High Degree Of Acceptance Research Articles

Family Physicians’ Perceptions and Use of Electronic Clinical Decision Support During the First Year of Implementation

An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users' perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 ± 1,33). Their perception of the ease of use of the system (mean 5,04 ± 1,41), usefulness (mean 4,69 ± 1,35) and facilitating conditions (4,43 ± 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.

P2-63 How socio-cultural and religious beliefs influence attitudes of Iranian recipient couples towards assisted reproductive donation procedures

IntroductionThe revolutionary advance in the field of reproductive technologies has created controversial sociological, cultural, religious, moral and legal issues. Considering the potential impact of these complex issues on the practice...

ST‐IM model: a whole brain approach to implementation

PurposeThe purpose of the paper is to present a practical case study of a mid‐size Indian organisation, where the whole brain thinking (WBT) approach has been successfully used to align strategy to development needs, based on a simple but powerful model, the ST‐IM™; the authors also share how WBT has been useful in increasing the effectiveness of the implementation of key strategic projects.Design/methodology/approachThe approach was to engage the wider team (leadership and managers) in the formulation and implementation of strategic goals by making them aware of their thinking preferences/mindsets through a collaborative approach to working. Project teams were then formed and the project plan – right from the project definition to the milestones – was created, using the whole brain walk around. This approach helped managers to identify “gaps” and bridge these gaps. The Herrmann Brain Dominance Instrument (HBDI®) was used as a tool to “colour” the organisation (the leadership team and all managers).FindingsThere was a high degree of acceptance of the WBT concept and the HBDI profiles generated among managers at all levels. This acceptance of their own thinking preferences as well as avoidances has led to managers being willing to become more flexible in their thinking – to become more “situationally whole brained” when required, leading to a visibly higher degree of success of implementation of projects.Originality/valueThe ST‐IM model demonstrates a practical way for organisations to engage the potential of a much wider team in the implementation of strategies.

The application of therapeutic music (TM) during the radiotherapy in order to improve the patient compliance and minimize incorrect positioning during the treatment.

e19585 Background: The modern radiotherapy demands a high degree of acceptance and compliance from the patient. It was examined, whether calming and relaxation of the patient with TM during the rad...

A Comparison of Conventional and New Rubber Dam Systems in Dental Practice

Rubber dam is an important tool in dentistry-in the past as well as today. As a result of a lack of acceptance of the conventional system, introduced by Barnum in 1869, new systems were developed (eg, OptraDam® by Ivoclar Vivadent AG, Schaan, Liechtenstein). This system was advertised as being very comfortable and easy to use, without distracting clamps. The aim of this study was to investigate if a new rubber dam system would be better accepted by patients and dentists than the conventional one. Two hundred patients from the Department of Conservative Dentistry and Periodontology received at least one treatment with the conventional rubber dam (Dental Dam, Coltène Whaledent, Langenau, Germany) and one with the new rubber dam (OptraDam®, Ivoclar Vivadent). Staff/students and patients were asked to complete questionnaires with regard to the advantages and disadvantages of the particular system after every treatment. Among patients, students, and dentists in the dental school environment there is a high degree of acceptance of rubber dam in general. During the study there were only very few situations in which neither of the systems could be used. The conventional rubber dam was preferred by all patients, students, and dentists (p<0.0001). Our study confirms that there is a high degree of acceptance of the rubber dam when it is compulsory to use. The reasons for the refusal during the daily workload of a practice remain unclear, but appear to be independent of the material or design available. A new design does not necessarily imply better acceptance.

Developing a web-based system to create, deliver and assess language proficiency within the PAULEX Universitas Project

This study aims to examine the feasibility of a number of technical solutions implemented in a web-based system designed for the creation and management of online language exams within PAULEX Universitas, a project for the development of an online platform to design, deliver and assess the foreign language exam within the Spanish national University Entrance Examination. The paper provides an overview of the context and a discussion of current changes in Spanish ministerial policies, followed by a description of the PAULEX testing platform and a discussion on the technological solutions adopted. Lastly, the paper reflects upon a quantitative analysis derived from a pilot experience conducted in Valencia with over 200 students and their respective teachers, the results of which indicate that in spite of the difficulties, the implemented solutions have a high degree of acceptance

Comparison of student examiner to faculty examiner scoring and feedback in an OSCE

to help reduce pressure on faculty staff, medical students have been used as raters in objective structured clinical examinations (OSCEs). There are few studies regarding their ability to complete checklists and global rating scales, and a paucity of data on their ability to provide feedback to junior colleagues. The objectives of this study were: (i) to compare expert faculty examiner (FE) and student-examiner (SE) assessment of students' (candidates') performances on a formative OSCE; (ii) to assess SE feedback provided to candidates, and (iii) to seek opinion regarding acceptability from all participants. year 2 medical students (candidates, n = 66) participated in a nine-station formative OSCE. Year 4 students (n = 27) acted as SEs and teaching doctors (n = 27) served as FEs. In each station, SEs and FEs independently scored the candidates using checklists and global rating scales. The SEs provided feedback to candidates after each encounter. The FEs evaluated SEs on the feedback provided using a standardised rating scale (1 = strongly disagree, 5 = strongly agree) for several categories, according to whether the feedback was: balanced; specific; accurate; appropriate; professional, and similar to feedback the FE would have provided. All participants completed questionnaires exploring perceptions and acceptability. there was a high correlation on the checklist items between raters on each station, ranging from 0.56 to 0.86. Correlations on the global rating for each station ranged from 0.23 to 0.78. Faculty examiners rated SE feedback highly, with mean scores ranging from 4.02 to 4.44 for all categories. There was a high degree of acceptability on the part of candidates and examiners. student-examiners appear to be a viable alternative to FEs in a formative OSCE in terms of their ability to both complete checklists and provide feedback.

Komplettresektion benigner Mammabefunde mittels ultraschallgeführter großlumiger Vakuumbiopsie: medianes Follow-up von 13 Monaten

PURPOSE:This study investigated whether ultrasound-guided vacuum biopsy (VB) with curative intent is suitable for the complete extirpation of selected, sonographically detectable, benign breast lesions, and evaluated the limitations of the method. Our study is based on a long-term median follow-up of 13 months (minimum follow-up 6 months). PATIENTS AND METHODS:Between February 2001 and December 2006 299 patients underwent hand-held, ultrasound-guided VB at the Tuebingen University Breast Center. Inclusion criteria: biopsy was performed with the intention of complete resection and the lesion showed a benign histology, and clinical and sonographical follow-up was carried out for at least 6 months after the biopsy, meaning that the patient did not undergo surgery of the biopsied area during that period. A total of 92 patients with 100 lesions were followed up clinically and sonographically for an average of 13.2 months. RESULTS:A complete removal of sonographically visible lesions (median diameter 13.0 mm) was achieved in 83.5 % of all cases if leasions measured 18 mm or less. Palpable lesions could be reduced by VB in 75.2 % of cases. Complications such as infections or minor bleeding were rare and well treatable. 9.8 % of patients had suspected scar formation at the biopsy site. CONCLUSION: VB is an ambulatory procedure associated with little pain. It is a minimally invasive biopsy technique for benign lesions and a good alternative to open excision with a high degree of acceptance by patients. Complications are rare and similar to that observed with conventional microbiopsy. Results were confirmed by a long-term median follow-up of 13 months (minimum 6 months).

Komplettresektion benigner Mammabefunde mittels ultraschallgeführter großlumiger Vakuumbiopsie: medianes Follow-up von 13 Monaten

PURPOSE:This study investigated whether ultrasound-guided vacuum biopsy (VB) with curative intent is suitable for the complete extirpation of selected, sonographically detectable, benign breast lesions, and evaluated the limitations of the method. Our study is based on a long-term median follow-up of 13 months (minimum follow-up 6 months). PATIENTS AND METHODS:Between February 2001 and December 2006 299 patients underwent hand-held, ultrasound-guided VB at the Tuebingen University Breast Center. Inclusion criteria: biopsy was performed with the intention of complete resection and the lesion showed a benign histology, and clinical and sonographical follow-up was carried out for at least 6 months after the biopsy, meaning that the patient did not undergo surgery of the biopsied area during that period. A total of 92 patients with 100 lesions were followed up clinically and sonographically for an average of 13.2 months. RESULTS:A complete removal of sonographically visible lesions (median diameter 13.0 mm) was achieved in 83.5 % of all cases if leasions measured 18 mm or less. Palpable lesions could be reduced by VB in 75.2 % of cases. Complications such as infections or minor bleeding were rare and well treatable. 9.8 % of patients had suspected scar formation at the biopsy site. CONCLUSION: VB is an ambulatory procedure associated with little pain. It is a minimally invasive biopsy technique for benign lesions and a good alternative to open excision with a high degree of acceptance by patients. Complications are rare and similar to that observed with conventional microbiopsy. Results were confirmed by a long-term median follow-up of 13 months (minimum 6 months).

Internet Accessible Remote Experimentation: Setting the Right Course of Action

This paper will have two parts. In the first part the author will focus on the current status of remote experimentation designs and how this has impacted our education and research activities with a notion that whether we are moving too fast while its acceptance has not yet realized. While for the second part, the author will describe some of the developments of remote experiment designs through his own work.&#x0D; Researchers have been working on remote experimentations for a considerable period of time and are making remarkable breakthroughs utilizing cutting edge technologies and current understanding of educational and learning strategies. After all of these developments, the popularity of remote experimentations is still very limited and does not have the attention of the academic community to incorporate them as a part of their regular curriculum. There are a number of factors that hinder acceptance of remote laboratories as a part of a curriculum. These are integration of a number of areas, modular designs, commercial products, maintenance, and administrative support. The paper will address these issues and will highlight how we can move forward in a coordinated manner so there will be a viable remote experimentation infrastructure with a high degree of acceptance.&#x0D; The author has a number of federal research grants (USA) where he has developed Internet accessible remote experimentation facilities. These facilities have features like use of single computer for accessing multiple experiments, manipulating experimental setup from remote locations, integrated assessment, and real-time learning management features. The developed facilities have used for delivering a number of experiment courses, while gathering data in terms of achieving learning outcomes and assessing the effectiveness of the system in terms of system designs.

The Development and Validation of a Brief Performance-Based Fall Risk Assessment Tool for Use in Primary Care

To report the development, external validity, reliability, and feasibility of a falls risk assessment tool for use in primary care. Two prospective cohort studies, a test-retest reliability study, and a feasibility study were included. Seven hundred and sixty four older community-living people (mean age = 75.3 years, SD = 5.8) participated in the tool development study, 362 people (mean age = 80.25 years, SD = 4.5) participated in the external validation study, 30 older people took part in the test-retest reliability study, and 32 clinicians participated in the feasibility study. The fall risk assessment score (number of risk factors) displayed a good ability to discriminate between multiple fallers (those who experienced two or more falls) and non-multiple fallers in the external validation study (area under the receiver operating characteristic curve = 0.72, 95% confidence interval = 0.66-0.79). Each of the performance items; low contrast visual acuity, tactile sensitivity, sit to stand, alternate step, and near tandem stand ability; and measures of previous falls and medications could discriminate between prospectively categorized multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.4 in the development study. The probability of future multiple falls increased from 7% with the identification of zero or one risk factor up to a probability of 49% with the identification of six or more risk factors. The assessment items exhibited moderate to excellent test-retest reliability and a high degree of acceptance by health professionals. The assessment tool is an externally validated, reliable, and feasible falls risk assessment that can accurately predict multiple falls and assist with guiding interventions in community living older people.

Fourier transform infrared spectroscopic determination of ammonium at sub-microgram level in waters and biological fluids following removal of nitrate from sample matrix by zerovalent iron nanoparticles

Experimental parameters were optimized for rapid and precise determination of ammonium ion by FTIR spectroscopy in presence of nitrate ion in water and in samples collected from humans. Nitrates, whose FTIR spectra strongly overlap with those of ammonium ion, were removed from the sample matrix by treating it with zero-valent iron nanoparticles in acidic medium. The infrared peak at 1,400 cm−1 was selected for determination of ammonium ion. Diffuse reflectance FTIR gives both qualitative and quantitative information on ammonium in a KBr matrix. The limit of detection and the limit of quantification of the method are 0.15 ng per 20 µL−1, and 0.5 ng per 20 µL−1, respectively. The relative standard deviation is 6% (n = 8). The results were compared to those of ion chromatography and show a high degree of acceptability. The method can be applied over a wide concentration range using small sample volumes.

Vienna International Summer School on Experimental and Clinical Oncology for Medical Students: An Austrian Cancer Education Project

The "International Summer School on Experimental and Clinical Oncology for Medical Students" is organised at the Medical University of Vienna to teach a multidisciplinary approach to oncology to medical students in the final phase of their studies. The program includes biology, diagnosis, clinical and psycho-oncology. Lectures are given by medical, radiation and surgical oncologists. Teaching includes case reports, poster presentations and role-play. As part of the organising committee, Austrian students organise a social program. Since 1999, six courses have been held (147 students from 19 countries). Students recorded high satisfaction with organisation, scientific content and topic range. Case presentations, poster presentations and role-play were very useful. Early criticism that the program was too intense (long lectures and little interaction) has been answered. The summer school has a high degree of acceptance and is a very useful tool to teach medical students about oncology and approaching a cancer patient.

35M MAX: the first bus rapid transit system in Salt Lake County

Bus rapid transit (BRT) is becoming one of the most popular transit services in the USA. A total of 106 miles of BRT service is scheduled for deployment in the State of Utah in future years. This research looked at the first BRT deployment in West Valley City, Salt Lake County, Utah. The 10.8 miles long BRT line was launched on July 14, 2008, and shortly after the launching the first operational data became available. In addition, a series of surveys were conducted to gain feedback from the users of the BRT system. Preliminary results show significant improvements in transit operations, with a 33% increase in ridership, reductions of close to 15% in travel times and improved reliability. Survey results show a high degree of acceptance among the system users. In general, the BRT system has proven itself to be very successful, bringing significant improvements to transit riders.

Die Zukunft der gewerblichen Genossenschaften und der genossenschaftlichen Verbände

Zusammenfassung Internationalisierung, Konzentration, permanente Leistungsverbesserung und hohe Akzeptanz seitens der mittelständischen Anschlusshäuser sichern eine positive Entwicklung der gewerblichen Genossenschaften. Die genossenschaftlichen Verbände müssen sich auf höhere Anforderungen in Prüfung und Beratung einstellen und ihr Angebot strukturell zukunftsorientiert und wettbewerbskonform ausrichten.

Not seeing the forest for the trees? The environmental effectiveness of forest certification in Sweden

Forest certification can be conceived as one of many rapidly growing non-state market driven (NSMD) modes of governance. The environmental effectiveness of forest certification is oftentimes evaluated by indicators such as stringency of standards, degree of participation by key stakeholders, certified area, etc. In political science, forest certification as an NSMD governance arrangement is usually evaluated in terms of the quality of the decision-making procedures (input legitimacy) rather than for its problem solving capacity, i.e. its environmental performance or effectiveness. We conceptualize environmental effectiveness as a function of a standard's environmental stringency and the area covered by the standard, the latter dependent on the degree of social acceptance. Accordingly, the environmental effectiveness of different certification schemes ought to be evaluated taking both the standard stringency and the area certified into account. The forest certification process in Sweden illustrates how forestry history and regional differences affect the development, acceptance and adoption of different certification schemes. Industrial and Northern forestry owners favour the NGO led Forest Stewardship Council (FSC) standards whereas Southern small-scale private forest owners preferred to develop an alternative scheme the Programme for Endorsement of Forest Certification (PEFC). We demonstrate that there is a bifurcated geographical coverage of the two certification schemes along a north–south divide coupled with a similarity in standard stringency and a high degree of acceptance in their different areas of dominance. Both forest certification schemes display a similar degree of environmental effectiveness — but in different parts of the country and for different types of ownership.

Gay Language: Defying the Structural Limits of English Language in the Philippines

Gay language has achieved a higher degree of acceptance in recent years in the Philippines. Both gays and non-gays can be heard uttering gay expressions. But the main role of gayspeak for gay people in the Philippines is to function as an “armor” to shield themselves from the chasm and the social stigma caused by gender differences. From a linguistic point of view, this paper not only describes the nature of this gay language and how expressions are coined; it also looks at how code mixing (gayspeak + English language) is made possible. This paper also examines how this code-mixing creatively violates the grammatical structure of the use of the English language in the Philippines.

Randomized clinical trial of stapled haemorrhoidopexy performed under local perianal block versus general anaesthesia

The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia. Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3-6 months after surgery. The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23.1 in the general anaesthesia group and 29.4 in the local anaesthesia group (P = 0.376); mean peak pain scores were 42.1 and 47.9 respectively (P = 0.537). Mean change in symptom load was also similar between the groups, with score differences of 7.0 in the general anaesthesia group and 6.1 in the local anaesthesia group. No patient had a recurrence of prolapse. Perianal local block is easy to apply with a high degree of acceptability among patients. Postoperative pain, restoration of anatomy and symptom resolution were similar to that of stapled haemorrhoidopexy performed under general anaesthesia. ISRCTN19930199 (http://www.controlled-trials.com).

Patients’ coping profiles and partners’ support provision

This study explored whether 13 coping strategies exhibited in the week after cancer surgery could be aggregated into a smaller number of meaningful coping profiles. Moreover, patients’ coping profiles and genders were examined as predictors of partners’ support provision in the month after surgery. Coping strategies were measured with Brief COPE questionnaire, and provided partner support was assessed with Berlin Social Support Scales. Cluster analysis based on 321 patients yielded three distinct coping patterns: Accommodative Coping, Disengaging Coping, and Assimilative Coping. These encapsulate ways and extent of coping during the week after cancer surgery. Accommodative Coping was characterized by low levels of active problem-directed strategies but a high degree of acceptance and humour, whereas Assimilative Coping represented positive reframing and active strategies. Based on 122 couples, associations between patients’ coping profiles and subsequent spousal support provision were examined. Partners provided least support to patients in the Accommodative Coping category and most support to patients in the Assimilative Coping category. Female partners provided more support than did male partners. Patients’ coping behaviours in the week after cancer surgery affected subsequent provision of support by their partners.

Oral Vinorelbine

The treatment of advanced breast cancer is continually evolving, with the aim of improving the quality and duration of remission and, in some instances, survival. In this setting, the importance of quality of life cannot be underestimated, and growing attention is being paid to treatment convenience and compliance. New anticancer agents have improved efficacy, but for many of them, toxicity often remains a problem. Vinorelbine seems to represent both an active and a well tolerated treatment for metastatic breast cancer. In particular, the oral formulation has similar efficacy to that of the injectable formulation and has demonstrated generally favourable tolerability, with a high degree of acceptance by both patients and physicians. The availability of this and other novel, well tolerated and effective treatments provides greater potential to tailor treatment to meet individual patient needs and, therefore, also provide the potential to improve patient outcomes. Preliminary data suggest that oral vinorelbine may permit continued, effective chemotherapy when further parenteral therapy with more intensive and more toxic agents is considered inappropriate. Early findings also suggest that oral vinorelbine, when administered together with another new oral agent, capecitabine, may be a valid choice in metastatic breast cancer treatment. Furthermore, vinorelbine plus the monoclonal antibody trastuzumab, with or without oral capecitabine, appears to be another regimen that may be worthy of additional study in patients with human epidermal growth factor-2 positive advanced breast cancer.