bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occupational stress of hospital pharmacists in South Africa
Authors: Rothmann Sebastiaan , Malan Madelaine 
Published: August 2007

AbstractObjectiveTo investigate the construct validity and reliability of the Pharmacist Stress Inventory (PSI) and to identify occupational stressors for hospital pharmacists in South Africa.MethodA cross-sectional survey design was used. Exploratory factor analyses, descriptive statistics, and multivariate analysis were used to analyse the results. The PSI was developed as a measuring instrument and administered together with a biographical questionnaire.SettingA stratified random sample (n = 187) of pharmacists in South African hospitals was studied.Key findingsThree internally consistent factors, namely job demands, pharmacy-specific stressors and lack of resources were extracted. The level of severity of the various stressors was calculated, and it seems that unavailability of medicine is the stressor that has the highest level of severity. Other stressors that had high severity ratings include: frequent interruptions, poorly motivated coworkers, high levels of workload and insufficient salaries. The type of pharmacy influenced the levels of stress experienced.ConclusionThe levels of stress currently experienced by South African hospital pharmacists need to be identified and addressed in order to reduce the stress experienced and improve the quality of work life for these individuals.
Analgesic users' sources of medicine information
Authors: Närhi Ulla , Helakorpi Satu 
Published: August 2007

Abstract

Objective
To identify the sources of medicine information used by Finnish analgesic users. Method A questionnaire on health behaviour was sent to a random sample (n = 5000) of 15–64-year-old Finnish adults in 2005. The respondents were asked to list the sources of medicine information (both self-medication and prescription medicines) used by them. Only those respondents who had used only analgesics during the week prior to the study were included.

Key findings
The response rate was 66%, and 15% of those (n = 502) had used only analgesics during the previous week. Doctors (35%), patient information leaflets (PILs) (33%), and pharmacists (33%) were the most common sources of medicine information. Other sources were nurses (9%), relatives and friends (7%), advertisements (4%), internet (4%), radio and TV (3%), newspapers and books (3%) and health food stores (1%). Almost half of the respondents (49%) had not received medicine information from health professionals. Women reported PILs, pharmacists, newspapers and books as sources of medicine information more often than men. The differences were statistically significant.

Conclusions
Analgesic-only users seem not to receive much medicine information from health professionals, which may be a risk especially with self-medication. Women seem to have more sources of medicine information than men.
Reallocating resources: how should the National Institute for Health and Clinical Excellence guide disinvestment efforts in the National Health Service?
Authors: Pearson Steven , Littlejohns Peter 
Published: August 2007

The recent acute budgetary pressures within the English National Health Service (NHS) have accentuated calls for targeted disinvestment thereby eliminating ineffective or low-value services to provide resources that can be reallocated toward more cost-effective purposes. This challenge extends beyond allocating new resources wisely, a goal that has been, since its inception, the primary focus of the National Institute for Health and Clinical Excellence (NICE). But on 6 September 2006, the Department of Health announced a new mandate for NICE to help the NHS identify interventions that are not effective. This paper discusses current NICE efforts to support value in the NHS and then explores the policy options available to the Institute as it prepares to launch a programme to meet the NHS request for guidance on disinvestment. All of the possible options present challenges. NICE will need to collaborate in new ways with partners inside, and perhaps outside, the NHS. However, the Institute has an established reputation for rigour, transparency and political durability that makes it well qualified to sustain public support in the face of difficult decisions. Disinvestment will provide a stern test of these qualities.
Inter-rater reliability of case-note audit: a systematic review
Authors: Lilford Richard , Edwards Alex , Girling Alan , Hofer Timothy , Di Tanna Gian Luca , Petty Jane , Nicholl Jon 
Published: August 2007

Objective: The quality of clinical care is often assessed by retrospective examination of case-notes (charts, medical records). Our objective was to determine the inter-rater reliability of case-note audit. Methods: We conducted a systematic review of the inter-rater reliability of case-note audit. Analysis was restricted to 26 papers reporting comparisons of two or three raters making independent judgements about the quality of care. Results: Sixty-six separate comparisons were possible, since some papers reported more than one measurement of reliability. Mean kappa values ranged from 0.32 to 0.70. These may be inflated due to publication bias. Measured reliabilities were found to be higher for case-note reviews based on explicit, as opposed to implicit, criteria and for reviews that focused on outcome (including adverse effects) rather than process errors. We found an association between kappa and the prevalence of errors (poor quality care), suggesting alternatives such as tetrachoric and polychoric correlation coefficients be considered to assess inter-rater reliability. Conclusions: Comparative studies should take into account the relationship between kappa and the prevalence of the events being measured.
Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experiments
Authors: Turner David , Tarrant Carolyn , Windridge Kate , Bryan Stirling , Boulton Mary , Freeman George , Baker Richard 
Published: August 2007

Objectives: To estimate the relative importance to patients of continuity of care compared with other aspects of a primary care consultation. Methods: We carried out a discrete choice experiment in Leicestershire and London on a stratified random sample of 646 community dwelling adults taken from general practitioner (GP) registers, plus 20 interviews with Punjabi, Urdu and Gujarati speakers. The attributes examined were: the type of professional consulted, relational continuity, informational continuity and access. Results: Individuals' values changed according to their reason for making a primary care consultation. If consulting for minor familiar symptoms, individuals would be prepared to trade off one extra day's wait to see a GP rather than a nurse, 0.9 days for relational continuity, and 1.6 days for informational continuity. If consulting for a new condition they were uncertain about, they would be prepared to trade off an additional wait of 3.5 days to see a GP rather than a nurse, 2.4 days for relational continuity and 3.9 days for informational continuity. For a routine check-up, an individual would be prepared to trade off an additional wait of 3.5 days to see a GP rather than a nurse, 4.2 days for relational continuity and 7.8 days for informational continuity. Conclusions: Respondents stated their preference to wait longer to see a familar medical practitioner who was well informed about their case when they had a problem causing uncertainty or needed a routine check-up. They preferred quick access for likely minor 'low impact' symptoms. Appointment systems in general practice should be sufficiently flexible to meet these different preferences.
Impact of patients' socioeconomic status on the distance travelled for hospital admission in the English National Health Service
Authors: Propper Carol , Damiani Michael , Leckie George , Dixon Jennifer 
Published: August 2007

Objectives: To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status. Methods: Using Hospital Episode Statistics for 2003–04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward. Results: There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards. Conclusions: Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas.
Are the best available clinical effectiveness data used in economic evaluations of drug therapies?
Authors: Hanratty Barbara , Craig Dawn , Nixon John , Rice Stephen , Christie James , Drummond Michael 
Published: August 2007

Objectives: Use of evidence on clinical effectiveness that is of poor quality or is biased in favour of the therapy under study is a concern in economic evaluations and may contribute to a mistrust of pharmacoeconomic studies. This study aimed to determine whether the authors of economic evaluations use the best available evidence for clinical effectiveness. Methods: One hundred economic evaluations of drug therapies (published in 2001–2003) were sampled randomly from the National Health Service Economic Evaluation Database, and the source of clinical evidence was identified. For each therapy, alternative, high quality sources of clinical effectiveness data were sought by searching the Database of Abstracts of Reviews of Effects and Health Technology Assessment databases. The magnitude and direction of the effect size in the different sources of evidence were compared. Results: Relevant systematic reviews were found for only 32 of the 100 economic evaluations in the sample. In three cases these reviews had been identified by the authors of the economic evaluations and two of these cases were used in the evaluation. Comparisons were possible in 21 cases. The clinical effects reported in all 21 comparisons were similar in direction but differed in magnitude. Compared to the systematic reviews, the authors of economic evaluations used evidence that was more favourable in five cases, less favourable in four cases, and similar in 12 cases. Six of the economic evaluations and corresponding systematic reviews did not present measures of effectiveness in a manner that allowed comparison. Conclusions: Authors of economic evaluations have not made sufficient use of the evidence available from systematic reviews of clinical effectiveness. The central role of economic evaluations in health policy makes it essential that improvements in economic methods are accompanied by a structured search for the highest quality information on clinical effectiveness.
Impact of managed care on physicians' decisions to manipulate reimbursement rules: an explanatory model
Authors: VanGeest Jonathan , Weiner Saul , Johnson Timothy , Cummins Deborah 
Published: August 2007

Objective: To develop and test an explanatory model of the impact of managed care on physicians' decisions to manipulate reimbursement rules for patients. Methods: A self-administered mailed questionnaire of a national random sample of 1124 practicing physicians in the USA. Structural equation modelling was used. The main outcome measure assessed whether or not physicians had manipulated reimbursement rules (such as exaggerated the severity of patients conditions, changed billing diagnoses, or reported signs or symptoms that the patients did not have) to help patients secure coverage for needed treatment or services. Results: The response rate was 64% ( n = 720). Physicians' decisions to manipulate reimbursement rules for patients are directly driven not only by ethical beliefs about gaming the system but also by requests from patients, the perception of insufficient time to deliver care, and the proportion of Medicaid patients. Covert advocacy is also the indirect result of utilization review hassles, primary care specialty, and practice environment. Conclusions: Managed care is not just a set of rules that physicians choose to follow or disobey, but an environment of competing pressures from patients, purchasers, and high workload. Reimbursement manipulation is a response to that environment, rather than simply a reflection of individual physicians' values.
Risk Mitigation in Newsvendor Networks: Resource Diversification, Flexibility, Sharing, and Hedging
Authors: Van Mieghem Jan A. 
Published: August 2007

This paper studies how judicious resource allocation in networks mitigates risk. Theory is presented for general utility functions and mean-variance formulations and is illustrated with networks featuring resource diversification, flexibility (e.g., inventory substitution), and sharing (commonality). In contrast to single-resource settings, risk-averse newsvendors may invest more in networks than risk-neutral newsvendors: some resources and even total spending may exceed risk-neutral levels. With normally distributed demand, risk-averse newsvendors change resource levels roughly proportionally to demand variance, while risk-neutral agents adjust only proportionally to standard deviation. Two effects explain this operational hedge and suggest rules of thumb for strategic placement of safety capacity and inventory in networks: (1) Risk pooling suggests rebalancing capacity toward inexpensive resources that serve lower-profit variance markets. This highlights the role of profit variance (instead of demand variance) in risk-averse network investment. (2) Ex post revenue maximization suggests rebalancing capacity toward substitutable flexible but away from shared capacity when markets differ in profitability. Capacity imbalance and allocation flexibility thus mitigate profit risk and truly are operational hedges.
Psychosocial interventions for carers of survivors of stroke: A systematic review of interventions based on psychological principles and theoretical frameworks
Authors: Eldred Clare , Sykes Catherine 
Published: August 2007

Purpose Most stroke survivors are cared for at home by informal carers, usually their partners or children. The chronic burden of meeting these care needs can have a significant impact on the psychological well‐being of the carer. The aim of this review is to analyse interventions that target psychosocial functioning in carers of stroke survivors to understand how such interventions can reduce the burden of caring.Method Seven studies that reported on randomized controlled trials of psychosocial interventions for informal adult carers of a survivor of stroke, which reported validated measures of psychological health outcome and met a satisfactory rating of quality were included in this systematic review.Results A forest plot of two studies that used education and counselling as the intervention for patients and spouses indicate a more favourable outcome for the intervention on the global family functioning scale. The Clarke, Rubenach, and Winsor (2003) study showed that patients were more likely to benefit from an intervention consisting of counselling and education than spouses.Conclusions It is noted that there are relatively few studies investigating the impact of psychologically based interventions for carers of stroke survivors and the quality of evidence is varied. However, there is evidence of good quality to show that stroke patients benefit from a counselling combined with education intervention. The clinical implications of this review suggests, according to current available evidence, that those working with survivors of stroke and their families should consider providing counselling and education interventions to patients in the first instance. More research is needed to determine the effectiveness of interventions aimed at improving the psychosocial functioning of carers of survivors of stroke.
Bruckner and the Politics of Memory: Repentance and Resistance in Contemporary France
Authors: Bracher Nathan 
Published: August 2007

Pascal Bruckner's stinging indictment of the "the tyranny of penitence" has made a timely contribution to the debate over history and memory that has long constituted a major given of French politics. The practical ramifications of his arguments can be found in the closely watched performances of public memory marking the first day in office of newly elected President Nicolas Sarkozy, who conspicuously broke with Chirac's habit of national contrition.	Sarkozy's memorial gestures announce a new approach to the politics of commemoration in France. However, this new approach to the nation's past has also been inspired by the positions articulated in the recent books of Max Gallo and even by a rejuvenated Gaullist discourse of unity and grandeur in the Resistance. Both Gallo and Sarkozy delivered speeches at the Cascade du Bois de Boulogne, where 35 young résistants were massacred by the Germans after having been betrayed by their collaborationist compatriots. Although "classic" in their eulogy of the résistants's idealism and courage, these speeches were innovative, first in stressing the political and social diversity of these Resistance martyrs, and second, in clearly stigmatizing the historical crimes committed by certain French citizens all while portraying the young résistants as having sacrificed their lives to an ideal of civilization and freedom that was France's true heritage. As Bruckner has recently argued, the memory of World War II still concerns the entire French nation: as such, it can transcend the traumatic memories particular to such and such groups by providing a common set of historical references and even shared memories. Voiced most incisively by Pascal Bruckner, the insistence on France's need for an unblinkered approach to the past that refuses to engage in self-flagellation provides a common set of historical references, fosters support for the basic precepts of the French Republic, and creates shared memories without turning a blind eye to crimes and injustices and has unquestionably received a positive response from the sixth president of the Fifth Republic.
Increased Concentrations of Antibody-Bound Circulatory Cell-Free DNA in Rheumatoid Arthritis
Authors: Zhong Xiao-Yan , von Mühlenen Ines , Li Ying , Kang Anjeung , Gupta Anurag Kumar , Tyndall Alan , Holzgreve Wolfgang , Hahn Sinuhe , Hasler Paul 
Published: August 2007

Abstract
Background: Increased concentrations of cell-free DNA have been found in several disorders and have been interpreted as evidence of increased rates of cell death or turnover. Evidence from in vitro and animal experiments suggests that DNA may play a role in the pathogenesis of rheumatoid arthritis (RA).
Methods: We measured cell-free DNA in plasma and serum from patients with RA and healthy controls by use of quantitative PCR for glyceraldehyde-3-phosphate dehydrogenase (GAPDH) DNA. We used protein G Sepharose™ bead adsorption of plasma and elution to isolate antibody-bound DNA.
Results: In paired plasma and serum samples of 16 healthy controls the median GAPDH copies were 4500 genome equivalents (GE)/mL plasma (range 319–21 000) and in 26 RA patients 17 000 GE/mL plasma (2100–2 375 000, P = 0.0001). In the serum from normal controls the median GAPDH copies were 35 000 GE/mL (1700–239 000) and from RA patients 222 000 GE/mL (21 000–2 375 000, P = 0.004). A median of 81% of the cell-free DNA in RA was associated with antibody compared with 9% in healthy controls (P = 0.001). The concentrations of DNA did not vary with the type of therapy patients received.
Conclusions: These results provide new evidence for a role of cell-free DNA-antibody complexes in the etiology of RA, suggest new avenues for basic research, and may prove to be relevant to diagnosis and assessment of therapy.
T-Cell Regulatory Gene CTLA-4 Polymorphism/Haplotype Association with Autoimmune Pancreatitis
Authors: Chang Ming-Chu , Chang Yu-Ting , Tien Yu-Wen , Liang Po-Chin , Jan I-Shiow , Wei Shu-Chen , Wong Jau-Min 
Published: August 2007

AbstractBackground: Autoimmune pancreatitis (AIP) is a distinct disease entity of chronic pancreatitis. Cytotoxic T lymphocyte–associated antigen 4 (CTLA-4) is a key negative regulator of the T-cell immune response, and its gene is highly polymorphic. Many positive associations between cytotoxic T-lymphocyte–associated protein 4 (CTLA4) single-nucleotide polymorphisms and various autoimmune diseases have been identified. We investigated possible genetic associations of CTLA4 in a Chinese population with AIP.Methods: We performed genotyping for CTLA4 (49 A/G, −318 C/T, and CT60 A/G) and tumor necrosis factor (TNF)-α promoter (−857 C/T, −863 C/A, and −1031 C/T) by use of PCR sequence-specific primers and direct sequencing, respectively, in 46 patients with AIP, 78 patients with chronic calcifying pancreatitis (CCP), and 200 healthy individuals.Results: We found a significant increase in CTLA4 49A carriers in patients with AIP compared with healthy individuals (78.3% vs 48%; P &lt;0.0001). The frequency of CTLA4 49A was also significantly higher in patients with AIP compared with CCP (78.3% vs 37.1%; P &lt;0.0001). CTLA4 49A conferred a higher risk of AIP [with CCP, odds ratio (OR) 7.20; P &lt;0.0001]. The −318C/+49A/CT60G haplotype was associated with a higher susceptibility to AIP (OR 8.53; P = 0.001). The TNF-α promoter −863A was associated with extrapancreatic involvement in patients with AIP.Conclusion: CTLA-4 49A polymorphism and −318C/+49A/CT60G haplotype are associated with AIP in a Chinese population.
Cultural values in commercials: Reaching and representing the multicultural market?
Authors: Koeman Joyce 
Published: August 2007

Abstract
Advertisers in the Netherlands and Flanders are discovering marketing opportunities to market to specific target groups such as children and adolescents, and their growing numbers in the ethnic minority population. There have been relatively few empirical studies on the portrayal of these audience segments. In light of the first steps in ethnic marketing theory and practice in the Netherlands and Flanders, this study questions how advertising campaigns actually deal with ethnicity and the multicultural market. This issue is tackled by means of a quantitative and comparative content analysis of Dutch, Flemish, American, Turkish, and Chinese television commercials. The first section of this article sketches a theoretical framework for the measurement of cultural values and the representation of ethnic minorities in commercials. On the one hand it draws on previous cross-cultural research examining the individualism/collectivism dimension of culture (cf. Hofstede, 1991; Schwartz, 1992; Gudykunst, 1998) and on the other hand on advertising research concerned with both content-related, and style characteristics of commercials (e. g., De Pelsmacker and Geuens, 1997). In the second section, the methodology is discussed through an examination of the sample and coding instrument. The results section reveals both similarities and differences in the use of values and communication styles in commercials from individualistic as well as collectivistic cultures. Finally, the conclusions of this study are discussed and recommendations for further research are presented.