Objective In 2015, the U.S. Preventive Services Task Force updated their hypertension recommendations to advise that adults with elevated office blood pressure (BP) undergo out-of-office BP measurement to exclude white-coat hypertension prior to diagnosis. Our goal was to determine the most important barriers to primary care providers’ ordering ambulatory and home BP monitoring in the U.S. Methods We enrolled 63 primary care providers into nominal group panels in which participants iteratively listed and ranked barriers to ambulatory and home BP monitoring. Results Top ranked barriers to ambulatory BP monitoring were challenges in accessing testing, costs of testing, concerns about the willingness or ability of patients to successfully complete tests, and concerns about the accuracy and benefits of testing. Top ranked barriers to home BP monitoring were concerns about compliance with the correct test protocol, accuracy of tests results, out-of-pocket costs of home BP devices, and time needed to instruct patients on home BP monitoring protocol. Conclusions Efforts to increase the use of ambulatory and home BP monitoring by primary care providers in the U.S. should prioritize increasing the financial and personnel resources available for testing and addressing provider concerns about patients’ ability to conduct high quality tests.
Metadata enables users to find the resources they require, therefore it is an important component of any digital learning object repository. Much work has already been done within the learning technology community to assure metadata quality, focused on the development of metadata standards, specifications and vocabularies and their implementation within repositories. The metadata creation process has thus far been largely overlooked. There has been an assumption that metadata creation will be straightforward and that where machines cannot generate metadata effectively, authors of learning materials will be the most appropriate metadata creators. However, repositories are reporting difficulties in obtaining good quality metadata from their contributors, and it is becoming apparent that the issue of metadata creation warrants attention. This paper surveys the growing body of evidence, including three UK-based case studies, scopes the issues surrounding human-generated metadata creation and identifies questions for further investigation. Collaborative creation of metadata by resource authors and metadata specialists, and the design of tools and processes, are emerging as key areas for deeper research. Research is also needed into how end users will search learning object repositories. IntroductionThe emergence of the concept of reusable learning objects has been a major recent development in e-learning (Littlejohn, 2003). Much discussion and exploratory work has been undertaken, moving us towards what has been called "the learning object economy" (Downes, 2001;Campbell, 2003), where teachers, course developers and learners can share, reuse and re-purpose digital materials for incorporation into teaching and learning. Some potential benefits of this 'economy' include: minimising duplication of effort for individual teachers across subject areas; reducing costs for * Corresponding author. Centre for Academic Practice, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow G1 1QE, UK. Email: sarah.currier@strath.ac.uk 6 S. Currier et al.institutions (Duncan, 2003b); and providing access to a wider variety of learning materials. In the past few years, various institutions and projects have been developing repositories for these reusable learning objects supported by international standardization work, notably the suite of specifications produced by the IMS Global Learning Consortium (IMS). suggests that the next stage of development in this "economy of education" should be the development of a network of distributed learning object repositories.Because metadata enables users to discover and select digital learning resources suitable to their requirements, it is a vital component of the learning object economy, any future distributed networks and the learning object repositories within them. Extensive groundwork has been carried out in this area, mainly centred upon the development of the IEEE Learning Object Metadata standard, known as 'the LOM' (IEEE LTSC, 2002). IEEE worked closely with the inter...
ObjectiveTo identify and prioritize patient‐ and rheumatologist‐perceived barriers to achieving disease control.MethodsPatients with rheumatoid arthritis (RA) and rheumatologists from the Corrona registry were invited by e‐mail to participate in nominal groups. Two separate lists of barriers were created, 1 from RA patient–only nominal groups and the other from rheumatologist‐only nominal groups, and barriers were sorted into themes. Next, using an online survey, a random sample of RA patients from the Corrona registry were asked to rank their top 3 barriers to achieving disease control.ResultsFour nominal groups totaling 37 RA patients identified patient barriers to achieving control of RA activity that were classified into 17 themes. Three nominal groups totaling 25 rheumatologists identified barriers that were classified into 11 themes. The financial aspects of RA care ranked first for both types of nominal groups, while medication risk aversion ranked second among the perceived barriers of the physician nominal group and third among those of the RA patient nominal group. Among the 450 RA patients surveyed, 77% considered RA a top health priority, and 51% reported being aware of the treat‐to‐target strategy for RA care; the 3 most important patient‐perceived challenges to achieving disease control were RA prognosis uncertainty, medication risk aversion, and the financial/administrative burden associated with RA care.ConclusionThere are common, potentially modifiable, patient‐ and rheumatologist‐reported barriers to achieving RA disease control, including perceived medication risk aversion, suboptimal treatment adherence, and suboptimal patient–physician communication regarding the benefits of tight control of disease activity in RA. Addressing these obstacles may improve adherence to goal‐directed RA care.
Purpose – The purpose of this paper is to explore the usefulness of the concept to thinking about Research Data Management (RDM). The concept of “wicked problems” seeks to differentiate very complex, intractable challenges from tamer issues where approaches to problem solving are well-understood. Design/methodology/approach – The paper is based on and co-authored by a collaboration of practitioners from libraries, information technology and research administration, with facilitators from the Sheffield Information School. Participants worked together in two-day-long workshops to understand the wicked problem concept and advice on leadership in wicked problem contexts. Findings – Participants concurred that RDM had many features of a wicked problem and most of Grint’s advice on leadership for wicked problems also resonated. Some elements of the issue were simple; participants were optimistic about improving the situation over time. Participants were resistant to the more negative or fatalistic connotations of the phrase “wicked problem”. Viewing RDM as a wicked problem is an interesting way of looking at it as a challenge for support professionals. Practical implications – The notion of a wicked problem is a generative concept that can be usefully added to professional vocabulary. Originality/value – The paper captures an in-depth response from practitioners to the notion of wicked problems as a lens for examining RDM.
PCPs face challenges getting their patients to re-initiate statins, particularly after a patient reports side effects.
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