Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals : a qualitative study

Aim: To explore health professionals’ experiences of barriers and facilitators to referring patients for pulmonary rehabilitation in a primary care setting.

Background: Pulmonary rehabilitation involves a multidisciplinary teamwork approach to improving
the quality of life for people with chronic obstructive pulmonary disease. This study aimed to find out about health care professionals’ experiences when referring patients. Reports suggest that a health care professional’s attitude towards a treatment affects the willingness of patients to accept advice.

Methods: Five focus group interviews were undertaken with 21 health professionals from North Midlands, UK. Data were analysed using a thematic analysis drawing on the techniques of grounded theory.

Findings: Chronic disease management has been delegated to Practice Nurses in many cases leaving some nurses feeling unsupported and some General Practitioners feeling deskilled. Problems with communication, a lack of adequate and timely local service provision, a difficult referral process, time pressures and lack of information were barriers to health care professionals making an offer of pulmonary rehabilitation. An explanatory model is proposed to describe how addressing barriers to referral may improve health care professionals views about pulmonary rehabilitation and therefore may mean that they present it in a more positive manner.

Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial

Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion
To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration
Australian New Zealand Clinical Trial Registry ACTRN12609000705280

Microstructural and molecular level characterisation of plastic crystal phases of pyrrolidinium trifluoromethanesulfonyl salts

Ambient temperature conductive plastic crystal phases of alkylmethylpyrrolidinium trifluoromethanesulfonyl amide (TFSA) salts are studied using positron annihilation lifetime spectroscopy (PALS) to examine the role of vacancy size and concentration in conductivity. The ethyl methylpyrrolidinium TFSA salt (P₁₂ TFSA) has larger vacancies and a greater concentration of vacancies than the dimethylpyrrolidinium TFSA salt (P₁₁ TFSA) over the temperature range investigated. The relative vacancy size and concentration vary with temperature and reflect the solid–solid transitions as measured by differential scanning calorimetry (DSC). P₁₂ TFSA has greater conductivity than P₁₁ TFSA and has furthermore been observed to exhibit slip planes at room temperature. P₁₂ TFSA has greater entropy changes associated with solid–solid phase transitions below the melting point than P₁₁ TFSA possibly indicating greater rotational freedom in P₁₂ TFSA. These results support the notion that the diffusion, conduction, and plastic flow properties of the pyrrolidinium TFSA salts are derived from the lattice vacancies.

The restorative role of apology in resolving medical disputes: Lessons from Chinese legal culture

This article is the first exploration of the Chinese notion of apology from a comparative legal perspective. By reviewing the significance of apology in the context of Chinese culture, the article presents a three-dimensional structure of apology that, in contrast to the understanding the research community now has, defines acknowledgement of fault, admission of responsibility, and offer of reparation as three essential elements of an apology. It is the combination of these three elements that enables apology to serve as a form of reparation. The article further places the three-dimensional apology in the context of the Chinese concept of "the relations of humanity," arguing that an apology accompanying admission of fault and responsibility may help to restore the harmony of relations and, by so doing, resolve medical disputes positively.

A text analytics evaluation of a first-year engineering project-based unit

In the undergraduate engineering program at Griffith University in Australia, the unit 1006ENG Design and Professional Skills aims to provide an introduction to engineering design and professional practice through a project-based learning (PBL) approach to problem solving. It provides students with an experience of PBL in the first-year of their programme. The unit comprises an underpinning lecture series, design work including group project activities, an individual computer-aided drawing exercise/s and an oral presentation. Griffith University employs a ‘Student Experience of Course’ (SEC) online survey as part of its student evaluation of teaching, quality improvement and staff performance management processes. As well as numerical response scale items, it includes the following two questions inviting open-ended text responses from students: i) What did you find particularly good about this course? and ii) How could this course be improved? The collection of textual data in in student surveys is commonplace, due to the rich descriptions of respondent experiences they can provide at relatively low cost. However, historically these data have been underutilised because they are time consuming to analyse manually, and there has been a lack of automated tools to exploit such data efficiently. Text analytics approaches offer analysis methods that result in visual representations of comment data that highlight key individual themes in these data and the relationships between those themes. We present a text analytics-based evaluation of the SEC open-ended comments received in the first two years of offer of the PBL unit 1006ENG. We discuss the results obtained in detail. The method developed and documented here is a practical and useful approach to analysing/visualising open-ended comment data that could be applied by others with similar comment data sets.

Promise more, leave less

Following Kim and Ritter (1999) who find that earnings forecasts provide more accurate valuations of IPOs, this paper analyses whether the owners of companies seeking to list will leave less money on the table if positive dividend per share (DPS) yield forecasts are made in the prospectus. Our findings indicate that DPS yield forecasts by directors of Industrial company IPOs have been an important ingredient in the amount of money left on the table. A similar result is found for Limited Liability IPOs and those that do not offer options to subscribers to buy more shares. The offer of an operational dividend reinvestment plan in the prospectus does not appear significant in reducing the amount of money left on the table.

Women's decisions about amniocentesis : new dilemmas, new fears

Explores how the development and availability of prenatal diagnostic testing creates dilemmas for pregnant women that previous generations of women never had to face. Examines the reasons for the women's decisions about amniocentesis in the context of their reproductive, personal and social circumstances. The thesis concludes that, regardless of whether the study participants had accepted or rejected the medical offer of prenatal diagnosis, it was shaped by their desire to gain a sense of control in reproduction.

LiI-doped N,N-Dimethyl-Pyrrolidinium iodide, an archetypal rotator-phase ionic conductor

N,N-Dimethyl-pyrrolidinium iodide, and the effect of doping with LiI, has been investigated using DSC, NMR, and impedance spectroscopy. It was found that the addition of a small amount of LiI enhances the ionic conductivity by up to 3 orders of magnitude for this ionic solid. Furthermore, a slight decrease in phase transition onset temperatures, as well as the appearance of a superimposed narrow line in the ¹H NMR spectra with dopant, suggest that the LiI facilitates the mobility of the matrix material, possibly by the introduction of vacancies within the lattice. ⁷Li NMR line width measurements reveal a narrow Li line width, decreasing in width and increasing in intensity with temperature, indicating mobile Li ions.

Lithium-doped plastic crystal electrolytes exhibiting fast ion conduction for secondary batteries

Rechargeable lithium batteries have long been considered an attractive alternative power source for a wide variety of applications. Safety and stability1 concerns associated with solvent-based electrolytes has necessitated the use of lithium intercalation materials (rather than lithium metal) as anodes, which decreases the energy storage capacity per unit mass. The use of solid lithium ion conductors - based on glasses, ceramics or polymers - as the electrolyte would potentially improve the stability of a lithium metal anode while alleviating the safety concerns. Glasses and ceramics conduct via a fast ion mechanism, in which the lithium ions move within an essentially static framework. In contrast, the motion of ions in polymer systems is similar to that in solvent-based electrolytes - motion is mediated by the dynamics of the host polymer, thereby restricting the conductivity to relatively low values. Moreover, in the polymer systems, the motion of the lithium ions provides only a small fraction of the overall conductivity2, which results in severe concentration gradients during cell operation, causing premature failure3. Here we describe a class of materials, prepared by doping lithium ions into a plastic crystalline matrix, that exhibit fast lithium ion motion due to rotational disorder and the existence of vacancies in the lattice. The combination of possible structural variations of the plastic crystal matrix and conductivities as high as 2 3 1024 S cm21 at 60 8C make these materials very attractive for secondary battery applications.

Strategies for agent-based negotiation in e-trade

£-negotiation handles negotiation over the Internet without human supervision and has shown effectiveness in concluding verifiable and more favorable agreements in a reasonably short time. In this chapter, the authors discuss the negotiation 5ystem and its components with particular emphasis on negotiation strategies. A negotiation strategy defines strategic tactics, which advise on the proper action to select from a set of possible actions that optimizes negotiation outcomes. A strategy should integrate negotiation goals and reactive attitudes. Usually, a fixed strategy is implemented during the course of negotiation regardless ofsignificant decision-makingfactors including market status, opponent :S profile, or eagerness for a negotiated goods/service. The chapter presents the main negotiation strategies and outlines the different decision-makingfactors that should be considered. A strategy uses a utility function to evaluate the offer of an opponent and advises on the generation of a counter offer or the best interaction. The authors finally discuss different utility functions presented in the literature.

The role of brand orientation in explaining retail offer advantage

We provide a conceptualisation and operationalisation of brand orientation within the context of retailing. We then empirically test this operationalisation in terms of a retail offer advantage across the dimensions of merchandise, trading format, customer service and customer communication. Our results suggest that the degree to which a retailer values brands and its practices are oriented towards building brand capabilities provides a valuable theoretical framework to explain variations in retailers' advantage over their competitors.

Decoration of nitrogen vacancies by oxygen atoms in boron nitride nanotubes

Decoration of nitrogen vacancies by oxygen atoms has been studied by near-edge X-ray absorption fine structure (NEXAFS) around B K-edge in several boron nitride (BN) structures, including bamboo-like and multi-walled BN nanotubes. Breaking of B-N bonds and formation of nitrogen vacancies under low-energy ion bombardment reduces oxidation resistance of BN structures and promotes an efficient oxygen-healing mechanism, in full agreement with some recent theoretical predictions. The formation of mixed O-B-N and B-O bonds is clearly identified by well-resolved peaks in NEXAFS spectra of excited boron atoms.