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Online Communication Between Doctors and Patients in Europe: Status and Perspectives
Van Gemert-Pijnen, Lisette
Nijland, Nicol
Adler, Kenneth
Santana, Silvina
Lausen, Berthold
Bujnowska-Fedak, Maria
Chronaki, Catherine
Kummervold, Per Egil
Rasmussen, Janne
Sorensen, Tove
Journal of Medical Internet Research
Use of the Internet for health purposes is steadily increasing in Europe, while the eHealth market is still a niche. Online communication between doctor and patient is one aspect of eHealth with potentially great impact on the use of health systems, patient-doctor roles and relations and individuals' health. Monitoring and understanding practices, trends, and expectations in this area is important, as it may bring invaluable knowledge to all stakeholders, in the Health 2.0 era.
Our two main goals were: (1) to investigate use of the Internet and changes in expectations about future use for particular aspects of communication with a known doctor (obtaining a prescription, scheduling an appointment, or asking a particular health question), and (2) to investigate how important the provision of email and Web services to communicate with the physician is when choosing a new doctor for a first time face-to-face appointment. The data come from the second survey of the eHealth Trends study, which addressed trends and perspectives of health-related Internet use in Europe. This study builds on previous work that established levels of generic use of the Internet for self-help activities, ordering medicine or other health products, interacting with a Web doctor/unknown health professional, and communicating with a family doctor or other known health professional.
A representative sample of citizens from seven European countries was surveyed (n = 7022) in April and May of 2007 through computer-assisted telephone interviews (CATI). Respondents were questioned about their use of the Internet to obtain a prescription, schedule an appointment, or ask a health professional about a particular health question. They were also asked what their expectations were regarding future use of the Internet for health-related matters. In a more pragmatic approach to the subject, they were asked about the perceived importance when choosing a new doctor of the possibility of using email and the Web to communicate with that physician. Logistic regression analysis was used to draw the profiles of users of related eHealth services in Europe among the population in general and in the subgroup of those who use the Internet for health-related matters. Changes from 2005 to 2007 were computed using data from the first eHealth Trends survey (October and November 2005, n = 7934).
In 2007, an estimated 1.8% (95% confidence interval [CI], 1.5 - 2.1) of the population in these countries had used the Internet to request or renew a prescription; 3.2% (95% CI 2.8 - 3.6) had used the Internet to schedule an appointment; and 2.5% (95% CI 2.2 - 2.9) had used the Internet to ask a particular health question. This represents estimated increases of 0.9% (95% CI 0.5 - 1.3), 1.7% (95% CI 1.2 - 2.2), and 1.4% (95% CI 0.9 - 1.8). An estimated 18.0% (95% CI 17.1 - 18.9) of the populations of these countries expected that in the near future they would have consultations with health professionals online, and 25.4% (95% CI 24.4 - 26.3) expected that in the near future they would be able to schedule an appointment online. Among those using the Internet for health-related purposes, on average more than 4 in 10 people considered the provision of these eHealth services to be important when choosing a new doctor.
Use of the Internet to communicate with a known health professional is still rare in Europe. Legal context, health policy issues, and technical conditions prevailing in different countries might be playing a major role in the situation. Interest in associated eHealth services is high among citizens and likely to increase.
Online physician-patient interaction; email communication; online prescription ordering; scheduling appointments online; eHealth services utilization and trends; Internet; Europe; survey; logistic regression analysis
Related Articles
Identification of general characteristics, motivation, and satisfaction of internet-based medical consultation service users in Croatia
Klinar, Ivana
Balažin, Ana
Baršić, Bruno
Tiljak, Hrvoje
Croatian Medical Journal
To identify users' reasons to look for physician consultation on the internet instead of visiting a physician and to explore their general characteristics, motivation, and satisfaction with internet medical consultation service 'Your Questions.'
Users of a free internet medical consultation service 'Your Questions' (www.plivazdravlje.hr) were invited to participate in a web-based survey designed to explore their general characteristics (age, sex, etc), reasons for using the service, the nature of their health problem or question, and their satisfaction with the service. Respondents were divided into two groups: users who consulted an internet physician only (Group I) and users who used internet consulting before or after visiting a physician (Group II).
The response rate was 38% (1036/2747), with 79% female respondents. A fifth of the respondents (21%) consulted an internet physician only (Group I). Multivariate analysis revealed that the respondents in Group I were younger (median 24 vs 28 years in Group II), more interested into questions about pregnancy (odds ratio [OR], 1.984; 95% confidence interval [CI], 1.203-3.272), more often embarrassed to talk to a physician in person (OR, 1.828; 95% CI, 1.119-2.989), and more motivated to protect their privacy (OR, 1.727; 95% CI, 1.252-2.380). They also had greater satisfaction with the service (77% vs 60%, P < 0.001).
The factors associated with the use of internet-based medical consultation services were younger age, need for privacy protection, avoidance of embarrassment at the physician's office, and having a question related to pregnancy. This reveals the internet medical consultation service as a useful health promotion supplement that is particularly applicable for the population of young adults.
Related Articles
Survey of Doctors' Experience of Patients Using the Internet
Potts, Henry W. W
Wyatt, Jeremy C
Licciardone, John
Kiley, Robert
Journal of Medical Internet Research
There have been many studies showing the variable quality of Internet health information and it has often been assumed that patients will blindly follow this and frequently come to harm. There have also been reports of problems for doctors and health services following patient Internet use, but their frequency has not been quantified. However, there have been no large, rigorous surveys of the perceptions of Internet-aware doctors about the actual benefits and harms to their patients of using the Internet.
To describe Internet-literate doctors' experiences of their patients' use of the Internet and resulting benefits and problems.
Online survey to a group of 800 Web-using doctors (members of a UK medical Internet service provider, Medix) in September and October 2001.
Responses were received from 748 (94%) doctors, including 375 general practitioners (50%). Respondents estimated that 1%-2% of their patients used the Internet for health information in the past month with no regional variation. Over two thirds of the doctors considered Internet health information to be usually (20%) or sometimes (48%) reliable; this was higher in those recently qualified. Twice as many reported patients experiencing benefits (85%; 95% confidence interval, 80%-90%) than problems (44%; 95% confidence interval, 37%-50%) from the Internet. Patients gaining actual physical benefits from Internet use were reported by 40% of respondents, while 8% reported physical harm. Patients' overall experiences with the Internet were judged excellent 1%, good 29%, neutral 62%, poor 9%, or bad <1%. Turning to the impact of patient Internet use on the doctors themselves, 13% reported no problems, 38% 1 problem, and 49% 2 or more problems. Conversely, 20% reported no benefits for themselves, 49% 1 benefit, and 21% 2 or more benefits.
These doctors reported patient benefits from Internet use much more often than harms, but there were more problems than benefits for the doctors themselves. Reported estimates of patient Internet usage rates were low. Overall, this survey suggests that patients are deriving considerable benefits from using the Internet and that some of the claimed risks seem to have been exaggerated.
Internet; information quality; attitude to computers; questionnaires; patient education
Related Articles
Information Needs and Visitors' Experience of an Internet Expert Forum on Infertility
Himmel, Wolfgang
Meyer, Juliane
Kochen, Michael M
Michelmann, Hans Wilhelm
Potts, Henry
Journal of Medical Internet Research
Patients increasingly use health portals and Web-based expert forums (ask-the-doctor services), but little is known about the specific needs of Internet users visiting such websites, the nature of their requests, or how satisfied they are with Internet health experts.
The aim of this study was to analyze the information requests of (mostly female) patients visiting an Internet expert forum on involuntary childlessness and their satisfaction with the experts' feedback.
We posted an electronic questionnaire on a website hosting an expert forum on involuntary childlessness. The questionnaire was "activated" whenever a visitor sent a question or request to the expert forum. The survey focused on the reasons for visiting the expert forum and whether the visitors were satisfied with the experts' answers to previously posted questions. The free-text questions of visitors who answered the survey were analyzed using Atlas-ti, a software program for qualitative data analysis.
Over a period of 6 months, 513 out of 610 visitors (84%) answered the questionnaire. The majority of respondents (65.5%) expected general information about involuntary childlessness, conception, or an evaluation of drugs. Others were concerned about their actual treatment (40.6%) and therapeutic options (28.8%). Out of 225 respondents who had previously contacted the forum, 223 had received an answer, and 123 (55.2%) were satisfied with the experts' answers. About half (105/223) of those users who had previously received an answer from the expert forum stated that they had discussed it with their own doctor. More of these users were satisfied with their subsequent care in fertility clinics than users who did not talk to their doctor about their Internet activities (93.9% vs 76.1%; P = .015 ). According to the qualitative analysis, many requests (n = 194) were more or less trivial, especially those for information on basic aspects of reproduction. More than one-third of visitors (n = 199) sent detailed results of diagnostic tests and asked for a first or second opinion. Requests to the expert forum were also sent in order to obtain emotional support (17%) or to complain about a doctor (15%).
Visitors who sent their laboratory findings to receive a thorough evaluation or a second opinion had a good command of the opportunities that an expert forum offers. One important expectation of the forum was emotional support, indicating psychological needs that were not met by medical providers. Future websites must find a compromise in order to protect experts from being overwhelmed by general, nonspecific requests while supporting patients with individualized answers.
Consumer health informatics; telemedicine; Internet; e-health; infertility; remote consultation
Related Articles
Improving hospital doctors' working lives: online questionnaire survey of all grades
Dornhorst, A
Cripps, J
Goodyear, H
Marshall, J
Waters, E
Boddy, S
on, b
Postgraduate Medical Journal
Background: In 2001, the Department of Health produced the Improving Working Lives (IWL) for Doctors document. This is the first national survey which asks hospital doctors what changes are needed to improve their working lives.
Methods: An online questionnaire was run over a period of six weeks and was open to all doctors of all grades. Doctors were asked to choose their top five factors from a list of 35 diverse choices or to provide alternatives in free text. Demographic data were also collected.
Results: 1603 hospital doctors working in the UK completed the online questionnaire. Improved secretarial or managerial support was the first IWL choice for consultants, with different aspects of clinical and non-clinical support representing their top four choices. Junior hospital doctors and staff and associate specialist grades (staff grades, associate specialists, and clinical assistants) identified improved support for education and training as their first choice, while among the female specialist registrars, it was improved support for childcare.
Greater opportunities to develop new skills was an important issue for doctors in the surgical specialties and improved access to mentoring was important for all junior doctors, staff and associate specialist grades, and doctors from black and ethnic minority groups.
Conclusions: Hospital doctors in the UK need more support to improve their working lives. The principle needs are better secretarial and managerial support for consultants; education, training, and mentoring for junior doctors and staff and associate specialist grades; and improved opportunities to develop new skills for those in surgical specialties. Support with childcare is an important issue for female specialist registrars. The Department of Health, NHS trusts, deaneries, and Royal Colleges need to endorse policies that promote a training and working environment that will improve working lives for all hospital doctors, ensuring that appropriate and continuing support is available from the time doctors enter the new foundation programmes and proposed run-through grades, to their time spent as consultants in today's NHS.
Related Articles
A model for connecting doctors to university based medical resources through the Internet.
Vanzyl, A. J.
Cesnik, B.
Proceedings of the Annual Symposium on Computer Application in Medical Care
Medical Students and academics at large universities have access to rich and varied information resources. These resources tend not to be available from off campus sites. We have been running a trial to connect practicing doctors to some of the medical resources that are available within our university. We are using the Internet to facilitate this process. In doing so, a large number of non academic, but very practical problems have had to be solved. We examine in particular the roles that Internet service providers and Internet information providers play in such a project. In particular we describe the factors used in advising users on external service providers, and why we as part of a university have chosen not to fulfil the internet service provision role ourselves.
Related Articles
Why doctors use or do not use ethics consultation
Orlowski, J P
Hein, S
Christensen, J A
Meinke, R
Sincich, T
Journal of Medical Ethics
Ethics consultation is used regularly by some doctors, whereas others are reluctant to use these services.
To determine factors that may influence doctors to request or not request ethics consultation.
A survey questionnaire was distributed to doctors on staff at the University Community Hospital in Tampa, Florida, USA. The responses to the questions on the survey were arranged in a Likert Scale, from strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree to strongly agree. Data were analysed with the Wilcoxon test for group comparisons, the χ2 test to compare proportions and a logistic regression analysis.
Of the 186 surveys distributed, 121 were returned, giving a 65% response rate. Demographic data were similar between the groups saying yes (I do/would use ethics consultation when indicated) and no (I do not/would not use ethics consultation when indicated). No statistically significant differences were observed between the user and non‐user groups in terms of opinions about ethics consultants having extensive training in ethics or participating in ethics educational opportunities. On the issue "Ethics committee members or consultants cannot grasp the full picture from the outside", the non‐users were neutral, whereas the users somewhat disagreed (p = 0.012). Even more significant was the difference between surgeons and non‐surgeons, where, by logistic regression analysis, surgeons who believed that ethics consultants could not grasp the full picture from the outside were highly likely to not use (p = 0.0004). Non‐users of ethics consultations thought that it was their responsibility to resolve issues with the patient or family (72.2% agree, p<0.05). Users of ethics consultation believed in shared decision making or the importance of alternate points of view (90.8% agree, p<0.05).
Ethics consultations are used by doctors who believe in shared decision making. Doctors who did not use ethics consultation tended to think that it was their responsibility to resolve issues with patients and families and that they were already proficient in ethics.
Related Articles
Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors
Cheng, S
Song, H
Quality & safety in health care
Background: Increasing efforts have been made to provide information to help consumers to select a healthcare provider, but the public release of hospital performance data has had only a limited impact on consumer choice.
Objectives: To understand the experience of consumers in searching for physician performance information and to investigate the potential impact on their propensity to change doctors if hypothetically provided with physician specific performance information.
Design: A nationwide telephone interview survey using a structured questionnaire.
Setting: The survey was conducted in Taiwan, a country with a universal health insurance programme where residents are free to choose between physicians for any medical consultation.
Participants: 4015 adults aged over 20 years contacted by random digit dialling telephone calls.
Main outcome measures: Subjects were asked (1) if they have ever compared the quality of care provided by physicians in their area; (2) if they would consult a performance report if it was available; and (3) if they would change doctors on the basis of information provided in the report.
Results: Approximately half the subjects had made comparisons between doctors; 73% stated that they would consult a performance report if it was available, and 77% were prepared to change doctors if their doctor performed badly in the report.
Conclusions: Providing physician specific performance reports to the public may be viewed favourably by consumers of health care and have a significant impact on physician selection and hence quality improvement.
Related Articles
Who's My Doctor? First-Year Residents and Patient Care: Hospitalized Patients' Perception of Their "Main Physician"
Dalia, Samir
Schiffman, Fred J.
Journal of Graduate Medical Education
Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions.
We created a survey to judge patient satisfaction and to determine who patients believe is their "main physician" on the teaching service.
Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages.
Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician.
Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.
Related Articles
PHL12/478: Cancer Information on the Internet: Same patients, new questions?
Hiller, B
Journal of Medical Internet Research
1999;1(Suppl 1):e92.
Since 1986, the German Cancer Information Service at the German Cancer Research Center has been working as a national telephone service, answering more than 155.000 inquiries from cancer patients and their families. In 1996, the service received the first E-mail requests, and in early 1999, a Web site with more than 1,8 MB information on cancer related topics was installed. More and more callers name the internet as one of their information resources. Who are these callers? Which questions do they ask? Are there specific problems caused by the internet information?
In 1998, the questions of cancer patients and their families using electronic mail to contact the Cancer Information Service were compared to those of the callers. From April to September, 1999, a short interview was performed with callers identified as internet users, asking for the pros and cons and their special problems with their internet searches.
Cancer patients with access to the internet tend to use as many sources of information as possible and rate them differently. The internet is most valued for very specific information otherwise not available to patients, but only to health professionals. Treatment options are the main topic of interest. Patients and their families, however, still ask the Cancer Information Service for assistance in assessing the relevance of the news for their own situation, especially when clinical trials or unconventional methods are concerned. E-mail questions to the Cancer Information Service do not differ from those asked in phone calls.
Internet is developing into a new and powerful instrument to give patients access to cancer information. However, problems are caused by the number and diversity of Web sites presenting medical contents, the anonymity of many pages and the commercial aspects of information. Cancer organizations, i.e. hospitals, research centers and governmental institutions, should take the patients' needs into account in designing their Web sites. Guidelines, standards and methods of quality control could be helpful and should be established.
Neoplasms; Patient Education; Patient Psychology; Internet; Electronic Mail
Related Articles
Attitudes among NHS doctors to requests for euthanasia.
Ward, B. J.
Tate, P. A.
BMJ : British Medical Journal
OBJECTIVES--To explore NHS doctors' attitudes to competent patients' requests for euthanasia and to estimate the proportion of doctors who have taken active steps to hasten a patient's death. DESIGN--Anonymous postal questionnaire, with no possibility of follow up. The survey was conducted from December 1992 to March 1993. SUBJECTS--All (221) general practitioners and 203 hospital consultants in one area of England. RESULTS--273 doctors responded to a question on whether a patient had ever asked them to hasten death. Of these, 163 had been asked to; 124 of these had been asked to take active steps to hasten death; 38 of 119 (32%) of these had complied with such a request (95% confidence interval 23% to 40%). This proportion represented 12% of all those who returned a completed questionnaire and 9% of all those who had been sent a questionnaire (95% confidence interval 6.3% to 11.7%). A larger proportion of the respondents (142/307 (46%)), however, would consider taking active steps to bring about the death of a patient if it was legal to do so. CONCLUSIONS--Many doctors face difficult decisions about euthanasia. For the benefit of both patients and doctors euthanasia should be discussed more openly.
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A comparison of health information on Florida's free-nets.
Clark, D E
Bulletin of the Medical Library Association
In the popular rush to provide electronic consumer health information, particularly via the Internet, one system has been largely overlooked-the free-net. Free-nets are often text-based systems from which users choose topics from "menus." While the World Wide Web can be more graphically appealing, it can also be overwhelming. Medical information resources are available to diverse populations through free-nets, which are convenient, free services. The amount of information and range of topics they offer are vast. A study of Florida's free-nets during a six-month period involved five free-net systems. Survey items included user demographics, interlibrary loan services, attitudes toward providing medical advice, and availability of medical librarian expertise. Comparisons include the number of user queries on medical and health-related free-net menus, user-friendliness, and the type of health information provided.
Related Articles
Should a doctor prescribe hormone replacement therapy which has been manufactured from mare's urine?
Cox, D
Journal of Medical Ethics
Many clinicians are experiencing consumer resistance to the prescription of equine HRT (that is hormone replacement therapy which has been manufactured from mare's urine). In this paper I consider the ethical implications of prescribing these preparations. I decide that patients should have a right to refuse such treatment but also ask whether a prescribing doctor should choose one preparation over another on moral grounds. I determine that there is prima facie evidence to suggest that mares may suffer and that prescription of equine HRT (instead of synthetic oestrogen-oestriol) would therefore have to be justified in terms of either offering greater benefits to the women or offering greater value for money to the health service. I find that there is no substantial evidence to suggest that equine HRT offers unique advantages over and above oestriol. I conclude that it would be preferable for a doctor to recommend the synthetic oestrogen to women who want relief from the symptoms of the menopause and protection from osteoporosis and cardiovascular disease.
Related Articles
Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers
Dosani, Sabina
Schroter, Sara
MacDonald, Rhona
Connor, Jackie
BMJ : British Medical Journal
Objectives To estimate the proportion of advertised non-consultant hospital posts that do not conform to nationally recognised terms and conditions of service and to investigate why these posts exist, who fills them, and what the doctors in such jobs do.
Design Analysis of job advertisements and a cross sectional survey of advertisers.
Setting Job advertisements in one of the leading UK publications listing hospital doctor vacancies (BMJ Careers).
Results Nearly a quarter of non-consultant posts advertised in the two study periods (23% and 21%) were for non-standard grade posts. A questionnaire was sent to the medical staffing officer for each post. Of 430 questionnaires sent out 192 (45%) were returned. 98 trusts said they advertised non-standard grades because there was no more funding from the deanery for approved posts and 75 because service needs could not be met by doctors in training grades. In 132 posts (69%) the post holder would be required to do on-call work, and 50 advertisers (26%) required on-call duty for 1 in 5 or more frequently, which would conflict with the European Working Time Directive. 131 advertisers (68%) expected the posts to be filled by doctors from outside the European Economic Area.
Conclusions Non-standard grade posts are mostly being created to meet service requirements when there is no more funding for standard training posts and are expected to be filled by doctors from overseas. Doctors in such posts can be more easily exploited and their careers hindered. The Department of Health's annual census should include non-standard grade doctors.
Related Articles
Bone densitometry at a district general hospital: evaluation of service by doctors and patients.
Madhok, R
Kirby, P
Fordham, J
Stamp, P
Green, S
Cooper, C
Quality in Health Care
OBJECTIVE--To assess doctors' and patients' views about a district general hospital bone densitometry service and to examine existing practice to influence future provision. DESIGN--Three postal surveys: (a) of doctors potentially using the service, (b) of patients undergoing a bone densitometry test during a six month period, and (c) of the referring doctors of the patients undergoing the test. SETTING--Bone densitometry service at South Cleveland Hospital, Middlesbrough and two district health authorities: South Tees and Northallerton. SUBJECTS--All general practitioners (n=201) and hospital consultants in general medicine, rheumatology, obstetrics and gynaecology, orthopaedics, radio therapy and oncology, haematology, and radiology (n=61); all patients undergoing an initial bone densitometry test (n=309) during a six month period; and their referring doctors. MAIN MEASURES--Service awareness and use, knowledge of clinical indications, test results, influence of test results on patient management, satisfaction with the service and its future provision. RESULTS--The overall response rates for the three surveys were 87%, 70%, and 61%. There was a high awareness of the service among doctors and patients; 219(84%) doctors were aware and 155 of them (71%) had used it, and patients often (40%) suggested the test to their doctor. The test was used for a range of reasons including screening although the general use was consistent with current guidelines. Two hundred (65%) bone densitometry measurements were normal, 71(23%) were low normal, and 38(12%) were low. Although doctors reported that management of patients had been influenced by the test results, the algorithm for decision making was unclear. Patients and doctors were satisfied with the service and most (n=146, 68%) doctors wanted referral guidelines for the service. CONCLUSIONS--There was a high awareness of, use of, and satisfaction with the service. Patients were being referred for a range of reasons and a few of these could not be justified, many tests were normal, and clinical decision making was not always influenced by the test result. It is concluded that bone densitometry services should be provided but only for patients whose management will be influenced by test results and subject to guidelines to ensure appropriate use of the technology.
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Attitudes of doctors to the Alma Ata recommendations in Sri Lanka.
Varnam, M A
British Medical Journal (Clinical research ed.)
A detailed postal questionnaire was sent to 400 general practitioners, hospital doctors, and Ayurvedic practitioners in Sri Lanka as part of a wider study to investigate the delivery of primary medical care. The responses to questions that were related to the Alma Ata recommendations, which aim at providing "health for all by the year 2000," and the perceived health needs of the population are reported. Basic sanitation, clean water, adequate nutrition, and improved health education were considered to be the most important needs. When asked to suggest one change in health care 30% of the doctors recommended the integration of primary and secondary care services.
Related Articles
Survey of perceived stress and work demands of consultant doctors.
Agius, R M
Blenkin, H
Deary, I J
Zealley, H E
Wood, R A
Occupational and Environmental Medicine
OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.
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Junior doctor titles following implementation of Modernising Medical Careers in the UK
Islam, Shofiq
Deekes, Andrew
Lee, Alexandra
Hoffman, Gary
Isgar, Brian
JRSM Short Reports
Recent changes in postgraduate medical training in the UK collectively organized under the auspices of Modernising Medical Careers (MMC) have created new labels for junior doctors in training. It would appear that many nurses and other health workers do not understand the new terminology. We aimed to investigate the knowledge of nursing staff about new junior doctor titles in a district general hospital. As far as we are aware, this is the first survey to determine the views and knowledge of the new terms among staff working in the NHS.
Questionnaire study.
District general hospital, West Midlands, UK.
Fifty-five randomly selected staff nurses working in the surgical directorate.
Main outcome measure
Questions were asked about their views and knowledge of the current nomenclature. To objectively assess knowledge of the new titles respondents were asked to match equivalent positions with those based on the old system.
Only 22% (n = 12) of respondents felt that they fully understand current terms in usage. Seventy-six percent (n = 42) felt that it was 'very important' that titles accurately convey role and seniority of the doctor. The most common titles correctly matched were FY1 and House Officer (n = 45, 81%) and FY2 and First Year Senior House Officer (n = 35, 64%). Only 9% (n = 5) of staff nurses correctly matched ST3 to Junior Registrar and 13% (n = 7) correctly matched ST7 to Senior Registrar. Ward-based staff nurses demonstrated greater familiarity with titles when compared to nurses who work mainly in the outpatient clinic and theatre setting (p = 0.017). We did not identify a statistically significant association with demographic characteristics (age, gender, experience) and knowledge of the new terms (p > 0.05). Approximately 98% (n = 54) of the staff surveyed felt that terms are confusing to nurses and need to be simplified.
Our survey revealed that nursing staff lacked knowledge of the current terminology to describe doctors in training. This may have implications for staff expectations regarding specific role of junior doctor in terms of clinical decision-making, working relationships and communication between team members, and ultimately patient care.
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Searching for Cancer Information on the Internet: Analyzing Natural Language Search Queries
Bader, Judith L
Theofanos, Mary Frances
Kiley, Robert
Zeng, Q
McCaul, Kevin
Journal of Medical Internet Research
Searching for health information is one of the most-common tasks performed by Internet users. Many users begin searching on popular search engines rather than on prominent health information sites. We know that many visitors to our (National Cancer Institute) Web site, cancer.gov, arrive via links in search engine result.
To learn more about the specific needs of our general-public users, we wanted to understand what lay users really wanted to know about cancer, how they phrased their questions, and how much detail they used.
The National Cancer Institute partnered with AskJeeves, Inc to develop a methodology to capture, sample, and analyze 3 months of cancer-related queries on the Ask.com Web site, a prominent United States consumer search engine, which receives over 35 million queries per week. Using a benchmark set of 500 terms and word roots supplied by the National Cancer Institute, AskJeeves identified a test sample of cancer queries for 1 week in August 2001. From these 500 terms only 37 appeared ≥ 5 times/day over the trial test week in 17208 queries. Using these 37 terms, 204165 instances of cancer queries were found in the Ask.com query logs for the actual test period of June-August 2001. Of these, 7500 individual user questions were randomly selected for detailed analysis and assigned to appropriate categories. The exact language of sample queries is presented.
Considering multiples of the same questions, the sample of 7500 individual user queries represented 76077 queries (37% of the total 3-month pool). Overall 78.37% of sampled Cancer queries asked about 14 specific cancer types. Within each cancer type, queries were sorted into appropriate subcategories including at least the following: General Information, Symptoms, Diagnosis and Testing, Treatment, Statistics, Definition, and Cause/Risk/Link. The most-common specific cancer types mentioned in queries were Digestive/Gastrointestinal/Bowel (15.0%), Breast (11.7%), Skin (11.3%), and Genitourinary (10.5%). Additional subcategories of queries about specific cancer types varied, depending on user input. Queries that were not specific to a cancer type were also tracked and categorized.
Natural-language searching affords users the opportunity to fully express their information needs and can aid users naïve to the content and vocabulary. The specific queries analyzed for this study reflect news and research studies reported during the study dates and would surely change with different study dates. Analyzing queries from search engines represents one way of knowing what kinds of content to provide to users of a given Web site. Users ask questions using whole sentences and keywords, often misspelling words. Providing the option for natural-language searching does not obviate the need for good information architecture, usability engineering, and user testing in order to optimize user experience.
Cancer; Internet; search engines; natural language processing
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Does smoking status affect the likelihood of consulting a doctor about respiratory symptoms? A pilot survey in Western Australia
Jiwa, Moyez
Arnet, Hayley
Halkett, Georgia
Smith, Marthe
O'Connor, Moira
Rhodes, Julia
Poland, Kate
Bulsara, Max
BMC Family Practice
Smokers attribute respiratory symptoms, even when severe, to everyday causes and not as indicative of ill-health warranting medical attention. The aim of this pilot study was to conduct a structured vignette survey of people attending general practice to determine when they would advise a person with respiratory symptoms to consult a medical practitioner. Particular reference was made to smoking status and lung cancer.
Participants were recruited from two general practices in Western Australia. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of sixty four vignettes, based on six clinical variables. Twenty eight vignettes described cases with at least 5% risk of cancer. For analysis these were dubbed 'cancer vignettes'. Respondents were asked if they would advise a significant other to consult a doctor with their respiratory symptoms. Logistic regression and non-parametric tests were used to analyse the data.
Three hundred questionnaires were distributed and one hundred and forty completed responses were collected over six weeks. The majority (70.3%) of respondents were female aged forty and older. A history of six weeks' of symptoms, weight loss, cough and breathlessness independently increased the odds of recommending a consultation with a medical practitioner by a factor of 11.8, 2.11, 1.40 and 4.77 respectively. A history of smoking independently increased the odds of the person being thought 'likely' or 'very likely' to have cancer by a factor of 2.46. However only 32% of cancer vignettes with a history of cigarette smoking were recognised as presentations of possible cancer.
Even though a history of cigarette smoking was more likely to lead to the suggestion that a symptomatic person may have cancer we did not confirm that smokers would be more likely to be advised to consult a doctor, even when presenting with common symptoms of lung cancer.
Related Articles
Struggles for recognition: a content analysis of messages posted on the Internet
Andersen, Anders Johan W
Svensson, Tommy
Journal of Multidisciplinary Healthcare
The Internet has enlarged the possibilities of human communication and opened new ways of exploring perceptions of mental health. This study is part of a research project aiming to explore, describe, and analyze different discourses of mental health in Norway and Sweden, using material from Internet-based services.
To examine messages posed by users of publicly available question-and-answer services and to describe their content.
A Web search was used to identify Norwegian and Swedish Websites offering mental health services by email or posted messages. A total of 601 messages from 20 services, 10 Norwegian and 10 Swedish, were analyzed by means of qualitative content analysis and further interpreted in light of the social theory of recognition by Honneth.
Eight categories emerged from the analysis: family life, couples, others, violence, the ungovernable, self-image, negotiating normality, and life struggles. These categories were then grouped into three themes: (1) relationship to significant others, (2) relationship to self, and (3) relationship to the social community. The themes promoted an understanding of mental health as closely connected to political and social factors.
The results showed a variety of concerns from various parts of life and empowered the view that mental health should be understood broadly, at a conceptual level. Mental health emerged as a deeply relational concept that emphasized the equal distribution of chances in life. It strengthened the moral grammar of social inclusion and the acceptance of plurality in social life.
Internet-based services; mental health; public health; social theory
Related Articles
Online Access to Doctors' Notes: Patient Concerns About Privacy
Eysenbach, Gunther
Laranjo, Liliana
Brumen, Bostjan
Vodicka, Elisabeth
Mejilla, Roanne
Leveille, Suzanne G
Ralston, James D
Darer, Jonathan D
Delbanco, Tom
Walker, Jan
Elmore, Joann G
Journal of Medical Internet Research
Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online access to their primary care doctors' notes and then collected survey data about their experiences, including their concerns about privacy before and after participation in the intervention.
To identify patients' attitudes toward privacy when given electronic access to their medical records, including visit notes.
The design used a nested cohort study of patients surveyed at baseline and after a 1-year period during which they were invited to read their visit notes through secure patient portals. Participants consisted of 3874 primary care patients from Beth Israel Deaconess Medical Center (Boston, MA), Geisinger Health System (Danville, PA), and Harborview Medical Center (Seattle, WA) who completed surveys before and after the OpenNotes intervention. The measures were patient-reported levels of concern regarding privacy associated with online access to visit notes.
32.91% of patients (1275/3874 respondents) reported concerns about privacy at baseline versus 36.63% (1419/3874 respondents) post-intervention. Baseline concerns were associated with non-white race/ethnicity and lower confidence in communicating with doctors, but were not associated with choosing to read notes or desire for continued online access post-intervention (nearly all patients with notes available chose to read them and wanted continued access). While the level of concern among most participants did not change during the intervention, 15.54% (602/3874 respondents, excluding participants who responded "don't know") reported more concern post-intervention, and 12.73% (493/3874 respondents, excluding participants who responded "don't know") reported less concern.
When considering online access to visit notes, approximately one-third of patients had concerns about privacy at baseline and post-intervention. These perceptions did not deter participants from accessing their notes, suggesting that the benefits of online access to medical records may outweigh patients' perceived risks to privacy.
electronic medical records; patient access to records; patient portals; privacy; consumer health informatics; personal health records
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Cross-sectional survey of users of Internet depression communities
Powell, John
McCarthy, Noel
Eysenbach, Gunther
BMC Psychiatry
Internet-based depression communities provide a forum for individuals to communicate and share information and ideas. There has been little research into the health status and other characteristics of users of these communities.
Online cross-sectional survey of Internet depression communities to identify depressive morbidity among users of Internet depression communities in six European countries; to investigate whether users were in contact with health services and receiving treatment; and to identify user perceived effects of the communities.
Major depression was highly prevalent among respondents (varying by country from 40% to 64%). Forty-nine percent of users meeting criteria for major depression were not receiving treatment, and 35% had no consultation with health services in the previous year. Thirty-six percent of repeat community users who had consulted a health professional in the previous year felt that the Internet community had been an important factor in deciding to seek professional help.
There are high levels of untreated and undiagnosed depression in users of Internet depression communities. This group represents a target for intervention. Internet communities can provide information and support for stigmatizing conditions that inhibit more traditional modes of information seeking.
Related Articles
'I've Never Found Doctors to be a Difficult Bunch': Doctors, Managers and NHS Reorganisations in Manchester and Salford, 1948–2007
Snow, Stephanie J.
Medical History
Since 1974 the National Health Service (NHS) has been subject to successive reorganisations which have shaped and reshaped patterns of administration, clinical care and services. This paper uses two sources of oral evidence: a Witness Seminar with a group of administrators who attended the NHS National Administrators' Training Scheme in the late 1950s and a collection of interviews with doctors and managers who have played key roles in the health services of Manchester and Salford between 1974 and 2007. It surveys the day-to-day interactions between doctors and administrators/managers in hospital settings and analyses what these reveal about relationships within the broader context of shifting organisational structures and management styles. It suggests that the evidence challenges the historical stereotyping of the two groups and that strong working relationships have been determined as much by the values of respect and association as by changes to structures or management styles.
Health Services; Medicine; Management; Administration; Doctors
Related Articles
'I've Never Found Doctors to be a Difficult Bunch': Doctors, Managers and NHS Reorganisations in Manchester and Salford, 1948–2007
Snow, Stephanie J.
Medical History
Since 1974 the National Health Service (NHS) has been subject to successive reorganisations which have shaped and reshaped patterns of administration, clinical care and services. This paper uses two sources of oral evidence: a Witness Seminar with a group of administrators who attended the NHS National Administrators' Training Scheme in the late 1950s and a collection of interviews with doctors and managers who have played key roles in the health services of Manchester and Salford between 1974 and 2007. It surveys the day-to-day interactions between doctors and administrators/managers in hospital settings and analyses what these reveal about relationships within the broader context of shifting organisational structures and management styles. It suggests that the evidence challenges the historical stereotyping of the two groups and that strong working relationships have been determined as much by the values of respect and association as by changes to structures or management styles.
Health Services; Medicine; Management; Administration; Doctors
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Chamber Events
<< Events for February 9, 2012 >>
Daufuskie Island Merchants and Tourism Association
8:30am - 10:00am - Meeting
The Daufuskie Island Merchants and Tourism Assocation meets the second Tuesday of the month. Meetings are open to Daufuskie Island stakeholders and those wishing to promote business and tourism on ...more
Lend Me a Tenor
8:00pm - 10:00pm - Other
February 7-26, 2012
It's 1934, and Cleveland's premiere opera producer is about to have a nervous breakdown. The opening night gala is about to become un disastro gigantesco, because the ...more
Phone: 843-842-ARTS

subset: commoncrawl


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Rock the Blocks! Blacksburg Music & Arts Festival scheduled this week
Alliens, Another Roadside Attraction, Pigeons Playing Ping Pong, Boogieburg, Grime Syndicate, URTH and Funk Punch are among the local, regional and national acts playing this weekend's Rock the Blocks! Blacksburg Music & Arts Festival.
A collection of Blacksburg-based businesses and scene supporters are sponsoring the event, scheduled for Friday and Saturday at seven downtown venues. The goal, according to organizers, is to "keep the scene going in Blacksburg by bringing local artists from underground onto the stage and making it an established music and arts destination."
Champs, 111 N. Main St.
Ceritano's, 428 N. Main St.
Gillie's, 153 College Ave.
Frank's Bar, 622 N. Main St.
Pita Vera (Friday only), 235 N. Main St.
She-Sha, 211 Draper Road N.W.
XYZ Gallery. 223 N. Main St.
Alliens, Another Roadside Attraction, Backwords, Bassdread, Blessed Unrest, Boogieburg, Brad T, Chup, Class A., Crinkles, Dave J, DJ Blon-D, DJ Fauxbo7, DJ Manta Ray, DJ Pyrite, Doc Greenburg's Patient Jazz, Dream Cop, Driftin Westward, Free Food, Funk Punch, Fustics, Grime Syndicate, Hoop Dreams, Human Infection, IMU URI, Justin Craig, Kiffy, Killazap, Kuru Band, Machinelf. Manndibles, Meeting House, Methadone Abortion Clinic, Mey Mey Fresh, Nevin Kight, Pathogenesis, Pigeons Playing Ping Pong, RTFM, Softspot, Spacemonster, Tee Street, The Boatmen, URTH, White Laces, Woofdog.
(Organizers note that the lineup is subject to change.)
Follow Rock the Blocks! at twitter.com/RockTheBlocksVA, facebook.com/rocktheblocks or rocktheblocks.com to see the schedule.
$20 wristbands on sale through today allow admission to all events; Cover charges at individual venues range from $3-$10. inticketing.com/events/rocktheblocks
703-254-7057, firstname.lastname@example.com, rocktheblocks.com
Tad Dickens, The Roanoke Times
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You're watching...
President makes surprise appearance at WH press briefing
Did he address issues surrounding his campaign?
Aug 20, 2012
Brad Blakeman, Dick Harpootlitan
You're watching...
Did he address issues surrounding his campaign?
Aug 20, 2012
Brad Blakeman, Dick Harpootlitan
Also in this playlist...
Auto-advance: ON
Auto-advanceThis transcript is automatically generated
On the campaign he had a lot to say.
In particular he's not being mean -- by asking for Mitt Romney's tax returns and making this a campaign issue.
Saying that.
Nobody has ever accuse governor rob me of being a felon we're gonna look at that in a moment and saying that although he has pointed out sharp differences between himself and mr.
Romney we meaning his campaign do not go out of bounds.
Here now to discuss some of that.
Bradley men and -- carpooling.
Part believe Brad as a former advisor to president George W.
Bush and Dick is -- chairman of South Carolina Democratic Party gentlemen thank you so much for being here.
So I think I wanna start with.
With the president saying it.
He hasn't gone out of bounds -- his campaign has not gone out of bounds because you're the reporter -- asking him about some of the ugliness in this campaign hasn't done that.
And that no one has ever accused mr.
Of being a felon do we have that Stephanie Cutter SoundBite.
Let me play that that that sound -- That that may contradict the president on -- I'll ask you to answer -- impact.
Mitt Romney threw his own words and his own signature.
Was misrepresenting.
His position that -- to the FCC which is a felony.
More he would misrepresenting.
His position that made to the American people to avoid -- responsibility.
For some of the -- went with -- his investment.
-- Well as an attorney you you're familiar with the position of slander per say the suit you this was a slanderous statement not backed up by -- and certainly allege that he was doing something that was.
Criminal a felony.
So the president may be taking what he considers to be the high road himself but certainly his campaign is not.
And let's remember the president had to be shamed in.
To making a surprise appearance before the white house press corps we're in the last week he's acted more like the president Disney corporation meeting with -- Entertainment Tonight.
And and People Magazine and all these other.
Social and entertainment publications instead of sitting down with a Wall Street editorial board.
Really meaningful interviews with Fox News or other competent.
And and important news outlets for the president to be -- today to do something that he should have been doing all -- -- let me just look at this point for a minute it as I wrote it down -- forgive me because I just took notes I did I don't have the actual transcript yet.
The president said nobody accused mr.
Romney of being a felon.
That sound -- that we just aired from his campaign spokesperson Stephanie Cutter his senior writer -- campaign.
Certainly seems to do exactly that does it not.
It does not and and we're both lawyers so let's under let's Parse this out and understand what she said.
He she said what they filed with the SEC said he was running bank.
She says -- error he was lying to the SEC which is a felony which he didn't do.
Or he's lying to the American people saying he -- he had nothing to do with -- during that.
A period of time which he did too he's not a Fallon he's a liar and and Brad there's nothing wrong.
A with with showing that he is why the American people.
About Spain which he obviously was doing because he wouldn't have filed they didn't file a misstatement or the FCC -- he -- like I'm claiming that he was.
And wasn't wait a second now doing a criminal act in his files he wasn't doing a criminal act nobody nobody so what can we say hit it -- a bit.
Well because you put you put -- in the context of he would not have done this criminal act of lying to the FCC.
So he must be lying to the American people when he said he had nothing to do with -- in 2001 but the SEC filing says he's the C -- -- let's switch in 2001.
The president was also asked in this campaign it about this campaign and he was asked about the -- put out by priorities USA which is the super pac supporting his candidacy.
That -- a minute -- -- was responsible for the death of a woman who lost her health care.
It in a company that had been taken over by -- He came -- I do not think governor Romney is responsible for that woman's death now his senior advisor and -- that I didn't approve -- produce at that it's barely run.
Brad his senior campaign advisors were asked about this -- at -- and refused to disavow the act.
Refused to go as far as the president did it by saying I don't think.
That Mitt Romney is responsible for that woman's death -- heat the president his campaign team has been given the opportunity to speak to this.
And for weeks now they have refused to expressly disavowed that add.
You know why now why does the president if the president doesn't believe that white any call up.
Bill Burton his former mean a spokesman and say bill take that down.
Well not only that but he did his campaign lied to the American people and said they didn't know who this guy was they had no contact with them.
When his campaign operatives were on the phone with this guy -- -- conference call they knew we was they had advanced knowledge before they.
Commercial came out of to what his story was -- allegations were.
And finally the press caught up -- this campaign.
And showed them that they had been outright lying and misleading the American people.
So while while I don't think the president should of got necessarily on the phone because their coordination rules between.
-- -- -- -- -- -- no it's not the problem.
They what -- can't call obviously take that down Kenny he can't nobody can go and I go on television.
He can go on in the media and say he disavows this and he wishes this kind of advertised and I'll give you the last -- and -- get the message.
Well and and eight.
Megan you got it entirely correct.
He cannot nor his campaign -- priorities.
And say don't do that.
Even though Mitt Romney's campaign is conceded they've been talking -- Little animal that any -- come out say with the president just said when they were on the Sunday shows and asked about this act.
Well I think.
For two reasons one they don't want disappearance of coordination.
With which is illegal and to.
The president was asked this first time he's been asked about it and he responded to now people are psyched about it like an eagle as far as what president it.
Because he they're not the president number one and -- -- -- -- -- and that's and that's why.
Now well they like Ali -- is that it's -- that that I got it got I've got to their back and forth couple seconds in the tiebreak at two gentlemen thank you so much is always.
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Another Duke win. Nothing out of the ordinary.
Recap notes after the jump
- Andre Dawkins wasn't anything close to being short of phenomenal last night. He buried seven three-point shots throughout the whole game, and I believe all seven of them were in the first half. He is my player of the game for sure. When Dawkins gets hot, you can't ever stop him, and he certainly demonstrated that against the Demon Deacons.
- Speaking of Dawkins, he was also put in place of Austin Rivers on the starting five last night. Rivers looked like his old-self though, scoring 20 points off the bench. Coach K replaced Rivers with Dawkins because of a maturation issue and because he wasn't playing as hard as Coach thought he should be.
- Ryan Kelly also looked great. He got a double-double by dropping 20 points, snagging 10 rebounds, and shooting 54% from the field. He would be my runner-up for player of the game.
- Duke is one win away from tying their consecutive wins at Cameron. If the Blue Devils beat Florida State tomorrow, then that mark will be met.
- Wake Forest went out there and competed with Duke. I give them credit for that. Although they lost by 18, it was a valiant effort by the Demon Deacons. As we all know, it's very very hard to win at Cameron Indoor Stadium.
- Next game for the Blue Devils is tomorrow. It'll be at home against the Florida State, who beat Duke last year when the Blue Devils were the #1 team in the country. Tip off is approximately 4:00 PM EST. Let's Go Blue Devils!


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O\'KEEFE Family Tree and O\'KEEFE Genealogy Records
Last updated: 2011-07-02 | Researchers: 1 | Journals: 2
This is the surname research page for O\'KEEFE. This section is designed to contain general information about O\'KEEFE genealogy research. Please consider adding some of your own research, either as an editor or with journals below.
What is this? This section (in blue) is available for editing to our advanced members, in a Wiki style. If you would like access to edit this surname page wiki, please contact us.
O\'KEEFE Family History and O\'KEEFE Family Genealogy Journals
Sort by: Newest | Alphabetical
Patrick O'Keefe was my great grand father, his son Michael O'Keefe mar...
by sfok33 on 2004-09-14 09:39:07. page views: 653, comments: 0
by sfok33 on 2004-09-14 09:39:07. page views: 653, comments: 0


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Prosecco cupcakes filled with Prosecco-infused whipped cream and topped with Prosecco frosting and sugar pearl "bubbles" for NYE.
Homemade hot chocolate is easier to make than you think with just a handful of ingredients that's already sitting in your pantry. And it's even better with a hint of Kahlúa!
The Boozy Maple Orchard: a simple cocktail with fall's best ingredients – just in time for holiday gatherings.
{recipe} Kahlua Cookie Dough Milkshake - Cookie dough ice cream meets cookie crumbles and Kahlúa for a simple, tasty, oh-so-creamy milkshake when you need your cookie dough fix!
Boozy Bread Pudding
{recipe} Kahlua Cookies and Cream Milkshake - An indulgent and creamy 5-minute spiked Oreo milkshake that will knock your socks off!
{recipe} Rose Apple Pie with Bourbon Glaze
{recipe} Orange Brewlius. Beer Orange Julius. So easy and so delicious, you have to try this!
{recipe} Skip the Starbucks run and try a boozy iced coffee you can make in less than 5 minutes!
{recipe} Boozy Oreo Cheesecake Bars - need I say more?
Beer Cheese Soup
This Glazed Doughnut Cocktail is tasty, fun, and looks great! Perfect for a grown-up spin on a childhood favorite.
{recipe} The Adult Chocolate Covered Pretzel Shake is loaded up with sweet liqueur, flavored vodka, chocolate covered pretzels, and ice cream. Yum!
Vanilla ice cream is blended with homemade bourbon caramel sauce, bourbon, espresso and leftover Halloween candy, then topped with whipped cream and sea salt.
{recipe} Mini pumpkin bundt cakes with a secret boozy chocolate glaze that makes these TO DIE FOR!
Snack guilt free with these Boozy Nuts n Chocolate Flapjacks.
Delicious and quick recipe for Tennessee Honey Whiskey cupcakes
Hazelnut Panna Cotta with a Honey Cocoa Glaze. As easy to make as jello, and SO much tastier.
Jalapeño Bloody Mary with Quick Pickled Vegetables
Peach, strawberry, and orange popsicles with a touch of cointreau and vodka. A summer cocktail on a stick.
The ultimate boozy shake!
Grilled Maple Bourbon Glazed Panzanella Salad
Cocktail-themed cupcakes are so fun to eat - including these White Russian cupcakes topped with a boozy Kahlua buttercream!
Beer Sangria. Perfect party pitcher for those summer get togethers!
Kahlua cookies and cream ice cream - an irresistible combination of rich coffee flavor, Oreos & a nice dose of Kahlua!
5 Boozy Ice Cream Recipes - bringing the cocktail and the cream together.
Beat the heat with strawberry margarita granita - fruity, frozen & boozy!
Vanilla Rum Horchata Cocktail Recipe
What better way to eat your fruits than a watermelon... Jello shot!
{recipe} Mojito Sorbet, the perfect dessert for hot and humid summer weather with flavors of mint, lime, and rum!
Campari + strawberry limeade ice pops, with suggestions for other fruit and alcohol combinations. Swirled with homemade frozen yogurt.
Mini Gin & Tonic Cupcakes.
Cocktail time: Boozy blueberry limeade.
Boozy Watermelon Mint Lemonade! This drink features rum (or vodka), watermelon, lemon, mint, & a secret ingredient to make it the tastiest & most thirst-quenching cocktail ever!


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"A Future With Hope" was the theme for the 2008 General Conference of The United Methodist Church that met in Fort Worth, TX between April 23 and May 2. Our hope in Christ envisions "One Family Tree" that thrives as persons of all sexual orientations and gender identities make disciples of Jesus Christ for the transformation of the world. This blog records of the work of the Common Witness Coalition and Soulforce at the 2008 General Conference.
The Wedding
The Marriage of Susan Laurie and Julie Bruno
"Sue and I celebrate with you our covenant of love and partnership. God has been a part of our relationship for over 25 years. Our faith grounds us and our church family grounds us. Reconciling is our church family..."
General Conference Witness
The Plenary Witness
"The communion table at the center of our worship life has been
shrouded as a reminder that the body is broken..."
Walking Over The Wounded
"Yesterday the General Conference walked over gay and lesbian people. Today you will have to do it again..."
Decision 1032 Remains in Effect
The General Conference rejected petition 80088 and Decision 1032 remains in force in The United Methodist
Church. The Decision had affirmed a local pastor's right to deny a gay
man membership in his congregation...
Organized Prayer Actions Outside Legislative Sessions
After the Young Adult Rally, MoSAIC and OnFire led the crowd into the
Fort Worth Convention Center to conduct organized prayer actions
outside of legislative sessions...
Civil Rights Leaders Speak Out
Methodist Civil Rights Leaders Address General Conference
The panelists wrestled with the
connections between the "isms": racism, anti-semitism, sexism,
heterosexism, homophobia, agism, able-ism, etc. "They all come from
the same kind of place," Caldwell reflected, saying that we will not
get rid of heterosexism until the root of all the "isms" is unearthed...
Young Adults Speak Out
Young Adult March and Rally
"I have so many friends that will not come to church with me because
they believe the church does not want them and God does not want them..."
Young Adults Speak Out
"Young people have chosen a future
of hope. Hope is that all people will be welcome in our church..."
Parents Speak Out
Parents Reconciling Network Luncheon
"We knew in our heart that our daughter, the same as our son, was compatible with Christian teaching."
Transgender Christians Speak Out
Transgender Press Conference
"I spent the first 46 years of my life homeless...I'm talking about a kind of homelessness born of a disconnect between my internal spiritual self and my external physical self. I was born transgender..."
Legislative Outcome and Legislative Strategy
"Efforts to move the UMC toward fuller inclusion of LGBT persons through
revisions in the section on Human Sexuality in the Social Principles
were defeated. In fact, the language that was adopted represents a move
in a more exclusionary direction..."
Media Coverage
- Same-sex couple says 'I do' outside church assembly
- 'Christian conferencing' follows demonstration
- Demonstrators call church's 'anti-gay' policies sinful
- United Methodists uphold homosexuality stance
- Rally urges inclusion regardless of sexual identity
- Delegates seek General Conference ethics panel
- Doubts arise following gifts of cell phones
- Transgender United Methodists share stories
All News Stories and Press Releases
Event Coverage
Complete Schedule
Complete schedule with links to covered events
Pre-General Conference Flashnet Topics
Holy Conferencing/Funding Ban; Global Restructuring; Family; Judicial
Council Elections; Youth and Young Adults; Unity


text:
The wayfreight has been on duty since 6:00 a.m. in Eden Valley. After waiting for two westbounds and an eastbound, they were able to get on the main to do some work in town before having to clear... (more)
The old is leading the new as a GP20C-ECO trails on the wayfreight east of Brooten.
SOO 4449 DME 6076 and DMVW 6306 sit waiting on a new crew to take the train to Minot North Dakota from Flaxton North Dakota. What a colourful midwestern lineup to start the 2 day trip chasing arou... (more)
After grabbing some food, the hauler departs McDonalds heading back for St Paul light power. Only week remain for this operation before the plant closes and the rails turn to rust.
A short 0700 Superior heads back to its namesake behind two classy geeps. Looking back, I must admit I feel spoiled, having only shot CP geeps once or twice over the past two years, with the major... (more)
Lohrbach and Larson keep an eye out as they head for Stinson, while the large BNSF served Peavey elevators tower in the distance.
A CP local passes the Franklin Park Metra Station while commuters wait for their inbound train to arrive.
SOO power profile at Nahant.
Switch dog for the day is a venerable GP-38-2.


text:
You're watching...
As Super as Cars Get
Fox Car Report drives the 217 mph Lamborghini Aventador...in the rain
Oct 5, 2011
You're watching...
Fox Car Report drives the 217 mph Lamborghini Aventador...in the rain
Oct 5, 2011
Also in this playlist...
Auto-advance: ON
Auto-advanceThis transcript is automatically generated
It's a car that needs no introduction.
Because it speaks Roberts.
2012 labor -- a -- -- is simply as super as cars.
And if it's night vigil looks -- to work for you the technology that lies underneath it where.
The event to doors built under the aluminum and carbon fiber chassis that was developed in conjunction with Boeing.
It has an -- -- six point five liter 690.
Horsepower V twelve engine.
That it shares with no other car and a push -- suspension design featuring horizontally positioned shocks and springs that it has only in common with recent.
Ours and of course it -- scissors stores along within the interior said to be inspired by the cabin of a fighter plane but it's much cooler than any fighter -- I've ever seen.
Would you like that the included this little feature.
Harris sixty takes less than three seconds you'll be -- and link between logically.
Even certain that.
Ever any waves a tough.
Seventeen and alert and everything will work for all of that things the margin -- seven speed transmission shifts in milliseconds.
But it is handling -- that's that's the part many big labor -- be -- it's just astonishingly easy to drive.
That's the big thing all wheel drive system that.
Wallace stability control just -- wonders with his big -- Keep in mind this is an enormous power probably bigger -- you drive your -- around.
The track here at -- -- -- -- -- challenge on the best of days this is our program.
The price.
Dollars let's -- a lot.
The other thing about it embodiment -- and -- TV network.
But I'm pretty sure that's the way to go -- battles to deal with.
2012 -- -- event adored her guests to view foxnews.com.
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Home & Garden
Jim Beam Extra Large Fish Basket
Finally a grilling basket that can serve the whole family! Our unique oversized fish-shaped basket is designed to get the job done, and get it done right. Extra sturdy construction wont buckle when turning heavy fish. Intelligently designed parawood handle removes for closed top grilling and oven roasting. Non-stick stainless steel basket keeps the skin on fish and makes clean up easy. Dimensions: Length: 19.75 inches. Height: 6 inches. Width: 3 inches.$107.94 -
Home & Garden
Get ready for the holidays with holiday decor, or create an outdoor oasis with garden and patio furniture and fashions that are fun and functional.
Art Glass Box
Glass charm box designed by American glass artist Kathy Gustafson. Made of molded clear and beveled green glass, the hinged lid is framed in beaded metal and accented with a heart charm.
2"W x 3"H x 2"D.
Lead free solder.$29.00 -
Home & Garden
Get ready for the holidays with holiday decor, or create an outdoor oasis with garden and patio furniture and fashions that are fun and functional.
Whimsical Branches Jewelry Tree
Display your treasures and keep them in reach. Made from recycled iron with a bronzed finish, handcrafted tree holds earrings, bracelets, necklaces, and pins on multiple loops and branches.
Very simple assembly.$29.00 -
The Kiss Hand Mirror
In honor of Gustav Klimt's evocative masterpiece. This hand mirror is illustrated on both the back and the front handle of the mirror using a reverse glass decoration technique.
Measures 8"H, with a 4-inch round mirror.
Handmade in Peru.$29.00 -
18 Piece Stainless Steel Barbecue Set with Aluminum Storage Case
Be prepared to barbecue anywhere with the Chef's Basic Select 18 piece Stainless Steel Barbecue Set. This handsome set features a gourmet basting brush, 8" all-purpose blade, heavy-duty barbecue fork, 4-piece steak knives, 8-piece corn holder set, soft inner-case lining, grill cleaning brush, jumbo tongs, slotted turner with tenderizer and bottle opener and polished aluminum case. Dimensions: Length: 19 inches. Height: 9.375 inches. Width: 3.25 inches.$139.96 -
Art Glass Treasure Box
For treasures diminutive in size but not necessarily small in sentimental value. This artisan glass box, designed by American artist Kathy Gustafson, is made of molded clear and purple glass accented with a dangling flower charm.
The hinged beveled glass lid is framed in beaded metal. Lead free solder.
3-1/4"H x 3"W x 3"D
Imported.$36.00 -
Jim Beam 3 Piece Grill Topper
Grill versatility is the name of the game with Jim Beam reusable Grill Toppers the perfect surface for preparing savory meats and crispy vegetables. Light weight and sporting the Jim Beam Logo these vented aluminum toppers protect your grills suface and makes for quick and easy clean-up. Our toppers can even be trimmed to costum fit any size grill with a simple pair of household scissors.$179.88 -
18 Pc Stainless Steel BBQ Set
Grill like a pro with this uniquely designed 18 pc BBQ Set from Chefs Basics Select. This comprehensive set of BBQ tools includes tongs, basting brush, turner, steak knives and corn holders. It is perfect for any BBQ event. The tools are made from heavy duty materials and come in a handy case that can be stored almost anywhere. The tools are easy to clean and are non stick. With this BBQ Set you will always have the right tools for any of your BBQ needs. Dimensions:. Length: 17. Height: 12. Width: 3$119.94 -
6 LED Barbecue Clip Light
Grill like a pro anytime with this heavy-duty 6-LED Barbecue Clip Light form Chef's Basics Select. The light is made from high heat-resistant material and also features a. 360-degree pivoting light-heads a 15-inch goose-neck that directs light anywhere 6 long-lasting super-bright LED lights that last up to 100,000 hours and a magnetic base. The BBQ Clip Light attaches to most surfaces safely for ease-of-use and convenience. The BBQ Clip Light is perfect for late night grilling. It is battery operated and hence no wiring is needed. Take it camping to the beach or for a late night BBQ!. Dimensions:. Length: 5. Height: 18.5. Width: 5.5.$179.88 -
Jim Beam 2 Pack Kabob Grilling Basket
Easily make great tasting shish kabobs on the grill with the Jim Beam Kabob Grilling Basket 2 Pack. Simply prepare your favorite meat, vegetables and fruit and insert into the locking baskets. Place the basket over the grill and cook. The extra long parawood handles make it easy to flip the kabobs without losing food through the grill. Ergonomicly designed heavy-duty construction. Dimensions: Length: 19.625 inches. Height: 1.375 inches. Width: 1.625 inches.$95.88 -
7 Piece Barbecue Apron & Utensil Set
Save space and stay organized with this handsome 7-piece Barbecue Apron and Utensil Kit. This all-in-one apron comes complete with professional grade steel and solid wood implements such as, a slotted turner with built-in bottle opener, fork, tongs, oven mitt and salt& pepper shakers. The heavy-gauge Nylon apron features an adjustable locking fastener, and the fold-n-snap design is ideal for travel and storage. All of the tools fit neatly inside the apron pockets. Dimensions: Length: 17.5 inches. Height: 24.5 inches.$179.88 -
Vacuum Seal Container Set
Lock in freshness with our eleven-piece storage container! Create an airtight leak-proof barrier with the handheld vacuum pump high-heat resistance silicone gaskets and lid-locking latches all specifically designed to seal in freshness! Great for marinades too by saving time in speeding up the flavor-infusion process! Containers nest neatly for convenient & easy storage. Ideal for leftovers use during travel and outdoors. Dimensions:. Length: 8. Height: 6.5. Width: 8$149.94 -
Precious Moments Christmas Eve Drive
My friend, Roy Swanson, alias Santa, lived in San Francisco many years ago. One Christmas he decided to cut the top off his wagon. You might ask yourself, why? Well, he wanted to load it with mega stuff and drive through all areas of San Francisco on Christmas Eve dressed as Santa, that's why! He would go into all areas of the city from the rich as well as somewhat dangerous areas and everyone would stop what they were doing to wave at "Santa". There is nothing like Santa, who can bring a smile to the face of each person, no matter whom or where they are in life. Oh what a magical night! - Pipka.
This is the third figurine of a five year series of Santa traveling around the world in different forms of transportation. Each Santas Journey figurine is limited to 950, making it a treasured piece of art. The first in this series was the Antique Car Santa (#10120) and the second being Santa's Red Truck (#10126). A unique feature is the novelty lighted lantern on each years sculpture; this battery operated lantern is intended for temporary, novelty lighting use. It is not intended for a nightlight. Popularity of this piece may warrant additional editions. If this occurs, future editions will be marked accordingly.$78.95 -
Jim Beam Neoprene Grilling Mitten
Get maximum comfort and insulation with this Neoprene grilling mitt. Textured silicone hand and finger surface helps grip tools, spices and sauces when working around the grill. Thick inner padding protects your hand and wrist from high heat and grease splatters. Soft and pliable for an easy grip, this mitten was built tough for serious cooking. Built in hanging loop for easy storage anywhere around the grill. Dimensions: Length: 7.5 inches. Height: 16 inches. Width: 1 inch.$59.94 -
Abundant Wood Jewelry Box
Store a lifetime of treasures in this spacious, well-made chest. Made by hand from teak wood with a distressed antiqued finish. Chest has six drawers, a hinged lid, and multiple compartments. Raised sections on either side of the lid fold back to reveal secret hiding places.
A compartment below the lid has its own cover with knob. Solid brass hardware includes ornate handles and a front latch that may be secured with a small lock (not included).
15"W x 10"H x 8-1/2"D$149.00 -
Jim Beam Large Grill Basket
Our large rectangular non-stick grilling basket will keep you in the backyard all summer. There's almost no limit to what you can cook in this amazing oversized basket. Adjustable lid has four settings to manage from the slimmest cut to the thickest meats and produce. Tight fitting top keeps your food intact and makes turning easy. Works wonders for fish fillets, steaks, ribs, chicken, and more! Removable handle allows for top down grilling. Dimensions: Length: 27.75 inches. Height: 12 inches. Width: 2.125 inches.$119.94 -
Jim Beam Slim Flexible Grill Basket
Use our flexible basket for grilling generous quantities of delicate foods like seafood and vegetables or toasting slices of garlic bread. Specially engineered so that smaller pieces wont drop through the grill. Adjustable design accommodates foods of various thickness and easily flips over for even cooking. The long parawood handle keeps hands safely away from heat. Handle is also removable for covered grilling. Dimensions: Length: 11 inches. Height: 16 inches. Width: 1.5 inches.$107.94


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Be ready to discover Europe's most wonderful treasures: the world's finest museums, breathtaking architecture and amazing landscapes.
Many know that for sheer European romance, nothing beats a ride on the rails, but trains can also often be the most efficient means of getting around.
Share your travels with visiteurope.com and let everyone know about your European adventures.
Tourism is flourishing in the Baltic States of Estonia, Latvia and Lithuania.
The Mediterranean Region defies description; so rich is it in dramatic history and bewitching scenery.
The Rhine, one of Europe's great rivers, brings to mind wine and beautiful landscapes.
Any electrical device you wish to bring on your trip can be used with the aid of an electrical travel kit.
Take just a few extra precautions to protect your valuables and travel documents.
Consider safeguarding your trip so that you can minimize the financial impact.
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Contact: Dan Finanger Executive Director, TCM 612-925-3500, ext. 12 Jackie Liu Marketing Manager, TCM 612-925-3500, ext. 13 FOR IMMEDIATE RELEASE TWIN CITIES MARATHON REGISTRATION HALF FULL Minneapolis, Minn. – May 4, 2001 – Registration for the 20th running of the Twin Cities Marathon on October 7th is half full. In the 2 days since registration opened, 4,284 people have registered for the 8,500 runner field, including 2,950 from on-line registrations. On-line registration will close at 6,000 entrants. Registration is on pace to fill in record time. Runners are encouraged to register as soon as possible. Runners can check the marathon's website at www.twincitiesmarathon.org for on-line registration availability through Active.com. To pick up a registration form in person, stop by the Twin Cities Marathon office in the Calhoun Beach Club or check with local running stores and major health clubs. For more information, please call the Twin Cities Marathon office at 612-925-3500. Twin Cities Marathon continues its 10th consecutive year as the designated USATF National Masters Championship for men and women. In addition to the marathon, the Twin Cities Marathon features a three-day weekend celebration of fitness, including a Saturday 5K Fun Run/Walk and children's fun runs, a pasta dinner, a two-day Health and Fitness Expo and a 10 mile race on Sunday. Major sponsors for the 2001 marathon are Cub and the Calhoun Beach Club. The major media sponsors are KARE 11 and Cities 97. The designated community contributions are Bolder Options, Second Harvest Food Bank of Greater Minneapolis and St. Paul and Twin Cites Marathon scholarship program. Twin Cities Marathon, Inc. is a non-profit organization that directs the Twin Cities Marathon as a community service for the Minneapolis/St. Paul area. Visit us at www.twincitiesmarathon.org. # # #
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Battling another MC is a daunting enough proposition, but Watts MC Daylyt has done it while (at various times) wearing a ski-mask, stripping naked or dressed as Batman. Through it all, he's become one of the most successful and in-demand battlers working today. We spoke with him about his relations ... More >>
My school year is officially over. Last Thursday was the last day of school for the eighth graders in my science class. Teachers came on Friday to clean rooms and begin prep work for next fall and gossip about basically everyone who has a heartbeat (and, in some instances, even those without). Thi ... More >>
Karen O's Outfit Karen O's wardrobe on Friday night was bad ass. The Yeah Yeah Yeah's front woman appeared on the main stage in a technicolor cape draped over a suit that looked like it was made of mercury. The vibrant collage was topped with a headpiece that Liberace might have worn had he ever bee ... More >>
Get a book. Collect a stack. Raise the stakes. Repeat. That's the objective of bourré, the underground card game popular with the pro athlete set. Chances are you've heard about it and didn't even know it. Remember when Taft High School alum and ex-NBAer Gilbert Arenas pulled a gun on his the ... More >>
At the end of November, Trinidad James, a 25-year-old Trinidadian rapper living in New York, released a video for "All Gold Everything," the unsuspectingly gargantuan single found on his otherwise mostly middling mixtape, Don't Be S.A.F.E. The video was PERFECT, and flung James, then of a tepid amou ... More >>
There's a future NBA champion being built piece-by-piece at the Staples Center this year. It has a point guard destined for the Hall of Fame, a dominant power forward, a young, outrageously athletic 7-foot center and a shooting guard with no fear, no conscience and no hesitation. I'm talking, of co ... More >>
[Editor's note: Why This Song Sucks determines why particular tracks blow using science. It appears on West Coast Sound every Wednesday.] Song: Chris Brown's "Don't Wake Me Up" History: "Don't Wake Me Up" is the hyper danceclub track from Chris Brown's latest album, Fortune. Apparently, wherever ... More >>
Updated at the bottom with personal details on Eric Yee, and the comments that may have triggered his arrest. (Headline has been changed to reflect the suspect's identity.) Originally posted at 9:30 a.m. The L.A. County Sheriff's Department is refusing to release the name of a young Asian man in h ... More >>
[Editor's note: Why This Song Sucks determines why particular tracks blow using science. It appears on West Coast Sound every Wednesday.] Song: The Beatles' "I Want To Hold Your Hand" History: The Beatles are The Beatles and "I Want To Hold Your Hand" is "I Want To Hold Your Hand." Let's all just ... More >>
By J. Pablo Top 20 Greatest L.A. Rap Albums Of All Time: The Complete List Over the last few years, hip-hop artists who grew up in the hood but wanted to go beyond clichéd gangsterisms have been on the rise; Kendrick Lamar, Curren$y, A$AP Rocky, Big K.R.I.T. Hailing from L.A.'s Leimert Park neig ... More >>
You (probably) don't know him, but trust when I tell you that T is a real shitbag. In our little cluster of townhomes, there are six boys who live there. A quick scouting report: There is a family that lives across from us. They have three boys; J and D and L. They're sweet kids, and the boys' ... More >>
Playboy Jazz Festival Hollywood Bowl 6-16-12 This past weekend the Playboy Jazz Festival celebrated its 34th anniversary with two days of bands, both jazz and otherwise. It was also a farewell to Bill Cosby, who would be MCing for the last time. The crowd came prepared to party and even caught some ... More >>
For the last couple months, I've run an after school basketball program at a middle school. Much as I'd like to say I Phil Jacksoned 'em into a championship caliber squad, that they've grown from piddly-poop to a run 'n gun offensive juggernaut with impenetrable defense, the truth is that the team - ... More >>
Rick Ross feat. Busta Rhymes 1-13-12 Nokia Theatre See also: Fictional Cutting-Room Floor Outtakes From Rick Ross' Amazing GQ Profile Better than: Actually being Big Meech. Or Larry Hoover. At least in 2012. "Schindler and I are like peas in a pod! We're both factory owners, we both made shells f ... More >>
Only the best for the King. So went the line of thinking when a $3,000 birthday cake was deemed unworthy of Miami Heat basketball player LeBron James and promptly discarded. And now no one's left to pick up the tab. The Miami Herald reports that Boca Raton baker Alethea Hickman had received a frant ... More >>
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Will his old tricks still work?
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Food PartyTomorrow kicks off five days of found footage feting known as the Everything is Festival at Cinefamily. It's a celebration of diggers, curators, and collectors as much as the weird, funny, campy, boogerfaced footage they unearth. Along with Joe Dante's four-hour legend The Movie Org ... More >>
The best player in the NBA is still with us.The Lakers flamed out like Charlie Sheen in rehab -- in spectacular, unprecedented fashion (via a sweep the likes of which coach Phil Jackson has never seen). And now Phil Jackson says he's coached his last NBA game and Kobe Bryant is talking about ... More >>
Also, Into the Woods, Barrymore and more
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Plus, Brief Interviews With Hideous Men, In Search of Beethoven and more
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question for recurrence task fixed show for "today"
this may not quite suitable be question here. i want just clarify that if it works now or not. Otherwise, i can filled in votebox later...
i have some of task with recurrence every day. Due to the task of very low priority, i may not want do it today. so, in second day, it will show under the bucket of the "yesterday" task. And same situation will plus over due days later..
It sound not very good for some of case.
I want to take newspaper "NY time" every day. So, i add one recurrence task as "ev day" to reminder me.
-->if i have forgot it and the task not got "finished" click.
-->The second day, it show in yesterday, not today. But, i do not want to got yesterdays newspaper but today's.
And in the case, i have filter as default page of Todoist, "tod, +3". This recurrence task will not show any more. But actually, it show be there.
i just want to have one feature to fixed tasks of recurrence. it can always in the today's bucket, by fixed or other way..
Asked by Peter Gao on Mar 22, 2013 - 03:10
David Trey on Mar 22, 2013 - 07:58
Hello Peter,
This feature is unfortunately not possible and you're welcome to add a request to the Votebox. For now, you could either postpone the task to tomorrow if you won't make it today, but we strongly recommend to include overdue tasks in your start page (tod, +3, od). The default queries always include overdue to make sure you won't miss them as it's currently not possible to have a task stay as due "today" and never get overdue.
Best regards,