Encouraging practitioners to use resources: evaluation of the national implementation of a resource to improve the clinical management of alcohol-related problems in Indigenous primary care settings

This paper reports on the evaluation of the implementation of the National Recommendations for the Clinical Management of Alcohol-Related Problems in Indigenous Primary Care Settings undertaken in 2001 through 74 standardized workshops, which sought to determine: ( 1) whether this approach to implementation influenced the likelihood that the National Recommendations would be used; ( 2) whether it influenced participants' willingness to engage with Indigenous patients regarding alcohol-related issues; and ( 3) whether the implementation as a whole influenced both practice and clinicians' willingness to engage. Evaluation included pre-/post-workshop and follow-up questionnaires and a focus group. The findings presented indicate that distribution of clinical resources alone is not sufficient to ensure use and that, particularly for medical practitioners, appropriate introduction not only increases use but also positively influences willingness to engage with alcohol-related problems as part of primary clinical care. Further, the enthusiasm for guideline production should be tempered by the need to develop effective implementation strategies.

2D strain - a new approach to strain and strain rate: the solution to the angle-dependence of tissue Doppler?

Purpose: Tissue Doppler strain rate imaging (SRI) have been validated and applied in various clinical settings, but the clinical use of this modality is still limited due to time-consuming postprocessing, unfavorable signal to noise ratio and major angle dependency of image acquisition. 2D Strain (2DS) measures strain parameters through automated tissue tracking (Lagrangian strain) rather than tissue velocity regression. We sought to compare the accuracy of this technique with SRI and evaluate whether it overcomes the above limitations. Methods: We assessed 26 patients (13 female, age 60±5yrs) at low risk of CAD and with normal DSE at both baseline and peak stress. End systolic strain (ESS), peak systolic strain rate (SR), and timing parameters were measured by two independent observers using SRI and 2D Strain. Myocardial segments were excluded from the analyses if the insonation angle exceeded 30 degrees or if the segments were not visualized; 417 segments were evaluated. Results: Normal ranges for TVI and CEB approaches were comparable for SR (-0.99 ± 0.39 vs -0.88 ± 0.36, p=NS), ESS (-15.1 ± 6.5 vs -14.9 ± 6.3, p=NS), time to end of systole (174 ± 47 vs 174 ± 53, p=NS) and time to peak SR (TTP; 340 ± 34 vs 375 ± 57). The best correlations between the techniques were for time to end systole (rest r=0.6, p

Accommodative communication as a mediator to the negative effects of cultural identity on perceptions of foreign management practices and perceptions of organisational climate

This Study examines whether cultural identity has an impact on perceptions of foreign management practices and perceptions of organisational climate. Based on social identity theory as a conceptual framework, it is assumed that the salience of cultural identity leads to in-group bias in interpreting organisational events. This study also examines whether managers' accommodative communication behaviour mediates these relationships. In a multinational organisation, employees see the foreign company as a symbol, and the person that deals with them in everyday working relationships in the organisation is their direct leader. It is argued that the salience of cultural identity wiU depend on employees' perceptions of the way managers attach meaning to foreign managerial practices and communicate it to them. Interaction with managers who create a distance with their employees and who fail to Usten to what employees need may be a socially appropriate way to invoke the salience of cultural identity in the working relationship. The participants were 206 Indonesian employees from three multinational organisations. Using a questionnaire, this study shows that participants with strong cultural identity had more negative perceptions of foreign management practices and organisational climate. Furthermore, this study indicates that managers' accommodative communication behaviour mediated these relationships.