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A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar’s test for paired data and Fisher’s exact test.
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population “almost always” versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial’s findings.
The purpose of this study was to develop a communication skills training (CST) module for oncology healthcare professionals on how to more effectively respond to patient anger. We also sought to evaluate the module in terms of participant self-efficacy and satisfaction.
The development of this module was based on a systematic review of the literature and followed the Comskil model previously used for other doctor–patient CST. Using an anonymous 5-point Likert scale, participants rated their pre-post self-efficacy in responding to patient anger as well as their satisfaction with the course. Data were analyzed using a paired sample t test.
During the academic years 2006–2009, 275 oncology healthcare professionals participated in a CST that focused on responding to patient anger. Participants' confidence in responding to patient anger increased significantly (p < 0.001) after attending the workshop. They also agreed or strongly agreed to five out of six items assessing course satisfaction 92–97% of the time.
Significance of results:
We have developed a CST module on how to respond to patient anger, which is both effective and useful. Training healthcare professionals to respond more effectively to patient anger may have a positive impact on the patient–physician relationship.
This book originated around 1990, when the two authors crossed paths on the main campus of the University of Kentucky and struck up a conversation about solar energy advances and the idea of sustainable cities. In spite of the gulf separating our disciplines (political science and architecture), we found an enormous overlap in interests in the solar movement and sustainability. Out of that stimulating discussion came a mutual commitment to engage in a series of periodic meetings guided by an evolving list of readings that might help clarify our common grounding in going beyond solar energy and conservation to a vision of sustainable cities emanating from the model of the polis (Yanarella) and the ideal of the medieval Italian hilltown (Levine). This reading and discussion process led to the penning of a sustainable city manifesto and to involvement in contributing to an international charter through Levine's participation in the Aalborg conference in Denmark as keynote speaker. From there, the authors achieved modest university funding to support a multidisciplinary seminar and lecture series, which culminated in the establishment of the Center for Sustainable Cities as a joint research and policy center under the aegis of the university's Colleges of Arts and Sciences and Architecture.
The substantive chapters in this book are just part of the theoretical and design work generated from our individual and collaborative efforts over more than twenty-five years.
Sustainability is an idea whose time has come. Clearly, in an age of mounting finite resource scarcities, rapid climate change and continuing global population growth – combined with the growing clamor for economic “development” Western-style – the sustainability movement is not going to go away. Sadly, the meaning of sustainability and sustainable development remains highly contested and subject to ongoing and fierce dispute. Today, this state of affairs is evidenced by the growing shift away from the language of sustainability and its variants to the increasingly popular – and easier to swallow – term, “green.”
In his latest book, Hot, Flat, and Crowded: Why We Need a Green Revolution – and How It Can Renew America (2008), author and New York Times columnist Tom Friedman both criticizes this confusion over “green” vs “sustainability” and abets it (dubbing the needed sustainability transformation in book subtitle and text as a “green” revolution). His critique in most respects is right on the money. Pointing to the proliferation of books and popular magazine articles on the many ways of “going green,” he scolds: “In the green revolution we're having, everyone's a winner, nobody has to give up anything…That's not a revolution. That's a party. We're having a green party” (Friedman, 2008: 251). What really separates a “green party” from a genuine sustainability revolution? And what light do these two terms shed on the other gradations on the environmentalism to sustainability continuum that have entered the global sustainability debate?
As the era of late modernity fatefully slouches into the second decade of a new millennium, at least two contradictory responses to mounting evidence of increasing global environmental damage are apparent. On the one hand, the nations of the north, abetted by various international agencies like the United Nations and the World Bank, produce ringing statements of endorsement for the pathway of sustainable development and formulate protocols setting limits on the most worrisome problems affecting them. On the other hand, many nations of the south in alliance with environmental and peace and justice nongovernmental organizations (NGOs) advance locally based, nonhierarchical policy solutions that assign heavy responsibilities to the industrialized north to share in the burden of charting a new course beyond unsustainable practices and processes and toward global equity and environmental repair.
If the world is changing faster than academicians and policymakers can reconceptualize it, it seems that an acute problem of coming to grips with persistent problems of population control, sustainable development and international peace may lie in the difficulty of formulating a new vocabulary and conceptual framework. These would be adequate to grasp the complexity of the forces shaping key developments in the economics and politics of global change and their impact upon regions and localities trying to adjust or respond to these imposing elements. In debates over sustainable development, the concept of sustainable development remains contested, often mustering wide support and weakly-grounded consensus precisely because it is left unexplicated and not concretely defined (see Chapter 1).
China is currently undergoing a program of massive, unprecedented urbanization and industrialization. Within the next five to ten years, a minimum of 200 million Chinese farmers will leave their villages to become factory workers in hundreds of new and greatly enlarged towns and cities. Accompanying this shift are strong indications of massive unsustainability from an economic, social, cultural and environmental point of view. The way in which these Chinese cities are conceived and constructed will have portentous consequences not only for China but for the rest of the planet as well (Figure 11.1).
It is vital that rapidly industrializing societies such as China's pursue sustainable alternatives to this ill-conceived development; in recent years, we have seen some institutional and governmental interest in China in a search for such alternatives. With a keen understanding of the importance of identifying pathways to mitigate unsustainable development in China, the European Commission sponsored a five-year research program addressing future prospects for sustainability in the numerous small villages in which 70 percent of the Chinese people still live.
SUCCESS is an acronym for “Sustainable User's Concepts for China Engaging Scientific Scenarios,” (ICA4–CT–W2002–10007). The SUCCESS project's goal was to explore the prospects for a sustainable future for the Chinese village as a social and cultural question as well as from ecological and economic points of view. (For a recently published work generated as an outcome of this project, see: Dumreicher et al., 2005; Dumreicher and Prañdl-Zika, 2008; Dumreicher, 2006; Marschalek, 2008; Mortimer and Grant, 2008; and Shaw, Hunter and Mortimer, 2007).
Against the background of the imposing dangers to international stability, global ecological equilibrium and human survival, we close this book with a summary of the road most traveled to date in the projects and programs to build sustainable cities and city-regions. Despite the welter of “sustainable cities” populating the built environment of the twenty-first century, we argue that only the road less traveled – i.e., the strong sustainability strategy outlined in this book and used as a critical evaluative framework for analyzing representative cases around the world – holds out hope of creating new sustainable city-regions across the globe. Such cities can, and must be, guided by their technological tools, architectural blueprints and sociocultural practices defining strong and robust sustainability. Only this approach offers genuine hope of closing the gap and overcoming the frictions between the nations of the north and those of the south. That is, we can only accomplish this goal by greening the cities of the north and providing exemplary strategies, tools and programs for the developing nations of the south to pursue an alternative and ecologically resilient path to strong urban sustainability. Only then will incrementalist, reformist, smart strategies dominating the sustainability debate be surpassed by the achievement of true sustainability locally that radiates outward regionally, nationally and globally.