Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^

The role of residual stresses in the performance and durability of prestressing steel wires

Residual stresses developed during wire drawing influence the mechanical behavior and durability of steel wires used for prestressed concrete structures, particularly the shape of the stress–strain curve, stress relaxation losses, fatigue life, and environmental cracking susceptibility. The availability of general purpose finite element analysis tools and powerful diffraction techniques (X-rays and neutrons) has made it possible to predict and measure accurately residual stress fields in cold-drawn steel wires. Work carried out in this field in the past decade, shows the prospects and limitations of residual stress measurement, how the stress relaxation losses and environmentally-assisted cracking are correlated with the profile of residual stresses and how the performance of steel wires can be improved by modifying such a stress profile

Insights, attitudes, and perceptions about asthma and its treatment : a multinational survey of patients from Europe and Canada

Acknowledgments Editorial assistance was provided by Ken Kauffman and Patricia Abramo, Adelphi Communications, New York, NY. This assistance was funded by Merck & Co., Inc.

Mechanical Properties and Durability of CNT Cement Composites

In the present paper, changes in mechanical properties of Portland cement-based mortars due to the addition of carbon nanotubes (CNT) and corrosion of embedded steel rebars in CNT cement pastes are reported. Bending strength, compression strength, porosity and density of mortars were determined and related to the CNT dosages. CNT cement paste specimens were exposed to carbonation and chloride attacks, and results on steel corrosion rate tests were related to CNT dosages. The increase in CNT content implies no significant variations of mechanical properties but higher steel corrosion intensities were observed.

Influence of using slag cement on the microstructure and durability related properties of cement grouts for micropiles

Today, the use of micropiles for different applications has become very common. In Spain, the cement grouts for micropiles are prepared using ordinary Portland cement and w:c ratio 0.5, although the micropiles standards do not restrict the cement type to use, provided that it reaches a certain compressive strength. In this study, the influence of using slag cement on the microstructure and durability related properties of cement grouts for micropiles have been studied until 90 hardening days, compared to an ordinary Portland cement. Finally, slag cement grouts showed good service properties, better than ordinary Portland cement ones.

Predictive Models of Alcohol Use Based on Attitudes and Individual Values

Two predictive models are developed in this article: the first is designed to predict people's attitudes to alcoholic drinks, while the second sets out to predict the use of alcohol in relation to selected individual values. University students (N = 1,500) were recruited through stratified sampling based on sex and academic discipline. The questionnaire used obtained information on participants' alcohol use, attitudes and personal values. The results show that the attitudes model correctly classifies 76.3% of cases. Likewise, the model for level of alcohol use correctly classifies 82% of cases. According to our results, we can conclude that there are a series of individual values that influence drinking and attitudes to alcohol use, which therefore provides us with a potentially powerful instrument for developing preventive intervention programs.

Changing Attitudes And Expectations In A University Setting: A Case Study

First and second year students enrolled in a four-year movement education based university Physical Education program completed a questionnaire regarding their expectations on entering university. In addition, graduates of the program were interviewed, one year after graduation, with regard to their understanding of and attitude towards movement education and how these had developed relative to their overall degree program. Most students had no knowledge of movement education prior to entering the program and the selection of this particular program was simply coincidental with their desire to pursue physical education. Whereas the students did participate in an activity course and a theory course in Year 1, it was only when participating in a Year 2 movement course which combined theory and practice within the same course that students recognized the movement base of the content. The progress of the students through the program reflects distinct declarative and procedural stages in knowledge development followed by an ability to generalize that knowledge a conceptual stage. The real understanding of movement education came as the students were required to teach movement education to students, children, and other groups.

Considering Efficacy of an Outdoor Environmental Education Program: Facilitating Elementary Students’ Environmental Knowledge, Attitudes, and Behaviours

Various sources have sought to consider the educational interventions that foster changes in perception of and attitudes toward nature, with the ultimate intent of understanding how education can be used to encourage environmentally responsible behaviours. With these in mind, the current study identified an outdoor environmental education program incorporating these empirically supported interventions, and assessed its ability to influence environmental knowledge, attitudes, and behaviours. Specifically, this study considered the following research questions: 1) To what degree can participation in this outdoor education program foster environmental knowledge and encourage pro-environmental attitudes and self-reported pro-environmental behaviours? 2) How is this effect different among students of different genders, and those who have different prior experiences in nature? Two motivational frameworks guided inquiry in the current study: the Value-Belief-Norm Model of Environmentalism (VBN) and the Theory of Planned Behaviour (TPB). The study employed a quantitative survey methodology, combining contemporary data measuring knowledge, attitudes, and behaviours with archived data collected by program staff, reflecting frequency of environmentally responsible behaviour. Further, a single qualitative item was included for which students provided “the first three words that [came] to mind when [they] think of the word nature.” Terms provided before and after the program were compared for differences in theme to detect subtle or underlying changes. Quantitative results indicated no significant change in student knowledge or attitudes through the outdoor environmental education program. However, a significant change in self-reported behaviour was identified from both the contemporary and archived data. This agreement in positive findings across the two data sets, collected using different measures and different participants, lends evidence of the program’s ability to encourage self-reported pro-environmental behaviour. Further, qualitative results showed some change in students’ perceptions of nature through the program, providing direction for future research. These findings suggest that this particular outdoor education program was successful in encouraging students’ self-reported environmentally responsible behaviour. This change was achieved without significant change in knowledge or environmental attitudes, suggesting that external factors not measured in this study might have played a role in affecting behaviour.

The Relation Between Civic Education and Political Attitudes and Behavior

It is generally assumed that civic education efforts will have a positive effect on the political attitudes and behaviors of adolescents and young adults. There is less agreement, however, on the most effective forms of civic education. In the present study, we distinguish between formal civic education, an open classroom climate and active learning strategies, and we explore their effect on political interest, efficacy, trust and participation. To analyze these effects, we rely on the results of a two-year panel study among late adolescents in Belgium. The results indicate that formal civic education (classroom instruction) and active learning strategies (school council membership and, to a lesser extent, group projects) are effective in shaping political attitudes and behavior. An open classroom climate, on the other hand, has an effect on political trust. We conclude that there is no reason to privilege specific forms of civic education, as each form contributes to different relevant political attitudes and behaviors.

National survey of speeding and other unsafe driving actions. Volume II: driver attitudes and behavior.

National Highway Traffic Safety Administration, Office of Research and Traffic Records, Washington, D.C.

Reflectivity and durability of epoxy pavement markings. Interim report.

Federal Highway Administration, Office of Research, Development and Technology, Washington, D.C.

Satellite mentality; political attitudes and propaganda susceptibilities of non-Communists in Hungary, Poland, and Czechoslovakia

"A report of the Bureau of Applied Social Research, Columbia University."