Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.

Le processus décisionnel sous-jacent à la rétroaction corrective des enseignants de français langue seconde à l'oral

L’objectif de cette étude qualitative est de décrire et de comprendre le processus décisionnel sous-jacent à la rétroaction corrective d’un enseignant de langue seconde à l’oral. Pour ce faire, elle décrit les principaux facteurs qui influencent la décision de procéder à une rétroaction corrective ainsi que ceux qui sous-tendent le choix d’une technique de rétroaction particulière. Trois enseignantes de français langue seconde auprès d’un public d’adultes immigrants au Canada ont participé à cette recherche. Des séquences complètes d’enseignement ont été filmées puis présentées aux participantes qui ont commenté leur pratique. L’entretien de verbalisation s’est effectué sous la forme d’un rappel stimulé et d’une entrevue. Cet entretien constitue les données de cette étude. Les résultats ont révélé que la rétroaction corrective ainsi que le choix de la technique employée étaient influencés par des facteurs relatifs à l’erreur, à l’apprenant, au curriculum, à l’enseignant et aux caractéristiques des techniques. Ils ont également révélé que l’apprenant est au cœur du processus décisionnel rétroactif des enseignants de langue seconde. En effet, les participantes ont affirmé vouloir s’adapter à son fonctionnement cognitif, à son état affectif, à son niveau de langue et à la récurrence de ses erreurs. L’objectif de cette étude est d’enrichir le domaine de la formation initiale et continue des enseignants de L2. Pour cela, des implications pédagogiques ont été envisagées et la recommandation a été faite de porter à la connaissance des enseignants de L2 les résultats des recherches sur l’efficacité des techniques de rétroaction corrective, particulièrement celles qui prennent en compte les caractéristiques des apprenants.

Exploring the effectiveness of virtual product placement on recall and recognition of new brands

This paper investigates the effectiveness of virtual product placement as a marketing tool by examining the relationship between brand recall and recognition and virtual product placement. It also aims to address a gap in the existing academic literature by focusing on the impact of product placement on recall and recognition of new brands. The growing importance of product placement is discussed and a review of previous research on product placement and virtual product placement is provided. The research methodology used to study the recall and recognition effects of virtual product placement are described and key findings presented. Finally, implications are discussed and recommendations for future research provided.

Exploring product placement in video games : an investigation of recall effects

Despite its growth and prominence, product placement is generally under-researched and this is even more apparent in the area of placement in video gaming. This paper presents exploratory focus group research into this practice. Findings indicate that the introductory footage to a game provides placement opportunities with the highest level of recall, while peripheral non-action is the worst. Interestingly, recall also appears to be higher for individual brands as opposed to manufacturer brands.

Recall

One of the key issues in today’s competitive business environment advertising effectiveness. An important component to any advertising campaign or commercial is, whether or not it will be remembered. If a consumer cannot remember one’s brand name, how can one persuade them to buy it? Over the years, various techniques have been designed to measure the impact and effectiveness of advertisements, as well as how well they are remembered.

Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced. Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement. Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%). Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Data and process requirements for product recall coordination

When an organisation becomes aware that one of its products may pose a safety risk to customers, it must take appropriate action as soon as possible or it can be held liable. The ability to automatically trace potentially dangerous goods through the supply chain would thus help organisations fulfill their legal obligations in a timely and effective manner. Furthermore, product recall legislation requires manufacturers to separately notify various government agencies, the health department and the public about recall incidents. This duplication of effort and paperwork can introduce errors and data inconsistencies. In this paper, we examine traceability and notification requirements in the product recall domain from two perspectives: the activities carried out during the manufacturing and recall processes and the data collected during the enactment of these processes. We then propose a workflow-based coordination framework to support these data and process requirements.

Factors associated with recall of media reports about vitamin D and sun protection

Objective: To assess the recall of media reports about vitamin D and associated factors. Methods: Analysis of cross-sectional telephone interview data (2,001 Queensland adults, 18-70 years) on vitamin D and personal sun protection, recall of media reports and participant characteristics. Results: 83.7% of participants had heard of vitamin D, 47.5% through the media. Only 513 (25.6%) participants recalled the media content within four main themes: vitamin D is beneficial/comes from the sun (47.0%); some people aren’t getting enough vitamin D, need more sun (27.9%); need to balance sun exposure and skin protection (11.5%); or other (13.6%). Only 65 of the 950 participants (6.8%) reported a change to their behaviour(s) due to the media report. Conclusion: Although the media were the main source of information about vitamin D for almost 50% of participants, recall of the content and direct effect on behaviour was low. Only a small minority recalled a balanced media report of beneficial and harmful aspects of sun exposure. Implications Health professionals often supply media with background information. To achieve best public health practice for sun protection and vitamin D, information to foster balanced media reports should be provided.

Improving recall in appearance-based visual SLAM using visual expectation

In this paper, we present a new algorithm for boosting visual template recall performance through a process of visual expectation. Visual expectation dynamically modifies the recognition thresholds of learnt visual templates based on recently matched templates, improving the recall of sequences of familiar places while keeping precision high, without any feedback from a mapping backend. We demonstrate the performance benefits of visual expectation using two 17 kilometer datasets gathered in an outdoor environment at two times separated by three weeks. The visual expectation algorithm provides up to a 100% improvement in recall. We also combine the visual expectation algorithm with the RatSLAM SLAM system and show how the algorithm enables successful mapping

Growth-hormone-stimulated dentinogenesis in Lewis dwarf rat molars

In dentinogenesis, certain growth factors, matrix proteoglycans, and proteins are directly or indirectly dependent on growth hormone. The hypothesis that growth hormone up-regulates the expression of enzymes, sialoproteins, and other extracellular matrix proteins implicated in the formation and mineralization of tooth and bone matrices was tested by the treatment of Lewis dwarf rats with growth hormone over 5 days. The molar teeth were processed for immunohistochemical demonstration of bone-alkaline phosphatase, bone morphogenetic proteins-2 and -4, osteocalcin, osteopontin, bone sialoprotein, and E11 protein. Odontoblasts responded to growth hormone by more cells expressing bone morphogenetic protein, alkaline phosphatase, osteocalcin, and osteopontin. No changes were found in bone sialoprotein or E11 protein expression. Thus, growth hormone may stimulate odontoblasts to express several growth factors and matrix proteins associated with dentin matrix biosynthesis in mature rat molars.

Bovine colostrum modulates cytokine production in human peripheral blood mononuclear cells stimulated with lipopolysaccharide and phytohemagglutinin

Bovine colostrum has been shown to influence the cytokine production of bovine leukocytes. However, it remains unknown whether processed bovine colostrum, a supplement popular among athletes to enhance immune function, is able to modulate cytokine secretion of human lymphocytes and monocytes. The aim of this investigation was to determine the influence of a commercially available bovine colostrum protein concentrate (CPC) to stimulate cytokine production by human peripheral blood mononuclear cells (PBMCs). Blood was sampled from four healthy male endurance athletes who had abstained from exercise for 48 h. PBMCs were separated and cultured with bovine CPC concentrations of 0 (control), 1.25, 2.5, and 5% with and without lipopolysaccharide (LPS) (3 microg/mL) and phytohemagglutinin (PHA) (2.5 microg/mL). Cell supernatants were collected at 6 and 24 h of culture for the determination of tumor necrosis factor (TNF), interferon (IFN)-gamma, interleukin (IL)-10, IL-6, IL-4, and IL-2 concentrations. Bovine CPC significantly stimulated the release of IFN-gamma, IL-10, and IL-2 (p < 0.03). The addition of LPS to PBMCs cocultured with bovine CPC significantly stimulated the release of IL-2 and inhibited the early release of TNF, IL-6, and IL-4 (p < 0.02). Phytohemagglutinin stimulation in combination with bovine CPC significantly increased the secretion of IL-10 and IL-2 at 6 h of culture and inhibited IFN-gamma and TNF (p < 0.05). This data show that a commercial bovine CPC is able to modulate in vitro cytokine production of human PBMCs. Alterations in cytokine secretion may be a potential mechanism for reported benefits associated with supplementation.