The dimensions of self-service technologies and the relation to 'self'

This paper assesses the “behavioural” notion of “self” across the various dimensions of self-service technologies (SSTs). In the context of SSTs, it is acknowledged that the customer role is extended to include that of “service employee”. Therefore, the authors propose the need to explore this new role, from the customer’s perspective, across a diverse range of SSTs. This proposition is supported in that prior research has looked generally across a broad range of SSTs, as opposed to drawing comparisons across the different types of SSTs. In bringing together two classification schemes of SSTs, which does not appear to have been done previously, the authors draw on past research and industry examples to explore the customer experience across different categories of SSTs. It is proposed that the dimensions of SSTs, including level of customer participation as influenced by the purpose of the SST, location of the SST, and type of technology employed, will uniquely influence the notion of “self”, and thus the customer’s SST experience. These propositions have implications for both future research and practice. Future research is needed to study empirically the characteristics of specific SSTs, and compare the many different types of SSTs, and how their unique characteristics influence the customer’s production/consumption experience. When marketers gain a better understanding of the dimensions of individual SSTs, and their influence on the customer, more effective management and use of SSTs will result.

The Australian advertising self-regulatory framework - Who`s complaining?

Complaints about advertising in Australia have been on the increase in recent years under the stewardship of the new industry self-regulatory body, the Advertising Standards Board. This study utilises clustering analyses based on geodemographic and psychographic data to present a concrete profile of complainants about advertising in Australia. The findings indicate that the advertising publics must shoulder responsibility and ensure that greater care is taken to include all members of Australian society in the current complaints
process and that this inclusivity will ensure that the highest possible standards are the norms of the industry.

A creative twist: management theory, creativity and the arts

For many theorists and practitioners in the area of organizational theory, HRM, marketing and other domains of organization studies, organizational creativity is something to be distilled and managed as an element of organizational performance. The article argues, however, that this process of appropriation from the creative arts is subject to a number of problematic transitions. The article's starting point is the notion of creativity itself. Within the creative arts, the question of what constitutes creativity and its relationship to artistic practice is subject to considerable debate. This debate centers on the question of whether creativity represents an essentialist and inexplicable (even spiritual) component of artistic practice or whether creativity is a trait of work and cannot be attributed as a unique aspect of art. The mantra of creativity provides nothing more than a means to control individuals and provide them with a false hope that contributing to the success of business will provide a means to self fulfillment.

Evaluation of a stress management course in adult education centres in rural Australia

Objective: To investigate whether attending a six-week stress management course in a rural adult education centre is effective in reducing participants' levels of stress, anxiety and depression.

Design: Repeated measures design using self-report measures of stress, anxiety and depression at commencement and completion of a six-week stress management course, and six months post-completion follow up.

Setting and participants: One hundred and thirty-two adults (age range 18–73 years) living in a rural community who self-enrolled in the stress management course at adult education centres.

Intervention: The course consisted of six weekly group sessions. Each two-hour session conducted by mental health professionals, included teaching cognitive behavioural strategies targeted at reducing individual symptoms of stress.

Main outcome measures: Comparative analysis of pre- and post-test and six-month follow up on measures of stress (Stress Symptom Checklist), anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Results indicated a significant reduction in stress symptoms (F(7,90) = 34.92, P < 0.001), anxiety and depression (F(3,95) = 87.92, P < 0.001) from course commencement to course completion. These improvements were sustained six months after course completion for stress symptoms (F(11,65) = 22.40, P < 0.001), anxiety and depression (F(5,73) = 41.78, P < 0.001).

Conclusion: Findings demonstrate the stress management course is an effective community intervention in a rural community. Challenges for future implementation of the program are discussed.

Responding to self-harm in borderline personality disorder : from clinician frustration to therapeutic enquiry

Pessimistic attitudes and reactive behavioural management strategies act as a major barrier to effective service provision for patients with borderline personality disorder. This paper reviews research on countertransference reactions (negative professional attitudes) towards these patients and the professional response to the common presentation of self harm in this particular client group. The psychotherapeutic treatment of patients with borderline personality disorder is complex and both professionally and personally demanding. A clinical framework is proposed that enables clinicians to develop a more nuanced and empathic understanding of self harm within the context of personality disorder in order to facilitate enhanced therapeutic engagement with these challenging patients. A clinical case study illustrates the use of this framework and the potential for enhanced therapeutic management in conjunction with the recognition and reduction of clinician indifference and rejection, thus improving patient outcomes. (editor abstract)Pessimistic attitudes and reactive behavioural management strategies act as a major barrier to effective service provision for patients with borderline personality disorder. This paper reviews research on countertransference reactions (negative professional attitudes) towards these patients and the professional response to the common presentation of self harm in this particular client group. The psychotherapeutic treatment of patients with borderline personality disorder is complex and both professionally and personally demanding. A clinical framework is proposed that enables clinicians to develop a more nuanced and empathic understanding of self harm within the context of personality disorder in order to facilitate enhanced therapeutic engagement with these challenging patients. A clinical case study illustrates the use of this framework and the potential for enhanced therapeutic management in conjunction with the recognition and reduction of clinician indifference and rejection, thus improving patient outcomes.

Extent of heart failure self-care as an endpoint to patient education: a literature review

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status.
Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours.
Design/method: bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected.
Results: Ten randomized controlled trials were selected that used education as an intervention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported signifi cant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care.
Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.

Self-service technologies and voice intentions : an empirical investigation

Consumer dissatisfaction with self-service technologies (SSTs) has become prevalent. Although consumers’ voice has been studied in the interpersonal services context, in the context of SSTs it has been subject to very little conceptual or empirical scrutiny. To fill this void, this study tests empirically a model of the antecedents of consumers’ voice intentions in the context of unsatisfactory SST encounters. The findings suggest the need to integrate both “new” and “conventional” complaint behaviour management in the SST setting.

Self adjusted security architecture for mobile ad hoc networks (MANETs)

In this work we present a novel security architecture for MANETs that merges the clustering and the threshold key management techniques. The proposed distributed authentication architecture reacts with the frequently changing topology of the network and enhances the process of assigning the node's public key. In the proposed architecture, the overall network is divided into clusters where the clusterheads (CH) are connected by virtual networks and share the private key of the Central Authority (CA) using Lagrange interpolation. Experimental results show that the proposed architecture reaches to almost 95.5% of all nodes within an ad-hoc network that are able to communicate securely, 9 times faster than other architectures, to attain the same results. Moreover, the solution is fully decentralized to operate in a large-scale mobile network.

A randomized controlled trial of buprenorphine in the management of short-term ambulatory heroin withdrawal

Aim: To determine whether buprenorphine is more effective than clondine and other symptomatic medications in managing ambulatory heroin withdrawal.
Design: Open label. prospective randomized controlled trial examining
withdrawal and 4-week postwithdrawal outcomes on intention-to-treat.
Setting: Two specialist, out-patient drug treatment centres in inner city
Melbourne and Sydney, Australia.
Participants: One hundred and fourteen dependent heroin users were recruited. Participants were 18 yea rs or over. and with no significant other drug dependence, medical or psychiatric conditions or recent methadone treatment. One hundred and one (89%) participants completed a day 8 research interview examining withdrawal outcomes, and 92 (81%) completed day 35 research interview examining postwithdrawal outcomes.
Interventions: Participants randomized to control (n = 56) (up to 8 days or
clonidine and other symptomatic medications) or experimental (n = 58) (up to 5 days of buprenorphine) withdrawal groups. Following the 8-day withdrawal episode, participants could self-select from range of postwithdrawal options (naltrexone, substitution maintenance or counselling).
Measurements: Retention in withdrawal: heroin use during withdrawl: and
retention in drug treatment 4 weeks after withdrawal.
Secondary outcomes: Withdrawal severity: adverse events, and heroin use in the postwithdrawal period.
Findings: The experimental group had better treatment retention at day 8 (86% versus 57%, P = 0.001, 95% CI for numbers needed to treat (NNT) = 3-8) and day 35 (62% versus 39%, P = 0.02, 95% CI for NNT = 4-18): used heroin on fewer days during the withdralwal programlme (2.6 ± 2.5 versus 4.5 ± 2. 3.
P < 0.001. 95% CI = 1- 2.5 days) and in the postwithdrawal period (9.0±8.2
versus 14.6± 10. P<O.Ol. 95% CI = I .8- 9.4): and reported less withdrawal
severity. No severe adverse events reported.
Conclusions: Buprenorphine is effective for short-term ambulatory heroin
withdrawaI, with greater retention, less heroin use and less withdrawal discomfort during withdrawal: and increased postwithdrawal treatment retention than symptomatic medications.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Self-administration of medication in hospital: patients' perspectives

Background. Little information is available about patients' perspectives on self- or nurse-related administration of medication.

Aim. The aim of the study was to determine patients' perspectives about self-medication in the acute care setting.

Methods. A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002.

Findings. Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting.

Conclusions. In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.

Blood-nourishing and hard-softening capsule costs less in the management of osteoarthriticknee pain : A randomized controlled trial

The blood-nourishing and hard-softening (BNHS) capsule is a traditional Chinese formula used in the symptomatic treatment of inflammation and pain. We conducted this randomized controlled trial to compare the efficacy of BNHS with other commonly prescribed drugs. We recruited 120 patients from two teaching hospitals; 30 patients in each hospital were randomly assigned to receive BNHS. In one hospital, the 30 controls were given another traditional Chinese drug; whereas a Western medicine (chondroprotection drug/Viartril-s) was used as the control in the other hospital. Intervention was carried out over a period of 4 weeks. Primary outcome measures included self-reported pain level, and changes in stiffness and functional ability as measured by the Western Ontario McMaster Universities Osteoarthritis (WOMAC) index. Mixed models were used for statistical analysis. Substantial improvements in disease-specific symptoms were observed, after 4 weeks of treatment, in patients taking BNHS capsules. As assessed by the WOMAC index, pain level of the BNHS group decreased by 57% [95% confidence interval (CI) = 50, 63], stiffness by 63% (95% CI = 55, 71) and functional ability increased by 56% (95% CI = 50, 63). No significant differences were found in any of the outcome measures between the BNHS group and either of the comparison groups. No severe adverse effects were reported. However, this study lacked a placebo group; therefore, we conclude that BNHS appears to be as effective as commonly prescribed medicines for the relief of pain and dysfunction in knee osteoarthritis patients, but costs a lot less than other Western and herbal drugs in the study.

Terror Management Theory and Belief in an Afterlife

Research has shown that belief in an afterlife, a form of symbolic immortality, can alleviate the negative emotions associated with one’s mortality (Deschesne et. al, 2003). We found this aspect of TMT particularly interesting, but lacking any substantial research. Therefore, we set out to determine if belief in an afterlife could diminish the effects of mortality salience. As far as we know, our study is the first to use a pre-screening process to determine participants’ prior beliefs. One prediction might be that those who believe in an afterlife will be less affected by the effects of mortality salience.

Diabetes management in patients receiving palliative care

A literature review revealed no evidence-based guidelines specific to managing diabetes in the context of palliative care. The purpose of the current project was to describe the management practices of doctors and nurses caring for people with diabetes and advanced disease. Palliative care doctors, palliative care nurses, endocrinologists, and diabetes nurse educators participated in this study. A two-phase project was undertaken: 1) two focus groups, and 2) a cross-sectional survey using a self-completed questionnaire. The focus group and questionnaire data identified that doctors and nurses used a range of practices and blood glucose testing frequencies to control blood glucose based on experience and not according to a robust evidence base. Implications for practice include the importance of collaboration between diabetes and palliative care specialists, and the need to develop clinical management guidelines.

Interrelationship between anxiety, lifestyle self-reports and fitness in a sample of Hong Kong University students

Although anxiety in university students has been well documented, the influence of lifestyle and fitness status in relation to anxiety has not been investigated from a cultural perspective previously. To make recommendations regarding the avoidance or management of anxiety in this anxiety-prone cohort that are rationally based, this preliminary investigation examined the interrelationship between anxiety, lifestyle self-reports and aerobic fitness in Hong Kong Chinese University students. The State Trait Anxiety Inventory (Form Y-2) and a lifestyle questionnaire were completed by 213 students. Female students were more anxious than male students. Subjects with high anxiety reported more deleterious lifestyle behaviours including higher salt consumption and lower levels of exercise; in addition to more frequent symptoms of anxiety such as headaches and daytime somnolence. The extremes of this sample were stratified into a low anxiety group ( n =17) and a high anxiety group ( n =14) to compare their fitness status. Although both groups had below normal aerobic capacity, the higher systolic blood pressure observed for the high anxiety group is consistent with signs of anxiety, or greater deconditioning in this group or both. The results of this study have highlighted anxiety as a concern in Hong Kong University students and identified some lifestyle and fitness correlates. Understanding lifestyle and pathophysiological correlates of anxiety in Hong Kong University students that may have a cultural basis, is a crucial step toward averting or managing anxiety when these students are studying either in Hong Kong or abroad.