Aims and Objectives
To describe the development of the Patient Centeredness Index (PCI), evaluate its psychometric characteristics and evaluate the relationships between scores on the PCI and an ...established measure of empathy.
Background
Patient centeredness helps patients manage multiple chronic conditions with their providers, nurses and other team members. However, no instrument exists for evaluating patient centeredness within primary care practices treating this population.
Design
Multi‐site instrument development and validation. STROBE reporting guidelines were followed.
Methods
To identify themes, we consulted literature on patient centeredness and engaged stakeholders who had or were caring for people with multiple chronic conditions (n = 7). We composed and refined items to represent those themes with input from clinicians and researchers. To evaluate reliability and convergent validity, we administered surveys to participants (n = 3622) with chronic conditions recruited from 44 primary care practices for a large‐scale cluster randomised clinical trial of the effects of a practice‐level intervention on patient and practice‐level outcomes. Participants chose to complete the 16‐item survey online, on paper or by phone. Surveys assessed demographics, number of chronic conditions and ratings of provider empathy. We conducted exploratory factor analysis to model the interrelationships among items.
Results
A single factor explained 93% of total variance. Factor loadings ranged from 0.55–0.85, and item‐test correlations were ≥.67. Cronbach's alpha was .93. A moderate, linear correlation with ratings of provider's empathy (r = .65) supports convergent validity.
Conclusions
The PCI is a new tool for obtaining patient perceptions of the patient centeredness of their primary care practice. The PCI shows acceptable reliability and evidence of convergent validity among patients managing chronic conditions.
Relevance to clinical practice
The PCI rapidly identifies patients' perspectives on patient centeredness of their practice, making it ideal for administration in busy primary care settings that aim to efficiently address patient‐identified needs.
Trial registration
Clinicaltrials.org Protocol ID: WLPS‐1409‐24372. Title: Integrating Behavioural Health and Primary Care for Comorbid Behavioural and Medical Problems (IBHPC).
In Canada, perfluoroalkyl acids (PFAAs) have been the focus of several monitoring programs and research and surveillance studies. Here, we integrate recent data and perform a multi-media assessment ...to examine the current status and ongoing trends of PFAAs in Canada. Concentrations of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and other long-chain perfluorocarboxylates (PFCAs) in air, water, sediment, fish, and birds across Canada are generally related to urbanization, with elevated concentrations observed around cities, especially in southern Ontario. PFOS levels in water, fish tissue, and bird eggs were below their respective Draft Federal Environmental Quality Guidelines, suggesting there is low potential for adverse effects to the environment/organisms examined. However, PFOS in fish and bird eggs tended to exceed guidelines for the protection of mammalian and avian consumers, suggesting a potential risk to their wildlife predators, although wildlife population health assessments are needed to determine whether negative impacts are actually occurring. Long-term temporal trends of PFOS in suspended sediment, sediment cores, Lake Trout (Salvelinus namaycush), and Herring Gull (Larus argentatus) eggs collected from Lake Ontario increased consistently from the start of data collection until the 1990s. However, after this time, the trends varied by media, with concentrations stabilizing in Lake Trout and Herring Gull eggs, and decreasing and increasing in suspended sediment and the sediment cores, respectively. For PFCAs, concentrations in suspended sediment, sediment cores, and Herring Gulls generally increased from the start of data collection until present and concentrations in Lake Trout increased until the late 1990s and subsequently stabilized. A multimedia comparison of PFAA profiles provided evidence that unexpected patterns in biota of some of the lakes were due to unique source patterns rather than internal lake processes. High concentrations of PFAAs in the leachate and air of landfill sites, in the wastewater influent/effluent, biosolids, and air at wastewater treatment plants, and in indoor air and dust highlight the waste sector and current-use products (used primarily indoors) as ongoing sources of PFAAs to the Canadian environment. The results of this study demonstrate the utility of integrating data from different media. Simultaneous evaluation of spatial and temporal trends in multiple media allows inferences that would be impossible with data on only one medium. As such, more co-ordination among monitoring sites for different media is suggested for future sampling, especially at the northern sites. We emphasize the importance of continued monitoring of multiple-media for determining future responses of environmental PFAA concentrations to voluntary and regulatory actions.
•A multi-media assessment of PFAAs in Canada was performed.•PFAA levels were mostly higher in urban compared to remote locations.•Phase-outs and regulations were not consistently reflected in temporal trends.•This study allowed inferences that would be difficult with only one medium.
Scholars at War is the first scholarly publication to examine the effect World War II had on the careers of Australasian social scientists. It links a group of scholars through geography, ...transnational, national and personal scholarly networks, and shared intellectual traditions, explores their use, and contextualizes their experiences and contributions within wider examinations of the role of intellectuals in war. Scholars at War is structured around historical portraits of individual Australasian social scientists. They are not a tight group; rather a cohort of scholars serendipitously involved in and affected by war who share a point of origin. Analyzing practitioners of the social sciences during war brings to the fore specific networks, beliefs and institutions that transcend politically defined spaces. Individual lives help us to make sense of the historical process, helping us illuminate particular events and the larger cultural, social and even political processes of a moment in time. Contributors include Peter Hempenstall, JD Legge, Jock Phillips, John Pomeroy, Cassandra Pybus, David Wetherell, Janet Wilson.
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