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The training literature suggests that ongoing support (e.g., consultation) following initial training enhances training outcomes, yet little is known about the critical components of ongoing support and the lasting effects of ongoing support. The present study examined components of consultation calls that were provided to 99 community clinicians following training in the delivery of cognitive-behavioral therapy (CBT) for youth anxiety. The 104 recorded consultation calls were coded for content and consultative methods present. A subset of the training sample (N = 50) completed a 2-year follow-up interview during which they reported on their implementation rates of CBT since ending consultation. They also completed measures assessing CBT knowledge and attitudes toward evidence-based practices (EBPs). It was hypothesized that active learning (i.e., role-plays) would predict therapist adherence, skill, self-efficacy, and satisfaction at postconsultation, but regression analyses found no significant relation. However, level of clinician involvement during consultation calls significantly positively moderated the relation between active learning and clinician skill. Analyses of the follow-up data indicated (a) high implementation rates of CBT and (b) maintenance of overall attitudes toward EBPs, willingness to implement EBPs if mandated, views regarding the appeal of EBPs, and beliefs regarding the clinical utility of EBPs. A significant decline in CBT knowledge and openness toward EBPs was observed. Consultation call attendance positively predicted therapist CBT knowledge, overall attitudes toward EBPs, and attitudes regarding the appeal and clinical utility of EBPs at the 2-year follow-up. Implications, strengths and limitations, and future directions are discussed. / Psychology

Family businesses are a specific type of businesses that combine the family system with the business system. In this new system, emotions play an important role due to the long term relationships that exist amongst family members. This emotional component provides family businesses with unique advantages as well as challenges. Marriage and family therapists (MFTs) understand human relationships from a systemic approach. This specific training allows MFTs to be particularly well suited to help family businesses better deal with relational issues they might face by providing families with a different perspective for solution. Currently there is no consensus regarding the specific training MFTs should undergo in order to be better prepared to provide consulting services to family businesses. To meet this need, the purpose of this study is to identify the content for a model curriculum for MFT graduate students in family business consultation. A modified Delphi method with a mixed methods approach was used to obtain the content that a model curriculum should have. The Delphi method was used to obtain consensus on the opinions of MFT experts in family business consultation. A mixed methodology was used to triangulate the data obtained and to enrich the data gathered from a quantitative analysis. The results of this study show that marriage and family therapists wishing to pursue a career as family business consultants would benefit from additional training in the following specific areas: multidisciplinary theoretical approaches to understanding family businesses, consultation as a business, differences between consultation and therapy, and supervised practice. These results allowed the creation of curriculum components that could be used for a family business consultation course, workshops, and other educational events. Specialized training can help therapists provide better services to family businesses as well as an additional career avenue for the field of family therapy. / Ph. D.

Yes / Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalisation. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A ‘trigger film’ showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritised and appropriate solutions were developed. Review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. Setting and participants: Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. Results: The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. Conclusions: Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. / National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)

Consulting with the public on planning issues has become an endeavour formalized throughout Western democracies over the past half-century. However, there remains a dichotomy between the legislative minimums for this part of the planning process and the extraordinary efforts of some municipalities. Inefficiencies emerge as attempts are made by many municipalities to implement the contributions received, exposing the potentially different objectives held by each of the major consultation players. Academics suggest that the rationale for consultation appears to have advanced to the point where its value is beyond question, but that the means and frequency for its conduct are not. The literature on the subject is further split between that which focuses on the process of consultation and that which centres on its outcomes. Correspondingly, the fairness of consultation exercises can be viewed from the procedural and distributive points of view. To date, academic study in this field has largely been conducted along qualitative lines. Using a combination of questionnaires, interviews and a focus group to triangulate data received from the major players, an answer was sought to the hypothesis that consultation players possess distinct objectives for this planning exercise. The results indicated that planners and the public do subscribe to separate views for the purpose of consultation, which bias their paradigms of the other parties. Isolating other factors regarding each of these cohort groups further suggested that time, geography, and education often limit the participation of citizens, while planners feel constrained by time, apathy among participants, the political processes and certain fiscal realities. Therefore, changes to planning legislation are recommended that would indirectly reduce the burden for each of the major players by conducting anticipatory consultation. Such measures would reverse the onus of participating while requiring a lesser investment of staff and resources from municipalities. Future research would test the validity of this approach and engage political figures as the final cohort in the triangle of planning participation.

Consulting with the public on planning issues has become an endeavour formalized throughout Western democracies over the past half-century. However, there remains a dichotomy between the legislative minimums for this part of the planning process and the extraordinary efforts of some municipalities. Inefficiencies emerge as attempts are made by many municipalities to implement the contributions received, exposing the potentially different objectives held by each of the major consultation players. Academics suggest that the rationale for consultation appears to have advanced to the point where its value is beyond question, but that the means and frequency for its conduct are not. The literature on the subject is further split between that which focuses on the process of consultation and that which centres on its outcomes. Correspondingly, the fairness of consultation exercises can be viewed from the procedural and distributive points of view. To date, academic study in this field has largely been conducted along qualitative lines. Using a combination of questionnaires, interviews and a focus group to triangulate data received from the major players, an answer was sought to the hypothesis that consultation players possess distinct objectives for this planning exercise. The results indicated that planners and the public do subscribe to separate views for the purpose of consultation, which bias their paradigms of the other parties. Isolating other factors regarding each of these cohort groups further suggested that time, geography, and education often limit the participation of citizens, while planners feel constrained by time, apathy among participants, the political processes and certain fiscal realities. Therefore, changes to planning legislation are recommended that would indirectly reduce the burden for each of the major players by conducting anticipatory consultation. Such measures would reverse the onus of participating while requiring a lesser investment of staff and resources from municipalities. Future research would test the validity of this approach and engage political figures as the final cohort in the triangle of planning participation.

Die Kommunikation mit den Kunden und insbesondere die Kundenberatung sind in Zeiten permanent hohen Drucks am Markt durch Mitbewerber wichtiges Marketinginstrument, mit dem die Kunden möglichst dauerhaft an das eigene Unternehmen gebunden werden können. Auslöser für die vorliegende Arbeit war die Idee zur Realisierung einer Kundenberatung mittels Videokonferenzsystemen im Jahr 2000 im Zusammenhang mit dem durch das Bundesministerium für Bildung und Forschung (BMBF) geförderte Forschungsprojekt „intermobil Region Dresden“. Durch diese Implementierung sollten Internet-Informations- und Vertriebssysteme durch eine Funktion der Individualberatung ergänzt werden und damit ein persönliches Beratungsgespräch möglichst realitätsnah abbilden. Da im B2C-Bereich die Echtzeitberatung über das Internet eine bis jetzt weitgehend ungenutzte Beratungsform ist, obwohl die dafür notwendigen Technologien schon seit Jahren zur Verfügung stehen, verspricht eine wissenschaftliche Untersuchung dieses Gegenstandes neuen Erkenntnisgewinn und ist gleichzeitig wichtigste Motivation für diese Arbeit. Hauptziel und somit grundlegende wissenschaftliche Fragestellung ist es zu untersuchen, ob synchrone Videokommunikation ein geeignetes Echtzeit-Beratungsmittel für die Kundenberatung (in diesem Zusammenhang als Videoberatung bezeichnet) sein kann. In der vorliegenden Arbeit werden über die Planung eines Video Call Centers und den damit verbundenen Modellbetrachtungen Einsatzszenarios für die Videoberatung entwickelt. In diese Entwicklung fließen die Ergebnisse aus der Einzelfallanalyse des implementierten Videoberatungssystems ein. Diese Ergebnisse werden auf Basis der durchgeführten Labor- und Feldforschung gewonnen. Die Wirksamkeit des analysierten Video Call Centers in Bezug auf die Kundenzufriedenheit wird abschließend durch eine Evaluation unterstrichen.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 97-106.

Dans de nombreuses situations, les décideurs sont amenés à choisir une action ou une politique sans être parfaitement informés. De plus, il est parfois difficile ou coûteux d'acquérir directement les informations manquantes. Dans ce cas, ils peuvent solliciter l'aide des institutions ou individus informés. Ces derniers peuvent essayer d'influencer la décision en leur faveur en cachant ou en ne présentant qu'une partie de l'information. Par exemple, les employeurs s'appuient sur l'information présentée par les demandeurs d'emploi, les autorités financières utilisent les rapports des entreprises pour les évaluer et les élus consultent les experts avant de proposer une loi. Dans ces exemples, au moins certaines informations sont certifiables ou vérifiables. En d'autres termes, la partie informée peut prouver certaines déclarations en présentant des preuves ou le décideur peut vérifier l'exactitude de ces déclarations. Puisque la vérification peut être coûteuse ou prenante, le décideur ne peut souvent vérifier qu'une partie de l'information reçue. Ces contraintes déterminent la quantité d'information qui peut être vérifiée avant la prise de décision. Les deux premiers chapitres portent sur des modèles adaptés aux situations où le décideur doit évaluer une déclaration ou répondre à une demande faite par une personne ou une institution. Dans le troisième chapitre, je considère un cadre légèrement différent où le décideur consulte des agents informés avant de choisir une action.Dans le premier chapitre, j'étudie un modèle où les préférences de l'agent informé sont indépendantes de l'état. En communication unilatérale, seul l'agent envoie un message au décideur. En communication bilatérale, les deux échangent des messages. Je compare ces deux mécanismes en supposant que la même quantité de preuves peut être présentée dans les deux cas. Dans le mécanisme canonique de communication bilatérale, après avoir reçu une déclaration de la part de l'agent, le décideur lui demande de présenter une preuve en particulier. La décision dépend seulement de sa capacité à présenter la preuve demandée. Le résultat principal de ce chapitre stipule que la communication bilatérale améliore le résultat si la certification de l'information est limitée de manière à empêcher le décideur d'atteindre son optimum en communication unilatérale.Le deuxième chapitre, qui résulte d'un travail joint avec Frédéric Koessler (CNRS, École d’Économie de Paris), étudie l'implémentation en présence d'agents averses à l'ambiguïté. Nous montrons que si une règle d'allocation peut être implémentée avec une certification illimitée, elle peut également être implémentée avec une certification limitée d'information si le décideur peut utiliser des mécanismes de communication ambigus et si les agents sont averses à l'ambiguïté au sens du maxmin. L'implication inverse est vraie s'il ya un seul agent et une action de punition.Dans le troisième chapitre, j'étudie un modèle avec deux types d'agents informés. Un type veut maximiser l'action du décideur tandis que l'autre veut la minimiser. Dans ce cas, il peut y avoir besoin de consulter plus d'un agent. J'étudie la consultation séquentielle et j'examine son impact sur la révélation d'information. À l'équilibre, le décideur continue de consulter des agents informés tant que son incertitude est suffisamment élevée. Les agents minoritaires - en termes de préférences - peuvent influencer le décideur en cachant l'information lorsqu'elle est défavorable car il anticipe, à juste titre, que la majorité est davantage susceptible de le faire. En outre, la menace de consultation séquentielle peut être utilisée afin d'extraire des informations plus précises tout en consultant un seul agent. / In many situations, decision makers do not observe all relevant information which undermines their ability to choose the best action or policy. Moreover, it can be difficult or costly to directly acquire the missing information. In such cases, the decision maker may acquire information from privately informed parties with potentially different objectives. The issue is that they may try to influence the outcome in their favor either by withholding or selectively reporting information. For instance, employers rely on information presented by job applicants, financial authorities use firms' reports to evaluate them and elected representatives seek expert advice before selecting policies. In these examples, at least some information is certifiable or verifiable. In other words, the informed party can prove certain statements by presenting hard evidence or the decision maker can verify the accuracy of received claims and documents. Since verification can be costly or time consuming, the decision maker might be able to only partially check the claim. These constraints determine the amount of information that can be verified before the decision is made. The first two chapters focus on models that best describe settings where the decision maker has to evaluate a claim or respond to a request made by an individual or institution. In the third chapter, I consider a slightly different framework where the decision maker seeks advice by consulting informed agents.In the first chapter, I study the basic framework where the informed agent's preferences over the decision maker's actions are independent of the state. In unilateral communication, only the agent sends a message to the decision maker. In bilateral communication, both exchange messages sequentially. I study and compare these two types of mechanisms under the constraint that the agent can present the same amount of certifiable information in both cases. In the canonical bilateral communication mechanism, after receiving a claim from the agent, the decision maker asks him to certify a certain event and bases her decision on his ability to do so. The main result of this chapter essentially states that if information certification is limited and the limitation prevents the decision maker from achieving her first-best in unilateral communication then she strictly benefits from bilateral communication.In the second chapter, which results from a joint work with Frédéric Koessler (CNRS, Paris School of Economics), we study implementation in the presence of ambiguity aversion. We show that if an allocation rule can be implemented with unlimited information certification, then it can also be implemented with limited information certification if the designer can use ambiguous communication mechanisms, and if agents are averse to ambiguity in the sense of maxmin expected utility. The reverse implication is true if there is a single agent and a worst outcome.In the third chapter, I study a setting with two types of informed agents. One type prefers higher actions while the other prefers lower actions. The decision maker ignores the informed agent's preferences. In this case, it might not be sufficient to consult one agent. I study sequential consultation of more than one informed agent and examine its impact on information revelation. It is shown that in equilibrium the decision maker may consult more than one agent and that she continues to seek advice as long as her uncertainty is high enough. Learning on the equilibrium path happens through both revelation and withholding of information. It is possible for agents of the minority - in terms of preferences - to influence the decision maker by withholding information so that she chooses their favorite outcome when she should not. Moreover, sequential consultation can be used as a threat to extract more precise information while consulting only one agent.

Made available in DSpace on 2015-07-22T20:49:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24 / INTRODUÇÃO. A segunda opinião médica pode ser definida como a busca de conselhos ou informações médicas entre profissionais de saúde. OBJETIVO. Este trabalho tem o objetivo de apresentar os passos da construção de um sistema de segunda opinião médica, bem como os resultados da avaliação do sistema desenvolvido. MÉTODOS. No trabalho realizou-se um estudo observacional com enfoque etnográfico de investigação empírica. Um sistema web que reproduz o processo de segunda opinião médica definido foi construído a partir de tecnologias de software livre. Para a avaliação, o sistema foi utilizado por 49 médicos residentes da Universidade Federal de São Paulo que emitiram a sua opinião para 52 solicitações de segunda opinião médica. Como instrumentos de avaliação foram utilizados questionários a respeito do conhecimento prévio, da solicitação, de opinião e de satisfação. RESULTADOS. Foram emitidas 1.891 respostas de segunda opinião pelos médicos para as 52 solicitações. Na avaliação da satisfação subjetiva do usuário, o sistema apresentou média de 87,8% no quesito facilidade de utilização e 95,6% no quesito aprendizado para a utilização do sistema. Os médicos indicaram a necessidade de incluir recursos para auxiliar a observação de imagens como, por exemplo, ampliação (zoom), brilho e contraste, em 38,2% das respostas. Apontaram também, em 47,3% das respostas, que os dados clínicos constituem a informação de maior importância para a emissão da segunda opinião. Respostas às solicitações de segunda opinião apresentaram linguagem inadequada que poderia prejudicar a colaboração entre os médicos. CONCLUSÃO. Os resultados da construção e da avaliação deixam em evidência a efetividade do processo definido para a obtenção de segunda opinião médica em radiologia à distância. Palavras-chave: Telemedicina, Consulta Remota, Referência e Consulta, Radiologia, Diagnóstico por Imagem. / INTRODUCTION. The second opinion can be defined as the search of advices or medical information between health professionals. OBJECTIVE. The objective of this work is to present the steps of the construction of a second opinion system, as well as the evaluation results of the developed system. METHODS. In this work an observational study with an empirical ethnographic research focus was implemented. A web system was developed based on open-source technologies. For the evaluation, the system was used by 49 residents from the Federal University of São Paulo that informed their opinion to 52 medical second opinion requests. Questionnaires of previous knowledge, request, opinion and satisfaction where employed as evaluation tools. RESULTS. 1.891 second opinion responses were given by the physicians to the 52 requests. Regarding to the user satisfaction evaluation, the system presents a 87,8% mean in the easy utilization item and a 95,6% mean in learning to operate the system. The physicians showed the necessity to add resources to help observing images, as example, magnifying, brightness and contrast, on 38,2% of the responses. 47,3% responses indicated also that clinical information is the most important information for a second opinion emission. Inappropriate language was found on responses for medical second opinion requests which could difficult physicians’ cooperation. CONCLUSION. The results of the development and evaluation of the second opinion system show that the defined process was effective for the achievement of remote radiology second opinion. / TEDE / BV UNIFESP: Teses e dissertações