Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

The meshed control theory assumes that cognitive control and automatic processes work together in the natural attention of experts for superior performance. However, the methods adopted by previous studies limit their capacity to provide in-depth information on the neuromotor processes. This experiment tested the theory with an alternative approach. Twelve skilled golfers were recruited to perform a putting task under three conditions: (1) normal condition, with no focus instruction (NC), (2) external focus of attention condition (EC), and (3) internal focus (...) of attention condition (IC). Four blocks of 10 putts each were performed under each condition. The putting success rate and accuracy were measured and electroencephalographies (EEGs) were recorded. The behavioral results showed that the NC produced a higher putting success rate and accuracy than the EC and IC. The EEG data showed that the skilled golfers’ attentional processes in the NC initially resembled those in the EC and then moved toward those in the IC just before putting. This indicates a switch from more automatic processes to cognitive control processes while preparing to putt. The findings offer support for the meshed control theory and indicate the dynamic nature of neuromotor processes for the superior performance of athletes in challenging situations. (shrink)

In this paper I test major analytic theories of interpretation, including anti-intentionalism, the value-maximizing theory, actual intentionalism, and hypothetical intentionalism, against Li Shang-yin’s poem ‘The Ornamented Zither’. I argue that, based on the results of the test, all of these theories face grave difficulties. If their supporters want their accounts to be sustained in the debate over interpretation, they need to address the worries I raise.

The utterance model is a popular basis for theories of interpretation in the contemporary analytic philosophy of literature. This model suggests that interpretation should be constrained by a work's identity‐relevant factors in its context of production because a work, like an utterance, acquires its identity and content in part from its relations with that context. From a descriptive point of view, I argue that the implied author account of interpretation best describes critical practice following the current positions based on the (...) utterance model. That is, people who interpret in accordance with these positions end up interpreting an implied author. (shrink)

The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

The American Journal of Bioethics, Volume 11, Issue 8, Page 58-59, August 2011.

Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.

Background Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order. Methods This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, (...) 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order. Results We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so. Conclusion Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order. (shrink)

In contemporary analytic philosophy of art, the intentionalist debate is about whether the author’s intention is relevant to the interpretation of her work. Various positions have been proposed, and in this paper I defend what I call hypothetical author-hypothetical intentionalism, the position that interpretation is based on the intention attributed to the author constructed from the work. There are three aims to achieve: (1) to give a general account of hypothetical author-hypothetical intentionalism; (2) to present a moderate version of hypothetical (...) author-hypothetical intentionalism; (3) to defend the moderate version of hypothetical author-hypothetical intentionalism against actual intentionalism and actual author-hypothetical intentionalism. Against the current trend that focuses on actual authors, I hope to show that the hypothetical author account is still a sustainable contender in the intentionalist debate. (shrink)

Physicians play a substantial role in facilitating communication regarding life-supporting treatment decision-making including do-not-resuscitate in the intensive care units. Physician-related fact...

Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the (...) survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

Urban streetscapes are outdoor areas in which the general public can appreciate green landscapes and engage in outdoor activities along the street. This study tested the extent to which the degree of awareness of urban street trees impacts attention restoration and perceived restorativeness. We manipulated the degree of awareness of street trees. Participants were placed into four groups and shown different images: (a) streetscapes with absolutely no trees; (b) streetscapes with flashes of trees in which participants had minimal awareness of (...) the content; (c) streetscapes with trees; and (d) streetscapes with trees to which participants were told to pay attention. We compared the performance of 138 individuals on measures of attention and their evaluations of perceived restorativeness. Two main findings emerged. First, streetscapes with trees improved the performance of participants on attentional tests even without their awareness of the trees. Second, participants who had raised awareness of street trees performed best on the attentional test and rated the streetscapes as being more restorative. These findings enhance our knowledge about the role of an individual's awareness of restorative elements and have implications for designers and individuals who are at risk of attentional fatigue. (shrink)

Background Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors’ experience teaching in this program. Aim To explore the phenomenon of teaching and (...) learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. Design Phenomenological qualitative research. Methods Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. Ethical consideration The study was approved by the Institutional Review Board. Findings Three themes emerged from the tutors' teaching perspectives, including the instructor’s motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. Discussion Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students’ professions, and between different students’ professional maturities is observed. Conclusion Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication. (shrink)

Some theorists on literary interpretation have suggested a connection between Monroe C. Beardsley’s anti-intentionalism and hypothetical intentionalism based on an implied author. However, a full exploration has never been attempted. I undertake this task in this paper. A close reading of Beardsley reveals that he assumes something very similar to the implied author in interpretation. I distinguish five types of fictional works in terms of their narrative mode and show that my claim stands in at least four of the five (...) types. The significance of my argument lies in exposing the above version of authorism in anti-intentionalism. -/- Beardsley is generally perceived as advocating the irrelevance of authorial intention to literary interpretation. The common interpretation of his theory is that work-meaning is generated by linguistic conventions, with intention playing no role in meaning-determination. All the interpreter needs is knowledge of public, linguistic conventions in order to recover textual meaning. -/- Nevertheless, when dealing with the problem of interpretation, Beardsley explicitly talks about attributing textual meaning to a fictional speaker. Although he does not elaborate on the nature of this speaker, clues scattered in his writings point to the striking similarity of this theoretical apparatus to an implied author. The key lies in his presumption that every fictional work must have an ultimate speaker to whom meaning inferred from the text should be attributed. This claim is almost the core of an implied author theory of interpretation. -/- A difficulty in classifying Beardsley’s view as a version of the implied author position is that his characterization of the story’s presenter might apply better to the story’s narrator than to its implied author. To test this, I examine different types of narrative modes to see whether the fictional speaker merges with the implied author in each of these scenarios. -/- The first factor to consider for classifying narrative modes is whether the narrator’s presence is explicit or implicit. The narrative scenario in which the narrator is implicit can be further divided into two sub-types: either the story is told from an omniscient viewpoint or centers on the experience of a third-person character. In either case, the story is not told by any of the characters in the story; rather, it is told by an implicit speaker whose words the work purports to be. It seems reasonable to identify this fictional speaker with the implied author, for both function as the subject to which textual meaning is attributed. -/- As for the narrative mode in which the narrator is explicit, this involves first-person narratives. In these, either the narrator is reliable or unreliable. When the narrator is unreliable, a transcendental perspective is required in determining the text’s meaning, because what is said ultimately in the work is not equivalent to what is literally said by the unreliable narrator. It follows that an implicit speaker has to be assumed and she again coincides with the implied author. -/- Where the narrator is reliable but textual meaning transcends what is literally expressed, an implicit speaker is at play again. This narrative scenario is thus better classified as a case in which the narrator’s presence is implicit. This leaves us with the narrative scenario in which the narrator is a reliable spokesperson for the implied author. -/- The identification of the narrator with the implied author in the case last mentioned is controversial. The crucial difference between them is that the former is dramatized in the story while the latter is not. I accept that the narrator here is not happily called an implied author, though I also point out several similarities between the two. -/- Finally, I discuss four complications to my argument. The first concerns multiple points of view in a story. To accommodate this kind of narrative, Beardsley could argue that an implicit narrator is needed to explain the definite meaning concealed behind what is literally said by different characters. The second complication is about the ontological status accorded to the narrator and the implied author. It might be objected that the two reside in different fictional worlds and this is what makes their merging impossible. But it is questionable whether this is a definitional feature of the implied author; moreover, the interpreter can take the implied author to be an instrumentalist concept and hence avoid talk about the ontological status of fictional entities. The third complication claims that versions of the implied author position developed by philosophers tend to be based on a contextualist ontology of literature; however, Beardsley’s account is acontextual. This is not true, for Beardsley has exhibited contextualist leanings in his writings. Finally, it has been objected that the formalist resources Beardsley has are not enough to guarantee a single right interpretation. But if Beardsley is actually a contextualist, contextual constraints will come into play and raise the chance of getting a single right interpretation. -/- The article concludes by reflecting on the significance of the misrepresentation of anti-intentionalism: it is the intention of the actual author which anti-intentionalism is against. The position in question is actually developed in an intentionalist framework based on the implied author. (shrink)

This paper attempts to revive interest in the speech act theory of literature by looking into Monroe C. Beardsley's account in particular. Beardsley's view in this respect has received, surprisingly, less attention than deserved. I first offer a reconstruction of Beardsley's account and then use it to correct some notable misconceptions. Next, I show that the reformulation reveals a hitherto unnoticed discrepancy in Beardsley's position and that this can be explained away by a weak version of intentionalism that Beardsley himself (...) actually tolerates. Finally, I assess the real difficulty of Beardsley's theory and its relevance today. (shrink)

Interpretation in art refers to the attribution of meaning to a work. A point on which people often disagree is whether the artist’s or author’s intention is relevant to the interpretation of the work. In the Anglo-American analytic philosophy of art, views about interpretation branch into two major camps: intentionalism and anti-intentionalism, with an initial focus on one art, namely literature. -/- This article elaborates on variations on these theories of interpretation and considers their notable objections. The debate about interpretation (...) covers other art forms in addition to literature. The theories of interpretation are also extended across many of the arts. This broad outlook is assumed throughout the article, although nothing said is affected even if a narrow focus on literature is adopted. (shrink)

Modest actual intentionalism is a major position on interpretation in contemporary analytic aesthetics. The position consists of a disjunctive formulation according to which work-meaning is determined by the author’s intention when such intention succeeds or by non-intentionalistic factors when it fails. I challenge the disjunctive view by presenting a constructive dilemma, the conclusion being that modest actual intentionalism ends up either making non-intentionalistic factors idle or making authorial intent superfluous.

This study explored the effect of learning strategies in a student organization on cake art creativity. The participants were 27 student members of a cake decorating art club from one central university in Taiwan. A quasi-experimental pretest-posttest design was adopted, with 90 h of experimental teaching over 16 weeks. The results, which included the use of a questionnaire, classroom observation, and in-depth interviews, suggest that in terms of creativity, the group participating in flipped classroom learning significantly outperformed the group using (...) traditional learning strategies. Furthermore, flipped classroom learning promoted learner motivation and satisfaction. (shrink)

Monroe C. Beardsley has been interpreted by many theorists as advocating antiexternalism with respect to an artwork's aesthetically relevant properties, typically its meaning. According to this orthodox interpretation, the meaning of a work is not established by external or contextual factors but by what is internally present in the work. This acontextual account of meaning is challenged by contextualism, which claims that a work's identity and meaning are in part determined by contextual factors. However, a close look at textual evidence (...) shows that Beardsley actually leans toward contextualism. In particular, his speech act theory of literature compels him to hold an explicit contextualist position with respect... (shrink)

Monroe C. Beardsley's unavailability argument is one of the most underrated anti‐intentionalist arguments in the philosophy of interpretation. The main idea of this argument is that, since independent evidence of authorial intent is normally unavailable, the literary interpreter should focus on what a text means rather than on what the author intends it to mean. In this article I propose a revised version of the argument to show that the unavailability of authorial intent suffices to make actual intentionalism untenable as (...) a recommendation for finding out textual meaning. (shrink)

Body ownership concerns what it is like to feel a body part or a full body as mine, and has become a prominent area of study. We propose that there is a closely related type of bodily self-consciousness largely neglected by researchers—experiential ownership. It refers to the sense that I am the one who is having a conscious experience. Are body ownership and experiential ownership actually the same phenomenon or are they genuinely different? In our experiments, the participant watched a (...) rubber hand or someone else’s body from the first-person perspective and was touched either synchronously or asynchronously. The main findings: (1) The sense of body ownership was hindered in the asynchronous conditions of both the body-part and the full-body experiments. However, a strong sense of experiential ownership was observed in those conditions. (2) We found the opposite when the participants’ responses were measured after tactile stimulations had ceased for 5 s. In the synchronous conditions of another set of body-part and full-body experiments, only experiential ownership was blocked but not body ownership. These results demonstrate for the first time the double dissociation between body ownership and experiential ownership. Experiential ownership is indeed a distinct type of bodily self-consciousness. (shrink)

Sam Rose’s Interpreting Art is a short monograph about how people make sense of artworks. The book is mainly about the visual arts, although literary works are.

Judging similarities among objects, events, and experiences is one of the most basic cognitive abilities, allowing us to make predictions and generalizations. The main assumption in similarity judgment is that people selectively attend to salient features of stimuli and judge their similarities on the basis of the common and distinct features of the stimuli. However, it is unclear how people select features from stimuli and how they weigh features. Here, we present a computational method that helps address these questions. Our (...) procedure combines image-processing techniques with a machine-learning algorithm and assesses feature weights that can account for both similarity and categorization judgment data. Our analysis suggests that a small number of local features are particularly important to explain our behavioral data. (shrink)

The importance of organizational ambidexterity was stressed in different fields of management. This study was using a distinct method to measure the differences in the degree of ambidexterity to bridge the gap with the previous studies and to provide more insights in the successful management of exploitation and exploration. This study surveyed Taiwanese small and medium-sized enterprises to test the hypotheses. We issued 1000 questionnaires in total and received 234 valid ones. Results indicate exploitative and explorative capabilities exerting non-linear effect (...) on performance. Likewise, ambidexterity and its interaction with market orientation have positive influence on firm performance. This study used structural equation modeling to analyze data, as this approach is known to be particularly advantageous for the exploratory nature of this study. We also used hierarchical regression analysis to test interaction and moderating effects. The study contributes to the literature in two ways. First, we offer a clearer understanding of the complete concept of social capital, including inter-firm and intra-firm social capital, and how contributes to improving and extending existing exploitative capabilities. Second, this study outlines how market orientation can have different effects on an ambidextrous strategy that is adopted to improve Taiwanese SMEs performance. (shrink)