bluuebunny/crossref_metadata_2025_split huggingface dataset:
The STarT Back Tool: Physiotherapist Experience and Perceptions of its Clinical Utility
Authors: Woods Emma , Gaskell Lynne 
Published: October 2016

i) Rationale:The STarT Back Tool (SBT) has been recently validated for use as a prognostic screening tool with Lower Back Pain (LBP) patients in the primary care setting (1). A recent study by Hill et al (2) concluded that LBP outcomes and cost effectiveness could be improved from using the SBT to guide decision making and providing a stratified approach to care. The SBT was introduced to musculoskeletal physiotherapists working in the community setting for Bolton NHS Foundation Trust.This study aims to explore the perceptions and experiences of physiotherapists using the SBT in clinical practice. No study has yet explored thisii) Method:A qualitative study was conducted. A Nominal Group Technique (NGT) was undertaken to develop an appropriate set of questions for use in a single Focus Group (FG). The FG comprised of eight musculoskeletal physiotherapists. The FG was audio taped and the data obtained was analysed through Grounded Theory Methodology.iii) Results:Physiotherapists felt the SBT acted in a confirmatory manner. Although deemed easy to use, a number of barriers led to only a small impact on decision making. These being, perceived oversimplification of the decision making process, impact on professional reputations and professional development, risks associated with single treatment sessions, patient satisfaction and threats to patient centred care. iv) Conclusion:A number of barriers reduced Physiotherapist confidence in using the SBT to guide decision making and led to physiotherapists questioning whether a stratified approach to LBP management represented the ‘best care’ for their patients. The study highlighted the importance of a robust training prior to and during the implementation of the SBT and a stratified approach to care within physiotherapy departments.
Can a web-based tailored decision aid ‘stand alone’ for 65plus patients with localized prostate cancer?
Authors: Schrijvers Jessie 
Published: October 2016

Objectives: A pilot study was designed to examine the feasibility of a web-based DA and its included technology features, considering treatment choice for patients between 65 and 75 with localized prostate cancer. Patients and method: Twenty-nine patients, that had already been treated for localized prostate cancer, participated at an oral survey with close-ended questions about their internet use, the barriers and opportunities when accessing a web-based DA, their impression on the use of incorporated technology features and their preference for the booklet or the online DA version. Data were analyzed using non-parametrical statistics. Results: Participants with low internet use and without internet access at home preferred the booklet DA or a combination of both booklet as well as web-based format. Patient characterized as regular internet users with internet access at home preferred the web-based DA version and extensively used the tailoring component. The usage of other technology features such as value clarification tool and comparative tables was high while the use of the scientific information was limited. Conclusion: An online DA is a useful tool in a decision making process for patients characterized as frequent internet users with internet access at home, also in an older patient population.
Patient Satisfaction with the Health Services Provided by the Pharmacist at a General Hospital in Riyadh, Saudi Arabia
Authors: Al-Jumah Khalaf Ali , Hassali Mohamed Azmi , Alzaagi Ibrahim 
Published: October 2016

Background: Patient satisfaction is one of the main indicators for determining the quality of the services provided to patients by pharmacists.Objective: The purpose of this study was to determine the patients’ satisfaction and various factors affecting satisfaction with pharmacists dispensing services atKingSaudMedicalCity inRiyadh,Saudi Arabia.Methods: A cross-sectional study was conducted to explore patient satisfaction with the pharmacy services from August through September2013. A self-administered, 10-item questionnaire was administered randomly to 500 participants to evaluate patient satisfaction. Twenty questionnaires were excluded because they were incomplete. Statistical Package for Social Sciences (SPSS) version 17.0 for Windows was used to analyze the data.Results: The response rate of this study was 96%. Most of the respondents were female (252, 52.4%), and 69.9% of the sample visited the pharmacy 3 or more times per year. The majority of the patients reported a high level of satisfaction, which was slightly variable among the groups, particularly with respect to the education level and employment status of the patients. Patients with a high school education or less were the most satisfied with the pharmacy services with a mean score of 3.50 (df= 2.969, F= 3.659, p=<0.006). Unemployed patients were the most satisfied with the pharmacy services, with a mean score of 3.52 (df= 2.580, F= 3.138, p=<0.044).Conclusion: The patients reported a high level of satisfaction with the pharmacy services atKingSaudMedicalCity inRiyadh.
Acknowledging the patient with back pain: A systematic review based on thematic synthesis'
Authors: Damsgaard Janne Brammer , Jorgensen Lene Bastrup , Norlyk Annelise , Thomas James , Birkelund Regner 
Published: October 2016

Rationale and aims: Research shows that back patients’ illness experiences affect their interaction with the healthcare system. It is important to examine the exact nature of these experiences in order to shed valuable light on how back patients perceive their illness and hospitalisation. The aim of this literature review is to gain a better understanding of back patients’ illness experiences and to identify, systematise and integrate the findings of different qualitative studies that may elucidate barriers and the consequences or focal points in connection with care and treatment. Methods: The methodology for this literature review is based on the thematic synthesis used by James Thomas and Angela Harden. The literature review also draws on the sociological theories and arguments of Ulla Harriet Jensen and Trine Dalsgaard in which health professionals biological perception of the individual dominates the healthcare system and translates into a certain way of perceiving and explaining illnesses and symptoms. Results: The thematic analysis shows that it is through experiences and memories that we create our identity and consciousness. Ignoring the illness experiences can therefore be seen as disregarding, the patient as a human being. With this in mind, it is easier to understand why back patients often feel marginalised and mistrusted in their interactions with the healthcare system. Respectfully including the patients’ experiences is fundamentally about acknowledging the back patient as a human being. Conclusions: A synthesis of the included studies demonstrates the need for healthcare professionals to pay attention to back patients’ narratives in order to acknowledge them as human beings. This acknowledgement involves an ethical dimension and a sense of responsibility, manifested as respectful inclusion of the patient’s experiences. The body can never be understood merely as a biological entity and therefore illness is far more than having symptoms, diagnoses and treatment. The synthesis thus proposes an acknowledgment of this and a more holistic approach.
VIGNETTE-BASED DECISION POINT ANALYSIS (VDPA): A NOVEL METHOD OF EXPLORING PERSON-CENTERED CONTEXTUAL INFLUENCES ON CLINICAL DECISION-MAKING
Authors: Dharmaratne Sisira , Razee Husna , Ponnamperuma Gominda , Marambe Kosala , Dawson Andrew , Balasooriya Chinthaka 
Published: October 2016

Rationale and aims: Contextual factors are increasingly recognized as having a significant influence on clinical-decision-making. Contextual influences however, are considered ‘less scientific’ or ‘non-clinical’ in the eyes of practicing clinicians, making it a sensitive issue for discussion. Therefore, exploring these contextual influences can be challenging. Methods which can circumvent this challenge are required to evaluate clinical decision making at natural settings. This paper reports on the development of an innovative research method to address this challenge of exploring contextual influences and similar sensitive and complex clinical practice issues. Method: The researchers conducted a field research to test an interview based method which was termed as ‘Clinician Recalled Vignette (CRV) Method’. Based on reflections on the field research experience this preliminary method was refined to develop an innovative method which is potentially capable of eliciting sensitive and complex clinical practice issues. Results: Reflections on field test data provided preliminary evidence on the usefulness of the CRV method and limitations. The method that was refined, in response to limitations, focused on key decision points relevant to the clinical vignettes recalled by clinicians, and included a mechanism to identify how contextual factors influence these key decision points. This innovative method was termed ‘Vignette-based Decision Point Analysis’. Conclusions: The innovative method discussed in this paper will assist other researchers in conceptualising and conducting research projects to explore sensitive and complex clinical practice issues in natural settings.
Prevalence and associations of gender concordance in general practice consultations: a cross-sectional analysis.
Authors: Thomson Allison , Morgan Simon , Tapley Amanda , Van Driel Mike , Henderson Kim , Oldmeadow Chris , Ball Jean , Spike Neil , McArthur Lawrie , O'Mara Peter , Scott John , Magin Parker 
Published: October 2016

Rationale, aims and objectives: Gender effects on physician-patient interactions are well-established and gender concordance of the physician-patient dyad influences consultation dynamics, person-centeredness and outcomes. We aimed to establish the prevalence and associations of gender-concordant and gender-discordant consultations of general practice (family medicine) trainees and to compare outcomes of gender-concordant and gender-discordant consultations.Method: A cross-sectional analysis from an ongoing cohort study. The outcome measure was whether a consultation included a gender concordant (female-female, male-male) or discordant (male-female, female-male) physician-patient dyad. Independent variables related to patient, physician (registrar), practice, consultation content and consultation outcome.Results: Five hundred and ninety-two general practice (GP) registrars (trainees) in 4 of Australia’s 17 regional training programs provided data on 56,234 individual consultations. Sixty-two point nine percent of consultations were gender-concordant (73.5% female-female, 26.5% male-male) and 37.1% were gender-discordant (47.0% male physician-female patient, 53% female physician-male patient). Associations of having a gender-concordant consultation were patient female gender and younger age (<55), the patient not being new to the registrar and the registrar being part-time, younger and having worked at the practice previously. Addressing a reproductive/contraceptive/ genital problem was associated with gender concordance. Gender-concordant consultations were ‘complex’: significantly longer than gender-discordant consultations, addressed a greater number of problems, resulted in more pathology ordered, more follow-up organised and more learning goals generated.Conclusions: Gender-concordant consultations may be more complex and gender-concordance is ‘sought’ by patients rather than being random. Thus, efforts could be made in general practice to provide access to both male and female GPs, especially for female patients or groups or patients with particular needs.
The Diverse Journeys of Rural Older Adults with Atrial Fibrillation
Authors: Rush Kathy L , Oelke Nelly D , Shay Matt , Reid Robert C 
Published: October 2016

Rationale, aims and objectives: Atrial fibrillation (AF) is a serious chronic heart condition characterized by an irregular, rapid heartbeat and unpredictable course. Patients with AF often struggle with managing the impact of the disease on daily activities. Afflicted rural dwelling patients face added challenges including inequities in health services and a lack of cardiac specialty services. AF patient journeys through the healthcare system have not been well documented, but offer a valuable tool for improving patient management and outcomes. The purpose of this study was to document individual AF patient journeys of rural living older adults. Method: This study used a 6-month longitudinal design to examine the rural healthcare experiences of 10 AF patients. AF patient journeys were mapped using information gathered through interviews, written logs, photographs and an electronic health record review. Thematic analysis was used in clustering common features of the healthcare journeys of older adult patients with AF and a typology developed to describe them. Results: Each patient’s journey with AF was unique. Symptom and disease severity, health service utilization and needs emerged as differentiating features in the identification of 3 journey types: (1) Stable, (2) Chronically Unstable and (3) Acute Crisis. Conclusions: These journey types provide a valuable person-centered tool to assess patient needs at any point in the AF trajectory and to address salient risks that accompany each type to improve management of the increasing number of persons suffering from AF.
Do higher levels of uncertainty in illness reduce the perceived health related quality of life of Multiple Sclerosis (MS) patients?
Authors: Gitto Lara , Giammanco Maria Daniela 
Published: October 2016

Background: Multiple Sclerosis (MS) represents one of the most common causes of neurological disability and the unpredictability and severity of its manifestations determine uncertainty in illness. While MS patients’ Health Related Quality of Life (HRQoL) has been frequently assessed, the impact of uncertainty on HRQoL has not been adequately considered to date. The objective of the study was to reduce this gap in the literature.Design: One hundred and twenty patients with relapsing-remittingMS were interviewed in order to gather information about their assessment of HRQoL, measured with the Visual Analogue Scale (VAS) and their perceptions of uncertainty in illness assessed through the Mishel Uncertainty in Illness Scale (MUIS). The relationship between HRQoL and two dimensions of uncertainty, namely “ambiguity” and “inconsistency”, have been tested with diverse Tobit and Probit specifications.Results: Inconsistency exhibited a negative and significant correlation in all the specifications of the model. Marginal effects suggested how a unit change in the total score of the inconsistency scale determined an increase of 6.2% in the probability to report a VAS score higher than 60 (median score in the sample). Ambiguity and inconsistency, jointly considered, had a marginal effect of 2.1%.Conclusions: This study contributes to the assessment of the patient’s general status over the standard parameters for quality of life. It may represent the starting point for further analyses on the impact of separate facets of the Uncertainty in Illness on HRQoL, experienced not only by MS patients, but also by other patients suffering from chronic conditions.
Training clinicians in whole person-centred healthcare
Authors: Broom Brian 
Published: October 2016

Since 1987 in New Zealand a form of person-centred healthcare has emerged, which was originally loosely referred to as ‘medicine and story’ and then developed into a University program titled MindBody Healthcare, but more recently has been described in clinical settings and publications as the Whole Person Approach. This paper emphasises the co-emergence of physicality and subjectivity from conception and the harm that comes from keeping mind and body apart in the treatment of physical illness of all kinds. Symbolic physical diseases provide particularly vivid and glaring examples of the need to attend to patient subjectivity as a part of treatment. Clinicians must learn to deal with whole persons and the patient’s story is a practical doorway into the complexity of this whole. Training clinicians over two decades to become whole person-focussed and competent has revealed that clinicians need sustained education to move from the typical Western healthcare dualistic view of patients with physical disease to a unitive, non-dualistic, whole person understanding. It takes time, practice, support and supervision for this to be expressed comfortably in clinical settings. The shift from expert clinician-to-disease focus to a more human-to-human dynamic, underwriting everything that is done, can be very challenging for some clinicians. Specific attitudes are required and some skills in eliciting relevant story can be learned quite easily. There are many sources of resistances to these changes in the health institutions and clinicians are more of a problem than patients. Each clinical discipline within the health sector tends to have unique problems. But the rewards for whole person practice are great for both clinicians and patients.
Notions of clinical excellence in hospital medicine: a brief reflection on specific case studies
Authors: Kotwal Susrutha , Howell Eric , Brotman Daniel , Wright Scott 
Published: October 2016

Background: The individuals who are being admitted to our hospitals are generally sicker and more medically complex than ever before. These patients rely on highly skilled healthcare providers for this acute medical care, yet clinical excellence in hospital medicine has not been well described in the literature. Objective: The intention of this manuscript is to highlight examples of clinical excellence in hospital medicine, from published literature, as they relate to the definition formulated by the Miller-Coulson Academy of Clinical Excellence. Results: Exemplary case reports and research studies in hospital medicine were identified to describe each of the domains of excellence: communication and interpersonal skills, professionalism and humanism, diagnostic acumen, skillful negotiation of the healthcare system, knowledge and having scholarly approach to clinical practice.Conclusion: Applying the definition of clinical excellence to hospital medicine can establish the standards for which physicians and trainees might aspire. Reflecting upon the efforts of commendable role models and praiseworthy teams in hospital medicine, may allow us all to improve along the continuum towards clinical mastery.
Influence of doping in InP buffer on photoluminescence behavior of InPBi
Authors: Wang Peng , Pan Wenwu , Cao Chunfang , Wu Xiaoyan , Wang Shumin , Gong Qian 
Published: October 2016

Abstract
InP1−

x
Bi
x
epilayers with 1.0% bismuth concentration were grown on InP(001) substrates by gas-source molecular beam epitaxy. Silicon and beryllium were doped into the InP buffer layer, and their influences on the photoluminescence (PL) emission of InPBi were investigated. The PL emission of InPBi was found to be intensified by beryllium doping into the InP buffer layer. However, there was no influence of silicon doping. To investigate the reason for the PL intensity enhancement of InPBi, the carrier transport behavior at the interface was also discussed.
Aboveground and belowground arthropods experience different relative influences of stochastic versus deterministic community assembly processes following disturbance
Authors: Ferrenberg Scott , Martinez Alexander S. , Faist Akasha M. 
Published: October 2016

BackgroundUnderstanding patterns of biodiversity is a longstanding challenge in ecology. Similar to other biotic groups, arthropod community structure can be shaped by deterministic and stochastic processes, with limited understanding of what moderates the relative influence of these processes. Disturbances have been noted to alter the relative influence of deterministic and stochastic processes on community assembly in various study systems, implicating ecological disturbances as a potential moderator of these forces.MethodsUsing a disturbance gradient along a 5-year chronosequence of insect-induced tree mortality in a subalpine forest of the southern Rocky Mountains, Colorado, USA, we examined changes in community structure and relative influences of deterministic and stochastic processes in the assembly of aboveground (surface and litter-active species) and belowground (species active in organic and mineral soil layers) arthropod communities. Arthropods were sampled for all years of the chronosequence via pitfall traps (aboveground community) and modified Winkler funnels (belowground community) and sorted to morphospecies. Community structure of both communities were assessed via comparisons of morphospecies abundance, diversity, and composition. Assembly processes were inferred from a mixture of linear models and matrix correlations testing for community associations with environmental properties, and from null-deviation models comparing observed vs. expected levels of species turnover (Beta diversity) among samples.ResultsTree mortality altered community structure in both aboveground and belowground arthropod communities, but null models suggested that aboveground communities experienced greater relative influences of deterministic processes, while the relative influence of stochastic processes increased for belowground communities. Additionally, Mantel tests and linear regression models revealed significant associations between the aboveground arthropod communities and vegetation and soil properties, but no significant association among belowground arthropod communities and environmental factors.DiscussionOur results suggest context-dependent influences of stochastic and deterministic community assembly processes across different fractions of a spatially co-occurring ground-dwelling arthropod community following disturbance. This variation in assembly may be linked to contrasting ecological strategies and dispersal rates within above- and below-ground communities. Our findings add to a growing body of evidence indicating concurrent influences of stochastic and deterministic processes in community assembly, and highlight the need to consider potential variation across different fractions of biotic communities when testing community ecology theory and considering conservation strategies.