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PubMed2004

A national survey on the effect of pharmaceutical promotion on medical students.

The pharmaceutical industry affects physicians' clinical decision-making, especially their prescribing behaviour. However, little is known of the interactions between medical students and the pharmaceutical industry. The purpose of the present study was to examine the extent and perceived influence of pharmaceutical promotion on Finnish medical students and students' attitudes towards such promotion. Altogether 952 students (34%) responded to an anonymous questionnaire that was distributed to all Finnish medical students at varying levels of study. Students reported that they attended presentations by pharmaceutical company representatives on a frequent basis. A total of 44% attended at least twice a month. Students regarded the pharmaceutical industry as one of their most important sources of pharmaceutical information. The importance attached to pharmaceutical promotion as a source of pharmaceutical information and the intensity of pharmaceutical marketing increased over the course of medical studies. Although most students were not in favour of reducing promotion, the students largely believed that such activities would affect their future prescribing behaviour, and the awareness of this influence increased over the course of studies. The fact that medical students are commonly exposed to pharmaceutical promotion should be addressed in medical education.

Attitude to Health↗
PubMed2000

The Leeds Assessment Scale of Handicap: its operationalisation, reliability, validity and responsiveness in in-patient rehabilitation.

PURPOSE: This paper describes the application of the handicap dimension of the International Classification of Impairments, Disabilities and Handicaps. METHOD: A method of assessing four of the six roles (or areas of expected competency) was developed and applied to an in-patient population, aged 16 to 65 years, receiving specialist rehabilitation following neurological damage. Handicap assessment was a collaborative process by a multidisciplinary team. Difficulties were experienced in measuring inter-rate reliability in the busy, clinical setting. RESULTS: We conclude that handicap assessment in an in-patient rehabilitation unit which uses a multidisciplinary approach to treating patients with complex physical, sensory and cognitive problems is both feasible and useful. CONCLUSION: The developed scale, The Leeds Assessment Scale of Handicap, provides a valid and valuable summary of human disadvantage, complementing the common disability assessments.

Activities of Daily Living↗
PubMed2006

Rehabilitation Medicine Summit: Building Research Capacity--executive summary.

The advancement of medical science depends on the production, availability, and utilization of new information generated by research. A successful research enterprise depends not only on a carefully designed agenda that responds to clinical and societal needs but also on the research capacity necessary to perform the work. Research that is likely to enhance clinical practice presupposes the existence of a critical mass of investigators working as teams in supportive environments. Unfortunately, far too little research capacity of that kind exists in rehabilitation medicine to ensure a robust future for the field. The "Rehabilitation Medicine Summit: Building Research Capacity" was conceptualized as a way of fashioning a long-term plan to foster the required developments.

Biomedical Research↗
PubMed2004

The logic of collaboration in education and the human services.

Collaboration is a complex intervention with multiple components. It is both a process innovation and a product innovation, and it entails institutional development and change. These and other defining features implicate its contingencies. For example, collaboration is tailor made for needs, problems, and opportunities that manifest novelty, complexity, uncertainty, and interdependent relationships. Contingencies like these signal important constraints. For example, collaboration exacts steep transaction costs. Its potential benefits justify these costs and serve as incentives for its development. In fact, collaboration may be a defining feature of competent and optimal practice, and the failure to collaborate may be indicative of negligence and malpractice.

Community Participation↗
PubMed2006

Quality of life and psychopathology: investigations into their relationship.

OBJECTIVE: Quality of life (QOL) has become a topic of growing interest in medical and psychiatric practice in general, and in research in particular. Although the body of knowledge about the complex relationship between QOL and psychiatric disorders is growing, understanding this relationship still remains difficult. Therefore, the aim of the present study was to get more and new insights into this relationship. It was hypothesized that QOL would be negatively related to the presence as well as the severity of psychopathology. METHOD: A random sample of Dutch adult psychiatric outpatients (n=410) completed the World Health Organization Quality of Life assessment instrument, abbreviated version (WHOQOL-Bref). In addition, DSM-IV axis I and II diagnoses were obtained. Comparisons were made between scores of the psychiatric outpatients, diagnostic subgroups within this population, and the scores of a general population. RESULTS: Compared with the general population, psychiatric outpatients scored significantly worse on all aspects of QOL. Within the group of outpatients, participants with DSM-IV diagnoses had worse scores than those without. Participants with comorbidity had the worst QOL. CONCLUSIONS: It is concluded that QOL scores are negatively related to both the presence and the severity of psychopathology, and that the presence of a personality disorder plays a role in subjectively experienced QOL.

Adult↗
PubMed2004

Using social networks to understand and prevent substance use: a transdisciplinary perspective.

We review findings from research on smoking, alcohol, and other drug use, which show that the network approaCh is instructive for understanding social influences on substance use. A hypothetical network is used throughout to illustrate different network findings and provide a short glossary of terms. We then describe how network analysis can be used to design more effective prevention programs and to monitor and evaluate these programs. The article closes with a discussion of the inherent transdisciplinarity of social network analysis.

Biomedical Research↗
PubMed2004

In search of reflective behavior and shared understanding in ad hoc expert teams.

The work reported on here concentrates on virtual ad hoc expert teams for the integration of learning and working, as ad hoc teams seem to be one way to cope with complexity in a knowledge-intensive society. In order to let ad hoc teams learn and work together, group members require effective communication and shared understanding among each other. Two empirical studies were conducted to study collaborative learning and shared understanding, one exploratory study and one experiment. In the first study, it was explored how virtual design teams work and learn together. Based on conceptual ideas, collaborative learning and shared understanding were observed and assessed in a design team over a period of four months. It was concluded that shared understanding was suboptimal; mainly due to the effect that hardly any questions were raised and answered. The second study elaborates on the need to encourage question-answer patterns and reflective behavior in such teams. A tool was developed that supported questioning behavior. As it was hypothesized that this tool leads to better questioning behavior, which in turn results in more reflective behavior and in increased shared understanding, an experiment was conducted. In the exploratory study, as well as in the experimental study, the perceived shared understanding increased over time. However, in both studies suboptimal questioning behavior and little reflective activity were noticed. The main results of the two empirical studies are compared and discussed.

Adult↗
PubMed2003

Multi-agency, multi-professional work: experiences from a drug prevention project.

Policy documents at local, national and international level continue to call for greater multi-agency and multi-professional working. These calls are based on three arguments: (1) health and illness are created and influenced by multiple factors outside of health service policy, (2) health improvement requires collaboration between statutory, voluntary and private sector organizations, and (3) efficiency and effectiveness are aided when duplication of effect is avoided and service transition is as seamless as possible. However, there remains limited process-orientated research that has explored the difficulties and challenges faced during multi-agency and multi-professional work. This study employed qualitative methods (interviews, participant observation and documentary analysis) to understand the social construction of a multi-agency and multi-professional health promotion project orientated toward the prevention of drug-related harm. The findings illustrate the ways in which the processes involved in securing funding led to multiple and competing project aims, how changes in personnel and the internal (re)organization of agencies created disjunctions in project membership and shared understandings of key priorities, and how the social need to keep group members 'onside' and committed, competed with the imperatives of prioritization and addressing issues surrounding differentials in power between members and between agencies.

Cooperative Behavior↗
PubMed2004

Donor-recipient interaction: the Heidelberg model of evaluation and consultation.

BACKGROUND: In order to avoid psychological complications in living-donor transplantation, careful evaluation and consultation of the donor-recipient system is necessary. This article describes the Heidelberg consultation procedure before and after transplantation. This approach emphasizes close collaboration between physician and psychologist in joint interviews. METHODS: Consultations focus on family genogram, the history of the donation idea; stability and balance of relationship; expectations; hesitations and doubts; discussion of complications; previous hospital experiences; the offer to provide crisis intervention when needed. RESULTS: In 20% of all cases, unresolved problems appear. These include: unilaterally dependent relationships; unrealistic hopes for change; anxious avoidance to reflect complications; lack of medical information; risky health behaviour; negative experiences with hospitals. When properly consulted, half of these couples resign from transplantation. CONCLUSIONS: Close physician-psychologist collaboration adds significant value to a 'psychologist-only' consultation. Discussing hesitations and concerns strengthens confidence in the professional transplantation system. Access to post-transplant consultation needs further improvement.

Adult↗
PubMed2000

Promoting effective practice in secondary care.

BACKGROUND: This qualitative study aimed to explore the views of key stakeholders regarding the role that public health professionals have or should have in the provision of effective health care within the National Health Service. METHODS: A national (England) questionnaire survey generated a sample for qualitative telephone interviews and two site case studies. The interviews were conducted in three stages: first, 27 interviews were based on assessed reported levels of organizational activity, including non-respondents; next, views in six areas were consolidated by extra interviews; finally, two extra areas were visited for individual and group interviews. The interviews were analysed for salient themes. RESULTS: There was a widespread view that public health had not delivered its potential. Many Trusts currently wanted public health to have influence over commissioning, provide health needs assessments and epidemiological skills, and provide a strategic focus and unbiased advice. Evaluation of actual activity varied widely; local history and congruent personalities seemed to be associated with perceived success. In some cases there was mutual suspicion between Health Authorities and Trusts. Public health was often perceived by Trusts to have been marginalized. This perception was not shared by Public Health Consultants, who highlighted lack of resources as a reason for lack of involvement. The contribution of public health professionals working in Trusts was highly regarded. Barriers included overcoming initial prejudice and combating isolation within Trusts. There were four categories of response in respect of the potential future role for public health in implementing effective health care: no role; collaborative working between Health Authority Public Health Departments and Trusts; deployment of public health workers within Trusts, and an undecided group. Overall, the skills of public health, especially strategic vision and population perspectives, were seen as valuable but as yet unrealized. CONCLUSIONS: Public health skills (but not necessarily professionals) may be valuable in implementing effective health care in Trusts. However, public health professionals must refocus and market their skills to Trusts if the discipline is to play a key role in this task.

Attitude of Health Personnel↗
PubMed2002

Boomers vs. X-ers.

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Attitude of Health Personnel↗