Effectiveness of routine provision of feedback from patient-reported outcome measurements for cancer care improvement: a systematic review and meta-analysis.

BACKGROUND: Research shows that feeding back patient-reported outcome information to clinicians and/or patients could be associated with improved care processes and patient outcomes. Quantitative syntheses of intervention effects on oncology patient outcomes are lacking. OBJECTIVE: To determine the effects of patient-reported outcome measure (PROM) feedback intervention on oncology patient outcomes. DATA SOURCES: We identified relevant studies from 116 references included in our previous Cochrane review assessing the intervention for the general population. In May 2022, we conducted a systematic search in five bibliography databases using predefined keywords for additional studies published after the Cochrane review. STUDY SELECTION: We included randomized controlled trials evaluating the effects of PROM feedback intervention on processes and outcomes of care for oncology patients. DATA EXTRACTION AND SYNTHESIS: We used the meta-analytic approach to synthesize across studies measuring the same outcomes. We estimated pooled effects of the intervention on outcomes using Cohen's d for continuous data and risk ratio (RR) with a 95% confidence interval for dichotomous data. We used a descriptive approach to summarize studies which reported insufficient data for a meta-analysis. MAIN OUTCOME(S) AND MEASURES(S): Health-related quality of life (HRQL), symptoms, patient-healthcare provider communication, number of visits and hospitalizations, number of adverse events, and overall survival. RESULTS: We included 29 studies involving 7071 cancer participants. A small number of studies was available for each metanalysis (median = 3 studies, ranging from 2 to 9 studies) due to heterogeneity in the evaluation of the trials. We found that the intervention improved HRQL (Cohen's d = 0.23, 95% CI 0.11-0.34), mental functioning (Cohen's d = 0.14, 95% CI 0.02-0.26), patient-healthcare provider communication (Cohen's d = 0.41, 95% CI 0.20-0.62), and 1-year overall survival (OR = 0.64, 95% CI 0.48-0.86). The risk of bias across studies was considerable in the domains of allocation concealment, blinding, and intervention contamination. CONCLUSIONS AND RELEVANCE: Although we found evidence to support the intervention for highly relevant outcomes, our conclusions are tempered by the high risk of bias relating mainly to intervention design. PROM feedback for oncology patients may improve processes and outcomes for cancer patients but more high-quality evidence is required.

Development and evaluation of a standardized technique to assess teat skin temperature of dairy cows using infrared thermography.

Much research has been done to develop methods to assess dimensional teat traits in dairy cows. In contrast, diagnostic techniques to reliably assess the circulatory system of teats are limited. Infrared thermography facilitates measurements of skin temperature and could be used to detect physiological and pathological changes to the teat tissue associated with machine milking, as temperature reflects the underlying blood circulation and tissue metabolism. Our objective was to develop and evaluate a scanning technique to quantify teat skin temperature in dairy cows using infrared thermography. Using a portable thermography camera, 2 operators obtained duplicate scans of both hind teats from 20 Holstein cows, resulting in 80 thermographic images (20 cows × 2 operators × 2 images). Average teat skin temperatures at the proximal, middle, and distal teat aspects were determined. We used Pearson correlation coefficients (r), intraclass correlation coefficients (ICC), and concordance correlation coefficients (CCC) to assess interoperator reproducibility (i.e., agreement between measurements performed by different operators) and intraoperator repeatability (i.e., agreement between measurements performed by the same operator). Pearson correlation coefficients revealed a very strong correlation for measurements at the proximal, middle, and distal aspects of the teat, respectively, between operators (r ≥0.95) and duplicate scans (r ≥0.94) within operators. Intraclass correlation coefficients and CCC indicated excellent interoperator reproducibility (ICC ≥0.95, CCC ≥0.95) and excellent intraoperator repeatability (ICC ≥0.94, CCC ≥0.94), respectively, for measurements at all 3 aspects. Least squares means (95% confidence interval) for average teat skin temperatures at the proximal, middle, and distal teat aspects, respectively, were 33.2 (32.6-33.8), 32.4 (31.5-33.2), and 30.9 (29.8-32.0) °C for operator 1, and 33.2 (32.6-33.8), 32.4 (31.6-33.3), and 31.0 (29.9-32.0) °C for operator 2. Average temperatures between duplicate scans within operators at the proximal, middle, and distal aspects, respectively, were 33.3 (32.7-33.9), 32.5 (31.7-33.3), and 31.0 (29.9-32.1) °C for the first scan and 33.2 (32.6-33.8), 32.3 (31.5-33.1), and 30.8 (29.7-31.9) °C for the second scan. We conclude that infrared thermography facilitates precise measurements of skin temperatures of cows' hind teats.

Delta thermal radiomics: An application in dairy cow teats.

We describe a novel approach for analyzing thermal images by way of radiomics (i.e., thermal radiomics) and how it can be used to monitor short-term temperature changes of dairy cow hind teats; that is, delta thermal radiomics. The heat generated from metabolic activities and blood-flow patterns can be visualized using thermal radiography of the skin surface. The hind teats from 25 dairy cows were imaged with a digital thermal camera and the images were converted to medical images (DICOM format) by mapping the multi-channel colorized thermal image to a monochromatic image whose intensities represent temperature. The 50 teats (left and right hind) were then manually segmented by 2 investigators. Radiomics analysis, which is a common method of extracting semantic and nonsemantic image biomarkers from medical images for machine learning, was performed. To evaluate whether this approach can detect pre- and postmilking differences, 18 cows were imaged before and after milking, the teats were manually segmented, and radiomic calculations were performed. Student's t-test was used to provide an estimate of the likelihood of whether postmilking thermal image biomarkers are the same as premilking thermal image biomarkers, and Cohen's d was used to evaluate the size of the effect (d > 1.2). To evaluate uncertainties from manual segmentation, the Dice similarity score (DS) between the 2 investigators' segments was computed. The average DS (95% confidence limit) was 0.952 (0.913-0.982) when comparing the 2 investigators' segmentations. There was no significant difference in DS when comparing the left and right segmented teats, suggesting that teats can be segmented consistently. No differences (d < 0.36) were observed when comparing image biomarkers from one investigator's segments with the other's, suggesting that image biomarkers computed from one investigator's segmentation of teats are not likely to differ from those computed from the other investigator. When comparing image biomarkers before and after milking, 109 image biomarkers were analyzed, and 17 image biomarkers were simultaneously significant and exhibited effect size. Thus, delta thermal radiomics offers a noninvasive and quantitative method of monitoring skin temperature changes in humans and animals after an intervention. The advantage of this approach is that it can reveal both perceptible and imperceptible surface temperature features that may be useful for detecting and managing dairy teat health.

Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review.

BACKGROUND: Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures. METHODS: A protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors. RESULTS: 2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts. CONCLUSIONS: There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area.

Adoption of adjuvant bisphosphonates for early breast cancer into standard clinical practice: Challenges and lessons learnt from comparison of the UK and Australian experience.

International guidelines recommend adjuvant bisphosphonates (BPs) for post-menopausal women with early breast cancer to reduce recurrence and mortality. However, globally, wide variation exists in their adoption. In the UK, adjuvant BPs were a recommendation in the breast cancer Clinical Reference Group service specification and were included as a priority for implementation by the national oncologists group UK Breast Cancer Group in November 2015, promoting national uptake, guidance and funding arrangements. In 2018, adjuvant BPs were recommended by the UKs National Institute for Health and Care Excellence. In Australia, adjuvant BPs are still 'off-label' and do not receive national reimbursement or endorsement. To date there has been no research into the prescribing habits of these agents in Australia. With the aim to gather data on adjuvant BPs prescribing practices, online surveys were developed and disseminated to breast oncologists in both countries between December 2018 and June 2019. Almost all of the UK oncologists prescribed adjuvant BPs, demonstrating that education, endorsement from professional bodies, presence of national guidelines and funding decisions have been critical to implementation. In contrast, only 48% of the Australian responders prescribed adjuvant BPs, while 83% reported that they would prescribe them if funding was available. Lack of local protocol guidance was also seen as a major barrier. This study was intended to assess the pathway taken for adjuvant BP implementation in the UK and how it might inform changes in Australian practice and also guide other countries with similar issues with the ultimate aim of improving the care of women with early breast cancer globally.

Feasibility of the use of deep learning classification of teat-end condition in Holstein cattle.

Infections with pathogenic bacteria entering the mammary gland through the teat canal are the most common cause of mastitis in dairy cows; therefore, sustaining the integrity of the teat canal and its adjacent tissues is critical to resist infection. The ability to monitor teat tissue condition is a key prerequisite for udder health management in dairy cows. However, to date, routine assessment of teat condition is limited to cow-side visual inspection, making the evaluation a time-consuming and expensive process. Here, we demonstrate a digital teat-end condition assessment by way of deep learning. A total of 398 digital images from dairy cows' udders were collected on 2 commercial farms using a digital camera. The degree of teat-end hyperkeratosis was scored using a 4-point scale. A deep learning network from a transfer learning approach (GoogLeNet; Google Inc., Mountain View, CA) was developed to predict the teat-end condition from the digital images. Teat-end images were split into training (70%) and validation (15%) data sets to develop the network, and then evaluated on the remaining test (15%) data set. The areas under the receiver operator characteristic curves on the test data set for classification scores of normal, smooth, rough, and very rough were 0.778 (0.716-0.833), 0.542 (0.459-0.608), 0.863 (0.788-0.906), and 0.920 (0.803-0.986), respectively. We found that image-based teat-end scoring by way of deep learning is possible and, coupled with improvements in image acquisition and processing, this method can be used to assess teat-end condition in a systematic and efficient manner.

Δ9-tetrahydrocannabinol: Drug discrimination abuse liability testing in female Lister Hooded rats: Trials, tribulations and triumphs.

INTRODUCTION: The assessment of the abuse potential of CNS-active drugs is a regulatory requirement. Drug discrimination is one of the nonclinical tests that contribute to this assessment by providing information on a drug's potential to induce a discriminative stimulus comparable to that of a known drug of abuse. AIM: The objective was to validate drug discrimination in the rat for the purpose of supporting regulatory submissions for novel drugs with potential cannabinoid-like activity. METHODS: Ten female Lister hooded rats were trained to discriminate no-drug from Δ9-THC (1.5 mg/kg, IP) under a FR10 schedule of reinforcement. Once trained, a Δ9-THC dose-response curve was obtained using doses of 0.25, 0.75, 1.5, and 3 mg/kg, IP. This was followed by evaluation of amphetamine (0.3 mg/kg, SC); morphine (3 mg/kg, IP); midazolam (2.5 mg/kg, PO); and the synthetic cannabinoids WIN55,212-2 (0.75 to 2 mg/kg, IP), CP-47,497 (0.5 to 2 mg/kg, IP), and JWH-018 (1 mg/kg, IP) for their discriminative stimulus similarity to Δ9-THC. RESULTS: Pharmacological specificity was demonstrated by achieving the anticipated dose-response curve for Δ9-THC, and a vehicle-like response for the non-cannabinoid drugs. Although full generalisation was obtained for JWH-018, in contrast to published literature, WIN55,212-2 and CP-47,497 failed to generalise to Δ9-THC. DISCUSSION: Based on the literature review performed in light of the results obtained, contrasting and unpredictable behavioural responses produced by cannabinoids in animals and humans raises the question of the reliability and relevance of including drug discrimination and self-administration studies within an abuse potential assessment for novel cannabinoid-like drugs.

Technical note: A digital technique and platform for assessing dairy cow teat-end condition.

Because infections with pathogenic bacteria entering the mammary gland through the teat canal are the most common cause of mastitis in dairy cows, sustaining the integrity of the teat canal and its adjacent tissues is critical to resist infection. The ability to monitor teat tissue condition is therefore a key prerequisite for udder health management in dairy cows. However, to date, routine assessment of teat-end condition is limited to cow-side visual inspection, making the evaluation a time-consuming and expensive process. Here, we illustrate and demonstrate a method for assessing teat-end condition of dairy cows through digital images and software. A digital workflow has been designed where images of dairy cow teats are obtained and processed to display individual teats, and the cow and teat images are labeled and displayed through a graphical user interface. The interface then allows an evaluator to assess quarter- and cow-level teat-end condition and store the results for review and future analysis. The digital workflow permits several advantages such as the ability to perform remote teat-end condition assessments, and assess inter- and intrarater variability of teat-end condition scoring. We demonstrate the image-based teat-end condition assessment of 194 dairy cows that also had cow-side teat-end condition assessments by 2 expert evaluators. Weighted Cohen's kappa statistic (κ) was computed to measure the evaluators' concordance of categorical scores of quarter- and cow-level assessments when using cow-side and image-based assessments. Substantial agreement (0.61 ≤ κ ≤ 0.80) was observed between an evaluator's cow-side and image-based assessments at the quarter and cow level. Moderate agreement (0.41 ≤ κ ≤ 0.60) was observed between evaluators when using image-based assessments at the quarter and cow level. Near perfect agreement (κ = 0.89, 95% confidence interval 0.78-1.00) was observed between evaluators when using cow-side assessments at the quarter level, and substantial agreement (κ = 0.66, 95% confidence interval 0.53-0.79) was observed when using cow-side assessments at the cow level. This suggests that image-based teat-end condition classification is possible, and coupled with improvements in image acquisition and image processing, this method can be used to assess teat-end condition in a systematic and convenient manner.

Blood perfusion of teat tissue in dairy cows: Changes associated with pre-milking stimulation and machine milking.

Mechanical forces during machine milking of dairy cows evoke circulatory impairment of the teat tissue that may affect the teats' defense mechanisms against mastitis pathogens. Ample research describes dimensional changes of different teat traits after machine milking, whereas reports that describe changes in blood circulation of dairy cows' teats are limited. Therefore, the objectives of this study were to (1) describe changes in teat blood circulation that occur after pre-milking teat stimulation and machine milking and (2) study the effect of 2 different milking liners on machine milking-induced changes in teat blood flow. In a randomized trial, Holstein dairy cows were stratified by parity, stage of lactation, and average daily milk yield during the previous week, and allocated to 1 of 2 treatment groups. Treatment consisted of 1 milking observation with either a round or multisided concave milking liner. Teat scans were taken of the left front and the right hind teats using power Doppler ultrasonography. Imaging occurred before pre-milking udder preparation (T1), after completion of pre-milking udder preparation but before milking-unit attachment (T2), and immediately after unit detachment (T3). Perfusion intensity measurements from teat scans were performed with a commercially available software program. Data from 109 cows were analyzed. A general linear mixed model showed differences in perfusion intensity between time points. Least squares means (95% confidence intervals) for T1, T2, and T3, respectively, were 0.035% (0.026-0.047), 0.124% (0.093-0.164), and 0.095% (0.073-0.124). Conversely, no statistically significant differences between treatment groups were observed. We conclude that teat blood circulation is subjected to several influences, including inherent circulatory regulation mechanisms, as well as extrinsic factors such as machine milking. Future research is warranted to decipher the magnitude of their influence and to further our understanding of how these changes relate to the susceptibility to intramammary infection and milking performance.

Technical note: Development and evaluation of a standardized technique to assess blood perfusion in teats of dairy cows using power Doppler ultrasonography.

Ample research has described the assessment of dimensional changes for different teat traits, whereas diagnostic techniques to reliably assess blood circulation in teats of dairy cows are limited. Here, we describe the development and evaluation of a scanning technique to quantify blood flow in teats of dairy cows using power Doppler ultrasonography. In 2 consecutive trials, 384 teat scans [trial 1, n = 256 (sagittal plane, n = 128; transverse plane, n = 128); trial 2, n = 128 (transverse plane)] from 16 cows were obtained by the same 2 operators. Perfusion intensity from single images (trial 1) and video images (trial 2) were assessed using a commercially available software program. Intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC) were used to assess interoperator reproducibility (agreement between measurements performed by different operators) and intraoperator repeatability (agreement between measurements performed by the same operator). In trial 1, interoperator ICC and CCC indicated poor agreement (ICC ≤0.26, CCC ≤0.26). Intraoperator ICC and CCC demonstrated poor agreement between duplicate measurements within operators (ICC ≤0.19, CCC ≤0.19). Modifications after trial 1 included (1) a different ultrasound device, (2) analysis of video clips rather than single images, (3) restriction to 1 sectional plane (i.e., transverse), and (4) a scanning sequence such that repeated scans within operators were measured one after another. Through these modifications, intraoperator repeatability in trial 2 yielded fair to good agreement, with intraoperator ICC and CCC over both operators ranging from 0.44 to 0.70 and from 0.57 to 0.69, respectively, whereas interoperator ICC and CCC showed poor agreement (ICC = 0.35, CCC = 0.34). We conclude that repeatable measurements of blood perfusion intensity of teats in dairy cows can be attained with power Doppler ultrasonography. Power Doppler ultrasonography is a suitable tool to quantify slow flow in small vessels and may be an acceptable diagnostic technique to assess changes in blood circulation that result from machine milking in teats of dairy cows, although further research is necessary to validate this hypothesis.

The suppressive effect of a commercial extract from Durvillaea potatorum and Ascophyllum nodosum on infection of broccoli by Plasmodiophora brassicae.

A sand solution technique demonstrated the capacity for a commercial seaweed extract from Durvillaea potatorum and Ascophyllum nodosum (Seasol Commercial®) to significantly suppress infection of broccoli by Plasmodiophora brassicae. In the primary stages of infection, the extract reduced the number of plasmodia formed in the root hairs by 55 %. Later, in the secondary stages of infection, the extract reduced plasmodia in the root cortical cells by up to 84 %. The suppression of infection was found to be independent of the dilution of the extract applied (1:25 and 1:500). The basis for these results is unlikely to be a nutrient or pH effect since the extract had little impact on these parameters, particularly at the lower dilution (1:200). Rather, we hypothesise that the suppression of infection by the seaweed extract was due to its stimulation of resistance mechanisms in the host, which is possibly related to laminarins in the extract and/or the effect of exogenous growth regulators or undiscovered molecules in the extract disrupting the infection process.

Size of anal squamous cell carcinomas at diagnosis: a retrospective case series.

Anal squamous cell carcinoma is more common in HIV-positive homosexual men than in the general population and prognosis worsens with increasing tumour size. To identify opportunities for earlier diagnosis, we aimed to determine size and visibility of anal squamous cell carcinoma at diagnosis. We conducted a retrospective review of medical records between 1992 and 2010 from one hospital radiotherapy centre, a major centre for HIV care, in Melbourne, Australia. Of 128 cases of anal squamous cell carcinoma, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were externally visible and mean estimated tumour size was 36 mm (29 mm in HIV-positive and 38 mm in HIV-negative patients; p = 0.04) and 114/121 (94%) tumours were 1 cm or larger. The most frequent symptoms were bleeding (43%) and pain (36%) and mean duration of symptoms was 22 weeks. This suggests most anal squamous cell carcinoma were visible or palpable for some time before diagnosis, meaning that screening high-risk groups by anal inspection and palpation is plausible.

Genera of diaporthalean coelomycetes associated with leaf spots of tree hosts.

Four different genera of diaporthalean coelomycetous fungi associated with leaf spots of tree hosts are morphologically treated and phylogenetically compared based on the DNA sequence data of the large subunit nuclear ribosomal DNA gene (LSU) and the internal transcribed spacers and 5.8S rRNA gene of the nrDNA operon. These include two new Australian genera, namely Auratiopycnidiella, proposed for a leaf spotting fungus occurring on Tristaniopsis laurina in New South Wales, and Disculoides, proposed for two species occurring on leaf spots of Eucalyptus leaves in Victoria. Two new species are described in Aurantiosacculus, a hitherto monotypic genus associated with leaf spots of Eucalyptus in Australia, namely A. acutatus on E. viminalis, and A. eucalyptorum on E. globulus, both occurring in Tasmania. Lastly, an epitype specimen is designated for Erythrogloeum hymenaeae, the type species of the genus Erythrogloeum, and causal agent of a prominent leaf spot disease on Hymenaea courbaril in South America. All four genera are shown to be allied to Diaporthales, although only Aurantiosacculus (Cryphonectriaceae) could be resolved to family level, the rest being incertae sedis.

The GOFURTGO Study: AGITG phase II study of fixed dose rate gemcitabine-oxaliplatin integrated with concomitant 5FU and 3-D conformal radiotherapy for the treatment of localised pancreatic cancer.

BACKGROUND: Locally advanced inoperable pancreatic cancer (LAPC) has a poor prognosis. By increasing intensity of systemic therapy combined with an established safe chemoradiation technique, our intention was to enhance the outcomes of LAPC. In preparation for phase III evaluation, the feasibility and efficacy of our candidate regimen gemcitabine-oxaliplatin chemotherapy with sandwich 5-fluorouracil (5FU) and three-dimensional conformal radiotherapy (3DCRT) needs to be established. METHODS: A total of 48 patients with inoperable LAPC without metastases were given gemcitabine (1000 mg m(-2) d1 + d15 q28) and oxaliplatin (100 mg m(-2) d2 + d16 q28) in induction (one cycle) and consolidation (three cycles), and 5FU 200 mg m(-2) per day over 6 weeks during 3DCRT 54 Gy. RESULTS: Median duration of sustained local control (LC) was 15.8 months, progression-free survival (PFS) was 11.0 months, and overall survival was 15.7 months. Survival rates for 1, 2, and 3 years were 70.2%, 21.3%, and 12.8%, respectively. Global quality of life did not significantly decline from baseline during treatment, which was associated with modest treatment-related toxicity. CONCLUSION: Fixed-dose gemcitabine and oxaliplatin, combined with an effective and safe regimen of 5FU and 3DCRT radiotherapy, was feasible and reasonably tolerated. The observed improved duration of LC and PFS with more intensive therapy over previous trials may be due to patient selection, but suggest that further evaluation in phase III trials is warranted.

Fungal Planet description sheets: 69-91.

Novel species of microfungi described in the present study include the following from Australia: Bagadiella victoriae and Bagadiella koalae on Eucalyptus spp., Catenulostroma eucalyptorum on Eucalyptus laevopinea, Cercospora eremochloae on Eremochloa bimaculata, Devriesia queenslandica on Scaevola taccada, Diaporthe musigena on Musa sp., Diaporthe acaciigena on Acacia retinodes, Leptoxyphium kurandae on Eucalyptus sp., Neofusicoccum grevilleae on Grevillea aurea, Phytophthora fluvialis from water in native bushland, Pseudocercospora cyathicola on Cyathea australis, and Teratosphaeria mareebensis on Eucalyptus sp. Other species include Passalora leptophlebiae on Eucalyptus leptophlebia (Brazil), Exophiala tremulae on Populus tremuloides and Dictyosporium stellatum from submerged wood (Canada), Mycosphaerella valgourgensis on Yucca sp. (France), Sclerostagonospora cycadis on Cycas revoluta (Japan), Rachicladosporium pini on Pinus monophylla (Netherlands), Mycosphaerella wachendorfiae on Wachendorfia thyrsifolia and Diaporthe rhusicola on Rhus pendulina (South Africa). Novel genera of hyphomycetes include Noosia banksiae on Banksia aemula (Australia), Utrechtiana cibiessia on Phragmites australis (Netherlands), and Funbolia dimorpha on blackened stem bark of an unidentified tree (USA). Morphological and culture characteristics along with ITS DNA barcodes are provided for all taxa.

Validation of a questionnaire measuring patient satisfaction with general practitioner services.

BACKGROUND: In order that patient satisfaction may be assessed in a meaningful way, measures that are valid and reliable are required. This study was undertaken to assess the construct validity and internal reliability of the previously developed Patient Satisfaction Questionnaire (PSQ). METHOD: A total of 1390 patients from five practices in the North of England, the Midlands, and Scotland completed the questionnaire. Responses were checked for construct validity (including confirmatory factor analysis to check the factor structure of the scale) and internal reliability. RESULTS: Confirmatory factor analysis showed that items loaded on the appropriate factors in a five factor model (doctors, nurses, access, appointments, and facilities). Scores on the specific subscales showed highly significant positive correlations with general satisfaction subscale scores suggesting construct validity. Also, the prediction (derived from past research) that older people would be more satisfied with the service was borne out by the results (F (4, 1312) = 57.10; p < 0.0001), providing further construct validation. The five specific subscales (doctors, nurses, access, appointments, and facilities), the general satisfaction subscale, and the questionnaire as a whole were found to have high internal reliability (Cronbach's alpha = 0.74-0.95). CONCLUSION: The results suggest that the PSQ is a valid and internally reliable tool for assessing patient satisfaction with general practitioner services.

A CAT-derived one to three session intervention for repeated deliberate self-harm: a description of the model and initial experience of trainee psychiatrists in using it.

We describe a new Cognitive Analytic Therapy (CAT)-based intervention for those who repeatedly self-harm. It is specifically designed to be deliverable by staff with no training in psychotherapy. The intervention is simply manualized into sequential tasks that are mediated by new CAT-style standardized tools. A particular feature of this intervention is the deliberate use of feelings elicited in the therapist ('counter-transference') as (a) a guide to how professional poise is being threatened or lost and (b) an indicator of the appropriate focus for this very brief therapy. The psychiatrists' reflection on their elicited feelings is mediated by a new CAT tool, the 'Assessor's Response File' developed in this project. Audiotape analysis suggested that following a very brief learning period, trainee psychiatrists were able to adhere to the structure of the model and arrive at an appropriate reformulation in the first session but tended to be collusive in reciprocating the patients' dysfunctional coping styles.