Requests For Advice Research Articles

CN74 - Providing a nurse-led telephone intervention for patients treated with oral anticancer medication: Symptom management and adherence monitoring

BackgroundMany interventions to improve a safe use of oral anti-cancer agents have been reported during the last decade. Frequently, these interventions involve nurse-led follow-up, but there is limited data to suggest the proportion of adherence and toxicity related to treatment that nurses can detect. MethodsCAPRI, a randomized phase III trial comparing: an intervention combining Nurse Navigators (NNs) and a mobile application vs. Standard of care in cancer patients treated with oral anticancer agents was initiated in 2016 at Gustave Roussy (Villejuif, France). Nurses conduct regular telephone follow-up (1/week for the 1st month, 2/month for the following 3 months, then 1/3 weeks). During follow-up, they assess adherence, symptoms and supportive care needs. PROMS (Patient Reported Outcome Measure) (e.g. pain, appetite) are also recorded by the patient via the mobile application. A coding grid was developed to extract from the nurses intervention reports the information identified during follow-up and to categorize the actions implemented by them. All regular follow-ups over a 24-month period were studied. ResultsNurses carried out 2279 regular follow-ups concerning 237 patients, of which 1880 could be carried out (patient available). They detected treatment-related symptoms/toxicities (or worsening) in 582 (31%) of the regular follow-ups involving 193 patients. Interventions performed in these situations are advice given to the patient (55%), advice or indications after the oncologist’s request (23%), referral to a primary care professional (14%) or to a health facility (8%). Twenty-six regular follow-ups concerning 18 patients identified adherence issues. Actions implemented by nurses encompassed: patient advice (n=14), request for advice from the referring oncologist (n=10), introduction of a homecare nurse (n=2). ConclusionsClose and proactive nurse-led follow-up might help not only detecting and managing toxicities, but also identifying adherence issues in cancer patients receiving oral anti-cancer agents. Clinical trial identification2016-A00254-47. Legal entity responsible for the studyGustave Roussy. FundingFondation Philanthropia - Lombard Odier, Agence Nationale de la Recherche IHU-MMO, ARS Ile de France, Novartis, AstraZeneca. DisclosureAll authors have declared no conflicts of interest.

1756PD - The ImmunoTOX multidisciplinary board: A descriptive study of collaborative management of immune-related adverse events

BackgroundThe adverse events generated by immunotherapies are characterized by their wide diversity, unpredictability and reversibility by steroid used, and requires a delicate management. A collaborative organization of immunological toxicology management called ImmunoTOX (iTox) has been set up at Gustave Roussy to support physicians in their routine practice. MethodsDescriptive study of all consecutive advice given by the ImmunoTOX committee at Gustave Roussy from Apr 6, 2016 to Jan 2, 2019. The iTox committee organizes a multidisciplinary meeting twice a month with organs specialists, oncologists, pharmacovigilants, radiologists, around prescribing physicians facing difficult to manage or unusual immune related adverse events (irAEs). ResultsThe iTox committee delivered 398 pieces of advice for 356 patients (207 men and 149 women) receiving immunotherapies. Patients received anti-PD1 (55%) or anti-PDL1 (6%) given in monotherapy, or in combination with anti-CTLA4 (11%), or in combination with targeted therapy (11%), or another immunotherapy regimen (17%). The queries patterns for advices questioned the causal link (37%), rechallenge over G≥3 (27%), or a complex clinical management (25%) or the possibility of initiating immunotherapy in a patient with comorbidities (10%). The iTox committee retained a causal link between the adverse event and immunotherapy in 273 of the 356 patients (77%). Of these 273 patients with irAEs, the grade of maximum severity was grade 1-2 in 112 (41%), grade 3-4 in 148 patients (54%), and irAE ultimately resulted in death in 13 (5%) patients. The organ categories mostly involved by requests were lung (21%), gastrointestinal (13%), liver (12%), musculoskeletal (10%) and neurological (8%). Over the study period, the 273 patients with irAEs led to 313 requests for advice that recommended systemic corticosteroids (n=193, 62%) or a second immunomodulatory agents (n=45, 14%). ConclusionsThese results should help cancer hospitals to further appreciate the current medical needs in their management of irAEs. By a specific management, patients with autoimmune comorbidities and rechallenge over G≥3 could be regarded as precautions for use and not absolute contraindications. Clinical trial identificationCommission Nationale de l’Informatique et des Libertés N°2098694v0. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureJ. Michot: Advisory / Consultancy: BMS; Advisory / Consultancy: Pfizer; Honoraria (self), Honoraria (institution), Advisory / Consultancy: Cellgene; Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Roche; Honoraria (institution): Abbvie; Honoraria (institution): Xencor. J. Soria: Full / Part-time employment: MedImmune. C. Massard: Honoraria (institution), Advisory / Consultancy: BMS; Honoraria (institution), Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca; Honoraria (institution), Advisory / Consultancy, Leadership role: Lilly. All other authors have declared no conflicts of interest.

Clinician perception of a novel cardiovascular lifestyle prescription form in the primary and secondary care setting in Wales, UK.

To establish the views of clinicians on the feasibility and effectiveness of using a novel lifestyle prescription form (LRx) which requires co-signing by clinician and patient and is uniquely based on the design of the standard drug prescription form, in the primary and secondary health care settings. Thirty-six participants were issued with a "prescription" pad, of 20 LRx scripts, for 1month and requested to issue an LRx prescription to patients they deemed suitable during their consultation, recording their reason for use of the LRx. Each clinician was then asked to complete a comprehensive feedback questionnaire. Feedback of the LRx was overwhelmingly positive. The script was viewed as a more effective way to convey and support cardiovascular lifestyle advice, than usual care. Forty per cent (196 of 480) of the LRx scripts that were provided to primary and secondary care clinicians during the study period were issued. In most consultations, the LRx script was issued to reaffirm dietary advice. Nurses and health care assistants were more likely than doctors to use the LRx in response to a request for lifestyle advice from a patient. The LRx may be a useful addition to the clinician's communication toolkit to stimulate lifestyle behaviour changes in their patients. The main barrier to use in the study was lack of consultation time. SO WHAT?: Issuing the LRx is a method of solidifying lifestyle advice that clinicians could utilise, providing them with another tool in their behaviour change arsenal, particularly with familiarity with the tool.

"What is the best method of family planning for me?": a text mining analysis of messages between users and agents of a digital health service in Kenya

Background: Text message-based interventions have been shown to have consistently positive effects on health improvement and behavior change. Some studies suggest that personalization, tailoring, and interactivity can increase efficacy. With the rise in artificial intelligence and its incorporation into interventions, there is an opportunity to rethink how these characteristics are designed for greater effect. A key step in this process is to better understand how users engage with interventions. In this paper, we apply a text mining approach to characterize the ways that Kenyan men and women communicated with the first iterations of askNivi, a free sexual and reproductive health information service. Methods: We tokenized and processed more than 179,000 anonymized messages that users exchanged with live agents, enabling us to count word frequency overall, by sex, and by age/sex cohorts. We also conducted two manual coding exercises: (1) We manually classified the intent of 3,834 user messages in a training dataset; and (2) We manually coded all conversations between a random subset of 100 users who engaged in extended chats. Results: Between September 2017 and January 2019, 28,021 users (mean age 22.5 years, 63% female) sent 87,180 messages to askNivi, and 18 agents sent 92,429 replies. Users wrote most often about family planning methods, contraception, side effects, pregnancy, menstruation, and sex, but we observed different patterns by sex and age. User intents largely reflected the marketing focus on reproductive health, but other topics emerged. Most users sought factual information, but requests for advice and symptom reports were common. Conclusions: Young people in Kenya have a great desire for accurate and reliable information on health and wellbeing, which is easy to access and trustworthy. Text mining is one way to better understand how users engage with interventions like askNivi and maximize what artificial intelligence has to offer.

"What is the best method of family planning for me?": a text mining analysis of messages between users and agents of a digital health service in Kenya.

Background: Text message-based interventions have been shown to have consistently positive effects on health improvement and behavior change. Some studies suggest that personalization, tailoring, and interactivity can increase efficacy. With the rise in artificial intelligence and its incorporation into interventions, there is an opportunity to rethink how these characteristics are designed for greater effect. A key step in this process is to better understand how users engage with interventions. In this paper, we apply a text mining approach to characterize the ways that Kenyan men and women communicated with the first iterations of askNivi, a free sexual and reproductive health information service. Methods: We tokenized and processed more than 179,000 anonymized messages that users exchanged with live agents, enabling us to count word frequency overall, by sex, and by age/sex cohorts. We also conducted two manual coding exercises: (1) We manually classified the intent of 3,834 user messages in a training dataset; and (2) We manually coded all conversations between a random subset of 100 users who engaged in extended chats. Results: Between September 2017 and January 2019, 28,021 users (mean age 22.5 years, 63% female) sent 87,180 messages to askNivi, and 18 agents sent 92,429 replies. Users wrote most often about family planning methods, contraception, side effects, pregnancy, menstruation, and sex, but we observed different patterns by sex and age. User intents largely reflected the marketing focus on reproductive health, but other topics emerged. Most users sought factual information, but requests for advice and symptom reports were common. Conclusions: Young people in Kenya have a great desire for accurate and reliable information on health and wellbeing, which is easy to access and trustworthy. Text mining is one way to better understand how users engage with interventions like askNivi and maximize what artificial intelligence has to offer.

Discharge against medical advice (DAMA) in paediatrics: An approach to promote safety and ethics.

Requests for discharge against medical advice are often challenging for clinicians to navigate, especially when the patient is a child. An informed, standardized approach to managing situations where children and their families are requesting to leave against medical advice is essential to maximizing safety and ethics for patients and staff, yet such situations are often not handled this way. Paediatric discharge against medical advice (DAMA) requests are best managed when clinicians ensure the patient's best interests are met, understand and act upon their professional obligations, and engage in guided discussion with patients and families that involves both shared and informed decision-making strategies. A process map can capture these criteria and readily provide clinicians with a bedside reference tool when managing paediatric DAMA requests.

‘Between Politics and Scholarship’: The First Decade of the Institut für Zeitgeschichte, 1949–1958

Through the consultation and examination of meeting minutes, correspondence, and memoranda, this article contends that a political-scholarly nexus characterized the formation of the Munich-based Institut für Zeitgeschichte and directly shaped its research activities within the first decade of its existence, from 1949 to 1958. As a government-funded body it was obliged to service the needs of those governments at a federal and state level, in response to bureaucratic, administrative, and judicial demands – most notably the construction of expert reports (or Gutachten) in response to government requests for advice. The research directions of the Institute were driven by the demands of West German society beginning to come to terms with its Nazi past, and expressed through its political representatives.

Electronic Advice Request System for Nephrology in Alberta: Pilot Results and Implementation.

Background:Residents of rural areas of Alberta face significant barriers regarding access to specialist care, resulting in delays in provision of optimal care. Electronic referral and consultation systems are promising tools for facilitating timely access to specialist care, especially for people living in rural locations.Objective:To report our initial experience with the launch of an electronic advice request system for ambulatory kidney care in Alberta, Canada.Methods:We analyzed electronic advice requests for nephrology services in Alberta after the system’s pilot launch, from October 2016 to December 2017. Data for province-wide advice request utility by primary care providers (PCPs) were extracted from Alberta Netcare for analysis.Results:The total number of electronic advice requests directed to nephrology was 118 (mean number of requests: 2 per week). Only 31 (26.3%) of the cases required a face-to-face clinic visit with a nephrologist. Most (87; 73.7%) cases were managed by PCPs with ongoing nephrologist support via the advice request tool. Typical nephrologist response time was 5.7 ± 0.6 (mean ± SEM) days.Conclusion:These preliminary data suggest that the electronic advice request program has potential to enhance timely access to specialist kidney care and minimize unnecessary nephrologist visits while reducing response time. Broad implementation of this system may have a substantial positive impact on health outcomes and improve cost-effectiveness for nephrology care in the long term, particularly in rural communities of Alberta.

A New Resource for Research and Risk Analysis: The Updated European Food Safety Authority Database of Xylella spp. Host Plant Species.

Following a series of requests for scientific advice from the European Commission starting in 2013, the European Food Safety Authority (EFSA) conducted a pest risk assessment and created a comprehensive Xylella fastidiosa host plant database. The last update of the database, published in September 2018, includes information on host plants of both X. fastidiosa and X. taiwanensis, together with details on botanical classification, infection conditions, geographic location, pathogen taxonomy including information on subspecies, strain and sequence type, detection techniques, and tolerant/resistant response of the plant. This updated database of host plants of Xylella spp. reported worldwide provides a key tool for risk management, risk assessment, and research on this generalist bacterial plant pathogen.

The role of telemedicine in the management of maxillofacial trauma in emergency departments – preliminary results

New technologies have over the past forty years become widespread across all domains of basic and applied research particularly in health-related fields. Telemedicine is a form of remote medical practice using information and communication technologies. It connects one or more health professionals with other health professionals or with patients. Within the framework of emergencies in maxillofacial surgery, requests received for specialist advice often pertain to procedures to be followed for facial wounds, bites, burns, maxillofacial bone trauma or facial cellulitis. These requests for specialist advice were previously made by phone between emergency physicians and maxillofacial specialists, with exchange of patient photos by text messaging, which raised security issues. We collaborated with the Telehealth Normandy Health Cooperation Group (GCS TSBN) for the implementation of a mobile application using the “Therap-e” telemedicine platform. This platform links together websites and remote health professionals via the Internet. Physicians communicate over a mobile network or from a health institution, in online or offline mode, synchronously or asynchronously, using any medium (tablet, PC, Mac, smartphone). This scheme both ensures secure transmission of personal and clinical data (especially facial photographs) and records specialist advice in patient medical records. The purpose of tele-expertise applications in an emergency context is to provide a solution to the demographic problems facing healthcare professionals and to rise to the growing challenges surrounding quality and security issues.

Arthritis-Related Support in a Social Media Group for Quilting Hobbyists: Qualitative Study.

BackgroundPeople with arthritis are increasingly seeking support online, particularly for information about social role participation while experiencing symptoms of chronic arthritis. Social media enables peer-to-peer support on how serious leisure (eg, hobbies such as quilting) can be adapted to allow participation. Research is needed to understand what type of peer support is provided online and how this support occurs.ObjectiveThe aim of our study was to explore what kind of support is offered by fellow hobbyists (with or without arthritis) in response to requests for advice in a social media group.MethodsThree vignettes were posted on a Facebook quilting group regarding arthritis-related symptoms or impairments that affect how people quilt. A Facebook Insights report was used to examine the groups’ demographics. Responses to the vignettes were thematically analyzed.ResultsThe members of the quilting Facebook group were mostly women (18,376/18,478, 99.45%), aged 55 to 64 years, and most were located in the United States. In response to the vignettes, the 22 participants predominantly offered emotional support and shared information. Participants shared their real-life experiences and creative means in adapting medical advice to their crafting. More than half (30/54, 56%) of the advice that was offered aligned with the OrthoInfo medical best practice guidelines relevant to the vignettes.ConclusionsSerious leisure social media groups can be useful forums for sharing information about arthritis-related issues. People do respond to requests for support and information, although there is a difference between quilting support (eg, “I need a new iron, what should I buy?”) and health support (eg, “I have arthritis, what scissors should I buy?”). People provide emotional support for life events on serious leisure social media platforms (eg, offering condolences when a person states that she is making a memory quilt), and this extends to health issues when group members reveal them.

Legal Consensus as to Embargo Claims; an Investigative Study

Certain political sanctions have been recently imposed against Qatar by Bahrain, Egypt, Saudi Arabia and the United Arab Emirates. Given the fact that Qatar is very busy constructing a number of projects in preparation for the FIFA World Cup in 2022, it’s unsurprising that the Quantity Surveyors have had some requests for advice from contractors whose operations in Qatar have been affected by the sanctions and who are looking for a means of claiming extension of time and/or damages. Equitable principles codified in the Qatar Civil Law include the requirement for parties to a contract to conduct themselves "consistent with the dictates of good faith" and an implied duty of the employer to cooperate with its contractors and not to delay or prevent their contract performance. Furthermore, where a contractor has suffered excessive losses arising from exceptional events the contractor may be able to raise an exceptional event's argument pursuant to Article 171 of the Qatar Civil Law, and if successful, the approach is to reduce the contractor's burdensome obligation to a reasonable limit after balancing the interests of the parties. This paper is to explore the legal consensus pertaining the embargo in Qatar using civil codified law provisions, standard forms of contracts for public works and the author’s firsthand experience in drafting and review of claims on embargo.

Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test.

BackgroundSuicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach.ObjectiveWe field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention.MethodsWe field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program.ResultsOf the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated.ConclusionsText4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy.

The value of WhatsApp communication in paediatric burn care

BackgroundTelemedicine is increasingly applied in developed settings to facilitate transfer of information to and from burn surgeons across vast geographic areas. WhatsApp is a widely available and extremely user-friendly encrypted smartphone application that does not require the expensive physical and personnel infrastructure that characterizes many of these telemedicine systems. The aim of this study was to review the use of WhatsApp to facilitate paediatric burn injury consultations to a regional burn centre in a developing country, where burn care continues to be thwarted by administrative apathy, poor resource allocation and lack of attention to medical and nursing education at all levels. MethodsA retrospective review was undertaken of all consultations using WhatsApp over an 18-month period, received by the burn centre’s two senior medical practitioners. The specific origin and nature of the telemedicine requests for advice, transfer or follow-up were collected, as were data relating to the demographics of the patients, the aetiology, mechanism and extent of the burn injury. The impact of the system of communication in terms of reductions in admissions and clinic visits was assessed, and a cost analysis was undertaken. Feedback was also obtained from those health practitioners regularly using the service. Results838 communications occurred during the study period, which included 1562 distinct clinical queries. 486 interactions (58%) originated from within the hospital, the majority of which were initiated by surgeons in training or burn nurse practitioners. 352 (42%) consultations were from outside the hospital. Queries related to the full spectrum of burn care, including emergency management and stabilization, triage and transfer, the need for escharotomy, fluid resuscitation, wound care, the timing and nature of surgical intervention, as well as follow-up and rehabilitation.While no significant changes in the number of surgical interventions or admissions were observed when compared to the five years prior to the intervention, outpatient visits reduced significantly during the study period. It was estimated that over 150 unnecessary admissions were also avoided as a result of the triage made possible by WhatsApp, which translated into considerable cost saving for the institution. DiscussionIncorporating WhatsApp technology into the daily processes of burn care has significantly improved the quality of paediatric burn care referrals to specialist burn services. Specifically, WhatsApp has contributed to reductions in unnecessary referrals and outpatient visits, facilitated opportunities for continuing medical education, improved the care of major burn injuries through more effective prehospital communication, and enabled greater allocation of scarce specialist resources at the burn centre. This study motivates for the wider application of WhatsApp for burn care referrals, especially in developing countries.

The burden of inbox-messaging systems and its effect on work-life balance in dermatology

The burden of inbox-messaging systems and its effect on work-life balance in dermatology

Delivery of the antimalaria on advice in pharmacies deprived of the district of Bamako, Mali

Context and Objective: Malaria is a well-known disease of the Malian population; as a result pharmacists are giving more and more advices regarding this disease to the population. In order to better understand the problem of the delivery of antimalarials without prescription, we initiated this study with the objective of studying the practice of dispensing antimalarials without prescription in accordance with the guidelines of Mali's national malaria program.Patient and Methods: This was a cross-sectional descriptive study on the delivery of antimalarials based on counseling. We included in the study all clients aged 15 years and over who were received in Bamako pharmacies for a non-prescription antimalarial medication for themselves or for another person based on mutual consentment.Results: The study was carried out in 199 of the 230 pharmacies in the district of Bamako; we recorded 466 requests for advice. The sex ratio M / F was 1.7 and 28.9% of clients for whom the drug was intended were under 20 years of age, in which case 52.4% of the costumers were not the actual patients. Artemisinin-based combination therapy was the most recommended (52%). Sulfadoxine Pyrimethamine was the most widely purchased antimalarial among non-CTA antimalarials. In 34.5% of cases, antimalarials are associated with other therapeutic classes where analgesics / antipyretics constitute 77.6% of these classes followed by antibiotics (21%).Conclusion: The pharmacy is the first resort in the healthcare system for the majority of clients with clinical suspicion of malaria.Keywords: Advice, malaria, pharmacy, Bamako

Sharing “Sex Secrets” on Facebook: A Content Analysis of Youth Peer Communication and Advice Exchange on Social Media about Sexual Health and Intimate Relations

Social media present opportunities and challenges for sexual health communication among young people. This study is one of the first to examine the actual use of Facebook for peer communication of sexual health and intimate relations. Content analysis of 2186 anonymous posts in a “sex secrets” Facebook page unofficially affiliated with a Hong Kong University shows gender balance among posters, inclusiveness of sexual minorities, and frequent sharing of personal experiences in storytelling or advice seeking. The findings illuminate young people’s health concerns regarding condom use, avoiding pain, birth control, sexually transmitted infections, and body appearance. Relational concerns found entailed sexual practices, expectations, and needs—predominantly within dating relationships and include not wanting to have sex. Supportive communication among users was prevalent. A majority of posts involved advice solicitation in the form of request for opinion or information (30.38%), request for advice (13.68%), situation comparison (5.40%), or problem disclosure (9.97%). Comments to the advice-seeking posts were mostly supportive (69.49%); nonsupportive responses (unsolicited messages and gratuitous humor) were concentrated with ambiguous advice solicitations. These findings hold implications for understanding self-disclosure of intimate concerns within social networks, and attuning sexual health intervention on social media to young people’s actual needs and advice preferences.

Is there a need for a new governance model for regionalised Fisheries Management? Implications for science and advice

Over the years, the breadth and depth of EU marine policy has increased with revisions of the Common Fisheries Policy (CFP) and new legislation like the Marine Strategy Framework Directive (MSFD), Integrated Maritime Policy (IMP) and the Framework for Marine Spatial Planning Directive in Europe (FMSP). Not only do these different policies have different remits and hence scope, they also present a multitude of modes of implementation. Although the CFP and MSFD have many common goals when it comes to conservation and sustainable use of living marine resources, they differ substantially in governance set up and implementation modalities, including the underlying scientific advisory processes and structures. Regional cooperation and coordination is foreseen, but there is no governance model in place to coordinate requests for scientific advice, nor institutions coordinating the activities of advice providers, either across policies or across regions. This results in an increase in uncoordinated requests for scientific advice yet the pool of experts fuelling the advisory system is limited. As a result the European marine scientific advisory system is increasingly under pressure. In this paper the consequences of this problem are analysed and a redesign of the institutional governance setting to accommodate these challenges and make the science and advice system ready for the future is explored.

Family business succession and external advisors: the relevance of ‘soft’ issues

ABSTRACTThis paper focuses on family businesses’ opinions and perspectives concerning soft issues raised by the succession process and their willingness to involve an external advisor. An empirical research study based on multiple case studies was carried out. Through 25 direct interviews with the incumbent and/or successor, 15 Italian family businesses were analysed that have experienced or are going through a succession process and have involved, or have chosen not to involve, external advisors. Results underline that many family businesses are aware of the relevance of soft issues for a successful outcome of succession. However, this awareness does not always turn into a real request for advice. Family businesses often consider succession planning a private affair and prefer not to share it with external subjects. Instead, family businesses that have asked for external advisors have often complained, saying that they are mainly focused on hard issues and forget that managing soft issues is often the real key to effective succession.

Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners

BackgroundIn Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control.MethodTrial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period.ResultsEleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued.ConclusionThere is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented.Trial registrationAustralian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.