Motivations and perceived influences on rural and urban general practitioners when prescribing conventional non-steroidal anti-inflammatory drugs or COX-2 inhibitors

Background and objective: Prescribers in rural and remote locations perceive that there are different influences on their prescribing compared with those experienced by urban prescribers. The aim of this study was to compare the motivations and perceived influences on general practitioners (GPs) when prescribing COX-2 inhibitors rather than conventional non-steroidal anti-inflammatory drugs (NSAIDs) between rural and urban-based GPs in Queensland, Australia. Methods: A questionnaire was administered to two geographically distinct groups of GPs, one urban (n = 67) and one rural (n = 67), investigating the reasons that the GP would prescribe a COX-2 inhibitor rather than a conventional NSAID or vice versa and also focusing on patients requesting a prescription for a COX-2 inhibitor. Results and discussion: A 51% response rate (n = 68) was achieved. The difference between the rural and the urban GPs was that the urban GPs were more likely to perceive that they were influenced to prescribe COX-2 inhibitors by their patients' knowledge of these new (at the time) drugs. GPs in both the rural and urban areas perceived the COX-2 selective inhibitors to be safer than conventional NSAIDs, and that there was little difference in terms of efficacy between the two drug classes. However, GPs from both of the study areas stated that conventional NSAIDs were preferred over COX-2 selective inhibitors, primarily due to their expense, if their patients were not at risk for developing a GI bleed. Conclusion: The motivations and perceived influences to prescribe a COX-2 inhibitor in rural and in urban areas of Queensland, Australia were very similar. Almost all surveyed GPs in rural and urban areas had patients request a prescription, or enquire about the COX-2 inhibitors. Urban GPs were more likely to feel pressured to prescribe a COX-2 inhibitor than their rural counterparts, agreeing with other research which found that patient pressure to prescribe appears to be greater in urban general practice.

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.

Dynamic occupational therapy cognitive assessment for children: Perceived utility in Australian occupational therapy practice

Background and Aim: The Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), recently developed in Israel, assesses the cognitive areas: orientation, spatial perception, praxis, visuomotor construction and thinking operations of 6- to 12-year-old children. The dynamic aspect, which incorporates mediation and prompting, has been presented as a valuable clinical feature of this new assessment. This study investigated the cultural suitability, dynamic nature and comprehensiveness of the DOTCA-Ch as a single cognitive assessment for occupational therapy practice in Australia. Methods: Twenty-three paediatric occupational therapists participated in three tutorial and video demonstrations, which were then followed by a group interview. Results and Conclusion: Thematic analysis of transcripts identified four main themes: appropriateness of assessment tasks, language, mediation and clinical utility. Within each theme, the participants raised both positive and negative features. This paper highlights occupational therapists' mixed views on the clinical utility of this assessment in Australia. Limitations of this study and areas for further research are suggested

Adolescents' reactions to universal and indicated prevention programs for depression: Perceived stigma and consumer satisfaction

There is a common view that one of the major considerations in selecting between universal and indicated interventions is the marked stigma produced by the latter. However, to date there has been no empirical examination of this assumption. The current study examined reported stigma and program satisfaction following two school-based interventions aimed at preventing depression in 532 middle adolescents. The interventions were conducted either across entire classes by classroom teachers (universal delivery) or in small high risk groups by mental health professionals (indicated delivery). The indicated delivery was associated with significantly greater levels of perceived stigma, but effect sizes were small and neither program was associated with marked stigma in absolute terms. Perceived stigma was more strongly associated with aspects of the individual including being male and showing greater externalizing symptomatology. In contrast, the indicated program was evaluated more positively by both participants and program leaders and effect sizes for these measures of satisfaction were moderate to large. The results point to the need for further empirical evaluation of both perceived stigma and program satisfaction in providing balanced considerations of the value of indicated and universal programs.

Differences in sharing knowledge interpersonally and via databases: The role of evaluation apprehension and perceived benefits

Knowledge sharing is an essential component of effective knowledge management. However, evaluation apprehension, or the fear that your work may be critiqued, can inhibit knowledge sharing. Using the general framework of social exchange theory, we examined the effects of evaluation apprehension and perceived benefit of knowledge sharing ( such as enhanced reputation) on employees' knowledge sharing intentions in two contexts: interpersonal (i.e., by direct contact between two employees) and database (i.e., via repositories). Evaluation apprehension was negatively associated with knowledge sharing intentions in both contexts while perceived bene. it was only positively associated with knowledge sharing intentions in the database context. Moreover, compared to the interpersonal context, evaluation apprehension was higher and knowledge sharing lower in the database context. Finally, the negative effects of evaluation apprehension upon knowledge sharing intentions were worse when perceived benefits were low compared to when perceived benefits were high.

Effects of reflex stimulus intensity and stimulus onset asynchrony on prepulse inhibition and perceived intensity of the blink-eliciting stimulus

Prepulse inhibition of the blink reflex is widely applied to investigate information processing deficits in schizophrenia and other psychiatric patient groups. The present experiment investigated the hypothesis that prepulse inhibition reflects a transient process that protects preattentive processing of the prepulse. Participants were presented with pairs of blinkeliciting noises, some preceded by a prepulse at a variable stimulus onset asynchrony (SOA), and were asked to rate the intensity of the second noise relative to the first. Inhibition of blink amplitude was greater for a 110-dB (A) noise than for a 95-dB(A) noise with a 120-ms SOA, whereas there was no difference with a 30-ms SOA. The perceived intensity was also lower for the 110-dB(A) noise than for the 95-dB(A) noise with the 120-ms SOA, but not with the 30-ms SOA. The parallel results support a relationship between prepulse inhibition of response amplitude and perceived intensity. However, the prepulse did not reduce intensity ratings relative to control trials in some conditions, suggesting that prepulse inhibition is not always associated with an attenuation of the perceived impact of the blink-eliciting stimulus.

Why do people engage in collective action? Revisiting the role of perceived effectiveness

Research has shown limited support for the notion that perceived effectiveness of collective action is a predictor of intentions to engage in collective action. One reason may be that effectiveness has been in terms of whether the action will influence key decision makers. We argue that the effectiveness of collective action might be judged by other criteria, such as whether it influences third parties, builds an oppositional movement, and expresses values. Two hundred and thirty one attendees at a rally rated the effectiveness of the rally and their intentions to engage in future collective action. For those participants who were not members of an organization, intentions were linked to the perceived effectiveness of the rally in expressing values and influencing the public. For those who were members of an organization, intentions were linked only to the effectiveness of the rally in building an oppositional movement.

Using Rasch modeling to re-evaluate three scales related to physical activity: Enjoyment, perceived benefits and perceived barriers

Studies suggest that enjoyment, perceived benefits and perceived barriers may be important mediators of physical activity. However, the psychometric properties of these scales have not been assessed using Rasch modeling. The purpose of this study was to use Rasch modeling to evaluate the properties of three scales commonly used in physical activity studies: the Physical Activity Enjoyment Scale, the Benefits of Physical Activity Scale and the Barriers to Physical Activity Scale. The scales were administered to 378 healthy adults, aged 25–75 years (50% women, 62% Whites), at the baseline assessment for a lifestyle physical activity intervention trial. The ConQuest software was used to assess model fit, item difficulty, item functioning and standard error of measurement. For all scales, the partial credit model fit the data. Item content of one scale did not adequately cover all respondents. Response options of each scale were not targeting respondents appropriately, and standard error of measurement varied across the total score continuum of each scale. These findings indicate that each scale's effectiveness at detecting differences among individuals may be limited unless changes in scale content and response format are made.

Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization

Background It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularization (EHSCR) provided an opportunity to assess pharmacological treatment and outcome in patients with proven CAD who were ineligible for revascularization. Methods We performed a secondary analysis of EHS-CR data. After excluding patients with ST-elevation myocardial infarction and those in whom revascularization was not indicated, 4409 patients remained in the analyses. We selected two groups: (1) patients in whom revascularization was the preferred treatment option (n = 3777, 86%), and (2) patients who were considered ineligible for revascularization (n = 632, 14%). Results Patient ineligible for revascularization had a worse risk profile, more often had a total occlusion (59% vs. 37%, p < 0.001), were treated more often with ACE-inhibitors (65% vs. 55%, p < 0.001) but less likely with aspirin (83% vs. 88%, p < 0.001). Overall, they had higher case-fatality at 1-year (7.0% vs. 3.7%, p < 0.001). Regarding self-perceived health status, measured via the EuroQol 5D (EQ-5D) questionnaire, these same patients reported more problems on all dimensions of the EQ-5D. Furthermore, in the revascularization group we observed an increase between discharge and 1-year follow up (utility score from 0.85 to 1.00) whereas patients ineligible for revascularization did not improve over time (utility score remained 0.80) Conclusion In this large cohort of European patients with CAD, those considered ineligible for revascularization had more co-morbidities and risk factors, and scored worse on self-perceived health status as compared to revascularized patients in the revascularization group. With the exception of ACE-inhibitors and aspirin, there were no major differences regarding drug treatment between the two groups. Given these clinically significant observations, there appears to be a role for nurse-led, multidisciplinary, rehabilitation teams that target clinically vulnerable patients whose symptoms remain refractory to standard medical care.

Multidimensional analysis of perceived risk in commercial air travel

This study attempts to assess the role of perceived risk in air passenger behaviour. A survey of 889 respondents is used to investigate a multidimensional concept of perceived risk and to analyse the differences between socio-demographic characteristics regarding passengers' risk assessment. The results indicate that financial risk and temporal risk are the most important in the context of commercial air travel. All perceived risk dimensions differ according gender, age, cultural background, income, previous experience, and reason for travelling. (C) 2006 Elsevier Ltd. All rights reserved.

Anti-American sentiment and America's perceived intent to dominate: An 11-nation study

Perceptions of America as a powerful but malevolent nation decrease its security. On the basis of measures derived from the stereotype content model (SCM) and image theory (IT), 5,000 college students in I I nations indicated their perceptions of the personality traits of, intentions of, and emotional reactions to the United States as well as their reactions to relevant world events (e.g., 9/11). The United States was generally perceived as competent but cold and arrogant. Although participants distinguished between the United States' government and its citizens, differences were small. Consistent with the SCM and IT, viewing the United States as intent on domination predicted perceptions of lack of warmth and of arrogance but not of competence and status. The discussion addresses implications for terrorist recruitment and ally support.