bluuebunny/crossref_metadata_2025 huggingface dataset:
Crambe tataria sebeók seeds and plants grown in vitro and in vivo fatty acid composition comparison
Authors: Pushkarova Nadia Oleksandrivna , Kalista Maria Sergiivna , Kharkhota Maxim Andriyovich , Rakhmetov Dzhamal , Kuchuk Mukola Viktorovich
Published: October 2016

Methods of in vitro conservation offer a number of advantages for endangered species preservation. Crambe tataria Sebeók biochemistry study (fatty acid (FA) composition, antioxidant activity (AOA), polyfructan and total soluble protein content) is fairly importaint and could show the potential value of this species in agriculture, Food and Chemical Industry or pharmacology including its use as a source of valuble genetic material and could lead to new promising sources of biofuel discovery. Also, comparison of in vitro and in vivo cultured plants could point out to the effect of in vitro culture methods on plants biochemical composition Fatty acid (FA) content was determined using Gas chromatography-mass spectrophotometry (GC/MS) of fatty acid ethers. Antioxidant activity was determined using DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging method. Total soluble protein content was measured using Bradford method and polyfructan content determination was based upon ketosugars ability to color in the acidic environment with resorcinol. Plants that were grown under in vitro and in vivo conditions and seeds were used in this research. Obtained data showed that C. tataria plants had high AOA and total soluble protein content along with high total FA content along with high content of α-Linolenic acid and absence of erucic acid. Difference in biochemical composition between plants grown in aseptic and not aseptic conditions was shown.
Selected technological properties and antibiotic resistance of enterococci isolated from milk
Authors: Čanigová Margita , Ducková Viera , Lavová Monika , Bezeková Jana , Kročko Miroslav
Published: October 2016

The aim of this work was to determine counts of enterococci in raw cow milk, to isolate and identify them, to determinate their antibiotic resistance, ability of lactose fermentation, proteolytic and lipolytic activity in different conditions of cultivation. Counts of enterococci were determined after 48 ±2 h cultivation on Slanetz-Bartley agar at 37 ±1 °C. The counts of enterococci in raw cow milk fluctuated from 1.80 x 102 to 1.77 x 103 CFU.mL-1 with average value 7.25 x 102 CFU.mL-1. Species identifications of enterococci isolates were performed using commercial EN-COCCUS test and confirmed by PCR. Majority of tested isolates (85.7%) was included to species E. faecalis. Antibiotic resistance was tested on Mueller-Hinton agar using following antimicrobial discs: vancomycin (VA) 30 µg.disc-1, gentamicin (CN) 120 µg.disc-1, erythromycin (E) 15 µg.disc-1, tetracycline (TE) 30 µg.disc-1, ampicillin (AMP) 10 µg.disc-1, teicoplanin (TEC) 30 µg.disc-1. From 13 isolates of enterococci, 1 strain was resistant to vancomycin, 1 strain to tetracycline and 1 to ampicillin, but higher prevalence of intermediate resistance of isolates was determined to tetracycline (5 strains). Ability of lactose fermentation was monitored by change of titratable acidity in UHT milk after 0, 18, 24, 40 and 48 h of cultivation at temperature 25, 30 and 37 °C. The tested strains of enterococci exhibit low milk acidifying ability. Production of proteolytic enzymes was evaluated after cultivation at temperature 7, 25 and 30 °C after 10 days on nutrient agar no. 2 with sterile skim milk (10% w/v) with pH 6.0 and 6.5. Proteolytic activity of tested enterococci strains varied depending on tested temperature and pH. Lipolytic activity was determined similarly like proteolytic activity but on tributyrin agar base with tributyrin (1% w/v). Lipolytic activity of isolated enterococci was very low. The tested strains produced halos with zone in range from 7 to 15 mm regardless of pH, cultivation time and temperature. Some of isolated and tested enterococci strains have shown suitable technological properties, but they have exhibited resistance to antibiotic.
Expanding living kidney donor criteria with ex-vivo surgery for renal anomalies
Authors: McGregor Thomas B. , Rampersad Christie , Patel Premal
Published: October 2016

Introduction: Renal transplantation remains the gold standard treatment for end-stage renal disease, with living donor kidneys providing the best outcomes in terms of allograft survival. As the number of patients on the waitlist continues to grow, solutions to expand the donor pool are ongoing. A paradigm shift in the eligibility of donors with renal anomalies has been looked at as a potential source to expand the living donor pool. We sought to determine how many patients presented with anatomic renal anomalies at our transplant centre and describe the ex-vivo surgical techniques used to render these kidneys suitable for transplantation.Methods: A retrospective review was performed of all patients referred for surgical suitability to undergo laparoscopic donor nephrectomy between January 2011 and January 2015. Patient charts were analyzed for demographic information, perioperative variables, urological histories, and postoperative outcomes.Results: 96 referrals were identified, of which 81 patients underwent laparoscopic donor nephrectomy. Of these patients, 11 (13.6%) were identified as having a renal anomaly that could potentially exclude them from the donation process. These anomalies included five patients with unilateral nephrolithiasis, four patients with large renal cysts (>4 cm diameter), one patient with an angiomyolipoma (AML) and one patient with a calyceal diverticulum filled with stones. A description of the ex-vivo surgical techniques used to correct these renal anomalies is provided.Conclusions: We have shown here that ex-vivo surgical techniques can safely and effectively help correct some of these renal anomalies to render these kidneys transplantable, helping to expand the living donor pool.
A proposed solution to a urological tightrope walk: The challenge of transition of spina bifida patients from pediatric to adult care in Ontario
Authors: Koyle Martin A. , Golda Nicole , Hillis Christopher , Oldershaw Betty , DeMelo Margaret , Uyeno Jennifer
Published: October 2016

N/A
Density-Functional Study of Structural and Electronic Properties of the ZrnAl±m Clusters
Authors: Yu Jun-Zai , Zhao Feng-Qi , Xu Si-Yu , Sun Lu-Jing , Ju Xue-Hai
Published: October 2016

The geometries, stabilities, and electronic properties of ZrnAl±m (n = 1 – 7 and m = 0, 1) clusters were investigated at the UB3LYP/LANL2DZ level. The variations of structural and electronic properties with the changes of n and m were probed. Several possible multiplicities of each cluster were tested. The multiplicity of the most stable neutral clusters is 4 instead of 2. For all the three differently charged of ZrnAl clusters, the lowest-energy geometry is in favor of three-dimensional structure when n ≥ 3. The Zr3Al+, Zr4Al–, Zr5Al +, Zr6Al– and Zr7Alclusters are more stable than their corresponding differently charged species of the same size. Moreover, the odd-even oscillations are found in the fragmentation energy and the second-order difference of total energies for ZrnAl– clusters. The Zr2Al+ cluster is more inert to chemical reaction than others judged by the HOMO-LUMO gaps. NBO analysis was done to analysis the electronic properties.
Properties of Extrusion Processed Corn and Corn Coproducts
Authors: Rich Jordan J. , Rosentrater Kurt A.
Published: October 2016

As the world population continues to grow, the demand for human food and animal feed grows exponentially. Aquaculture is the food sector which has been growing at the greatest rate for several years. Because of the expense of fishmeal in aquaculture fees, an inexpensive protein source could be corn-based proteins. Although many studies have focused on the effects of extruding corn-based blends along with other supplement ingredients, few studies have focused on the extrusion of individual corn-based ingredients. This study examined physical effects of extrusion on distillers dried grains with soluble (DDGS) and corn. Specific objectives included determining moisture content, water activity, color, unit density, durability, water stability, floatability, and bulk density for each corn-based extrudate. Blends were prepared with three levels of moisture (15, 25, and 35% db), and extrusion conditions included three screw speeds (50, 75, and 100 rpm) and three barrel temperatures (100, 125, and 150°C). Results showed that as the moisture content increased, the water activity increased in the raw ingredients, and the moisture content of the extrudates increased. As the screw speed increased, the bulk density decreased in the extrudates, and the mass flow rate increased. As the temperature increased, the floatability of the extrudates increased, while the bulk density decreased. The amount of protein and starch content in the corn products affected the physical quality of the pellets, which is important in aquaculture feed development.
Burgertevredenheid met lokaal gemeentebeleid: meten is weten
Authors: Rogge Nicky , De Jaeger Simon , Naets Gilles
Published: October 2016

Citizen satisfaction with municipal policy: you can manage what you measure

Local officials, policy makers and scholars are increasingly interested in using citizen satisfaction surveys as an instrument to evaluate and analyze the performances and services of municipalities. The key reason for this popularity is the increasing awareness that citizen satisfaction ratings can give a good identification of the effectiveness of the municipal policy. However, a consistent approach to measure citizen satisfaction of the municipal policy in a multidimensional manner has yet to emerge. The construction of such a multi-criteria satisfaction score on municipal policy is indeed an intricate matter with several conceptual and methodological difficulties to overcome. One important difficulty is the question how to aggregate multiple aspects of municipal policy into an overall satisfaction measure. The current paper advocates the ‘Benefit-of-the-Doubt’ (BoD) methodology to weigh and summarize citizen satisfaction ratings on multiple dimensions and tasks of municipal policy into an overall citizen satisfaction score. The label ‘benefit-of-the-doubt’ highlights the main conceptual starting point of the method: in the absence of detailed knowledge on the correct weights for the different dimensions and tasks of the municipality, the BoD-model looks for each evaluated municipality for the most favourable set of weights. As municipalities are usually rather sensitive about being compared and evaluated against each other, this quality is clearly an important advantage of the BoD-model. We present both a static and dynamic version of the model.
Maatschappelijke waarde
Authors: Vinkenburg Bastiaan
Published: October 2016

Maatschappelijke waarde

Reflection and Debate initiates academically inspired discussions on issues that are on the current policy agenda.
Kiezen tussen idealisme en scepsis
Authors: van Daal Rob
Published: October 2016

Kiezen tussen idealisme en scepsis

In this feature authors review recently published books on subjects of interest to readers of Beleid en Maatschappij.
De Verblijfsregeling Mensenhandel in de praktijk: over oneigenlijk gebruik en niet-gebruik
Authors: Klaver Jeanine , van der Leun Joanne
Published: October 2016

Misuse and non-take up of temporary protection measures for victims of human trafficking

In line with international and national legislation, the Netherlands offers certain services, including a temporary residence permit, to third country nationals who have fallen prey to human traffickers. Over the years, concerns have been often expressed about the perceived misuse of this regulation by foreigners who aim at legalising their stay. Based on interviews and file analysis the present article seeks to provide insight into to what extent it is possible to measure this misuse and the policy implications of the findings. In addition, the authors take into account non-use of the programme. The article confirms existing worries about misuse, provides indicators for misuse, but also concludes that at the level of individual cases practitioners cannot discern misuse from rightful use. At the same time, there are also groups that fall outside the reach of the programme. The article concludes with some policy recommendations on the basis of the findings.
De terugkeer van de geopolitiek
Authors: Kremer Monique
Published: October 2016

De terugkeer van de geopolitiek

Reflection and Debate initiates academically inspired discussions on issues that are on the current policy agenda.
De boemerang van de geopolitiek
Authors: van Apeldoorn Bastiaan
Published: October 2016

De boemerang van de geopolitiek

Reflection and Debate initiates academically inspired discussions on issues that are on the current policy agenda.
Bescheiden en pluriforme economen
Authors: Went Robert
Published: October 2016

Gastcolumn

In a column a journal editor or an author expresses his or her opinion on a particular subject.
Strategie, structuur en samenleving: drie dimensies van regionale uitvoeringskracht
Authors: Boogers Marcel
Published: October 2016

Strategy, structure and society: three dimensions of regional implementation strength

Nowadays municipalities in the Netherlands work together more intensively with other municipalities in the region. Also cooperation with companies, institutions and societal organizations is more often looked for at the regional level. In practice this brings along many problems and difficulties. For several reasons it appears not to be easy to combine the implementation strengths of municipalities and societal partners. This article presents a new approach (based on the theory of ‘new regionalism’) to regional implementation strength. This approach is not only about designing regional administrations, but is mainly about the factors that induce administrations as well as companies and institutions to commit themselves jointly for the region. To increase the regional implementation strength more is needed than the formation of a regional administrative structure in which municipalities do not cooperate in a non-committal manner. To induce municipalities and societal partners to commit themselves jointly to handling new tasks or new challenges it is also necessary to have a clear strategic vision on these issues that binds parties and makes them enthusiastic and that regional cooperation is rooted in a societal breeding ground. It also asks for an administrative structure that does justice to the contribution every municipality and societal partner makes to the realization of the strategy and for a democratic involvement of municipal councils and sector-based interest groups.
Uitvoeringskracht in sociale wijkteams: een beproefd concept in een nieuwe context
Authors: Oude Vrielink Mirjan , Sterrenberg Lydia , Koper Helga
Published: October 2016

Implementation strength in social neighbourhood teams: a well-tried concept in a new context

In the Netherlands at January 1st 2015 municipalities will most likely receive administrative and financial responsibility for work, youth and societal support. Anticipating this change almost all large municipalities have introduced social neighbourhood teams, inspired by the successful model of the ‘Achter-de-Voordeur-aanpak’ (Dutch for ‘Behind the Front Door-approach’). In this article the authors reflect on this development, because of criticisms about the vagueness surrounding the social teams and with its further development in mind. In a historical analysis they look at this phenomenon in relation to its political and policy context. The central research question is the change in vision that has occurred since the first experiments with neighbourhood social teams and the implications for their design. The authors show how the focus in the policy discourse has gradually moved to arguments concerning the efficiency of the societal support, more self-responsibility and self-direction and more participation in the society and the labour process. This makes a different model for neighbourhood teams desirable, especially in terms of (1) the target group of the approach, (2) the depth of the support and (3) the role of the generalist and the room for manoeuvre or the powers this generalist receives. A lot of municipalities choose to discover gradually what works. Next to the time pressure this might explain the vagueness of the plans for the design and organization of neighbourhood teams.
De ongeldigverklaring van de Dataretentierichtlijn: een nieuwe stap in de bescherming van de grondrechten door het Hof van Justitie
Authors: Hijmans Hielke
Published: October 2016

De ongeldigverklaring van de Dataretentierichtlijn: een nieuwe stap in de bescherming van de grondrechten door het Hof van Justitie

Op 8 april 2014 heeft het Hof van Justitie een opmerkelijk arrest gewezen in de gevoegde zaken Digital Rights Ireland en Seitlinger.

Het heeft voor het eerst wegens strijd met het EU-Handvest voor de grondrechten een richtlijn in zijn geheel vernietigd. Het Hof van Justitie heeft geoordeeld dat de Uniewetgever met de vaststelling van de Dataretentierichtlijn de door het evenredigheidsbeginsel gestelde grenzen heeft overschreden die hij in het licht van de artikelen 7, 8 en 52 lid 1 van het Handvest in acht dient te nemen. Het heeft geen beperking in de tijd aangebracht (het Hof van Justitie wijkt hiermee af van de conclusie van advocaat-generaal Cruz Villalón, overwegingen 154-158).

HvJ EU 8 april 2014, gevoegde zaken C-293/12 en C-594/12, Digital Rights Ireland en Seitlinger, EU:C:2014:238, n.n.g.
Patient experience at the time of practice transformation into Patient-Centered Medical Homes
Authors: Kern Lisa , Dhopeshwarker Rina , Edwards Alison , Kaushal Rainu
Published: October 2016

Purpose: The Patient-Centered Medical Home (PCMH) is a model of primary care that is being promoted for its potential ability to improve patient-centeredness, improve quality and decrease costs. The effect of the PCMH on patient experience is not clear, with some reports suggesting that patient experience may worsen during transformation. We sought to measure patient experience at the time practices transform into PCMHs.Methods: We conducted a cross-sectional survey of 419 adult patients who were cared for by 85 primary care physicians across 12 practices in the Hudson Valley region of New York State. We measured patient experience, using the 35 questions in the Clinician & Group – Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) – Adult Primary Care Questionnnaire (plus 14 additional questions drawn from other survey instruments) and compared the results to national CG-CAHPS benchmarks.Results: Patients’ experience overall was fairly positive, with 79% giving their doctors a ranking of 9 or 10 on a 10-point scale, with 10 being the highest. Patients’ experience in this sample was significantly more positive than the national benchmark on each of 6 subscales (p ≤ 0.05).  Patients were generally most satisfied with individual face-to-face encounters with their physicians and somewhat less satisfied with processes of care (such as receiving results from a test or receiving follow-up after discharge from the hospital).Conclusions: This study suggests that medical home transformation does not adversely impact patient experience and identifies organizational processes of care that could potentially be improved with the patient-centered medical home.
Parent and staff perceptions of family-centred care in two Australian children’s hospitals
Authors: Gill Fenella , Pascoe Elaine , Monterosso Leanne , Young Jeanine , Burr Charlotte , Tanner Ann , Shields Linda
Published: October 2016

Aim: This paper is a report of the comparison of perceptions of family-centred care by hospital staff (nurses, doctors and allied health staff) and parents of hospitalised children in two Australian tertiary paediatric hospitals.Background: Family-centred care is an accepted approach to caring for children and their families in hospital. Previous publications have been inconsistent, ranging from promoting its benefits and integration into practice, reporting operational difficulties and proposing that family-centred care may not be working at all. An evaluation of the model of care is long overdue. Method: A quantitative comparative cross-sectional survey was used to collect data in 2010 from a convenience sample of 309 parents of hospitalised children and 519 staff. Participants rated 20 items grouped into three subscales of respect, collaboration and support.Findings: Both parents and staff responses were positive and parents had significantly higher subscale scores for respect, collaboration and support (all p<0.0001). Parents’ responses for 19 of the 20 items were significantly higher than for staff. The item on which parents and staff did not differ was concerned with being able to question recommendations about the child’s treatment. Conclusion: Both parents and staff had positive perceptions of their family-centred care experiences. Parents’ perception of their experience was more positive than staff perceptions of their delivery of family-centred care in hospital. Whilst the positive experience by both consumers and healthcare providers is an important finding, reasons for differences, in particular in supporting parents, require further examination.
Long-term effects of empathy training in surgery residents: a one year follow-up study
Authors: Phillips Margot , Lorie Aine , Kelley John , Gray Stacy , Riess Helen
Published: October 2016

Objectives: This study is a 1-year follow-up investigation of the retention of the knowledge, attitudes and skills acquired after empathy training.Methods: Eight otolaryngology residents completed 5 assessment measures before and after empathy training and at 1-year. They attended a 90-minute focus group assessing clinical usefulness of the training, attitudes and factors that affect empathy.Results: Qualitative analysis revealed a positive response to the training and application of skills to clinical practices. Quantitative analyses suggest improvement in empathy after training was maintained at 1-year follow-up (p = 0.05). Knowledge of the neurobiology and physiology of empathy remained significantly greater than before the training (p = 0.007). Conclusions: Qualitative data indicate that the training program was well-received and helpful and follow-up focus groups provided physicians with opportunities for self-reflection and support from peers. Quantitative analysis demonstrated that improvement in self-reported empathy and objective knowledge of the neurobiology of emotions persist at 1-year follow-up. Accordingly, we recommend that empathy training and follow-up booster sessions become a standard component of residency training.
Is our healthcare system working for spinal surgery patients? Towards individualised care pathways and person-centered supports
Authors: McGregor Alison , Henley Ania , Morris Tim , Dore Caroline
Published: October 2016

As part of a randomised controlled study into the post-operative management of spinal surgery, this qualitative sub-study sought to explore the patients’ experience of the healthcare system and their perceptions of how the system had worked for them, with a view to establishing more appropriate care pathways and improved support materials for patients undergoing surgery.Patients taking part in the FASTER study (Function after spinal treatment, exercise and rehabilitation) were invited during their one year post-operative review to provide feedback on their healthcare experience following surgery. This study comprised 245 patients recruited from 7 hospitals, with 20 different spinal surgeons contributing patients.The majority (82%) of patients were referred through their general practitioner (GP). Forty percent identified a specific event that led to their pain; of these 48% reported a longstanding pain and 33% noted a sudden injury. Thirty percent waited less than a month for surgery and 32% 1-3 months. Eighteen percent experienced surgical cancellations. Many respondents felt that they had not been managed well by their GP pre-operatively, although it appeared that most GPs had followed current guidelines. In terms of their hospital stay the majority felt prepared and content with the care received and expressed faith in their surgical team. Although it appeared that patients were happy with their post-operative care, closer inspection revealed concerns with inadequate information, feelings of abandonment and poor communication from some healthcare professionals. Many reported that taking part in the research itself was a positive experience.Both negative and positive patient experiences have been identified. Patients express concern at the paucity of information they are given concerning their clinical journey, particularly in relation to discharge from hospital. In this era of social media and the internet there is a clear need to explore new methods of addressing patients’ information needs.
Ethical climate in a Belgian psychiatric inpatient setting: relation with burnout and engagement in psychiatric nurses
Authors: Faelens Astrid , Claeys Marleen , Sabbe Bernard , Schrijvers Didier , Luyten Patrick
Published: October 2016

Research suggests a relation between the ethical climate – that is, the organisational conditions and practices that affect the way ethical issues with regard to patient care are discussed and decided - and job satisfaction of nurses. Yet no study to date has investigated the relationship between ethical climate and job satisfaction in psychiatric nurses. This study aimed to address this critical gap in our knowledge by investigating the relationships among ethical climate and features of both burnout and engagement based on the Job Demands-Resources Model (JD - R model) in a large cross-sectional study of 265 nurses working in a large psychiatric inpatient hospital in Flanders, Belgium. Correlational and multiple hierarchical regression analyses were used to investigate the relationship between ethical climate, burnout and engagement. In addition, based on the JD-R model, we also investigated whether engagement mediated the relationship between ethical climate on the one hand and job satisfaction and turnover intention on the other and whether ethical climate moderated the relationship between emotional burden and burnout. Results showed that a positive ethical climate was related to lower levels of emotional exhaustion and distancing and higher levels of engagement and job satisfaction. Furthermore, although ethical climate did not buffer against the effects of emotional burden on burnout, higher levels of engagement explained in part the relationship between ethical climate and job satisfaction.
Patients’, carers’ and providers’ experiences and requirements for support in self-management of multiple sclerosis: a qualitative study
Authors: Deibel Francesca , Edwards Michelle , Edwards Adrian
Published: October 2016

Background: Self-management is a process increasingly promoted for the management of long term conditions, both for ethical reasons of enhancing autonomy and for likely cost-effectiveness, but the nature and scope of self-management strategies are currently highly variable.Objective: To identify patients’, carers’ and clinicians’ current experiences of self-management in multiple sclerosis (MS) and their recommendations for the development of a future MS-specific self-management interventionMethods: Qualitative study using focus groups and semi-structured one-to-one interviews with a purposive sample. Three focus groups were held with 25 patients with moderate to advanced multiple sclerosis and 4 carers. Ten clinicians were interviewed. Data underwent thematic analysis.Results: Participants perceived multiple aspects of MS to be amenable to self-management, but identified a current lack of service provision to support their abilities to self-manage. Participants felt that to address both the physical and psychosocial challenges posed by MS required better information provision, a strong relationship with healthcare professionals and a toolkit of self-management skills. Participants expressed concern at the lack of consideration currently given to carers, which should be addressed in future provision.Conclusion: The diverse experiences of patients living with MS warrant a multidisciplinary, flexible and proactive approach to improve their self-management capabilities, acknowledging both patients’ and carers’ unmet needs. The findings can be used to guide the development of future self-management interventions specific to individuals with multiple sclerosis.
To test or not to test: what is the value of knowing?
Authors: Rizzo John , Lee David
Published: October 2016

This paper develops a conceptual model for understanding the impact of the “value of knowing”, defined as the value of information from medical tests exclusive of treatment or life-planning decisions on a patient’s decision to undergo testing.  We draw upon the behavioral economic, loss-aversion, cost-benefit and willingness-to-pay literatures to develop a mathematical model of how a medical diagnostic test affects patients’ sense of wellbeing and how this phenomenon affects their decision to undergo testing.  The model allows simultaneous evaluation of the impact of baseline (pre-test) disease risk, test inaccuracy, prior information, worrying over disease onset, time preference and the degree of loss aversion on patients’ net assessment of the value of knowing.  We then simulate the net value of knowing under alternative hypothetical scenarios about test accuracy and patient characteristics.              Patients agree to testing when the expected benefits from good news (measured by willingness to pay) exceed the psychic costs of bad news (measured by willingness to accept).  The value of knowing from testing is shown to depend on test accuracy, pre-test disease risk, the patient’s discount rate, time to disease onset and the patient’s aversion to receiving bad news (loss).  Simulation results indicate that the value of knowing increases (and testing becomes more likely) when: tests are more accurate; the baseline expectation of a positive test is low and the adverse consequences of a positive test are either small or occur far in the future or patients do not worry about onset of future disease.
Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222
Authors: Rothenberger Lillian Geza
Published: October 2016

In recent years, there has undoubtedly been an “over-reliance on science” that has led to an unedifying “scientistic medicine” in patient care of most if not all medical disciplines [1]. Although I would not go so far as to say that these circumstances may lead to “an ethical and moral chaos within clinical practice,” I agree with Miles and Mezzich that “while it is imperative that medicine must be actively and continuously informed by science, science cannot function as the base of medicine.” Evidence generated by clinical or, in the early beginnings of research progress, even non-clinical trials can be very helpful, but to impose study results uncritically upon the individual patient would mean to neglect this person’s individuality. The individual needs may, for example, not be consistent with the inclusion criteria of the very study used as the evidence base for the treatment. I therefore welcome, then, the article by Miles and Mezzich, which discusses the need for a more critical reflection on scientific data before or within clinical use and the demand for more humanity in patient care in terms of a person-centered approach.
Adaptive many model medicine trumps monocultural models: comment on the Miles and Mezzich emergent model of modern clinical practice
Authors: Nunn Robin
Published: October 2016

In their provocative and insightful discussion paper, Miles and Mezzich consider two parallel, but philosophically divergent movements in medicine: evidence-based medicine and patient-centered care. They call for the integration or coalescence of these contrasting movements into one model that "combines the strengths of both movements, but which dispenses with the weaknesses of each." I share their goal of placing the person at the center of medicine, rather than subordinating the person to the depersonalized science and technology represented by current models of evidence-based medicine. Yet I envision a person-centered model, indeed any medical model, not as an overriding unified entity, but rather as one component in a complex "many model medicine". I have tried to show elsewhere that the use of many models is likely to produce better outcomes than the dominance of any single model. Multiple models entail multiple perspectives and methods that may be necessary to solve difficult medical problems. This pluralistic view is consistent with Peabody's view, cited in the discussion paper, that medical art and science are not opposites, but are foundational components of medicine.
Response to Miles and Mezzich
Authors: Kerry Roger , Anjum Rani Lill , Mumford Stephen
Published: October 2016

Miles and Mezzich offer a substantial and focussed account of a “crisis” of knowledge, care, compassion and costs in modern medicine. Their claim is that an over-emphasis on scientific, even scientistic medicine, has resulted in the depersonalisation of care. In response, they propose an emergent model of clinical practice grounded in person-centred medicine (PCM). We are honoured to have been offered an opportunity to respond to this paper. We will not attempt to de-construct the paper or rehearse arguments concerning the limitations of evidence-based medicine (EBM). Rather, we would like to support the general thesis of the paper and offer some form of thought related to how PCM might best develop.  In doing this, we will be very careful not to dismiss the valuable role that science and systematic research play in healthcare. Thus, we have little interest in using EBM as some form of ‘strawman’ by which to pronounce ‘the new way’. Parts of Miles and Mezzich’s paper appear at times to do this. Ultimately, however, we do not see this as the primary intent of their otherwise excellent discussion paper.
On medicine and science
Authors: Shahar Eyal
Published: October 2016

Most human minds probably agree that science is somehow concerned with understanding the universe which each of us visits for some fixed time. But that is not penetrating enough, for nothing was said about the content of the universe. What is there to understand?
Realizing person-centred care in residential care facilities for young adults with complex and chronic disabilities: the understanding, perception and beliefs of workers
Authors: Rissanen Lauren , Ehrlich Carolyn , Kendall Elizabeth , Muenchberger Heidi
Published: October 2016

Young people living with complex and chronic disabilities who require assistance with health-related needs are rarely receiving the optimum support and care that will enable their full participation in society, or simply to live as they choose. For young people with complex disabling health conditions, this situation may not only be unpleasant, but may have a detrimental impact on their outcomes. In Australia, considerable attention has been paid to the relocation of people from institutional care into community settings within purpose-built apartments. However, it is the service model and the residential workers who articulate that service model into practice that are crucial to stimulate better outcomes for young people.  In this study, a qualitative design was used to identify the major ways in which residential workers understood and articulated person-centred practice for young people with complex disabilities. Data were thematically analysed using an a priori coding framework. The study identified 4 main themes relevant to person-centred practice in this setting, namely: 1) recognition of the person in time and context; 2) recognition of individuality; 3) recognition of the relationship and 4) promotion of autonomy. Importantly, the themes were connected in a broad and multi-level way through communication. The findings indicate that to enact behaviours congruent with person-centredness, residential care workers may need to reframe their professional role, image and values. However, several barriers hindered this process (i.e., system/organisational constraints, time etc.) and participants clearly needed support, education and/or mentoring to improve their capacity to apply person-centred models and also to create meaningful care partnerships.
Referrer satisfaction with services provided at a national and specialist clinic for OCD and related disorders in children and adolescents
Authors: Hoerold Doreen , Krebs Georgina , Turner Cynthia , Heyman Isobel
Published: October 2016

Rationale: Referrer satisfaction is an often-neglected outcome measure in mental health services and can inform service improvements. We examined referrer satisfaction with a specialist OCD service for young people.Method:  An online satisfaction questionnaire, comprising 19 closed and one open-ended question, was sent to 155 referrers of whom 30 (19.4%) responded.Results: Satisfaction was high overall. However, higher levels of satisfaction were noted with respect to treatment plans as compared to treatment outcome. Referrers also made recommendations for service improvements, such as increased communication during treatment, recommendations for after-care, managing co-morbidity and improving patient engagement.Conclusions: Referrer satisfaction may be improved by addressing these aspects of the service.
Intelligent Kindness: professional healthcare and the future of the UK NHS
Authors: Campling Penny
Published: October 2016

The concept of ‘intelligent kindness’ is important at all levels of healthcare from the personal, through teams and work organisations to the political. A virtuous circle is envisaged, based on what motivates and assures compassionate practice, affecting patient experience and linking to staff morale, effectiveness, efficiency and outcome. The UK NHS is a system that invites Society to value and attend to its deepest common interests; a vital expression of kinship that can improve if Society, patients and, especially, staff can reconnect to the powerful motivation and attentiveness inherent in such connectedness.The healthcare task, however, puts us in touch with deep-seated, largely unconscious existential anxieties that can undermine the work and the organization. Not only are hospitals organized in a defensive structure against such anxieties - as described by Isobel Menzies Lyth, over 50 years ago - but these same anxieties drive the constant re-structurings that are so disruptive to the service and distracting from patient care. The forces at work in Society that threaten to undermine and fragment an ethical healthcare system are also described in relation to Susan Long’s thesis on the ‘perverse organisation’ - particularly the tendency to ‘turn a blind eye’ to the dangers of unmitigated market forces and industrialization.It is argued within this article that a focus on intelligent kindness in healthcare is more urgent than ever and that such a focus could act as an integrating force, minimizing the potential for harmful fragmentation. Models of good practice are described and an active refocussing on kindness within healthcare professions is encouraged.
Sustainable Change Sequence: A framework for developing behavior change interventions for patients with long-term conditions
Authors: Elwyn Glyn , Marrin Katy , Frosch Dominick L , White James
Published: October 2016

ObjectiveInteractive interventions are increasingly advocated to support behavior change for patients who have long-term conditions. Such interventions are most likely to achieve behavior change when they are based on appropriate theoretical frameworks. Developers of interventions are faced with a diverse set of behavioral theories that do not specifically address intervention development. The aim of our work was to develop a framework to guide the developers of interactive healthcare interventions that was derived from relevant theory, and which guided developers towards appropriate behavior change techniques.MethodsWe reviewed theories that inform behavior change interventions, where relevant to the management of long-term conditions. Theoretical constructs and behavior change techniques were grouped according to similarity in aims.ResultsWe developed a logic model that operationalizes behavior change theories and techniques into five steps likely to lead to sustained behavior change. The steps are: 1) create awareness of need; 2) facilitate learning; 3) enhance motivation; 4) prompt behaviour change; and 5) ensure sustainability of behaviour change.Conclusion and Practice implicationsA framework that sequences behavioural change techniques along a sustainability model provides a practical template for the developers of interactive healthcare applications and interventions.
Medicine of the Person: a charter for change following the Mid – Staffordshire Francis enquiry.
Authors: Cox John , Gray Alison
Published: October 2016

The findings of the Mid-Staffordshire Foundation Trust UK Inquiry, chaired by Robert Francis QC and its 290 recommendations for change in the culture of healthcare delivery are a stunning indictment of a management system that had lost the capacity to care for the patient [1]. Here, the healthcare had become unmoored from the core NHS values to care for patients and had become devoid of compassion, driven by top-down management system of secrecy and dishonesty, characterized by an almost total failure to listen to patients, families and carers.
Working through disclosure and apology with the person and family: a humanizing approach to medical error
Authors: Hovey Richard , Natoli Anna
Published: October 2016

Disclosing and communicating a medical error to a person (as patient) and/or family members can be an overwhelming and difficult conversation. The act of disclosing a medical error in addition to an apology is complex, intense and demanding for the person and family with the healthcare provider because it makes transparent which human or systems error(s), has caused the harm. This manuscript re-interprets narrative data from people (patients) and families who have experienced medical harm through an adaptation of Richard Kearney’s threefold approach to working through human trauma: (1) practical understanding, (2) cathartic narrative and (3) forgiveness (pardon) [1]. Through this analytical approach, the emphasis is on the nature of working through trauma as a dynamic process in the interaction among and between healthcare providers, patients and family members.
Cancer educational group intervention: impact on self-efficacy and anxiety among women recently diagnosed with breast cancer and undergoing surgery
Authors: Dubois Sylvie , Hanfield Louise , Folch Nathalie , Saucier Andreanne , Fleury Danielle , Pineault Raynald
Published: October 2016

Aim: To investigate the impact of an educational group intervention on self-efficacy and anxiety among women recently diagnosed with breast cancer.Method: A quasi-experimental longitudinal design was used. Women diagnosed with breast cancer and undergoing surgery (n = 113) were recruited from a university teaching hospital in Montreal, Quebec, Canada. At pre-admission, the intervention group(n = 57) received a group 90-minute information session (paper documents, video and demonstration) led by a nurse and a physiotherapist, which included material handling and time for questions and discussion. The control group(n = 56) received the usual care. Self-reported questionnaires were filled out at the time of the announcement of surgery(T0), after the training(intervention or usual care, T1) and at the first post-operative follow-up(T2).Results: Quantitative analysis using a mixed model for repeated measures showed no significant differences between the experimental and control groups in terms of the training session (group vs. individual). A time effect was observed in both groups for self-care and anxiety. In addition, several positive changes weremade in the clinical settings to optimize oncology healthcare.Conclusions: Future research would explore whether these findings reflect actual clinical practices or are more dependent on the specific cancer diagnosis.
Lay People’s Views on the Appropriateness of Psychotherapies
Authors: Mullet Etienne , Munoz Sastre Maria Teresa , Sordes-Ader Florence
Published: October 2016

Rationale, aims and objectives When choosing a particular psychotherapy, psychotherapists are expected to take into account their clients’ preferences, needs, and values, their own professional experience, and what is currently known regarding the real impact of these therapies. Psychotherapists widely vary the one from the other in the weight they attribute to each of these factors. We examined the way lay people judge of the appropriateness of therapeutic decisions taken by clinical psychologists.Methods 206 participants were presented with 24 vignettes depicting the way a psychotherapist has selected therapy. They were composed according to a three within-subject factor design: (a) the frequency with which the therapy was used in clinical practice in the area, (b) the patients’ usual level of appreciation of this therapy, and (c) the level of scientific evidence supporting the use of this therapy (strong evidence, weak evidence, unknown evidence and no evidence). The participants rated appropriateness of the decision in each case.Results For half the participants, the most important factor was the patients’ appreciation of the therapy in general. Even scientifically supported therapies were considered as only mildly appropriate if patients in general didn’t like them much. For the remaining half of participants, scientific evidence was the most important factor: Therapies that were well appreciated by patients were not viewed as appropriate if they were not scientifically grounded.Conclusions Creating authoritative multilingual web sites synthesizing the main findings regarding the impact of diverse therapies would be a way through which at least some patients could judge of the appropriateness of the technique they have been offered by their psychotherapists. Their (informed) reactions could ease changes in direction of more weight attributed to existing scientific evidence from the part of therapists.
Sarah Crockett, Activities for Older People in Care homes, London: Jessica Kingsley, 2013. ISBN 978-1-84905-429-4
Authors: Lindsay Margot
Published: October 2016

No abstract
Are Clinically Heterogeneous Studies Synthesized in Systematic Reviews?
Authors: Steurer Johann , Scharer Sarah , Wertli Maria , Miettinen Olli
Published: October 2016

Background To assess whether in systematic reviews there occurs synthesis of the results of original studies when these studies involve prognostically dissimilar patient groups. Methods Review of meta-analyses in systematic reviews on topics relevant to rheumatology or cardiology. In a survey panels of clinical experts assessed whether the distributions of prognostic indicators were sufficiently similar for the synthesis of results to be justified.  Results Generally, half of the experts judged the information about the prognostic indicators to be insufficient for judgment about the justifiability of the synthesis. When the panel members deemed the information to be sufficient, about half of the time they judged the synthesis to be unjustifiable due to prognostically dissimilar patient groups. Conclusion It appears that expert consumers of the meta-analysis results from systematic reviews are quite commonly unsettled about the justifiability of those syntheses.