How to recognize and manage psychological distress in cancer patients

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

A probabilistic switch model of information flow in social networks: Application for virtual circuits to organizational design

Network building and exchange of information by people within networks is crucial to the innovation process. Contrary to older models, in social networks the flow of information is noncontinuous and nonlinear. There are critical barriers to information flow that operate in a problematic manner. New models and new analytic tools are needed for these systems. This paper introduces the concept of virtual circuits and draws on recent concepts of network modelling and design to introduce a probabilistic switch theory that can be described using matrices. It can be used to model multistep information flow between people within organisational networks, to provide formal definitions of efficient and balanced networks and to describe distortion of information as it passes along human communication channels. The concept of multi-dimensional information space arises naturally from the use of matrices. The theory and the use of serial diagonal matrices have applications to organisational design and to the modelling of other systems. It is hypothesised that opinion leaders or creative individuals are more likely to emerge at information-rich nodes in networks. A mathematical definition of such nodes is developed and it does not invariably correspond with centrality as defined by early work on networks.

Telemedicine for rural and remote child and youth mental health services

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.

Public and private psychiatry: Can they work together and is it worth the effort?

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

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.

Stepping Stones Triple P: A pilot study to evaluate acceptability of the program by parents of a child diagnosed with an Autism Spectrum Disorder

The experience of parents of children with Autism Spectrum Disorder (ASD) in standard parenting programs has not been researched, although anecdotal evidence suggests that they do not find them acceptable. Forty-two parents of children with ASD were asked to view a DVD explaining individual parenting strategies from Stepping Stones, a new branch of the Triple P program targeted specifically at parents of children with disabilities. Parents were asked to rate each strategy for acceptability, usability and behavioural intention, i.e., their intention to use the strategy. Additionally, parental attributions and parental perceived control were explored as possible barriers to positive evaluations of Stepping Stones parenting strategies. A focus group of parents was used to gather more detailed parent response to the program. Parent responses to the program were generally positive and attribution of the child's behaviour to uncontrollable factors was found to predict higher ratings of usability. The results were interpreted within the context of Weiner's attributional theory and the theory of reasoned action. The limitations of this study and suggestions for future research are discussed. (c) 2005 Elsevier Ltd. All rights reserved.

PARCERIA ENTRE UNIVERSIDADE E ENTIDADES EMPRESARIAIS NO GRANDE ABC PAULISTA: A INTEGRAÇÃO ENSINO-PESQUISA E A PRÁTICA EMPRESARIAL

O Brasil situa-se, no início da década de 2010, dentro de um sistema econômico mundial que apresenta características de ampla globalização dos mercados e alta competitividade das organizações que compõe esse sistema, e que sinalizam a necessidade de profissionais que sejam agentes de mudança nesses contextos dinâmicos e repletos de desafios. Na maioria dos países, a maturidade do sistema de inovação está ligada ao investimento em Pesquisa e Desenvolvimento (P&D) e ao volume de geração de Propriedade Intelectual (PI). O Brasil, apesar de apresentar um Produto Interno Bruto (PIB) concentrado nos setores de agropecuária e de serviços, revela um nível de inovação gerado pelo setor produtivo e o seu consequente investimento em P&D muito baixos em comparação com a evolução desse mesmo PIB, denotando com isso que as empresas buscam, em seus países de origem, soluções já desenvolvidas e patenteadas para seu desenvolvimento ou procuram transferir a responsabilidade de produzir registros e patentes de inovações à academia. A integração da cultura acadêmica com a cultura empresarial é capaz de gerar benefícios mútuos, melhorando a competitividade do país; em outras palavras, é uma maneira de transformar o conhecimento em riqueza. Este trabalho relacionando os conceitos ensino-pesquisa e prática empresarial pretende estudar, sob o enfoque da realidade apresentada pelos Planos Estratégicos Regionais (PER) da Região do Grande ABC Paulista e das diretrizes do Plano Nacional de Pós-Graduação 2011-2020 (PNPG 2011-2020), o processo de integração do conhecimento científico existente entre as Entidades Empresariais (E-E) e as Universidades dessa mesma região. Através da metodologia de pesquisa de estudo de caso, analisaram-se as estratégias propostas pelas universidades e a prática do setor empresarial e as possíveis barreiras apontadas como restrições às interações entre eles. Nosso estudo enfocou a análise da relação entre esses dois atores e apontou as principais barreiras para a otimização dessa parceria, tais como o acesso a recursos, o aumento da competitividade via aumento da credibilidade na relação Universidade Empresa (U-E), o reconhecimento das realidades regionais e o latente descompasso entre o pensamento acadêmico e a realidade empresarial. Além disso, constatou-se a necessidade de uma mais ampla discussão, disseminação e implementação dos documentos setoriais, regionais e nacionais que regulam, esclarecem e fornecem bases estratégicas para o desenvolvimento da relação U-E, como forma de otimização do processo de transformação do conhecimento em riqueza social.

I got pregnant, I was so like ... crying inside...: experiences of women of Pakistani ancestry seeking contraception in the UK

South Asian women in Britain are less likely to use contraception than women in other ethnic groups. Previous studies have identified a lack of knowledge combined with low levels of English language and/or literacy as barriers to using contraception, but have not examined in detail women's experiences of accessing services. This qualitative study focused on the experiences of 19 Muslim women of Pakistani ancestry and the views of six health and community workers. The findings detail considerable institutional barriers to accessing contraceptive services, such as a lack of information and the paternalistic attitudes of some health professionals. The study suggests that, although all the women were motivated to access and use contraception, their ability to make informed choices was often limited. It was only when the women encountered advocates, who might be professionals or from their social networks, that they could begin to take control of their fertility. This study is consistent with earlier research and shows that lack of access to contraceptive services can have high personal and social costs for South Asian women.

University to business technology transfer — UK and USA comparisons

University to business technology transfer offers specific challenges, beyond those encountered in industry more widely. This paper examines the issues in university to business technology transfer in the UK and USA and presents the results of a survey of UK and US university technology transfer officers. Findings indicate significant differences in the motivations of universities in each country to transfer technology, the consistency of university technology transfer policies and the accessibility of university technologies to business. The study also looks at perceived barriers to university to business technology transfer and offers suggestions for possible improvements to the process. © 2006 Elsevier Ltd. All rights reserved.

An application of strategic group theory to the UK pharmaceuticals industry

Conducts a strategic group mapping exercise by analysing R&D investment, sales/marketing cost and leadership information pertaining to the pharmaceuticals industry. Explains that strategic group mapping assists companies in identifying their principal competitors, and hence supports strategic decision-making, and shows that, in the pharmaceutical industry, R&D spending, the cost of sales and marketing, i.e. detailing, and technological leadership are mobility barriers to companies moving between sectors. Illustrates, in bubble-chart format, strategic groups in the pharmaceutical industry, plotting detailing-costs against the scale of activity in therapeutic areas. Places companies into 12 groups, and profiles the strategy and market-position similarities of the companies in each group. Concludes with three questions for companies to ask when evaluating their own, and their competitors, strategies and returns, and suggests that strategy mapping can be carried out in other industries, provided mobility barriers are identified.

Does the motivation for foreign direct investment affect productivity spillovers to the domestic sector?

There is increasing empirical and theoretical evidence that foreign direct investment (FDI) may be motivated not by the desire to exploit some competitive advantage possessed by multinationals, but to access the technology of host economy firms. Using a panel of FDI flows across OECD countries and manufacturing sectors between 1984 and 1995, we test whether these contrasting motivations influence the effects that FDI has on domestic total factor productivity. The distinction between technology-exploiting FDI (TEFDI) and technology-sourcing FDI (TSFDI) is made using R&D intensity differentials between host and source sectors. The hypothesis that the motivation for FDI has an effect on total factor productivity spillovers is supported: TEFDI has a net positive effect, while TSFDI has a net negative effect. These net effects are explained in terms of the offsetting influences of productivity spillovers and market stealing effects induced by incoming multinationals.

Macro determinants of FDI inflows to Japan:an analysis of source country characteristics

This paper examines the source country determinants of FDI into Japan. The paper highlights certain methodological and theoretical weaknesses in the previous literature and offers some explanations for hitherto ambiguous results. Specifically, the paper highlights the importance of panel data analysis, and the identification of fixed effects in the analysis rather than simply pooling the data. Indeed, we argue that many of the results reported elsewhere are a feature of this mis-specification. To this end, pooled, fixed effects and random effects estimates are compared. The results suggest that FDI into Japan is inversely related to trade flows, such that trade and FDI are substitutes. Moreover, the results also suggest that FDI increases with home country political and economic stability. The paper also shows that previously reported results, regarding the importance of exchange rates, relative borrowing costs and labour costs in explaining FDI flows, are sensitive to the econometric specification and estimation approach. The paper also discusses the importance of these results within a policy context. In recent years Japan has sought to attract FDI, though many firms still complain of barriers to inward investment penetration in Japan. The results show that cultural and geographic distance are only of marginal importance in explaining FDI, and that the results are consistent with the market-seeking explanation of FDI. As such, the attitude to risk in the source country is strongly related to the size of FDI flows to Japan. © 2007 The Authors Journal compilation © 2007 Blackwell Publishing Ltd.

How do older people with sight loss manage their general health? A qualitative study

Purpose: Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Methods: Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Conclusion: Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Effective knowledge transfer: a terminological perspective - Dismantling the jargon barrier to knowledge about computer security

The research is concerned with the terminological problems that computer users experience when they try to formulate their knowledge needs and attempt to access information contained in computer manuals or online help systems while building up their knowledge. This is the recognised but unresolved problem of communication between the specialist and the layman. The initial hypothesis was that computer users, through their knowledge of language, have some prior knowledge of the subdomain of computing they are trying to come to terms with, and that language can be a facilitating mechanism, or an obstacle, in the development of that knowledge. Related to this is the supposition that users have a conceptual apparatus based on both theoretical knowledge and experience of the world, and of several domains of special reference related to the environment in which they operate. The theoretical argument was developed by exploring the relationship between knowledge and language, and considering the efficacy of terms as agents of special subject knowledge representation. Having charted in a systematic way the territory of knowledge sources and types, we were able to establish that there are many aspects of knowledge which cannot be represented by terms. This submission is important, as it leads to the realisation that significant elements of knowledge are being disregarded in retrieval systems because they are normally expressed by language elements which do not enjoy the status of terms. Furthermore, we introduced the notion of `linguistic ease of retrieval' as a challenge to more conventional thinking which focuses on retrieval results.

Understanding accountants' participation in accounting information systems implementation : Malaysian evidence

The study is a two-part study starting with a nationwide survey in the private sector. The hypotheses derived from the Western literature were not significantly supported when the results were analyzed. It seems that the existing literature related to the phenomenon under investigation is mainly Anglo-Saxon culture oriented which is different from the Malaysian culture where the study was conducted. However, access barriers to private sector organizations shifted the focus of the research to the second part of the study that examined the issues in detail in four public sector organizations currently implementing accounting information systems – two hospitals and two universities. In the second part of the main study, the researcher developed formal and substantive propositions from the qualitative interviews which were substantiated using a cross-case analysis; as a result, a model for accountants’ participation in AIS implementation is proposed. The research shows that the process of influencing accountants to participate in AIS implementation is more complex than the literature suggests. There were many issues that surfaced during the case studies, such as conflict and empowerment which set a foundation for further research about how participation can be secured to help make the implementation of AIS part of an organizational agenda success.