eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

Patient involvement in primary care mental health:a focus group study

Background: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. Aim: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. Design of study: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. Setting: Six primary care trusts in the West Midlands, England. Method: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. Results: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. Conclusions: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

Patients' and health professionals' views on primary care for people with serious mental illness:focus group study

Objective: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. Design: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. Setting: Six primary care trusts in the West Midlands. Participants: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. Results: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. Conclusions: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

An exploration of consumer resistance to innovation and its antecedents

Although firms are faced by a large number of market introduction failures, research into a major driver of these failures, customer resistance to innovation, is surprisingly scarce. While most authors have investigated positive adoption decisions, this paper focuses instead on consumer resistance to innovation. The current study presents a conceptual framework which explicates the major components of consumer resistance: (1) rejection, (2) postponement, and (3) opposition, and discusses two main groups of antecedents to consumer resistance: (1) degree of change required and (2) conflicts with the consumer’s prior belief structure. This framework is explored with both a literature review and a qualitative focus group study. These joint efforts result in the formulation of a model of consumer resistance. Finally, the authors discuss several relevant theoretical and strategic implications, and point out directions for future research.

'Listen to my madness':understanding the experiences of people with serious mental illness

This article explores the salience of disability theory for understanding the experiences of people with serious mental illness. Drawing on data from a focus group study, we suggest that users experience both impairment (as embodied irrationality) which can, in itself, be oppressive, and also have to manage their lives within a largely disabling society. We outline some of the strategies adopted by users to manage their situation and ensure they access and receive health services, and illustrate how these are a result of the complex relationship between disability and impairment. We suggest that using a framework of the social model of disability provides a useful way of understanding and making sense of the experience of users with serious mental illness. © Blackwell Publishing Ltd/Foundation for the Sociology of Health & Illness 2005.

The efficacy and safety of imeglimin as add-on therapy in patients with type 2 diabetes inadequately controlled with sitagliptin monotherapy

OBJECTIVE: This 12-week study assessed the efficacy and tolerability of imeglimin as add-on therapy to the dipeptidyl peptidase-4 inhibitor sitagliptin in patients with type 2 diabetes inadequately controlled with sitagliptin monotherapy. RESEARCH DESIGN AND METHODS: In a multicenter, randomized, double-blind, placebo-controlled, parallel-group study, imeglimin (1,500 mg b.i.d.) or placebo was added to sitagliptin (100 mg q.d.) over 12weeks in 170 patientswith type 2 diabetes (mean age 56.8 years; BMI 32.2 kg/m2) that was inadequately controlled with sitagliptin alone (A1C ≥7.5%) during a 12-week run-in period. The primary ef ficacy end point was the change in A1C from baseline versus placebo; secondary end points included corresponding changes in fasting plasma glucose (FPG) levels, strati fication by baseline A1C, and percentage of A1C responders. RESULTS: Imeglimin reduced A1C levels (least-squares mean difference) from baseline (8.5%) by 0.60% compared with an increase of 0.12% with placebo (between-group difference 0.72%, P < 0.001). The corresponding changes in FPG were -0.93 mmol/L with imeglimin vs. -0.11 mmol/L with placebo (P = 0.014). With imeglimin, the A1C level decreased by ≥0.5% in 54.3% of subjects vs. 21.6% with placebo (P < 0.001), and 19.8%of subjects receiving imeglimin achieved a decrease in A1C level of ≤7% compared with subjects receiving placebo (1.1%) (P = 0.004). Imeglimin was generally well tolerated, with a safety pro file comparable to placebo and no related treatment-emergent adverse events. CONCLUSIONS: Imeglimin demonstrated incremental efficacy benefits as add-on therapy to sitagliptin, with comparable tolerability to placebo, highlighting the potential for imeglimin to complement other oral antihyperglycemic therapies. © 2014 by the American Diabetes Association.

Humanizing outgroups through multiple categorization:the roles of individuation and threat

In three studies, we examined the impact of multiple categorization on intergroup dehumanization. Study 1 showed that perceiving members of a rival university along multiple versus simple categorical dimensions enhanced the tendency to attribute human traits to this group. Study 2 showed that multiple versus simple categorization of immigrants increased the attribution of uniquely human emotions to them. This effect was explained by the sequential mediation of increased individuation of the outgroup and reduced outgroup threat. Study 3 replicated this sequential mediation model and introduced a novel way of measuring humanization in which participants generated attributes corresponding to the outgroup in a free response format. Participants generated more uniquely human traits in the multiple versus simple categorization conditions. We discuss the theoretical implications of these findings and consider their role in informing and improving efforts to ameliorate contemporary forms of intergroup discrimination.

The development of discourse in a discourse of development:a case study of a group constructing a new discourse.

This thesis is a qualitative case study drawing on discourse analysis and ethnographic traditions. The aim of the study is to provide a description of the discourse consciously constructed by a group of six TESOL professionals in the interests of their own development. Once a week, the group met for one hour and took turns to act as 'Speaker'. The other five individuals acted as Understanders. The extra space given to the Speaker allowed a fuller articulation of a problem or focus than would normally be possible in other professional talk. The Understanders contributed moves to support this articulation. The description covers a two-year period (1998-2000) of this constructed discourse. Data, collected during this period, are drawn from several different sources: recordings, interviews, diaries and critical incident journals. The main recordings are of the actual Group Development Meetings (GDMs). Discussion of six transcribed GDMs demonstrates which discourse choices and decisions were important. In particular, the study looks at the key role played by 'Reflection' in this process. It is argued that Reflection is the key element in supporting the Speaker. The analysis of Reflection, which is considered from four perspectives (values, purpose, form and outcomes) draws on data from the featured cases. Issues relating to the transfer to other groups of this discourse-based approach to professional development are considered.

Strategic planning in a decentralised industrial group : a process-action study

The research was carried out within a major public company. It sought to implement an approach to strategic planning which accounted for organisational values as well as employing a holistic value-free analysis of the firm and its environment. To this end, an 'ecological' model of the firm was formulated. A series of value-free strategic policies for its development were generated. These policies were validated by the company's top-management.They compared favourably with their own planning outcomes. The approach appeared to be diagnostically strong but lacked sufficient depth in the context of finding realistic corrective measures. However, feedback from the company showed it to be a useful complementary process to conventional procedures, in providing an explicitly different perspective. The research empirically evaluated the company's value-systems and their influence on strategy. It introduced the idea of an organisational 'self-concept' pre-determining the acceptability of various strategies.The values and the "self-concept' of the company were identified and validated, They appeared to have considerable influence on strategy. In addition, tho company's planning process within the decentralised structure was shown to be sub-optimal. This resulted from the variety of value systems maintained by different parts of the organisation. Proposals attempting to redress this situation were ofJered and several accepted. The study was postured as process-action research and the chosen perspective could be succinctly described as a 'worm's-eye view', akin to that of many real planners operating at some distance from the decision-making body. In this way, the normal strategic functionings of the firm and any changes resulting from the researcher's intervention were observed and recorded. Recurrent difficulties of the planning process resulting from the decentralised structure were identified. The overall procedure suggested as a result of the research aimed to increase the viabiIity of planning and the efficiency of the process. It is considered to be flexible enough to be applicable in a broader context.

Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness

OBJECTIVE: To determine the accuracy, acceptability and cost-effectiveness of polymerase chain reaction (PCR) and optical immunoassay (OIA) rapid tests for maternal group B streptococcal (GBS) colonisation at labour. DESIGN: A test accuracy study was used to determine the accuracy of rapid tests for GBS colonisation of women in labour. Acceptability of testing to participants was evaluated through a questionnaire administered after delivery, and acceptability to staff through focus groups. A decision-analytic model was constructed to assess the cost-effectiveness of various screening strategies. SETTING: Two large obstetric units in the UK. PARTICIPANTS: Women booked for delivery at the participating units other than those electing for a Caesarean delivery. INTERVENTIONS: Vaginal and rectal swabs were obtained at the onset of labour and the results of vaginal and rectal PCR and OIA (index) tests were compared with the reference standard of enriched culture of combined vaginal and rectal swabs. MAIN OUTCOME MEASURES: The accuracy of the index tests, the relative accuracies of tests on vaginal and rectal swabs and whether test accuracy varied according to the presence or absence of maternal risk factors. RESULTS: PCR was significantly more accurate than OIA for the detection of maternal GBS colonisation. Combined vaginal or rectal swab index tests were more sensitive than either test considered individually [combined swab sensitivity for PCR 84% (95% CI 79-88%); vaginal swab 58% (52-64%); rectal swab 71% (66-76%)]. The highest sensitivity for PCR came at the cost of lower specificity [combined specificity 87% (95% CI 85-89%); vaginal swab 92% (90-94%); rectal swab 92% (90-93%)]. The sensitivity and specificity of rapid tests varied according to the presence or absence of maternal risk factors, but not consistently. PCR results were determinants of neonatal GBS colonisation, but maternal risk factors were not. Overall levels of acceptability for rapid testing amongst participants were high. Vaginal swabs were more acceptable than rectal swabs. South Asian women were least likely to have participated in the study and were less happy with the sampling procedure and with the prospect of rapid testing as part of routine care. Midwives were generally positive towards rapid testing but had concerns that it might lead to overtreatment and unnecessary interference in births. Modelling analysis revealed that the most cost-effective strategy was to provide routine intravenous antibiotic prophylaxis (IAP) to all women without screening. Removing this strategy, which is unlikely to be acceptable to most women and midwives, resulted in screening, based on a culture test at 35-37 weeks' gestation, with the provision of antibiotics to all women who screened positive being most cost-effective, assuming that all women in premature labour would receive IAP. The results were sensitive to very small increases in costs and changes in other assumptions. Screening using a rapid test was not cost-effective based on its current sensitivity, specificity and cost. CONCLUSIONS: Neither rapid test was sufficiently accurate to recommend it for routine use in clinical practice. IAP directed by screening with enriched culture at 35-37 weeks' gestation is likely to be the most acceptable cost-effective strategy, although it is premature to suggest the implementation of this strategy at present.

The introduction of group technology via coding techniques:a case study

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Detection of phosphatidylserine with a modified polar head group in human keratinocytes exposed to the radical generator AAPH

Phosphatidylserine (PS) is preferentially located in the inner leaflet of the cell membrane, and translocation of PS oxidized in fatty acyl chains to the outside of membrane has been reported as signaling to macrophage receptors to clear apoptotic cells. It was recently shown that PS can be oxidized in serine moiety of polar head-group. In the present work, a targeted lipidomic approach was applied to detecting OxPS modified at the polar head-group in keratinocytes that were exposed to the radical generator AAPH. Glycerophosphoacetic acid derivatives (GPAA) were found to be the major oxidation products of OxPS modified at the polar head-group during oxidation induced by AAPH-generated radicals, similarly to previous observations for the oxidation induced by OH radical. The neutral loss scan of 58Da and a novel precursor ion scan of m/z 137.1 (HOPO3CH2COOH) allowed the recognition of GPAA derivatives in the total lipid extracts obtained from HaCaT cells treated with AAPH. The positive identification of serine head group oxidation products in cells under controlled oxidative conditions opens new perspectives and justifies further studies in other cellular environments in order to understand fully the role of PS polar head-group oxidation in cell homeostasis and disease.

The neural correlates of reading impairment in adults with developmental dyslexia:evidence from fMRI between group analyses and an fMRI multiple-case study

The goal of this project was to investigate the neural correlates of reading impairment in dyslexia as hypothesised by the main theories – the phonological deficit, visual magnocellular deficit and cerebellar deficit theories, with emphasis on individual differences. This research took a novel approach by: 1) contrasting the predictions in one sample of participants with dyslexia (DPs); 2) using a multiple-case study (and between-group comparisons) to investigate differences in BOLD between each DP and the controls (CPs); 3) demonstrating a possible relationship between reading impairment and its hypothesised neural correlates by using fMRI and a reading task. The multiple-case study revealed that the neural correlates of reading in dyslexia in all cases are not in agreement with the predictions of a single theory. The results show striking individual differences - even, where the neural correlates of reading in two DPs are consistent with the same theory, the areas can differ. A DP can exhibit under-engagement in an area in word, but not in pseudoword reading and vice versa, demonstrating that underactivation in that area cannot be interpreted as a ‘developmental lesion’. Additional analyses revealed complex results. Within-group analyses between behavioural measures and BOLD showed correlations in the predicted regions, areas outside ROI, and lack of correlations in some predicted areas. Comparisons of subgroups which differed on Orthography Composite supported the MDT, but only for Words. The results suggest that phonological scores are not a sufficient predictor of the under-engagement of phonological areas during reading. DPs and CPs exhibited correlations between Purdue Pegboard Composite and BOLD in cerebellar areas only for Pseudowords. Future research into reading in dyslexia should use a more holistic approach, involving genetic and environmental factors, gene by environment interaction, and comorbidity with other disorders. It is argued that multidisciplinary research, within the multiple-deficit model holds significant promise here.

The influence of face and group orientation on the perception of luxury goods:a four market study of East Asian consumers

Purpose: The paper aims to further extend our understanding by assessing the extent to which two prominent cultural values in East Asia i.e. face saving and group orientation drive consumers' perceptions of luxury goods across four East Asian markets. Design/methodology/approach: A multi-methods research approach was adopted consisting of: an expert panel of close to 70 participants, group discussions with five extended East Asian families, personal interviews with eight East Asian scholars, a pilot test with over 50 East Asian graduate students and a multi-market survey of 443 consumer respondents in Beijing, Tokyo, Singapore and Hanoi. Findings: The authors extend previous conceptual studies by empirically investigating the impact of these two cultural values on the perception of luxury among East Asian societies. Specifically the study reveals that across all four markets face saving has the strongest influence on the conspicuous and hedonistic dimensions of luxury, group orientation meanwhile is the strongest predictor of the quality, extended self and exclusivity dimensions of luxury. Collectively these two cultural values significantly influence East Asian perceptions of luxury. Overall, the findings reiterate the importance of understanding different cultural values and their influence across different East Asian societies. Practical implications: The findings have important implications for managers of western luxury branded goods that are seeking to penetrate East Asian markets or seek to serve East Asian consumers. Specifically, to assist with developing suitable brand positioning, products, services, communications and pricing strategies. Originality/value: This study contributes to our understanding of the subject by exploring the impact of face saving and group orientation on the perception of luxury goods across four East Asian countries. Several directions for future research are suggested. © Emerald Group Publishing Limited.