General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process

The aim of this project was to describe general practitioners’ (GPs’) decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients’ referral. There was no association between GPs’ sex, age or hours worked per week and referral factors. We conclude that a GP’s judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients’ nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.

Users' information requirements and narrative reporting : the case of Iranian companies

This paper investigates whether the narrative section of Iranian companies' annual reports satisfies the information requirements of financial analysts employed by institutional investors. Taking a group of stakeholders (i.e. financial analysts) as the sample, a questionnaire survey was conducted to identify their top three information needs from the narrative sections of company annual reports in each of three information categories: Present, Analytical and Prospective. Following this survey, a checklist was prepared to analyse whether Iranian companies are disclosing this information required by financial analysts. Overall, the results partially support stakeholder theory as there is a general lack of information flow on the part of Iranian listed companies in meeting their stakeholders' information needs.

An evaluation of a mental health screening and referral pathway for community nursing care : nurses' and general practitioners' perspectives

Aims and objectives. To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia.
Background. War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework.
Design. A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods – quantitative and qualitative.
Methods. Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey.
Results. Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses.
Conclusions. Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties.
Relevance to clinical practice. The trialled pathway, which was modified and refined following the study, is an evidence-based
resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

Consumer concerns about food and health : examination of general and specific relationships with personal values and demographics

Purpose – Aims to investigate the relationships between consumers' food concerns and their personal values and demographic characteristics.

Design/methodology/approach – A questionnaire was administered in a cross sectional random population survey conducted among a sample of 1,000 adults in South Australia. The questionnaire elicited information about respondents' concerns about 20 food and health issues, the perceived importance of 23 values items derived from the Schwartz values inventory, and their demographic characteristics.

Findings – Principal components analyses derived four food concerns factors and six personal values factors. Respondents' safety concerns scores were positively associated with devout-tradition, order-discipline, and moderate-independent values. Their disease concerns score was positively linked to beauty-nature, devout-tradition, and order-discipline. Multiple regression and chi-square automatic interaction detection (CHAID) analyses showed that individual values items were strong predictors of consumers; specific concerns such as food and heart disease, and, genetic modification of foods.

Research limitations/implications – The research was based on a cross sectional study. More refined indices of food concerns and personal values should be used in replications of this preliminary study.

Practical implications – The findings support the use of psychographic market segmentation approaches in communication programs about food and health issues.

Originality/value – The findings suggest that personal values, may be stronger predictors of consumers' concerns about food and health issues than demographics. They also show that measurement level of values and concerns influence the observed strength of their relationships.

Towards the improved treatment of generalization of knowledge claims in IS research : drawing general conclusions from samples

This paper presents a framework for justifying generalization in information systems (IS) research. First, using evidence from an analysis of two leading IS journals, we show that the treatment of generalization in many empirical papers in leading IS research journals is unsatisfactory. Many quantitative studies need clearer definition of populations and more discussion of the extent to which ‘significant’ statistics and use of non-probability sampling affect support for their knowledge claims. Many qualitative studies need more discussion of boundary conditions for their sample-based general knowledge claims. Second, the proposed new framework is presented. It defines eight alternative logical pathways for justifying generalizations in IS research. Three key concepts underpinning the framework are the need for researcher judgment when making any claim about the likely truth of sample-based knowledge claims in other settings; the importance of sample representativeness and its assessment in terms of the knowledge claim of interest; and the desirability of integrating a study’s general knowledge claims with those from prior research. Finally, we show how the framework may be applied by researchers and reviewers. Observing the pathways in the framework has potential to improve both research rigour and practical relevance for IS research.

A predictive model of avian natal dispersal distance provides prior information for investigating response to landscape change

1. Informative Bayesian priors can improve the precision of estimates in ecological studies or estimate parameters for which little or no information is available. While Bayesian analyses are becoming more popular in ecology, the use of strongly informative priors remains rare, perhaps because examples of informative priors are not readily available in the published literature.
2. Dispersal distance is an important ecological parameter, but is difficult to measure and estimates are scarce. General models that provide informative prior estimates of dispersal distances will therefore be valuable.
3. Using a world-wide data set on birds, we develop a predictive model of median natal dispersal distance that includes body mass, wingspan, sex and feeding guild. This model predicts median dispersal distance well when using the fitted data and an independent test data set, explaining up to 53% of the variation.
4. Using this model, we predict a priori estimates of median dispersal distance for 57 woodland-dependent bird species in northern Victoria, Australia. These estimates are then used to investigate the relationship between dispersal ability and vulnerability to landscape-scale changes in habitat cover and fragmentation.
5. We find evidence that woodland bird species with poor predicted dispersal ability are more vulnerable to habitat fragmentation than those species with longer predicted dispersal distances, thus improving the understanding of this important phenomenon.
6. The value of constructing informative priors from existing information is also demonstrated. When used as informative priors for four example species, predicted dispersal distances reduced the 95% credible intervals of posterior estimates of dispersal distance by 8-19%. Further, should we have wished to collect information on avian dispersal distances and relate it to species' responses to habitat loss and fragmentation, data from 221 individuals across 57 species would have been required to obtain estimates with the same precision as those provided by the general model.

The place of information and communication technology-mediated consultations in primary care : GPs' perspectives

Background: New information and communication technologies such as email and text messaging have been shown to be useful in some aspects of primary care service delivery. Little is known about Scottish GPs’ attitudes towards the adoption of these technologies as routine consultation tools.

Objectives: To explore GPs’ perceptions of the potential place of new non-face-to-face consultation technologies in the routine delivery of primary care; to explore GPs’ perceived barriers to the introduction of these technologies and to identify the processes by which GPs feel that new consultation technologies could be incorporated into routine primary care.

Methods: Qualitative interview study: 20 in-depth semi-structured interviews carried out with maximum variation sample of GPs across Scotland.

Results: Whilst the face-to-face consultation was seen as central to much of the clinical and diagnostic work of primary care, many GPs were conditionally willing to consider using new technologies in the future, particularly to carry out administrative or less complex tasks and therefore maximize practice efficiency and patient convenience. Key considerations were access to appropriate training, IT support and medico-legal guidance.

Conclusions: GPs are conditionally willing to use new consultation media if clinically appropriate and if medico-legal and technical support is available.

Media-independent information representation and retrieval

In this paper we propose a media-independent knowledge indexing and retrieval system as a basis for an information retrieval system. The representation allows for sharing of low level information bearing objects and at the same time allows for maintaining of user-dependent views. The tools for maintenance and manipulation of concepts focus on the user and user's intentions. The aim of the system is to provide a set of flexible tools and let the user structure the knowledge in his or her own way, instead of attempting to build an all-encompassing common sense, or general knowledge representation.

Presenting evidence-based health information for people with multiple sclerosis : the IN-DEEP project protocol

Background - Increasingly, evidence-based health information, in particular evidence from systematic reviews, is being made available to lay audiences, in addition to health professionals. Research efforts have focused on different formats for the lay presentation of health information. However, there is a paucity of data on how patients integrate evidence-based health information with other factors such as their preferences for information and experiences with information-seeking. The aim of this project is to explore how people with multiple sclerosis (MS) integrate health information with their needs, experiences, preferences and values and how these factors can be incorporated into an online resource of evidence-based health information provision for people with MS and their families.

Methods - This project is an Australian-Italian collaboration between researchers, MS societies and people with MS. Using a four-stage mixed methods design, a model will be developed for presenting evidence-based health information on the Internet for people with MS and their families. This evidence-based health information will draw upon systematic reviews of MS interventions from The Cochrane Library. Each stage of the project will build on the last. After conducting focus groups with people with MS and their family members (Stage 1), we will develop a model for summarising and presenting Cochrane MS reviews that is integrated with supporting information to aid understanding and decision making. This will be reviewed and finalised with people with MS, family members, health professionals and MS Society staff (Stage 2), before being uploaded to the Internet and evaluated (Stages 3 and 4).

Discussion - This project aims to produce accessible and meaningful evidence-based health information about MS for use in the varied decision making and management situations people encounter in everyday life. It is expected that the findings will be relevant to broader efforts to provide evidence-based health information for patients and the general public. The international collaboration also permits exploration of cultural differences that could inform international practice.

A predictive model of avian natal dispersal distance provides prior information for investigating response to landscape change

1. Informative Bayesian priors can improve the precision of estimates in ecological studies or estimate parameters for which little or no information is available. While Bayesian analyses are becoming more popular in ecology, the use of strongly informative priors remains rare, perhaps because examples of informative priors are not readily available in the published literature.

2. Dispersal distance is an important ecological parameter, but is difficult to measure and estimates are scarce. General models that provide informative prior estimates of dispersal distances will therefore be valuable.

3. Using a world-wide data set on birds, we develop a predictive model of median natal dispersal distance that includes body mass, wingspan, sex and feeding guild. This model predicts median dispersal distance well when using the fitted data and an independent test data set, explaining up to 53% of the variation.

4. Using this model, we predict a priori estimates of median dispersal distance for 57 woodland-dependent bird species in northern Victoria, Australia. These estimates are then used to investigate the relationship between dispersal ability and vulnerability to landscape-scale changes in habitat cover and fragmentation.

5. We find evidence that woodland bird species with poor predicted dispersal ability are more vulnerable to habitat fragmentation than those species with longer predicted dispersal distances, thus improving the understanding of this important phenomenon.

6. The value of constructing informative priors from existing information is also demonstrated. When used as informative priors for four example species, predicted dispersal distances reduced the 95% credible intervals of posterior estimates of dispersal distance by 8-19%. Further, should we have wished to collect information on avian dispersal distances and relate it to species' responses to habitat loss and fragmentation, data from 221 individuals across 57 species would have been required to obtain estimates with the same precision as those provided by the general model.

Non-face to face consultations and communications in primary care : the role and perspective of general practice managers in Scotland

Background Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers’ attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients.

Objectives To investigate practice managers’ attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies.

Methods We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews.

Results Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand.

Conclusion Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics.Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/ communication technologies.

Characteristics of participants in Australia's Get Healthy telephone-based lifestyle information and coaching service : reaching disadvantaged communities and those most at need

To address increasing rates of overweight and obesity, a population-based telephone intervention was introduced in New South Wales, Australia. The Get Healthy Information and Coaching Service® (GHS) offered participants a 6-month coaching program or detailed self-help information. Determining the population reach of GHS is of public health importance to ensure that the program reaches disadvantaged groups. This paper describes the socio-demographic and risk profile of participants (n = 4828) in the first 18 months of operations, determines how representative they are of the population, assesses changes in participants’ socio-demographic profile and compares ‘information-only’ and ‘coaching’ participants. The results show that GHS users are representative of the adult population in relation to education, employment status, Aboriginal status, fruit and vegetable consumption and alcohol use. However, more female, middle-aged, English-speaking, rural and socially disadvantaged adults participated in GHS. Coaching Participants were more likely to be overweight and to be ex-smokers than the general population. There was substantial variability in GHS recruitment, when mass-reach television advertising was used, participants enrolled from a major city and from more disadvantaged communities. The GHS has broader population reach than many local interventions, but further efforts are needed to increase reach by Aboriginal communities, other minorities and men.

Regulatory theory insights into the past, present and future of general purpose water accounting standard setting

Purpose – Accounting and water industry experts are developing general-purpose water accounting (GPWA) to report information about water and rights to water. The system has the potential to affect water policies, pricing and management, and investment and other decisions that are affected by GPWA report users' understanding of water risks faced by an entity. It may also affect financial returns to accounting and auditing firms and firms in water industries. In this paper the authors aim to examine the roles of the accounting profession, water industries and other stakeholders in governing GPWA. Recognising that the fate of GPWA depends partly upon regulatory power and economics, they seek to apply regulatory theories that explain financial accounting standards development to speculate about the national and international future of GPWA.

Design/methodology/approach – Official documents, internal Water Accounting Standards Board documents and unstructured interviews underpin the authors' analysis.

Findings – The authors speculate about the benefits that might accrue to various stakeholder groups from capturing the GPWA standard-setting process. They also suggest that internationally, water industries may dominate early GPWA standards development in the public interest and that regulatory capture by accounting or water industry professionals will not necessarily conflict with public interest benefits.

Practical implications – Accounting for water can affect allocations of environmental, economic, social and other resources; also, accounting and water industry professional standing and revenues. In this paper the authors identify factors influencing GPWA standards and standard-setting institutional arrangements, and thereby these resource allocations. The paper generates an awareness of GPWA's emergence and practical implications.

Originality/value – This is an early study to investigate water accounting standard-setting regulatory influences and their impact.

Internal organizational factors influencing sustainable implementation of information systems : experiences from a local government in Indonesia

Many information systems (IS) studies have found that information systems implementation sustainability is determined by internal organizational factors. In general these studies have been conducted in private organizations and these factors may not be applicable to IS implementations sustainability within public organizations. This study examines what internal organizational factors play a role in the sustainable implementation of e-government initiatives using a case study of local e-government in Indonesia. It also considers how these factors contribute to sustainable systems by strengthening stakeholders’ commitment through invoking feelings of involvement as responsibilities are assigned to them. The study concludes that the internal factors contribute to collective action that influences sustainable implementation of information systems. Limitations and future research are briefly discussed.

A design pattern for responsible information systems education

This paper explores the idea of responsible systems design. To do so, it examines a case study - the accreditation of Information Systems (IS) courses by the professional body. A professionally accredited educational program, like any other non-trivial design product, represents the balancing of competing influences, ideas and stakeholders. The case is particularly relevant because there have been significant changes in the context of Australian IS education recently that have made more complex the task of designing educational systems in a responsible manner. A general approach to addressing this complexity is articulated here as a design pattern to guide IS educational design. The pattern identifies the influences on design, the processes and products of design and the feedback mechanism required to demonstrate that stakeholder requirements are satisfied. Design tensions and principles arising from the model are discussed and future work identified