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.^

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.

Cause-related sport sponsorship: An assessment of spectator beliefs, attitudes, and behavioral intentions

Marketing communications utilizing a non-profit cause (i.e., the sponsorship of a nonprofit cause) have emerged as a mainstream practice as practitioners respond to rising consumer expectations of corporate social responsibility (CSRI. The increasing popularity of cause-related marketing programs (CRMPS) can be attributed to the Integration of sponsorship in many organizations' sport marketing strategy. The purpose of this study was to examine the attitudes, beliefs, and purchase intentions of consumers exposed to a firm's sponsorship of a sporting event associated with a non-profit organization. A survey instrument was developed by a panel of experts, pre-tested, revised, and completed by (442 event spectators. Results suggested consumers' attitudes, beliefs, and purchase intentions toward the sponsoring company were positively impacted by the firm's involvement with cause-related marketing.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers. 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level. (c) 2005 Published by Elsevier Ltd.

Assessing professionalism: theory and practice

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather titan attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Individual spirit at work and its relationship with employee work attitudes and organisational outcomes:An empirical examination in corporate Thailand

The purpose of this thesis is to conduct empirical research in corporate Thailand in order to (1) validate the Spirit at Work Scale (2) investigate the relationships between individual spirit at work and three employee work attitudinal variables (job satisfaction, organisational identification and psychological well-being) and three organisational outcomes (in-role performance, organisational citizenship behaviours (OCB), and turnover intentions) (3) further examine causal relations among these organisational behaviour variables with a longitudinal design (4) examine three employee work attitudes as mediator variables between individual spirit at work and three organisational outcomes and (5) explore the potential antecedents of organisational conditions that foster employee experienced individual spirit at work. The two pilot studies with 155 UK and 175, 715 Thai samples were conducted for validation testing of the main measure used in this study: Spirit at Work Scale (Kinjerski & Skrypnek, 2006a). The results of the two studies including discriminant validity analyses strongly provided supportive evidence that Spirit at Work Scale (SAWS) is a sound psychometric measure and also a distinct construct from the three work attitude constructs. The final model of SAWS contains a total of twelve items; a three factor structure (meaning in work, sense of community, and spiritual connection) in which the sub-factors loaded on higher order factors and also had very acceptable reliability. In line with these results it was decided to use the second-order of SAWS model for Thai samples in the main study and subsequent analysis. The 715 completed questionnaires were received from the first wave of data collection during July - August 2008 and the second wave was conducted again within the same organisations and 501 completed questionnaires were received during March - April 2009. Data were obtained through 49 organisations which were from three types of organisations within Thailand: public organisations, for-profit organisations, and notfor-profit organisations. Confirmatory factor analysis of all measures used in the study and hypothesised model were tested with structural equation modelling techniques. The results were greatly supportive for the direct structural model and partially supportive for the fully mediated model. Moreover, there were different findings across self report and supervisor rating on performance and OCB models. Additionally, the antecedent conditions that fostered employees experienced individual spirit at work and the implications of these findings for research and practice are discussed.

Pharmacy and public health: examining the link between strategy and practice

Despite having been described by the then (2003) Chief Pharmaceutical Officer for England as ·probably the biggest untapped resource for health improvement", the development of the public health function of community pharmacists has been limited. However, devolution of healthcare budgets has led 10 differential rates of development of the public health function in each administration of the UK (England, Scotland, Wales and Northern Ireland). This is measured and reflected upon in this thesis. Two large-scale surveys were conducted, one of key strategic personnel (Directors of Public Health and Chief Pharmacists) in Primary Care Organisations (PCOs) and one of practicing community pharmacists. This research highlights the fact that community pharmacists have developed an individualistic, service-based approach to their engagement with public health that is contrary to the more collective approach adopted by the wider public health movement. The study measures the scope and level of health-improving services through community pharmacy across the UK and shows that the nature of the pharmacy contractor (independent, multiple etc.) may impact on the range and nature of services provided. Survey data also suggest that attitudes towards pharmacy involvement in the public health agenda vary markedly between Directors of Public Health, PCO Chief Pharmacists, and community pharmacists. Furthermore, within the community pharmacist population, attitudes are affected by a wide range of factors including the nature of employment (owner, employee, self-employed) and the type of employing pharmacy (independent, multiple etc.). Implications for policy and areas for further research aimed at maximising the public health function of community pharmacists are suggested.

Work-life balance benefits:employee attitudes and behaviors through the lens of social exchange theory

The question of what to provide employees in order that they reciprocate with desirable behaviors in the work place has resulted in a great amount of work in the area of social exchange. Although offering fair compensation, including salary or wages and employee benefits, has been extensively studied, the effects of offering specific types of benefits, such as work-life balance benefits, and the intangible rewards that such an offering inadvertently offers, has only been minimally explored. Utilizing past literature, this current research examined the offering of work-life balance benefits, the value employees place on those benefits, the communication of the benefits by the organization to employees, and their effect on employee attitudes and behaviors. The goal was to identify the effect on desirable outcomes when work-life balance benefits are offered to determine the usefulness to the organization of offering such benefits. To test these effects, a study of an organization known to offer a strong work-life balance benefits package was undertaken. This was accomplished through the distribution of questionnaires to identify the possible relationships involving 408 employee respondents and their 79 supervisors. This was followed with interviews of 12 individuals to ascertain the true reasons for links observed through analysis. Analysis of the data was accomplished through correlation analysis, multilevel analysis and regression analysis generated by SPSS. The results of the quantitative analysis showed support for a relationship between the offering of work-life balance benefits and perceived organizational support, perceived distributive justice, job satisfaction and OCBO. The analysis also showed a lack of support for a relationship between the offering of work-life balance benefits and organizational commitment, OCBI and IRB. The interviews offered possible reasons for the lack of support regarding the relationship between the offering of work-life balance benefits and organizational commitment as well as organizational citizenship behaviors (OCBI and IRB). The implications of these findings on future research, theory and practice in the offering of work-life balance benefits are discussed.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Teaching English to young learners in Europe:teachers' attitudes and perspectives

The introduction of languages into the primary curriculum has been the major development in language-in-education policy around the world over the last 20-25 years. In the vast majority of countries the language taught is English and it is being taught at an ever-earlier age. A relatively large amount of research has been carried out in Asia into teaching English to young learners (TEYL) from the point of view of language policy and planning and of policy implementation, especially in terms of the gap between policy and practice caused by the introduction of new methodologies such as communicative language teaching. However, to date far less research has been carried out into the situation in Europe, particularly concerning the attitudes of those most closely involved in policy implementation - the teachers themselves. This chapter examines the attitudes of teachers in six European countries (Italy, Latvia, Macedonia, Poland, Spain and Ukraine), uncovering the challenges they face and the changes they would like to see enacted to improve English language learning and teaching in their countries. The implications for policy, planning and teacher education are also discussed.

Oman's foreign policy: Foundations and practice

The object of this dissertation is to record and analyze the foreign policy of the Sultanate of Oman from the early twentieth century until 2004. It challenges the central assumption of the contemporary scholarship on the subject that Muscat's modern foreign policy begins in 1970. It is often presumed that the pre-1970 era does not merit a thorough investigation to understand Muscat's modus operandi today. This study argues that for a comprehensive understanding of Muscat's foreign policy since 1970, the frontier of the historical analysis of Oman's regional and international involvement should be pushed back to the 1930's, when the young Sultan Said assumed power over the country divided by the "Treaty" or the "Agreement" of Sib. Indeed, the thrust of this research lies at once in repudiating the conventional wisdom regarding both the persona of Sultan Said and the customary political/historical narrative of Said's reign. The critical analysis of this period is utilized to rebut the pervasive and largely inaccurate historical narrative of the events prior to 1970, to recount an original interpretation of the period, and to use the narrative as a preamble for subsequent foreign policy directions and initiatives. Furthermore, this dissertation covers the gaps in the literature resulting from the absence of any materials that either record or analyze Muscat's foreign policy from 1996 until 2004. In addition, his study provides new information and a fresh analysis of the international relations of the region, including great power rivalry, especially the competition between the United States and Great Britain, and the attitudes of major regional actors, such as Iran, Saudi Arabia, and Iraq. ^ The use of a thorough historical inquiry is vital to support the central claim of this dissertation; therefore, a large section of this dissertation is based almost exclusively on archival materials collected from the British Public Records Office, the University of Oxford and the Library of Congress. This project represents the most comprehensive use of archival materials on the subject matter to date. ^

Oman's foreign policy : foundations and practice

The object of this dissertation is to record and analyze the foreign policy of the Sultanate of Oman from the early twentieth century until 2004. It challenges the central assumption of the contemporary scholarship on the subject that Muscat's modern foreign policy begins in 1970. It is often presumed that the pre-1970 era does not merit a thorough investigation to understand Muscat's modus operandi today. This study argues that for a comprehensive understanding of Muscat's foreign policy since 1970, the frontier of the historical analysis of Oman's regional and international involvement should be pushed back to the 1930's, when the young Sultan Said assumed power over the country divided by the "Treaty" or the "Agreement" of Sib. Indeed, the thrust of this research lies at once in repudiating the conventional wisdom regarding both the persona of Sultan Said and the customary political/historical narrative of Said's reign. The critical analysis of this period is utilized to rebut the pervasive and largely inaccurate historical narrative of the events prior to 1970, to recount an original interpretation of the period, and to use the narrative as a preamble for subsequent foreign policy directions and initiatives. Furthermore, this dissertation covers the gaps in the literature resulting from the absence of any materials that either record or analyze Muscat's foreign policy from 1996 until 2004. In addition, his study provides new information and a fresh analysis of the international relations of the region, including great power rivalry, especially the competition between the United States and Great Britain, and the attitudes of major regional actors, such as Iran, Saudi Arabia, and Iraq. The use of a thorough historical inquiry is vital to support the central claim of this dissertation; therefore, a large section of this dissertation is based almost exclusively on archival materials collected from the British Public Records Office, the University of Oxford and the Library of Congress. This project represents the most comprehensive use of archival materials on the subject matter to date.

Geographical Literacy, Attitudes, and Experiences of Freshman Students: A Qualitative Study at Florida International University

The purpose of the study was to explore the geography literacy, attitudes and experiences of Florida International University (FIU) freshman students scoring at the low and high ends of a geography literacy survey. The Geography Literacy and ABC Models formed the conceptual framework. Participants were freshman students enrolled in the Finite Math course at FIU. Since it is assumed that students who perform poorly on geography assessments do not have an interest in the subject, testing and interviewing students allowed the researcher to explore the assumption. In Phase I, participants completed the Geography Literacy Survey (GLS) with items taken from the 2010 NAEP Geography Subject Area Assessment. The low 35% and high 20% performers were invited for Phase II, which consisted of semi-structured interviews. A total of 187 students participated in Phase I and 12 in Phase II. The primary research question asked was what are the geography attitudes and experiences of freshman students scoring at the low and high ends of a geographical literacy survey? The students had positive attitudes regardless of how they performed on the GLS. The study included a quantitative sub-question regarding the performance of the students on the GLS. The students’ performance on the GLS was equivalent to the performance of 12th grade students from the NAEP Assessment. There were three qualitative sub-questions from which the following themes were identified: the students’ definition of geography is limited, students recall more out of school experiences with geography, and students find geography valuable. In addition, there were five emergent themes: there is a concern regarding a lack of geographical knowledge, rote memorization of geographical content is overemphasized, geographical concepts are related to other subjects, taking the high school level AP Human Geography course is powerful, and there is a need for real-world applications of geographical knowledge. The researcher offered as suggestions for practice to reposition geography in our schools to avoid misunderstandings, highlight its interconnectedness to other fields, connect the material to real world events/daily decision-making, make research projects meaningful, partner with local geographers, and offer a mandatory geography courses at all educational levels.