegens inbreuken op de bepalingen van het mededingingsrecht van de lidstaten en van de Europese Unie aangenomen (Wetgevingsresolutie van het Europees Parlement van 17 april 2014 over het voorstel voor een richtlijn van het Europees Parlement en de Raad betreffende bepaalde regels voor schadevorderingen volgens nationaal recht wegens inbreuken op de bepalingen van het mededingingsrecht van de lidstaten en van de Europese Unie, A7-0089/2014). Deze richtlijn brengt met zich dat de lidstaten dienen te waarborgen dat het verhaal van schade in verband met schending van het kartelverbod en het verbod van misbruik van economische machtspositie wordt gefaciliteerd. In dit artikel wordt enerzijds een toelichting gegeven op de totstandkoming van de richtlijn en anderzijds besproken welke wetswijzigingen, if any, de Nederlandse wetgever dient door te voeren teneinde aan de verplichtingen uit hoofde van de richtlijn te voldoen.

Wetgevingsresolutie van het Europees Parlement van 17 april 2014 over het voorstel voor een richtlijn van het Europees Parlement en de Raad betreffende bepaalde regels voor schadevorderingen volgens nationaal recht wegens inbreuken op de bepalingen van het mededingingsrecht van de lidstaten en van de Europese Unie, A7-0089/2014.
De complexiteit van terugvordering van staatssteun
Authors: van Midden Gijs , Nieuwland Gijsbrecht
Published: October 2016

De complexiteit van terugvordering van staatssteun

Voor de terugvordering van (onrechtmatige of onverenigbare) staatssteun moet nationale grondslag bestaan. Niet steeds biedt het vermogensrecht adequate grondslagen om in civielrechtelijke context verleende steunmaatregelen terug te vorderen. Illustratief voor deze civielrechtelijke complexiteit is de zaak Kliq, waarin de Rechtbank Rotterdam artikel 6:212 BW inzake ongerechtvaardigde verrijking aangrijpt om via geldlening verstrekt voordeel terug te vorderen.

Rb. Rotterdam 18 september 2013, Staat der Nederlanden/J.R. Maas c.s. qq. (Kliq), ECLI:NL:RBROT:2013:9330
Ervaringen met Europese civiele procedures in Nederland
Authors: Kramer X.E.
Published: October 2016

Ervaringen met Europese civiele procedures in Nederland; Een terugblik en wenkend toekomstperspectief

De Europese betalingsbevelprocedure en de Europese procedure voor geringe vorderingen (small claims procedure) zijn de eerste twee eenvormige Europese civielrechtelijke procedures. De vraag is hoe deze Europese procedures in Nederland functioneren en in de praktijk worden ervaren. Om deze vraag te beantwoorden zijn, naast rechtspraakonderzoek, gegevens verzameld en interviews afgenomen bij onder meer rechtbanken. De uitkomsten zijn niet overweldigend positief; beide procedures worden vooralsnog weinig gebruikt en er zijn problemen rond de toepassing. De verwachting is echter dat de Europese procedures belangrijker zullen worden gezien de Europese ambities en het recente aanpassingsvoorstel van de Commissie voor small claims.Verordening (EG) nr. 1896/2006 van het Europees Parlement en de Raad van 12 december 2006 tot invoering van een Europese betalingsbevelprocedure, Pb. EU 2006, L 399/1 (EBB-Verordening);Verordening (EG) nr. 861/2007 van het Europees Parlement en de Raad van 17 juli 2007 tot vaststelling van een Europese procedure voor geringe vorderingen, Pb. EU 2007, L 199/1 (EPGV-Verordening);Voorstel voor een verordening van het Europees Parlement en de Raad tot wijziging van Verordening (EG) nr. 861/2007 van het Europees Parlement en de Raad tot vaststelling van een Europese procedure voor geringe vorderingen en Verordening (EG) nr. 1896/2006 van het Europees Parlement en de Raad van 12 december 2006 tot invoering van een Europese betalingsbevelprocedure, COM(2013)794 def.
Een voorstel voor een effectief rechtsmiddel voor overschrijdingen van het redelijketermijnvereiste
Authors: Beumer A.E.
Published: October 2016

Een voorstel voor een effectief rechtsmiddel voor overschrijdingen van het redelijketermijnvereiste

Op 26 november 2013 gaf de Grote Kamer van het Hof van Justitie een belangrijk oordeel in drie mededingingszaken, Kendrion, Groupe Gascogne, en Gascogne Deutschland. De drie uitspraken zullen de boeken ingaan als de uitspraken waarin het Hof van Justitie duidelijkheid verschafte over het rechtsmiddel dat particulieren kunnen instellen wanneer zij op EU-niveau worden geconfronteerd met een schending van het redelijketermijnvereiste. In lijn met eerdere jurisprudentie moest het Hof van Justitie kiezen tussen twee rechtsmiddelen. Ten eerste kon het Hof van Justitie, conform de zaak Baustahlgewebe, een schending vaststellen en vervolgens zelf (als een vorm van genoegdoening) de boete verlagen die de Commissie had opgelegd. Ten tweede kon het Hof van Justitie, in overeenstemming met de zaak Grüne Punkt, opteren voor een aparte schadevergoedingsactie. Het Hof van Justitie maakt een principiële keuze voor het tweede rechtsmiddel.HvJ EU 26 november 2013, zaak C-58/12 P, Groupe Gascogne/Commissie, zaak C-40/12 P, Gascogne Sack Deutschland/Commissie, en zaak C-50/12 P, Kendrion/Commissie, n.n.g.
Problems of Authority in Law and Anthropology: A Case Study on Aboriginal Australian Inheritance
Authors: Vines Prue
Published: October 2016

Problems of Authority in Law and Anthropology: A Case Study on Aboriginal Australian Inheritance

In this article I argue that the major issue in taxonomies of interdisciplinary research is the problem of authority. In a project on the needs of Aboriginal Australians in inheritance, involving interdisciplinary research using law (in both common law and customary law form) and anthropology, issues of translateability and truth/validity arose. Issues for the Aboriginal people included problems of identifying the correct kin, dealing with the body, and protecting customary law information and secrecy, all matters which the customary law could handle but which were not recognised by Australian common law. Because the characterization of these matters in law is often characterized as a problem of authority the article explores the various different ways forms of authority in law and anthropology exist and how they might clash. Because the anthropology concerned was about Aboriginal Customary Law there seemed to be a double problem of authority which needed to be resolved in order to ensure that the connections between the disciplines were clear and the inheritance issues could be resolved.
Hill, S. (ed.) (2011). The Knowledgeable Patient; Communication and Participation in Health, A Cochrane Handbook. Chichester: Wiley-Blackwell ISBN 978-1-4443-3717-4
Authors: Lindsay Margot
Published: October 2016

No abstract
Person-centered healthcare in the information age: Experiences from a user driven healthcare network
Authors: Price Amy , Biswas Tamoghna , Biswas Rakesh
Published: October 2016

Person-centered healthcare is central to the practice of compassionate medicine. The practice of person-centered healthcare occurs when intuitive and organizational thinking is engaged harmoniously, rather than in competition. Present healthcare systems relegate core providers and patients to 10-minute appointments for the purpose of meeting budgetary or patient access targets. It is unrealistic to expect such a system to be sufficient to share values and expertise. Often, important questions are left to those without the experience or expertise to answer. Person-centered healthcare can empower people to escape from fragmented medical care and displaced knowledge. The roles of patient and doctor can better serve medicine by asking all to go beyond their assigned roles to communicate and form relationships. These working partnerships will respect individual and role-based values, strengths and weaknesses. Being a patient is a condition or state somewhere between death and life that it is common to all. The patient is not an entity, but a person. Providing medical care is a profession, it is what physicians do, not who they are. Without cooperation between doctor and patient, medical intervention loses power and effectiveness. The consultation may be temporarily seized by social force and dominance, but it is maintained by respect and relationship. Respect is earned and negotiated by listening, observing and then acting in the best interests of others. This requires sensitive negotiation and the desire to build the bridges in medicine between knowledge and need. Great negotiators make it their business to know the strengths, values, needs and limitations of others. Power is intrinsically bound to what we value. What we value is what we will invest in. Let us assess the conditions we have to work with, reason together and build respect, access and relationships in healthcare.
Contextualizing science in the aftermath of the evidence-based medicine era: on the need for person-centered healthcare
Authors: Miles Andrew , Asbridge Jonathan
Published: October 2016

No abstract
The precarious future of the discourse of person-centered medicine
Authors: Little Miles
Published: October 2016

Discourses are more than just patterns of words. For discourse communities, they express ideologies and provide meanings that can be translated into action. They are vehicles for reform when they thrive. The discourse of person-centered medicine has had a vigorous start, with identifiable leaders, a vocabulary which has situated meanings, institutions such as meetings, letterheads and a college and a group of adherents that constitute a discourse community. For a discourse to thrive, its founding problematic has to be perceived as ‘real’ by its target audience – in this case, presumably, healthcare workers. Real in this sense can be defined as something perceived to have an influence on foundational values, for better or for worse. It is not yet clear that the discourse of person-centered medicine has convinced its target audience of the ‘crisis of knowledge, care, compassion and costs’ that it invokes to justify its proposed paradigm shift. In order to make it thrive, those who drive the discourse will need to ‘realise’ both the crisis it addresses and the outcomes it may achieve.
Is “scientifically informed, yet humanistic medicine” the solution to the crisis of modern medicine? A friendly corrective to the emergent model of Person-Centered Medicine
Authors: Goldenberg Maya
Published: October 2016

In Miles and Mezzich’s programmatic paper “The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice”, the authors draw from a wide variety of sources to frame a theoretical underpinning for the emerging concept of “person-centered medicine” as a model of clinical practice. The sources include humanistic and phenomenological medicine, the biopsychosocial model, evidence-based medicine, critics of evidence-based medicine and patient-centered care. Each offer commendable desiderata, which Miles and Mezzich selectively integrate into their burgeoning theoretical framework. My concern is that the selective uptake of desirably qualities from such diverse resources in order to progress person-centered medicine’s developing vision of “medicine for the person, by the person and with the person” obscures important theoretical differences among these sources that will likely result in difficulty for the concept of person-centered medicine. These diverse theoretical resources offer competing correctives to the problems with medicine. Some of these differences are irreconcilable and need to be highlighted in order to avoid creating conceptual confusion and allegiance to unproductive theoretical commitments at this critical point of framing and developing this emergent model of modern clinical practice.
Person-centered medicine: currents and crosscurrents in the United States
Authors: Tanenbaum Sandra
Published: October 2016

In their editorial introduction to an earlier issue of the International Journal of Person-Centered Medicine, Miles and Mezzich cite positive developments in the United States and United Kingdom. The creation, in the U.S., of the Patient-Centered Outcomes Research Institute (PCORI) is rightly portrayed by these authors as focusing serious attention on the needs of patients for meaningful information about their medical care. PCORI is in some ways--for example, in its apparent commitment to stakeholder engagement and methodological innovation - a departure from earlier public and private efforts to create an evidence base for medical practice. On the other hand, PCORI’s roots and much of the current discourse about its future reflect a residual hold by evidence-based medicine (EBM) on healthcare research and policy-making. First, PCORI was established primarily to promote the conduct of CER, the appetite for which derived from the demand for effectiveness research generally. Second, the patient-centeredness of PCORI is manifest primarily in the conduct of research rather than the process of care. Third, patient-centeredness is commonly taken to refer to patients as a group - as opposed to, say, physicians or researchers as a group -rather than to individual patients. Fourth, it will be difficult and expensive for PCORI to attend to heterogeneity of treatment effects. Fifth and perhaps most important, the creation of PCORI is contemporaneous with other, countervailing, developments in the U.S. healthcare system.
Process evaluation plan of a patient-centered home visitation program for potentially frail community-dwelling older people in general practice
Authors: Stijnen Mandy , Duimel-Peeters Inge , Vrijhoel Hubertus , Jansen Maria
Published: October 2016

Background: Evaluation studies examining the effectiveness of interventions tend to offer little insight into the mechanisms responsible for changes in outcomes. The present study has conducted a thorough process evaluation alongside a longitudinal quasi-experimental trial investigating the effects of a home visitation program for the early detection of health problems among potentially frail community-dwelling older people (≥ 75 years). We aim to describe the rationale for and steps undertaken in developing a process evaluation plan to identify the factors that influence the success or failure of this complex, patient-centered intervention within the primary care setting.Method: Using a theoretical framework underlying the process evaluation, process evaluation questions are formulated per component of the framework (i.e., implementation fidelity, dose delivered, dose received, reach, recruitment and context). The process evaluation plan shows how both quantitative (e.g., structured registration forms) and qualitative methods (e.g., semi-structured interviews) are applied in gathering process data for a complex, patient-centered intervention integrated within general practices. Process data are gathered with either formative or summative purposes among practice nurses and general practitioners from participating general practices and a purposive sample of older people.Conclusion: Conducting a process evaluation alongside a clinical trial will assist in deciding to what extent the intervention is effective, as well as what factors contribute to the intervention’s effectiveness. The insights gained are imperative for the development of patient-centered interventions that are likely to be sustained when implemented in the intended context.
Teaching medicine of the person to medical students during the beginning of their clerkships
Authors: Verhoeven Anita , Dekker Hanke
Published: October 2016

This article describes how medicine of the person is taught to 4th year medical students in Groningen, The Netherlands, as part of the teaching programme ‘Professional Development’. In that year, the students start with their clerkships. In this transitional phase from medical student to young doctor, issues of professional identity are raised. It is an intense period with feelings of uncertainty and overwhelming experiences. Therefore, parallel to the clerkships we have organised 28 meetings of 2 hours with extra time dedicated to reflection and learning. These groups consist of 10-12 students with a rotating student chair under supervision of an experienced teacher, or, “coach”. We focus on personal and professional development by reflecting on work-based experiences. In the first hour the students discuss in a structured way a critical incident experienced by one of them. Learning experiences include personal learning (as emotions), skills (as empathy development) and professional learning (discovering the profession). In the second hour the students discuss set medical-ethical dilemmas. The coach facilitates the group discussion and oversees the group dynamics. During the year, the students work on their portfolio including writing a personal development plan. In 3 individual interviews with the coach this plan is monitored. In the final interview the students are assessed by their coach on their professional development during the year. In this paper we present the results of the evaluation of this programme ‘Professional Development’ by the students and The Netherlands Association for Medical Education.
Participation in decision-making when starting long-term medication - patients´ experiences
Authors: Semark Birgitta , Petersson G , Engstrom S , Arvidsson E , Nilsson G
Published: October 2016

Rationale, aim and objective: To achieve the beneficial effect of drug treatment and reduce unnecessary healthcare costs, patients must be involved in shared decision-making. The aim of this study was to describe patient experiences of participation in decision-making when commencing long-term medication.Method: Nine patients at 2 healthcare centers were semi-structured interviewed about their experiences, beliefs and feelings about their participation in the decision to commence long-term medication. Data were analyzed by a qualitative content method. Results: Respondents stated that participating in decision-making in drug treatment requires knowledge of the relevant area and requires trust in the physician. The respondent’s responsibility and motivation were found to facilitate adherence to drug treatment. Conclusion: Patients sought participation in the decision-making of long-term medication use and expressed a needed for adequate time as part of this dialogue. If they lacked sufficient knowledge, patients wanted relevant and useful information from the physician. To experience trust in the physician through a ‘good’ encounter increases the possibility for participation and enhancement of medication adherence. In order to participate in decision-making, the patient needs the physician’s encouragement. It is contended that direct attempts to involve the patient in decision-making on long-term drug use directly increases the person-centeredness of clinical care.
Effectiveness of the Birleson Depression Self-Rating Scale (DSRS) in screening for depression in vulnerable young males with severe emotional and behaviour difficulties in a residential setting
Authors: Martin Colin , Carroll Denise , Duffy Tim
Published: October 2016

Depression in Looked After and Accommodated Children (LAAC) has been observed as being higher than in adolescents in the general population. The Birleson assessment instrument is frequently used to assess depression in young people. The focus of this paper is the evaluation of the effectiveness of the Birleson depression self-rating scale as an effective screening instrument for depression in adolescent males with emotional, behavioural, educational and social difficulties. One hundred and eighty-one participants from a Scottish residential centre (The Centre) for young males with severe emotional and behavioural difficulties participated in the study. The young people at the Centre consisted of 3 distinct groups: day pupils, residential and secure care (looked after and accommodated young people). As part of the admission process they completed the Birleson Depression Self-Rating Scale (DSRS) and also the standard professional approved Scottish LAAC health assessment. The analysis in this study showed that young people in secure care had a significantly higher level of depression than those in day care, as measured by the Birleson DSRS. Within the LAAC population at the Centre, a comparison of the Birleson DSRS detection rates for depression was made with findings from the standard health assessment. Prior to admission, 3% of the young people (n=6) at the centre had a previous clinical diagnosis of depression. The Birleson DSRS failed to identify 4 out of these 6 young people. The standard LAAC health assessment identified that 15% of LAAC (n=26) had current suicidal ideation/behaviours. Of the young people at the Centre who had current suicidal behaviours, the Birleson DSRS did not identify 27% of them. This raises concerns about the sensitivity of the Birleson DSRS to identify depression in this vulnerable population.
A 12-week healthy living programme piloted in community mental health – is it feasible and what is achievable?
Authors: Wheeler Amanda , Caldwell Samantha
Published: October 2016

The physical health outcomes of people with mental illness are significantly poorer compared to the normal population. The aims of this study were to (i) assess the feasibility and outcomes of a 12-week healthy living programme piloted in a community adult mental health setting and (ii) assess the lead author’s research and evaluation competency as part of the conditions of the Psychology Supervised Practice Programme. Participants were referred to the programme to learn and develop healthy living skills, assist in weight management, and enhance emotional wellbeing.  The programme included weekly educational sessions followed by an activity related to the education for 3-4 hours, between June-September 2010. The programme facilitators completed assessments with participants at Week 1 (baseline) and Week 12 (graduation) including; demographic and physical health indicators (e.g. weight, BMI, blood pressure), psychological wellbeing and overall satisfaction with programme. Seventeen participants commenced the healthy living programme pilot. There was an average weekly attendance of eleven people and nine graduated at Week 12. No meaningful change in physical health or psychological wellbeing could be determined from the measurements at 12 weeks however the graduates rated the programme highly, particularly the social perspective and healthy eating skills. This feasibility assessment of the HLP pilot illustrates the difficulties inherent in real-world service-based research but also highlights the potential benefits for future replication of the HLP for enhancing both physical health and quality of life for people with a serious mental illness. Key words: physical health, community mental health, healthy living, evaluation, group programme
Psychometric testing of the Family Satisfaction with Decision Making subscale (FS-ICU/DM) in an acute care pediatric hospital setting
Authors: Legrow Karen , Hodnett Ellen , Stremler Robyn , Cohen Eyal , Victor J.Charles
Published: October 2016

Aim. This paper is a report of the psychometric testing of the Family Satisfaction with Decision Making subscale of the Family Satisfaction with Care in the Intensive Care Unit questionnaire to determine whether it would be suitable to use as a primary outcome measure in a proposed randomized control trial in a pediatric hospital setting.Background. Parents have reported that relinquishing important aspects of their role is the most stressful element of a child’s hospitalization. Concerns over communication and decision-making processes have been particularly cited. Therefore, increasing parents’ satisfaction with their child’s care and responding to their priorities are key to improving quality of care. Instruments have been developed to measure global satisfaction with care among parents of hospitalized children. However none of these focus specifically on communication and decision-making processes. One instrument was found that measures these items, but in an adult intensive care unit, not a pediatric setting.Design/method. As a component of a larger study, a psychometric study was conducted in 2010 to assess the properties of the Family Satisfaction with Decision Making subscale in a pediatric setting. Eighty-two parents of children admitted to a large metropolitan pediatric hospital completed the subscale prior to their child’s transfer and/or discharge from the hospital.Results/Conclusion. The psychometric data indicated that the Family Satisfaction with Decision Making subscale showed evidence of good reliability and validity as a primary outcome measure that could be used for a future randomized controlled trial in a pediatric setting.
Assessing patient satisfaction with healthcare services at outpatient Urology Department of a tertiary hospital in Singapore
Authors: Kowitlawakul Yanika , Zhi Tan Jian , Qin Ho Shu , Mani Lata Raman Nee , Yobas Piyanee , Fai Chan Moon
Published: October 2016

Objectives  The patient satisfaction assessment at an outpatient Urology Centre in Singapore was based on one single question and it has failed to provide a direction of the areas for improvement. The objectives of this study were to identify the levels of patients’ satisfaction with health care services, the differences in general satisfaction within patients’ socio-demographic characteristics, and the most influential factor of healthcare services in predicting patients’ satisfaction.Method  The study is a cross-sectional descriptive study design, using a validated Patient Satisfaction Questionnaire (PSQ) in both English and Chinese language.  A total of 450 outpatients (85.1% response rate) participated in the study.   Results  In general, patients were moderately satisfied with healthcare services at the outpatient Urology Centre services. The satisfaction level was significantly higher for elderly patients compared with young and middle-aged adults.  Patients of private paying class were more satisfied with the services than those who were in the subsidized paying class. Doctors were found to be the most influential domain in predicting patients’ general satisfaction, followed by nurses.  About 56% of variance in general patient satisfaction was explained by doctors, nurses, access of care, appointments and facilities (R2=0.56).Conclusions  The moderate satisfaction scores imply that there is room for improvement in the quality of healthcare services delivery system. As doctors and nurses were identified as the strongest predictors of general satisfaction, this knowledge could allow nursing, medical education and management to develop strategies which will further increase the level of patient satisfaction.
Primacy of patient welfare or moral equality? The example of out-of-hours care
Authors: Buetow Stephen , Davis Rachel E
Published: October 2016

Deeply embedded in medical professionalism, the principle of primacy of patient welfare puts patient interests first. Despite the greater inherent dependence of patients on physicians than of physicians on patients, this principle acts against the right of physicians to be viewed as moral equals and can harm physicians, patients and health system performance. Referring to the current crisis in out-of-hours care provision in the United Kingdom, this paper therefore recommends people‑centred care informed by a principle of moral equality. Virtuous action is deemed necessary to apply this principle. It involves using deliberative dialogue to consider equal moral interests equally, make binding decisions to satisfy the interests likely to maximize overall welfare, and ensure that those whose interests are least satisfied are not worse off than before. This action addresses situationally the taken-for-granted assumption that the interests of the patient necessarily trump the interests of others.
On the need for transformational leadership in the delivery of person-centered clinical practice within 21st Century healthcare systems
Authors: Miles Andrew , Asbridge Jonathan Elliott
Published: October 2016

We write this Editorial Introduction following the conclusion of the First Annual Conference and Awards Ceremony of the European Society for Person Centered Healthcare (ESPCH) hosted by Francisco de Vitoria University, Madrid, Spain, on 3 & 4 July 2014. The Conference proved an important event which successfully brought together a very wide range of distinguished speakers and delegates from across the length and breadth of Europe, the United States of America, Canada, Australia, New Zealand and elsewhere. Following the close of Day One of the Conference, and prior to the Conference Dinner, we were pleased to confer on particularly eminent colleagues, the Society's Platinum, Gold, Silver and Bronze Medals, the Presidential Medal and the Senior Vice Presidential Medal and, in addition, to award the Society's Essay Prize and Book Prize.  A full Conference Report, with the usual obligatory photographs and a YouTube videolink to highlights of the proceedings, has been included within the first e-Bulletin of the European Society for Person Centered Healthcare, the Society's new bi-monthly and detailed Newsletter.
Karrie Marshall, Puppetry in Dementia Care: Connecting Through Creativity and Joy, London: 2013, Jessica Kingsley. ISBN 978-1-84905-392-1.
Authors: Lindsay Margot
Published: October 2016

No abstract
Patient-centred care: what consumer health organisations say and do
Authors: Kelly Fiona Sharne , Sav Adem , McMillan Sara , King Michelle A. , Whitty Jennifer A. , Wheeler Amanda J.
Published: October 2016

Concepts like patient-centered care and shared decision making are increasingly prominent topics in discourse on quality in healthcare with the growing prevalence of chronic disease. Although patient-centered care has been touted as a way forward, it remains an ambiguous concept with variable application in healthcare. Greater clarity is needed around the concept of patient-centered care alongside a stronger knowledge base on the perspectives of health consumers with complex needs and service providers, including those outside the formal healthcare system, such as consumer health organizations (CHO). This study explored CHO patient-centered policy, related practice, and organizational views on the potential value of pharmacy delivered patient-centered care.  In-depth interviews were conducted with 15 organizational representatives until no new themes emerged. Data were concurrently thematically analyzed by three researchers from a public health or pharmacy background.  Participants called for a paradigm shift away from the paternalistic biomedical model to shared power that values consumer choice and promotes active engagement in health. There was disparity between articulation of policy and practice, with CHOs often more patient-centered than they claimed to be.  Participants described a wealth of innovative and often patient-centered services, and ascribed under-utilization of these resources to limited awareness. Selected CHOs adopted strategies that health professionals can learn from, such as combining multiple elements of patient-centered care and seeking to build consumer capacity to self-manage. Health professional education, current infrastructure and remuneration were cited as barriers to more widespread delivery of patient-centered care. However, participants suggested creative solutions to address selected factors, some specific to pharmacy. Both pharmacy and CHOs are under-utilized healthcare resources and there is potential for synergy between these sectors to promote patient-centered care.  Pharmacy could benefit from insight into the CHO perspective of patient-centered care and also increase utilization of CHO services through direct referral.
Patients’ preferences for the management of knee injuries: a discrete choice experiment
Authors: Brealey Stephen , Chuang Ling-Hsian , Robling Michael , Bryan Stirling , Hood Kerenza
Published: October 2016

Objectives To elicit the preferences in two cohorts of patients with knee injuries who had been referred by their General Practitioner (GP) for Magnetic Resonance Imaging (MRI) or orthopaedic consultation; or were listed for an arthroscopy.  Methods A discrete choice experiment using a postal questionnaire asked for patients’ preferences for, and trade-offs between, the attributes of waiting time for diagnosis, treatment time, change in knee problem and out of pocket expenses.  Results Participants with knee injuries who responded to the questionnaire were: 148 of 218 (68%) in the GP cohort; and 95 of 121 (79%) in the arthroscopy cohort. Waiting time for diagnosis and treatment, as well as change in knee problem, were statistically significant important attributes. This applies less to out-of-pocket expenses although patients in the arthroscopy cohort were significantly more willing to pay extra for their treatment. There were no significant interactions between employment status and cost. For patient-related quality oflife, attributes for choosing a shorter time to diagnosis or treatment were statistically significant or borderline.  Conclusion Patients with knee injuries find shorter waiting time for diagnosis and treatment to be important as well as improvements in their knee problem. Out-of-pocket expenses were less important, except for patients waiting for an arthroscopy who were willing to pay extra.