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The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials  [PDF]
John M. Kelley, Gordon Kraft-Todd, Lidia Schapira, Joe Kossowsky, Helen Riess
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094207
Abstract: Objective To determine whether the patient-clinician relationship has a beneficial effect on either objective or validated subjective healthcare outcomes. Design Systematic review and meta-analysis. Data Sources Electronic databases EMBASE and MEDLINE and the reference sections of previous reviews. Eligibility Criteria for Selecting Studies Included studies were randomized controlled trials (RCTs) in adult patients in which the patient-clinician relationship was systematically manipulated and healthcare outcomes were either objective (e.g., blood pressure) or validated subjective measures (e.g., pain scores). Studies were excluded if the encounter was a routine physical, or a mental health or substance abuse visit; if the outcome was an intermediate outcome such as patient satisfaction or adherence to treatment; if the patient-clinician relationship was manipulated solely by intervening with patients; or if the duration of the clinical encounter was unequal across conditions. Results Thirteen RCTs met eligibility criteria. Observed effect sizes for the individual studies ranged from d = ?.23 to .66. Using a random-effects model, the estimate of the overall effect size was small (d = .11), but statistically significant (p = .02). Conclusions This systematic review and meta-analysis of RCTs suggests that the patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes. Given that relatively few RCTs met our eligibility criteria, and that the majority of these trials were not specifically designed to test the effect of the patient-clinician relationship on healthcare outcomes, we conclude with a call for more research on this important topic.
An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study
Rachel A Laws, Lynn A Kemp, Mark F Harris, Gawaine Davies, Anna M Williams, Rosslyn Eames-Brown
Implementation Science , 2009, DOI: 10.1186/1748-5908-4-66
Abstract: The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.Lifestyle risk factors such as smoking, poor nutrition, excessive alc
Reliability and validity of the Arabic version of the PedsQLTM 4.0 generic ore scales and PedsQLTM 3.0 diabetes module  [PDF]
Majedah Abdul-Rasoul, Fatemah AlOtaibi, Maria AlMahdi, Hessa AlKandari
Journal of Diabetes Mellitus (JDM) , 2012, DOI: 10.4236/jdm.2012.23047
Abstract: Background: Health related quality of life (HRQOL) has become a field of extensive research involving children and adolescents with diabetes. There are no HRQOL instruments designed or adapted for the Arabic culture and language. The objectives of the study are to test the Arabic translated version of the PedsQLTM 4.0 Generic Core Scales (GCS) and the PedsQLTM 3.0 Diabetes Module (DM) in children and adolescents with type 1 diabetes (T1DM) in Kuwait and analyse their psychometric properties. Methods: After the process of translation, committee review and pre-testing (linguistic validation), 131 children and adolescents with and 104 without T1DM, with their parents completed the Arabic version of GCS. Those with T1DM completed the Arabic DM. Demographic and diabetes-related data were collected using specially designed questionnaires. Internal consistency was checked by Cronbach’s alpha coefficient. The intraclass correlations coefficient, celling and floor effects and construct validity were assessed to determine the psychometric properties of both instruments. Results: Cronbach’s alpha of the child self-report and parent proxy-report was greater than 0.70, for both instruments, indicating internal consistency reliability. Items of both instruments had minimal missing responses, and required a brief time (5 - 7 minutes) to finish indicating their feasibility. No floor effect was demonstrated. Ceiling effect ranged from 5.8% to 15.8%. The GCS distinguished between healthy and diabetic children. The intraclass correlation coefficient (ICC) between child self-report and parent proxy-report of GCS scores showed good to excellent agreement, p < 0.001. However, in the DM reports, the correlation was lower, but still significant. Girls reported lower HRQOL scores in worries and communication subscales of the diabetes module than boys, p < 0.05. Conclusions: The Arabic version of the PedsQL GCS and PedsQL DM showed sufficient feasibility, reliability and validity to be used for research purposes in public health setting for children 2 - 18 years old and their parents.
The Northern Hemisphere Atmospheric Response to Spring Arctic Sea Ice Anomalies in CAM3.0 Model

ZHANG Ruonan,WU Bingyi,

大气科学 , 2011,
Abstract: The influence of Arctic Sea Ice Concentration (SIC) anomalies on the atmospheric general circulation during spring and summer is investigated with version 3.0 of the NCAR Community Atmosphere Model (CAM3.0). Regress the second EOF mode of ICE to observed ICE, and then added to climatic ICE as the external force of test. The results show that on the intraseasonal time scale, the atmospheric circulation anomalies evolved from spring to summer, and the spring Arctic SIC anomalies were thermally and dynamically consistent with atmospheric circulation, surface temperature, and rainfall anomalies in spring and summer, especially contributing to less spring rainfall in eastern China and more summer rainfall in northeastern and central China. While on short time scales, the initial adjustment of the atmospheric circulation is characterized by relationship of out of phase in geopotential height anomalies in the lower and upper troposphere locally, and after two weeks, the out of phase turned progressively to more barotropic with the responses propagating to remote areas, at last, the quasi-equilibrium stage of adjustment is reached in the sixth week. The remote responses are regarded as a stationary Rossby wave generated thermally and dynamically through an anomalous turbulent heat fluxes and atmospheric circulation internal varieties. At first, the surface heat fluxes were changed by anomalies in the Arctic SIC, and then a large scale stationary Rossby wave was triggered through the interaction with atmospheric circulation. The lower tropospheric response is baroclinic and thus favors upward emanation of wave activity flux in the negative height anomaly area; while, in upper levels, the energy is dispersed to East Asia through teleconnection, the internal varieties keeping the energy, and then affects the climate in this area.
Build Electronic Arabic Lexicon  [PDF]
Nidhal El-Abbadi,Ahmed Nidhal Khdhair,Adel Al-Nasrawi
Computer Science , 2013,
Abstract: There are many known Arabic lexicons organized on different ways, each of them has a different number of Arabic words according to its organization way. This paper has used mathematical relations to count a number of Arabic words, which proofs the number of Arabic words presented by Al Farahidy. The paper also presents new way to build an electronic Arabic lexicon by using a hash function that converts each word (as input) to correspond a unique integer number (as output), these integer numbers will be used as an index to a lexicon entry.
Arabizi Detection and Conversion to Arabic  [PDF]
Kareem Darwish
Computer Science , 2013,
Abstract: Arabizi is Arabic text that is written using Latin characters. Arabizi is used to present both Modern Standard Arabic (MSA) or Arabic dialects. It is commonly used in informal settings such as social networking sites and is often with mixed with English. In this paper we address the problems of: identifying Arabizi in text and converting it to Arabic characters. We used word and sequence-level features to identify Arabizi that is mixed with English. We achieved an identification accuracy of 98.5%. As for conversion, we used transliteration mining with language modeling to generate equivalent Arabic text. We achieved 88.7% conversion accuracy, with roughly a third of errors being spelling and morphological variants of the forms in ground truth.
Azhary: An Arabic Lexical Ontology  [PDF]
Hossam Ishkewy,Hany Harb,Hassan Farahat
Computer Science , 2014,
Abstract: Arabic language is the most spoken languages in the Semitic languages group, and one of the most common languages in the world spoken by more than 422 million. It is also of paramount importance to Muslims, it is a sacred language of the Islamic Holly Book (Quran) and prayer (and other acts of worship) in Islam is performed only by mastering some of Arabic words. Arabic is also a major ritual language of a number of Christian churches in the Arab world and it is also used in writing several intellectual and religious Jewish books in the Middle Ages. Despite this, there is no semantic Arabic lexicon which researchers can depend on. In this paper we introduce Azhary as a lexical ontology for the Arabic language. It groups Arabic words into sets of synonyms called synsets, and records a number of relationships between words such as synonym, antonym, hypernym, hyponym, meronym, holonym and association relations. The ontology contains 26,195 words organized in 13,328 synsets. It has been developed and contrasted against AWN which is the most common available Arabic lexical ontology.
What influences clinician’s satisfaction with radiology services?
Richard Lindsay,Steven McKinstry,Stephen Vallely,Gail Thornbury
Insights into Imaging , 2011, DOI: 10.1007/s13244-011-0099-y
Abstract: The only factor significantly associated with improved clinician satisfaction was the availability of an approachable radiology service. Availability of PACS did not appear to undermine the value placed on radiology reports.
Do clinical guidelines reduce clinician dependent costs?
George Kosimbei, Kara Hanson, Mike English
Health Research Policy and Systems , 2011, DOI: 10.1186/1478-4505-9-24
Abstract: Globally, health care expenditures have increased tremendously in the last decade raising concerns over their sustainability[1-4]and value for money. This increased investment is being made by both households and governments and represents a potential pool of resources that could be used elsewhere in the economy[2,4]. Such an increase in expenditure if resulting in improved health status would appear to be justified. However, there are concerns that extra spending on health is not yielding the anticipated health returns[1,5,6]. Therefore, there is an increasing interest in maximizing the efficiency of health care spending while at the same time increasing the effectiveness of service provision. One commonly used approach to improving the effectiveness of health care is to develop guidelines for the health care workers based on the best available evidence of what works[7-9]. Often such guidelines aim to improve outcomes through use of optimal treatment approaches and to reduce or limit costs by therapies or procedures. The degree to which guidelines work to change practices depends usually on the extent to which health workers change their behaviour in response to the guidelines as suggested in the Grimshaw 2004 review[7].The cost consequence of such interventions has received less attention in the literature. The degree to which costs can be expected to change in response to clinical guideline adoption will depend on both the responsiveness of health worker behaviour, and on the share of patient costs that are attributable to decisions made by health workers. We have coined the term "clinician-dependent costs"to describe the costs of care that are under the discretion of the healthcare provider. These costs include the costs of drugs, tests and investigations, and discretionary outpatient visits and inpatient stays. Changes in CDCs may arise from interventions such as clinical guidelines that aim to alter health workers use of available resources. We are therefore i
Arabic Language And Language Idea
Ahmet Muhammed KADDUR
Journal of International Social Research , 2010,
Abstract: Although there are many explanations about how and where the Arabic language originated, the appearance of this language as a unifying force took place in pre-Islamic Kurey with the emergence of urban life, wealth, rulership, and power. The main sources regarding this language are the Jahiliyya poetry in 6th century AD, the letters and treaty texts written during the era of the prophet and the four caliphs, and the Quran, which holds together almost all the eminent features of the formal language.The Arabic language includes the formal dialect, the ancient vernaculars, and the local dialects that emerged later. Formal Arabic enjoys a unique position among other languages because its influence spans seventeen hundred years. The Quran, the literary tradition, scientific productions, and the body of grammar play a key role in the continuation and renewal of this language and boost ts efficiency in meeting new and emerging needs. Linguistics are dictionaries and grammar rules formed for people to resist anguage mistakes. Today the Arabic language confronts threats, some of which are the disregard for the formal language in the saily life, the emergence of local dialects, and the potential replacement of Arabic with English. It’s fort his reason that Arabic grammar and linguistics are in a vital position.Arabic has come forward with intellectual matters and produced literary works in the modern age. The powerful relationship between language and nationalism can be observed when the Arab people and Arabic language are examined: as well as being the foundation for Arabs to form a national community, Arabic has played a significant role in constituting a viable political existence.
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