The Social Work Ethics Audit: A Risk-Management Strategy.

ERIC Educational Resources Information Center

Reamer, Frederic G.

2000-01-01

Article integrates current knowledge on social work ethics and introduces the concept of a social work ethics audit to aid social workers in their efforts to identify pertinent ethical issues; review and assess the adequacy of their current ethics-related practices; modify their practices as needed; and monitor the implementation of these changes.…

Practical applications of current loop signal conditioning

NASA Astrophysics Data System (ADS)

Anderson, Karl F.

1994-10-01

This paper describes a variety of practical application circuits based on the current loop signal conditioning paradigm. Equations defining the circuit response are also provided. The constant current loop is a fundamental signal conditioning circuit concept that can be implemented in a variety of configurations for resistance-based transducers, such as strain gages and resistance temperature devices. The circuit features signal conditioning outputs which are unaffected by extremely large variations in lead wire resistance, direct current frequency response, and inherent linearity with respect to resistance change. Sensitivity of this circuit is double that of a Wheatstone bridge circuit. Electrical output is zero for resistance change equals zero. The same excitation and output sense wires can serve multiple transducers. More application arrangements are possible with constant current loop signal conditioning than with the Wheatstone bridge.

Current loop signal conditioning: Practical applications

NASA Technical Reports Server (NTRS)

Anderson, Karl F.

1995-01-01

This paper describes a variety of practical application circuits based on the current loop signal conditioning paradigm. Equations defining the circuit response are also provided. The constant current loop is a fundamental signal conditioning circuit concept that can be implemented in a variety of configurations for resistance-based transducers, such as strain gages and resistance temperature detectors. The circuit features signal conditioning outputs which are unaffected by extremely large variations in lead wire resistance, direct current frequency response, and inherent linearity with respect to resistance change. Sensitivity of this circuit is double that of a Wheatstone bridge circuit. Electrical output is zero for resistance change equals zero. The same excitation and output sense wires can serve multiple transducers. More application arrangements are possible with constant current loop signal conditioning than with the Wheatstone bridge.

The recovery model and complex health needs: what health psychology can learn from mental health and substance misuse service provision.

PubMed

Webb, Lucy

2012-07-01

This article reviews key arguments around evidence-based practice and outlines the methodological demands for effective adoption of recovery model principles. The recovery model is outlined and demonstrated as compatible with current needs in substance misuse service provision. However, the concepts of evidence-based practice and the recovery model are currently incompatible unless the current value system of evidence-based practice changes to accommodate the methodologies demanded by the recovery model. It is suggested that critical health psychology has an important role to play in widening the scope of evidence-based practice to better accommodate complex social health needs.

Investigating influences on current community pharmacy practice at micro, meso, and macro levels.

PubMed

Hermansyah, Andi; Sainsbury, Erica; Krass, Ines

The nature of Australian community pharmacy is continually evolving, raising the need to explore the current situation in order to understand the potential impact of any changes. Although community pharmacy has the potential to play a greater role in health care, it is currently not meeting this potential. To investigate the nature of the contemporary practice of community pharmacy in Australia and examine the potential missed opportunities for role expansion in health care. In-depth semi-structured interviews with a wide-range of key stakeholders within and beyond community pharmacy circles were conducted. Interviews were audio-recorded, transcribed verbatim and analyzed for emerging themes. Twenty-seven key informants across Eastern half of Australia were interviewed between December 2014 and August 2015. Several key elements of the current situation representing the social, economic and policy context of community pharmacy have been identified. These elements operate interdependently, influence micro, meso and macro levels of community pharmacy operation and are changing in the current climate. Community pharmacy has untapped potential in primary health care, but it has been slow to change to meet opportunities available in the current situation. As the current situation is complex, interrelated and dynamic with often unintended and unpredictable consequences, this paper suggests that policy makers to consider the micro, meso and macro levels of community pharmacy operation when making significant policy changes. The framework proposed in this study can be a helpful tool to analyze the processes operating at these three levels and their influences on practice. Copyright © 2016 Elsevier Inc. All rights reserved.

The current status of evidence-based practice in juvenile justice.

PubMed

McKee, Esther Chao; Rapp, Lisa

2014-01-01

The advent of evidence-based practice (EBP) has significantly changed the juvenile justice system while producing intense controversy. The intent of this article is to provide an update on the current status of EBP in the juvenile justice system. Specifically, this article will describe the evolution of juvenile justice philosophy as it has informed current juvenile justice policies and programs, discuss the scope of current juvenile justice research regarding EBP, identify barriers to implementing EBP, expound on the development of EBP in juvenile justice, discern the characteristics of evidence-based interventions in the juvenile justice system, and finally describe how to select and assess evidence-based practices and interventions.

Looking Back to the Future: Current Issues Facing Nursing Education From the Reflections of a Member of the Silent Generation.

PubMed

Keating, Sarah B

2016-07-01

As a member of the Silent Generation, the author, through her lived experiences, reflects upon the successes and challenges facing nursing education in the mid-20th to 21st centuries. The author looks "back to the future" and reviews current issues that surround four key nursing education milestones. From the early entry-level baccalaureate programs in the 1950s to the current growth of the Doctor of Nursing Practice as entry into advanced practice, milestones in nursing education are linked to the cultural changes and healthcare system demands that took place at the time and their influence on nursing education and the profession. Looking to the future, the author speaks of the implications from the forecasted changes in the healthcare system that will demand interdisciplinary education and practice and the continued need for nursing research to increase the body of scientific knowledge in practice, education, and technology. Keating. © 2015 Wiley Periodicals, Inc.

Macro Trends and the Future of Public Health Practice.

PubMed

Erwin, Paul Campbell; Brownson, Ross C

2017-03-20

Public health practice in the twenty-first century is in a state of significant flux. Several macro trends are impacting the current practice of governmental public health and will likely have effects for many years to come. These macro trends are described as forces of change, which are changes that affect the context in which the community and its public health system operate. This article focuses on seven such forces of change: the Patient Protection and Affordable Care Act, public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, and globalized travel. Following the description of each of these, this article then turns to possible approaches to measuring, tracking, and understanding the impact of these forces of change on public health practice, including the use of evidence-based public health, practice-based research, and policy surveillance.

Maintenance of Certification: How Performance in Practice Changes Improve Tobacco Cessation in Addiction Psychiatrists’ Practice

PubMed Central

Ford, James H.; Oliver, Karen A.; Giles, Miriam; Cates-Wessel, Kathryn; Krahn, Dean; Levin, Frances R.

2017-01-01

Background and Objectives In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality improvement project to improve patient care. This study reports on findings from an MOC Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP). Method A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP. Results Of the physicians participating, 76% (n 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted improvement efforts focused on a single clinical measure. Results found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure. Conclusions The current findings suggest that addiction psychiatrists can leverage the MOC process to improve clinical care. PMID:27973746

The Student Disciplinary Process in the Private College and University: Is the Music Beginning to Change?

ERIC Educational Resources Information Center

Habecker, Eugene B.

A brief historical review of the student disciplinary process in private colleges and universities, as well as a discussion of current practices and principles of student discipline, provide background for discussion of future possibilities. The analysis of current practices and principles includes a brief theoretical discussion about the legal…

Preschool Teacher Well-Being: A Review of the Literature

ERIC Educational Resources Information Center

Hall-Kenyon, Kendra M.; Bullough, Robert V.; MacKay, Kathryn Lake; Marshall, Esther E.

2014-01-01

Much is changing in preschool education. Current reform primarily emphasizes standardized practice, academic outcomes, and accountability. Little attention has been given to how these changes are impacting the well-being of teachers. The purpose of this review is to summarize the current literature on preschool teacher well-being and identify…

Climate change and ecological public health.

PubMed

Goodman, Benny

2015-02-17

Climate change has been identified as a serious threat to human health, associated with the sustainability of current practices and lifestyles. Nurses should expand their health promotion role to address current and emerging threats to health from climate change and to address ecological public health. This article briefly outlines climate change and the concept of ecological public health, and discusses a 2012 review of the role of the nurse in health promotion.

Current economic trends in equine practice.

PubMed

Clark, Andrew R

2009-12-01

Current economic trends in equine practice are trends of weakness. Most practices, after a decade of double-digit growth, have migrated to survival mode within a few months. Understanding that all regions and disciplines are affected differently, using the Porter five forces model, we can identify changes that must be made in our business models first to survive and then to position ourselves to prosper when the recession ends. If we are to avoid long-term damage to our practices, we must use cost control and work efficiency in addition to price concessions.

Economic impact of converting an interventional pain medicine physician office-based practice into a provider-based ambulatory pain practice.

PubMed

Grider, Jay S; Findley, Kelley A; Higdon, Courtney; Curtright, Jonathan; Clark, Don P

2014-01-01

One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu.   Community hospital-based academic interventional pain medicine practice. Economic analysis of effect of change in price structure on clinical volumes. The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. Single practice entity and single geographic location in southeastern United States. The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice.  

Fair & Accurate Grading for Exceptional Learners

ERIC Educational Resources Information Center

Jung, Lee Ann; Guskey, Thomas R.

2011-01-01

Despite the many changes in education over the past century, grading and reporting practices have essentially remained the same. In part, this is because few teacher preparation programs offer any guidance on sound grading practices. As a result, most current grading practices are grounded in tradition, rather than research on best practice. In an…

Changing Teacher Practices: Proceedings of a National Conference (Austin, Texas, October 1981).

ERIC Educational Resources Information Center

Defino, Maria E., Ed.; Carter, Heather, Ed.

In this report of a working conference, experts in the teacher education field considered the adequacy of current research on teaching practices and obstacles in the implementation of changes based on research findings. In "How Useful Are the Findings from the Research on Teaching," Jane A. Stallings discussed findings from research on teaching…

Adapting to climate change in United States national forests

Treesearch

G. M. Blate; L. A. Joyce; J. S. Littell; S. G. McNulty; C. I. Millar; S. C. Moser; R. P. Neilson; K. O’Halloran; D. L. Peterson

2009-01-01

Climate change is already affecting forests and other ecosystems, and additional, potentially more severe impacts are expected (IPCC, 2007; CCSP, 2008a, 2008b). As a result, forest managers are seeking practical guidance on how to adapt their current practices and, if necessary, their goals. Adaptations of forest ecosystems, which in this context refer to adjustments...

Colorado's AgrAbility Project's Effects on KASA and Practice Changes with Agricultural Producers and Professionals

ERIC Educational Resources Information Center

Fetsch, Robert J.; Jackman, Danielle M.

2015-01-01

Disability rates resulting from work-related injuries remain steadily high among farmers and ranchers. To address the gap in services within this population, USDA implemented AgrAbility nationally. Using part of Bennett's hierarchical model, the current study evaluated the KASA and practice change levels of 401 farmers and ranchers and compared…

The future of pharmacy practice research - Perspectives of academics and practitioners from Australia, NZ, United Kingdom, Canada and USA.

PubMed

Babar, Zaheer-Ud-Din; Scahill, Shane; Nagaria, Raveena Amee; Curley, Louise E

2018-01-11

Healthcare is under significant pressure with the explosion of long term conditions, shift in worldwide demographics and is evolving through advances in technology. Aligned with this is the changing role of pharmacy from the traditional dispenser of medicines to having (in addition) a more advanced clinical role. This study aimed to understand what the pharmacy practice research agenda might look like from the viewpoint of pharmacy academics and practitioners across five high-income countries. Qualitative methods were used, and thirty one-hour interviews were undertaken with practitioners and academics from five economically advanced countries. These nations have comparable socio-economic status but differing health systems and include; Australia, Canada, New Zealand, United Kingdom and United States of America. Six key informants were chosen from each country, three academics and three community pharmacists. A general inductive analysis was undertaken to analyse the most common and recurring themes. These themes of research were based around current community pharmacy practice issues and the enablers to changing the profession. Specific areas pharmacy practice could be more involved with included long term health conditions. Some community pharmacists also believed that research into the impact of professional standards and policy change would be beneficial. The findings of this research suggest that current pharmacy practice research methods are sufficient, but need to be used more effectively. Participants identified a wide range of issues within community pharmacy practice. Academics largely focused on how research can be utilised in the community and how to implement findings to ensure sustainability of pharmacy practice research. Issues that community pharmacists would like to research are related to the current practice model, such as allocating time to provide patient-focused services in addition to managing a business. Copyright © 2018 Elsevier Inc. All rights reserved.

Volumetric change of silts following cyclic loading.

DOT National Transportation Integrated Search

2013-06-01

Estimating the settlement of adjacent structures during pile installation in silts is a challenging problem for : practicing engineers. The current state-of-practice relies primarily on local case studies and monitoring efforts, such as : inclinomete...

Freeway management and operations handbook

DOT National Transportation Integrated Search

1995-02-01

This paper: (1) describes current logistics practices as they are affected by truck size and weight limits; (2) examines how changes in truck size and weight limits might affect logistics practices; and (3) where possible, identifies research needed ...

Integrating patient-centered care and clinical ethics into nutrition practice.

PubMed

Schwartz, Denise Baird

2013-10-01

The purpose of this article is to present the application of patient-centered care and clinical ethics into nutrition practice, illustrate the process in a case study, and promote change in the current healthcare clinical ethics model. Nutrition support clinicians have an opportunity to add another dimension to their practice with the incorporation of patient-centered care and clinical ethics. This represents a culture change for healthcare professionals, including nutrition support clinicians, patients and their family. All of these individuals are stakeholders in the process and have the ability to modify the current healthcare system to improve communication and facilitate a change by humanizing nutrition support practice. Nutrition support is a medical, life-sustaining treatment, and the use of this therapy requires knowledge by the nutrition support clinician of patient-centered care concepts, preventive clinical ethics, religion/spirituality and cultural diversity, palliative care team role, and advance care planning. Integrating these into the practice of nutrition support is an innovative approach and results in new knowledge that requires a change in the culture of care and engagement and empowerment of the patient and their family in the process. This is more than a healthcare issue; it involves a social/family conversation movement that will be enhanced by the nutrition support clinician's participation.

Practice Management: The Game Changer

PubMed Central

Pessis, Paul

2016-01-01

The reimbursement landscape is undergoing significant changes. Practice management, which encompasses reimbursement, is becoming increasingly more important in securing business success. Each practitioner within a facility is responsible for fortifying the practice through thoughtful business protocols. Knowing legislation that impacts health care along with understanding the foundational components of reimbursement is key for keeping a practice financially healthy. Change is good, but making the changes is what counts! Legislation such as the Medicare Access and Chip Reauthorization Act defines the new payment models. Correcting current business practices might seem difficult on the surface, but implementing change is rewarding and an obligation of the practitioners within a facility to their patients. Financial stability for a practice occurs when sound business practices are routine. Today's audiologist must not only be proficient at performing his or her scope of practice, but must also accept that performing best business practices is part of the job. In the end, the patients seeking the services of the audiologist benefit most when a practice has the financial stability to be best in its class. PMID:28028326

Northridge 20 Symposium

Science.gov Websites

billion in direct damage. The event spurred important changes to the current practice of earthquake engineering and risk mitigation worldwide, including changes to building codes for steel structures and multi

Influence of Professional Learning Community (PLC) on Secondary Science Teachers' Culture of Professional Practice: The Case of Bangladesh

ERIC Educational Resources Information Center

Rahman, S. M. Hafizur

2011-01-01

While the current reform efforts in Bangladesh require a substantive change in how science is taught, an equally substantive change is needed in the culture of professional practice. This study will, therefore, investigate how science teachers' learning in a professional learning community (PLC) influences the ways in which participant teachers…

Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

ERIC Educational Resources Information Center

Kelly, Peter James

2010-01-01

The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

The implementation of problem-based learning: changing pedagogy in nurse education.

PubMed

Creedy, D; Hand, B

1994-10-01

Problem-based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice. The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student-centred approach to teaching and learning. This paper focuses on a group of volunteer nurse educators (n = 14) who attended a 7-month professional development programme centred on introducing pedagogical changes when adopting PBL. From this group, three nurse educators participated in an in-depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies. These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach. On completion of the programme, varying degrees of change in existing instructional practices were evident. This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process.

Artificial Intelligence: Threat or Boon to Radiologists?

PubMed

Recht, Michael; Bryan, R Nick

2017-11-01

The development and integration of machine learning/artificial intelligence into routine clinical practice will significantly alter the current practice of radiology. Changes in reimbursement and practice patterns will also continue to affect radiology. But rather than being a significant threat to radiologists, we believe these changes, particularly machine learning/artificial intelligence, will be a boon to radiologists by increasing their value, efficiency, accuracy, and personal satisfaction. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Striving for best practice: standardising New Zealand nursing procedures, 1930-1960.

PubMed

Wood, Pamela J; Nelson, Katherine

2013-11-01

To identify how nurses in the past determined best practice, using the context of New Zealand, 1930-1960. In the current context of evidence-based practice, nurses strive to provide the best care, based on clinical research. We cannot assume that nurses in the past, prior to the evidence-based practice movement, did not also have a deliberate process for pursuing best practice. Discovering historical approaches to determining best practice will enrich our understanding of how nurses' current efforts are part of a continuing commitment to ensuring quality care. Historical research. The records of the Nursing Education Committee of the New Zealand Registered Nurses' Association, 1940-1959, and the 309 issues of New Zealand's nursing journal, Kai Tiaki, 1930-1960, were analysed to identify the profession's approach to ensuring best practice. This approach was then interpreted within the international context, particularly Canada and the USA. For nearly 30 years, nurse leaders collaborated in undertaking national surveys of training hospitals requesting information on different nursing practices. They subsequently distributed instructions for a range of procedures and other aspects of nursing care to standardise practice. Standardising nursing care was an effective way to ensure quality nursing at a time when hospital care was delivered mostly by nurses in training. The reasons for and timing of standardisation of nursing care in New Zealand differed from the international move towards standardisation, particularly in the USA. Historically, nurses also pursued best practice, based on standardising nursing procedures. Examining the antecedents of the present evidence-based approach to care reminds us that the process and reasons for determining best practice change through time. As knowledge and practice continually change, current confident assertions of best practice should and will continue to be challenged in future. © 2013 John Wiley & Sons Ltd.

Strategies and methods for aligning current and best medical practices. The role of information technologies.

PubMed

Schneider, E C; Eisenberg, J M

1998-05-01

Rapid change in American medicine requires that physicians adjust established behaviors and acquire new skills. In this article, we address three questions: What do we know about how to change physicians' practices? How can physicians take advantage of new and evolving information technologies that are likely to have an impact on the future practice of medicine? and What strategic educational interventions will best enable physicians to show competencies in information management and readiness to change practice? We outline four guiding principles for incorporating information systems tools into both medical education and practice, and we make eight recommendations for the development of a new medical school curriculum. This curriculum will produce a future medical practitioner who is capable of using information technologies to systematically measure practice performance, appropriateness, and effectiveness while updating knowledge efficiently.

A mixed methods investigation of an online intervention to facilitate student midwives' engagement in effective conversations about weight-related behaviour change with pregnant women.

PubMed

Hart, Jo; Furber, Christine; Chisholm, Anna; Aspinall, Samantha; Lucas, Charlotte; Runswick, Emma; Mann, Karen; Peters, Sarah

2018-05-16

(1) To identify whether an online training intervention could increase midwifery students' knowledge of behaviour change techniques (BCTs) and intentions to use them in practice. (2) To identify students' views and current experiences of talking to women about weight-related behaviour change. Mixed methods study involving pre- and post-training assessments, and qualitative interviews with midwifery students. Online training course delivered at a University in the North of England, UK. Midwifery students in the third year of their undergraduate degree during 2015-2016. Online training focused on equipping students with knowledge of theoretically-informed BCTs, and the skills to use them opportunistically in existing practice settings. Likelihood of discussing obesity with women was assessed via a 12-item, 7-point Likert scale assessing students' attitudes, subjective norms, perceived behavioural control, and intentions. A 14-item checklist was used to assess BCT knowledge whereby students selected recognised BCTs (of 7 correct, 7 false). Students' views and experiences of current practice was explored through in-depth, semi-structured one-on-one interviews with a member of the research team. Students' subjective norms, perceived behavioural control, and knowledge of BCTs increased post-training but intention and attitudes did not. Interviews revealed three themes accounting for students experiences and views of behaviour change practice: (1) 'How training fits with current encounters with maternal obesity in midwifery training' (2) 'TEnT PEGS prepares students for practice', and (3) 'Value of tailored training'. Online BCT training can improve the midwifery students' confidence, knowledge and beliefs that this is part of their role. They also reported finding the training helpful in better preparing them for this challenging element of their routine practice. Online BCT training can be used to prepare undergraduate midwifery students for practice. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Deconstructing medical practice marketing.

PubMed

Kasbo, Abe

2010-01-01

The healthcare marketing game has radically changed. Medical practices must rely on strategies instead of tactics to better separate themselves from the competition. The Internet has become a disruptive force in marketing, tipping the balance and control of the reputations of medical practices to the patient. Done right, medical practices can harness this new energy to attract new patients and keep current patients loyal.

Theory versus practice in Strategic Environmental Assessment (SEA)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lobos, Víctor, E-mail: vlobosg@gmail.com; Centro de Estudios del Desarrollo, San Crescente 551, Las Condes, Santiago; Partidario, Maria

Could the theory of Strategic Environmental Assessment (SEA) be ahead of its time and decoupled from its practice? This paper evolved in search for this leading research question. Over the years the discourse on SEA experienced a gradual shift from the technocratic and rationalist thinking that supported its origin to more strategic approaches and integrated concepts, suggested since the mid 1990's. In this paper we share the results of our analysis of international thinking and practical experience with SEA. Results reveal that SEA practice changes very slowly when compared to advanced thinking supporting the noted shift. Current SEA practice showsmore » to be still predominantly rooted in the logic of projects' environmental impact assessment (EIA). It is strongly bound to legal and regulatory requirements, and the motivation for its application persists being the delivery of environmental (or final) reports to meet legal obligations. Even though advanced SEA theoretical thinking claim its potential to help decisions to look forward, change mind-sets and the rationale of decision-making to meet sustainability challenges and enhance societal values, we note a weak relationship between the theoretical development of SEA and its practice. Why is this happening? Which factors explain this apparent inertia, resistance to change, in the SEA practice? Results appear to demonstrate the influence of assumptions, understandings, concepts, and beliefs in the use of SEA, which in turn suggest the political sensitivity of the instrument. - Highlights: • Theoretical thinking in SEA is ahead of its time. • SEA international practice reveals inertia to move out of project’ EIA comfort zone. • World current SEA practice show similar understandings of 30 years ago. • 100 world reports and survey of practitioners supported world review. • SEA great challenge is to change paradigms into new scientific complexity theories.« less

Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

PubMed

Thompson, Trevonne M; Leikin, Jerrold B

2015-03-01

We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice--reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations.

An Analysis of States' Policies Regarding Social Media Use in Education

ERIC Educational Resources Information Center

Miller, Janette K.

2016-01-01

This policy analysis project focused on states' policies regarding social media use in education. Currently, policies, practices and laws are not keeping pace with the rapidly changing nature of technology. As a result of the quick advancement of social media practices, the need exists for organic policies and practices within the educational…

Remediation in Practicing Physicians: Current and Alternative Conceptualizations.

PubMed

Bourgeois-Law, Gisèle; Teunissen, Pim W; Regehr, Glenn

2018-04-24

Suboptimal performance in practicing physicians is a decades-old problem. The lack of a universally accepted definition of remediation, the paucity of research on best remediation practices, and the ongoing controversy regarding the institutional responsibility for enacting and overseeing this activity suggests that the remediation of physicians is not merely a difficult problem to solve, but a problem that the community does not grapple with meaningfully. Undoubtedly, logistical and political considerations contribute to this state of affairs; however, other underlying conceptual issues may also play a role in the medical profession's difficulties in engaging with the challenges around remediation.Through a review of the medical education and other literatures, the authors examined current conceptualizations of both remediation itself and the individual being remediated, as well as how the culture of medicine influences these conceptions. The authors explored how conceptualizations of remediation and the surrounding culture might affect not only the medical community's ability to support, but also its willingness to engage with physicians in need of remediation.Viewing remediation as a means of supporting practice change-rather than as a means of redressing gaps in knowledge and skill-might be a useful alternative conceptualization, providing a good place to start exploring new avenues of research. However, moving forward will require more than simply a reconceptualizion of remediation; it will also necessitate a change in how the community views its struggling members and a change in the medical culture that currently positions professional autonomy as the foundational premise for individual practice improvement.

Interaction of ice storms and management practices on current carbon sequestration in forests with potential mitigation under future CO2 atmosphere

Treesearch

Heather R. McCarthy; Ram Oren; Hyun-Seok Kim; Kurt H. Johnsen; Chris Maier; Seth G. Pritchard; Michael A. Davis

2006-01-01

Ice storms are disturbance events with potential impacts on carbon sequestration. Common forest management practices, such as fertilization and thinning, can change wood and stand properties and thus may change vulnerability to ice storm damage. At the same time, increasing atmospheric CO2 levels may also influence ice storm vulnerability. Here...

The impact of emerging technology on nursing care: warp speed ahead.

PubMed

Huston, Carol

2013-05-31

While myriad forces are changing the face of contemporary healthcare, one could argue that nothing will change the way nursing is practiced more than current advances in technology. Indeed, technology is changing the world at warp speed and nowhere is this more evident than in healthcare settings. This article identifies seven emerging technologies that will change the practice of nursing; three skill sets nurses will need to develop to acquire, use, and integrate these emerging technologies; and four challenges nurse leaders will face in integrating this new technology.

[General practitioners' opinion and attitude towards DMPs and the change in practice routines to implement the DMP "diabetes mellitus type 2"].

PubMed

Miksch, Antje; Trieschmann, Johanna; Ose, Dominik; Rölz, Andreas; Heiderhoff, Marc; Szecsenyi, Joachim

2011-01-01

Effective implementation of disease management programmes (DMPs) in primary care practices often requires changes in practice workflows and responsibilities and acceptance by the parties involved. Within the ELSID study (evaluation study of the DMP diabetes mellitus type 2) the physicians' attitudes toward DMPs were obtained and an optimised implementation of DMPs was developed by conducting a quality management cycle with primary care practice teams. The aim was to investigate which practice workflows will have to be changed and what kind of barriers to implement these changes are perceived. In 78 primary care practices of the two German federal states of Rheinland-Pfalz and Sachsen-Anhalt a quality management cycle was conducted using a structured analysis of the current state of DMP workflows and the need for improvement identified. Subsequently, an optimised workflow was developed and targets were agreed upon. After 6 months, the study team called to inquire about the current state of implementation and, if appropriate, actual barriers to change. After 6 months, 71 practices had been interviewed by phone. 64 of them (90.1%) had agreed on at least one target (e.g., to purchase new instrumentation, to regularly discuss feedback reports, to set up a patient registry). On average three targets had been formulated, and 2 out of 3 had been implemented in the meantime. In most cases lack of time was given as the reason for non-implementation. The majority of surveyed practices perceived some need for improvement. But sufficient resources (time, staff and money) are required to ensure efficient implementation of DMPs in primary care practices and their integration with routine processes. A redefinition of responsibilities for DMPs will strengthen the role of medical assistants and promote high-quality implementation of these programmes. Copyright © 2010. Published by Elsevier GmbH.

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

A new, but old business model for family physicians: cash.

PubMed

Weber, J Michael

2013-01-01

The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

The Power of Reflective Professional Development in Changing Elementary School Teachers' Instructional Practices

NASA Astrophysics Data System (ADS)

Cavedon, Carolina Christmann

With the new goal of K-12 education being to prepare students to be college and career ready at the end of high school, education needs to start changing at the elementary school level. The literature suggests that teachers need reflective professional development (PD) to effectively teach to the new standards and to demonstrate change to their current instructional practices. This mixed-method multiple-case study investigated the impacts of a reflective professional development (PD) in changing elementary school teachers' instructional practices. Teachers Instructional Portfolios (TIPs) were scored with a TIP rubric based on best practices in teaching mathematics problem-solving and science inquiry. The TIPs were also analyzed with a qualitative coding scheme. Case descriptions were written and all the collected data were used to explain the impacts of the reflective PD on changes in teachers' instructional practices. While we found no predictive patterns in relation to teachers changing their classroom practices based on the reflective PD, we claim that teachers' desire to change might contribute to improvements in instruction. We also observed that teachers' self-assessment scores tend to be higher than the actual TIP scores corroborating with the literature on the usage of self-assessment to evaluate teachers' instructional practices.

The constant current loop - A new paradigm for resistance signal conditioning

NASA Astrophysics Data System (ADS)

Anderson, Karl F.

A practical single constant current loop circuit for the signal conditioning of variable-resistance transducers has been synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature device are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. An adaptation of the current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations.

The constant current loop - A new paradigm for resistance signal conditioning

NASA Technical Reports Server (NTRS)

Anderson, Karl F.

1993-01-01

A practical single constant current loop circuit for the signal conditioning of variable-resistance transducers has been synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature device are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. An adaptation of the current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations.

Breaking up is hard to do: lessons learned from a pharma-free practice transformation.

PubMed

Evans, David; Hartung, Daniel M; Beasley, Denise; Fagnan, Lyle J

2013-01-01

Academic medical centers are examining relationships with the pharmaceutical industry and making changes to limit interactions. Most doctors, however, practice outside of academic institutions and see pharmaceutical detailers and accept drug samples and gifts. Little guidance for practicing physicians exists about transforming practices to become pharma-free. Consideration must be given to the impact on practice culture, staff views, and patient needs. A small private practice, setting out to transform into a pharma-free clinic, used a practice transformation process that examined the industry presence in the clinic, educated the doctors on potential conflicts of interest, and improved practice flow. Staff were given the opportunity to share concerns, and their issues were acknowledged. Educational interventions were developed to help providers keep current. Finally, efforts were made to educate patients about the policy. The clinic recorded the degree to which it was detailed. Loss of gifts, keeping current with new drugs, and managing without samples were noted concerns. Policy change champions developed strategies to address concerns. A shift in practice culture to a pharma-free clinic is achievable and maintainable over time. Barriers to success can be identified and overcome with attention given to careful gathering of information, staff input, and stakeholder education.

Health workforce needs: projections complicated by practice and technology changes.

PubMed

Cunningham, Rob

2013-10-22

As population growth and the aging of the overall population increase demand for health care, policymakers and analysts posit whether sufficient health care providers will be able to meet that demand. Some argue there are too few providers already; others say our current supply-demand problems lie with efficiency. But suppose both are correct? Perhaps the real challenge is to understand how physician practices are changing in response to market forces such as payment changes, provider distributions, and technology innovations. This issue brief reviews what is known about evolving practice organizations, professional mixes, information technology support, and the implications of these and other factors for public workforce policies.

Changes to nurses' practice environment over time.

PubMed

Roche, Michael A; Duffield, Christine; Friedman, Sarah; Twigg, Di; Dimitrelis, Sofia; Rowbotham, Samantha

2016-07-01

To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Positive nurse practice environments have been linked to nurse retention and care quality outcomes. The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared. On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period. The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline. Managers need to apply existing evidence to improve nurse practice environments and manage instability. © 2016 John Wiley & Sons Ltd.

Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

PubMed

Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

2017-12-01

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

An Assessment of Regional Water Resources and Agricultural Sustainability in the Mississippi River Alluvial Aquifer System of Mississippi and Arkansas Under Current and Future Climate

NASA Astrophysics Data System (ADS)

Rigby, J.; Reba, M.

2011-12-01

The Lower Mississippi River Alluvial Plain is a highly productive agricultural region for rice, soy beans, and cotton that depends heavily on irrigation. Development of the Mississippi River Alluvial Aquifer (MRAA), one of the more prolific agricultural aquifers in the country, has traditionally been the primary source for irrigation in the region yielding over 1,100 Mgal/day to irrigation wells. Increasingly, the realities of changing climate and rapidly declining water tables have highlighted the necessity for new water management practices. Tail-water recovery and reuse is a rapidly expanding practice due in part to the efforts and cost-sharing of the NRCS, but regional studies of the potential for such practices to alleviate groundwater mining under current and future climate are lacking. While regional studies of aquifer geology have long been available, including assessments of regional groundwater flow, much about the aquifer is still not well understood including controls on recharge rates, a crucial component of water management design. We review the trends in regional availability of surface and groundwater resources, their current status, and the effects of recent changes in management practices on groundwater decline in Mississippi and Arkansas. Global and regional climate projections are used to assess scenarios of sustainable aquifer use under current land use and management along with the potential for more widely practiced surface water capture and reuse to alleviate groundwater decline. Finally, we highlight crucial knowledge gaps and challenges associated with the development of water management practices for sustainable agricultural use in the region.

Child Abuse: Principles and Implications of Current Pediatric Practice.

ERIC Educational Resources Information Center

Newberger, Eli H.; Hyde, James N., Jr.

This paper summarizes data and experience with child abuse pertinent to child health practice. It goal is to foster sound and rational medical management. Because of the complex origins of child abuse, however, and of the institutional and social changes which shall have to accompany excellent practice if child abuse is effectively to be treated…

The medicalization of addiction treatment professionals.

PubMed

Roy, A Kenison; Miller, Michael M

2012-01-01

In a previous article, the authors described the changes initiated by recent health care legislation, and how those changes might affect the practice of medicine and the delivery of addiction services. This article reviews the same changes with respect to how they have the potential to change the practice activities of addiction physicians, addiction therapists, addiction counselors and addiction nurses, as well as the activities of administrators and service delivery financial personnel. Developments in delivery systems and the impact of those developments on professionals who work in addiction treatment are considered; current problems, potential solutions, and opportunities for clinicians under health reform are addressed. The goals envisioned for health system reform and the potential for realization of those goals via changes in addiction service delivery design and clinical practice are discussed.

An evidence-based public health approach to climate change adaptation.

PubMed

Hess, Jeremy J; Eidson, Millicent; Tlumak, Jennifer E; Raab, Kristin K; Luber, George

2014-11-01

Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

The Impact of Changing Government Policies and Institutional Practices on Master's by Coursework Students in Australia: A Viable Pathway to the PhD?

ERIC Educational Resources Information Center

Kiley, Margaret; Cumming, Jim

2014-01-01

The objective of this paper is to identify the impact of current national policies and emerging curricular practices on master's by coursework students in Australia. It is argued that the rate of top-down policy change, together with bottom-up innovation, is resulting in a high level of complexity that is challenging providers, staff and student…

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare. PMID:23617833

Financing a College Education: How It Works, How It's Changing. American Council on Education/Oryx Press Series on Higher Education.

ERIC Educational Resources Information Center

King, Jacqueline E., Ed.

This collection of 15 essays by policy analysts and higher education specialists examines student financial aid, how policy and practice have changed, how student costs at U.S. colleges and universities are currently being met, and why and how enhancements to current programs would make the system more equitable. Following an introduction by D.…

Partnering with patients to promote holistic diabetes management: changing paradigms.

PubMed

Lorenzo, Lenora

2013-07-01

To provide a review of best practice for clinical management of diabetes mellitus (DM) for nurse practitioners (NPs) and accelerate incorporation of key findings into current practice. A search was conducted in Pub Med, Ovid, CINAHL, and Cochrane's Database of Systematic Reviews. There are many challenges for DM care identified in the current health system. There is a great need to change care paradigms to engage patients in partnership for enhanced management and self-management in DM. A review of the best practice evidence revealed numerous models of care, strategies, and tools available to enhance diabetes care and promote health and well-being. The primary focus of this article is to engage NP clinicians to incorporate new strategies to augment management and improve clinical outcomes. Incorporation of best practice for DM management may accelerate the paradigm shift to more patient-focused care. Engaged, informed, and activated patients along with clinicians working in partnerships may enhance clinical outcomes. ©2013 The Author ©2013 American Association of Nurse Practitioners.

Applications of geographic information systems (GIS) for transportation and climate change

DOT National Transportation Integrated Search

2011-08-31

This report describes the current practice and application of GIS technologies for integrating climate change into the transportation decision-making process. It examines how select state, regional, and local agencies are using GIS to analyze, mitiga...

Mapping Climate Change: Six U.S. Case Studies

ERIC Educational Resources Information Center

Holmberg, Marjorie O.

2010-01-01

This research focuses on the current role of mapping practices in communicating climate change in the United States. This includes maps used in monitoring climate change, projecting its potential impacts, and identifying potential adaptation strategies at particular scales. Since few, if any, studies have been done specifically on mapping…

Developing "Emancipatory Interest": Learning to Create Social Change

ERIC Educational Resources Information Center

Caspersz, Donella; Olaru, Doina

2014-01-01

Developing an emancipatory interest enables individuals to free themselves from the intersubjective or commonly held meanings that dominate their understanding of their current world, and subsequently change their practices. We argue that developing an emancipatory interest is critical in learning to create social change, that is, wanting to…

Consulting to Facilitate Planned Organizational Change in Schools

ERIC Educational Resources Information Center

Zins, Joseph E.; Illback, Robert J.

2007-01-01

We present an update of our 1984 chapter on organizational interventions in educational settings. Our view of the organizational change process is described, followed by a discussion of the gap between current theory and practice. We describe several examples of promising organizational change initiatives, followed by our observations of future…

Change between Entry and Graduation in MSW Student Views on Social Work's Traditional Mission, Career Motivations, and Practice Preferences: Caucasian, Student of Color, and American Indian Group Comparisons

ERIC Educational Resources Information Center

Limb, Gordon E.; Organista, Kurt C.

2006-01-01

The current study builds on a previous study that examined change in student views on social work's traditional mission, career motivations, and practice preferences between entry into and graduation from master of social work programs. Results from 6,987 students at entry and 3,451 students at graduation showed that students at graduation…

Formative assessment as a vehicle for changing classroom practice in a specific cultural context

NASA Astrophysics Data System (ADS)

Chen, Jingping

2015-09-01

In this commentary, I interpret Xinying Yin and Gayle Ann Buck's collaborative action research from a social-cultural perspective. Classroom implementation of formative assessment is viewed as interaction between this assessment method and the local learning culture. I first identify Yin and Buck's definition of the formative assessment, and then analyze the role of formative assessment in the change of local learning culture. Based on the practice of Yin and Buck I emphasize the significance of their "bottom up" strategy to the teachers' epistemological change. I believe that this strategy may provide practicable solutions to current Chinese educational problems as well as a means for science educators to shift toward systematic professional development.

Walking and Talking with Living Texts: Breathing Life against Static Standardisation

ERIC Educational Resources Information Center

Phillips, Louise Gwenneth; Willis, Linda-Dianne

2014-01-01

Current educational reform, policy and public discourse emphasise standardisation of testing, curricula and professional practice, yet the landscape of literacy practices today is fluid, interactive, multimodal, ever-changing, adaptive and collaborative. How then can English and literacy educators negotiate these conflicting terrains? The nature…

Nursing education trends: future implications and predictions.

PubMed

Valiga, Theresa M Terry

2012-12-01

This article examines current trends in nursing education and proposes numerous transformations needed to ensure that programs are relevant, fully engage learners, reflect evidence-based teaching practices, and are innovative. Such program characteristics are essential if we are to graduate nurses who can practice effectively in today's complex, ambiguous, ever-changing health care environments and who are prepared to practice in and, indeed, shape tomorrow's unknown practice environments. Copyright © 2012 Elsevier Inc. All rights reserved.

Creating a Culture of Safety Around Bar-Code Medication Administration: An Evidence-Based Evaluation Framework.

PubMed

Kelly, Kandace; Harrington, Linda; Matos, Pat; Turner, Barbara; Johnson, Constance

2016-01-01

Bar-code medication administration (BCMA) effectiveness is contingent upon compliance with best-practice protocols. We developed a 4-phased BCMA evaluation program to evaluate the degree of integration of current evidence into BCMA policies, procedures, and practices; identify barriers to best-practice BCMA use; and modify BCMA practice in concert with changes to the practice environment. This program provides an infrastructure for frontline nurses to partner with hospital leaders to continually evaluate and improve BCMA using a systematic process.

Educational approaches aimed at preparing students for professional veterinary practice.

PubMed

Jaarsma, A D C; Dolmans, D H J M; Scherpbier, A J J A; van Beukelen, P

2009-08-01

Changes in society and dissatisfaction with current educational practices have led to changes in undergraduate veterinary curricula. New approaches that are thought to better prepare students for future professional veterinary practice are being introduced. One such change is a transition from conventional teacher-centred curricula to student-centred curricula. In student-centred curricula, students are actively involved in learning and teachers not only transmit knowledge but help students to obtain a deep understanding. Furthermore, learning within these curricula takes place in a multi-disciplinary context which is more relevant for the future of the profession. Another change is that more emphasis is put on training in academic skills, for instance, by establishing research internships. Finally, a new emphasis is being placed on training in more generic competencies, such as communication and business skills. These changes are assumed to better suit the profile of veterinary students today and in the future and to better prepare them for future veterinary practice.

Fundamentals of Aqueous Microwave Chemistry

EPA Science Inventory

The first chemical revolution changed modern life with a host of excellent amenities and services, but created serious problems related to environmental pollution. After 150 years of current chemistry principles and practices, we need a radical change to a new type of chemistry k...

Climate-smart conservation: putting adaption principles into practice

USGS Publications Warehouse

Stein, Bruce A.; Glick, Patty; Edelson, Naomi; Staudt, Amanda

2014-01-01

Climate change already is having significant impacts on the nation’s species and ecosystems, and these effects are projected to increase considerably over time. As a result, climate change is now a primary lens through which conservation and natural resource management must be viewed. How should we prepare for and respond to the impacts of climate change on wildlife and their habitats? What should we be doing differently in light of these climatic shifts, and what actions continue to make sense? Climate-Smart Conservation: Putting Adaptation Principles into Practice offers guidance for designing and carrying out conservation in the face of a rapidly changing climate. Addressing the growing threats brought about or accentuated by rapid climate change requires a fundamental shift in the practice of natural resource management and conservation. Traditionally, conservationists have focused their efforts on protecting and managing systems to maintain their current state, or to restore degraded systems back to a historical state regarded as more desirable. Conservation planners and practitioners will need to adopt forward-looking goals and implement strategies specifically designed to prepare for and adjust to current and future climatic changes, and the associated impacts on natural systems and human communities—an emerging discipline known as climate change adaptation. The field of climate change adaptation is still in its infancy. Although there is increasing attention focused on the subject, much of the guidance developed to date has been general in nature, concentrating on high-level principles rather than specific actions. It is against this backdrop that this guide was prepared as a means for helping put adaptation principles into practice, and for moving adaptation from planning to action.

A spatial analysis of the expanding roles of nurses in general practice.

PubMed

Pearce, Christopher; Hall, Sally; Phillips, Christine; Dwan, Kathryn; Yates, Rachael; Sibbald, Bonnie

2012-08-07

Changes to the workforce and organisation of general practice are occurring rapidly in response to the Australian health care reform agenda, and the changing nature of the medical profession. In particular, the last five years has seen the rapid introduction and expansion of a nursing workforce in Australian general practices. This potentially creates pressures on current infrastructure in general practice. This study used a mixed methods, 'rapid appraisal' approach involving observation, photographs, and interviews. Nurses utilise space differently to GPs, and this is part of the diversity they bring to the general practice environment. At the same time their roles are partly shaped by the ways space is constructed in general practices. The fluidity of nursing roles in general practice suggests that nurses require a versatile space in which to maximize their role and contribution to the general practice team.

Helping Dental Students Make Informed Decisions About Private Practice Employment Options in a Changing Landscape.

PubMed

Badger, Gary R; Fryer, Cheryl E S; Giannini, Peter J; Townsend, Janice A; Huja, Sarandeep

2015-12-01

According to the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors, 45.3% of new graduates planned to enter private practice immediately after graduation; of those, while 65% planned to become an associate dentist in a private practice, 28.3% intended to enter a corporate group practice-the only category that saw an increase over the previous year. Current trends indicate that the number of new graduates choosing to enter some form of private practice without further education will continue to remain high, due in large part to the need to repay educational debt. In light of these trends, the question that must be asked is whether dental schools are optimally preparing students to make informed decisions regarding future employment options in the changing dental practice landscape. This article argues that dental schools should review their curricula to ensure graduates are being prepared for this changing environment and the increased business pressures associated with dental practice. Important considerations in preparing dental students to be successful in the process of selecting a practice model are identified.

Groundwater nitrate concentration evolution under climate change and agricultural adaptation scenarios: Prince Edward Island, Canada

NASA Astrophysics Data System (ADS)

Paradis, Daniel; Vigneault, Harold; Lefebvre, René; Savard, Martine M.; Ballard, Jean-Marc; Qian, Budong

2016-03-01

Nitrate (N-NO3) concentration in groundwater, the sole source of potable water in Prince Edward Island (PEI, Canada), currently exceeds the 10 mg L-1 (N-NO3) health threshold for drinking water in 6 % of domestic wells. Increasing climatic and socio-economic pressures on PEI agriculture may further deteriorate groundwater quality. This study assesses how groundwater nitrate concentration could evolve due to the forecasted climate change and its related potential changes in agricultural practices. For this purpose, a tridimensional numerical groundwater flow and mass transport model was developed for the aquifer system of the entire Island (5660 km2). A number of different groundwater flow and mass transport simulations were made to evaluate the potential impact of the projected climate change and agricultural adaptation. According to the simulations for year 2050, N-NO3 concentration would increase due to two main causes: (1) the progressive attainment of steady-state conditions related to present-day nitrogen loadings, and (2) the increase in nitrogen loadings due to changes in agricultural practices provoked by future climatic conditions. The combined effects of equilibration with loadings, climate and agricultural adaptation would lead to a 25 to 32 % increase in N-NO3 concentration over the Island aquifer system. The change in groundwater recharge regime induced by climate change (with current agricultural practices) would only contribute 0 to 6 % of that increase for the various climate scenarios. Moreover, simulated trends in groundwater N-NO3 concentration suggest that an increased number of domestic wells (more than doubling) would exceed the nitrate drinking water criteria. This study underlines the need to develop and apply better agricultural management practices to ensure sustainability of long-term groundwater resources. The simulations also show that observable benefits from positive changes in agricultural practices would be delayed in time due to the slow dynamics of nitrate transport within the aquifer system.

Early Childhood Education in Botswana: A Case of Fragmented "Fits"

ERIC Educational Resources Information Center

Maunganidze, Langtone; Tsamaase, Marea

2014-01-01

Scholarly and institutional research on early childhood education is not a new phenomenon, but what is perhaps limited is extant literature that particularly focuses on revisiting current practices and their "dialogue" with the ever-changing environment that prevails especially in an African setting. The practices of providers of early…

Using Models to Understand Sea Level Rise

ERIC Educational Resources Information Center

Barth-Cohen, Lauren; Medina, Edwing

2017-01-01

Important science phenomena--such as atomic structure, evolution, and climate change--are often hard to observe directly. That's why an important scientific practice is to use scientific models to represent one's current understanding of a system. Using models has been included as an essential science and engineering practice in the "Next…

Building Basic Therapeutic Skills: A Practical Guide for Current Mental Health Practice.

ERIC Educational Resources Information Center

Heaton, Jeanne Albronda

Each therapeutic contact provides unique opportunities to ameliorate suffering and cultivate change. This volume addresses the inherent struggle in therapy to create a therapeutic relationship and make the work compassionate, efficient, and effective. It provides assistance to students, supervisors, and educators in doing therapeutic work while…

75 FR 37358 - Endangered and Threatened Wildlife and Plants; Revised Critical Habitat for the Arroyo Toad

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-29

... whether the DEA makes appropriate assumptions regarding current practices and any regulatory changes that... from adverse modification or destruction of critical habitat. In practice, situations with a Federal... Newhall Land and Farming Company (Newhall LFC). Newhall LFC developed the Natural River Management Plan...

A survey report: how hospitals measure liquidity.

PubMed

Cleverley, W O; Massar, G S

1983-11-01

Liquidity is an important financial concept that is widely understood although not authoritatively defined. In many situations the actual assessment of liquidity is based on the relationship of current assets and current liabilities. Nationally, a decline in traditional measures of liquidity such as current and quick ratios has occurred for both general industry and the hospital industry. There are a variety of possible explanations for this trend, but one of special interest in this article was the effect of financial reporting practices. A recent Principles & Practices Board survey of Financial Analysis Service subscribers indicated that there is a potential for underreporting working capital, (current assets less current liabilities), in the hospital industry. However, this does not necessarily imply that the recent decline in liquidity measures is in any way due to reporting practices. No information about changes in reporting practices was obtained in this study. Finally, the results of the study do suggest that examination of more than one liquidity indicator is useful. Specifically, restricting attention to just the current ratio could be misleading. In this vein, it is interesting to note that six measures of liquidity are used in the FAS. All may provide insight into an accurate assessment of liquidity.

A comparative analysis of the changes in nursing practice related to health sector reform in five countries of the Americas.

PubMed

Guevara, Edilma B; Mendias, Elnora P

2002-11-01

To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nurses about their perceptions of nursing practice and changes in work environments. Descriptions of characteristics and trends in nursing practice in the study sites were also obtained. Reorganization of health services has occurred in all five of the countries, responding to health sector reform initiatives and affecting nursing practice in each country. Respondents from all five countries mentioned an emphasis on private enterprise, changes in payment systems for patients and providers, redistributions in the nursing workforce, changes in the personnel mix and nursing-practice functions, work shifting from the hospital to the community, and greater emphasis on cost control and prevention in practice settings. The study provides initial information about current nursing issues that have arisen as a result of health care reform initiatives. Regardless of differences in service models or phases of health sector reform implementation, in all the countries the participating nurses identified many common themes, trends, and changes in nursing practice. The driving forces for change and their intensity have been different in the five countries. Nurses maintain their core values despite increased work stress and greater patient care needs in all the countries as well as economic crises in the Latin American countries.

Digitally Controllable Current Amplifier and Current Conveyors in Practical Application of Controllable Frequency Filter

NASA Astrophysics Data System (ADS)

Polak, Josef; Jerabek, Jan; Langhammer, Lukas; Sotner, Roman; Dvorak, Jan; Panek, David

2016-07-01

This paper presents the simulations results in comparison with the measured results of the practical realization of the multifunctional second order frequency filter with a Digitally Adjustable Current Amplifier (DACA) and two Dual-Output Controllable Current Conveyors (CCCII +/-). This filter is designed for use in current mode. The filter was designed of the single input multiple outputs (SIMO) type, therefore it has only one input and three outputs with individual filtering functions. DACA element used in a newly proposed circuit is present in form of an integrated chip and the current conveyors are implemented using the Universal Current Conveyor (UCC) chip with designation UCC-N1B. Proposed frequency filter enables independent control of the pole frequency using parameters of two current conveyors and also independent control of the quality factor by change of a current gain of DACA.

The Administration of Education for the Health Professions: A Time for Reappraisal.

ERIC Educational Resources Information Center

Hogness, John R.

Past and current practices as well as anticipated changes in administrative patterns in the health sciences are reviewed in the general context of the changing patterns of administration in higher education. The changes discussed include those in financial support, priorities, controls, and expectations. Several specific questions are addressed:…

Context, Communication and Commiseration: Psychological and Practical Considerations in Change Management

ERIC Educational Resources Information Center

Clarke, Hugh

2013-01-01

In this paper, the author draws upon his interest, as a psychotherapist, in working with change at a psychological and individual level, and on his experience of the radical changes currently taking place in higher education, specifically the University where he manages several services, including a Counselling Service. Through leading and…

In defense of genuine ignorance: supporting vitality and relevance in graduate curricula.

PubMed

Goren, S; Peter, L; Fischer, S

1992-01-01

Genuine ignorance, defined by John Dewey as curiosity and openmindedness in opposition to repetition of catch phrases and familiar propositions, is nurtured in graduate nursing curricula in which the educational process is congruent with course content. Preparation for advanced practice in the mental health environment of the foreseeable future required abandonment of the familiar medical model in favor of conceptual models consistent with current thinking in psychiatric nursing and exposure to current problems (homelessness, family violence, AIDS) and current problem solving strategies (brief treatment, family preservation). Involvement in practice-based research and operationalizing new perspectives on familiar clinical problems, are suggested as strategies for developing the advanced practitioner. Two of the authors, former graduate students, describe the impact of changed perspectives and research activity on their own practice.

Modifying physician behavior to improve cost-efficiency in safety-net ambulatory settings.

PubMed

Borkowski, Nancy; Gumus, Gulcin; Deckard, Gloria J

2013-01-01

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

Update in perioperative medicine: practice changing evidence published in 2016.

PubMed

Regan, Dennis W; Kashiwagi, Deanne; Dougan, Brian; Sundsted, Karna; Mauck, Karen

2017-10-01

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.

Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study.

PubMed

Ho, Jeffrey D; Dawes, Donald M; McKay, Evan M; Taliercio, Jeremy J; White, Scott D; Woodbury, Blair J; Sandefur, Mark A; Miner, James R

2017-01-01

Current Emergency Medical Services (EMS) documentation practices usually occur from memory after an event is over. While this practice is fairly standard, it is unclear if it can introduce significant error. Modern technology has seen the increased use of recorded video by society to more objectively document notable events. Stationary mounted cameras, cell-phone cameras, and law enforcement officer Body-Worn Cameras (BWCs) are increasingly used by society for this purpose. Video used in this way can often clarify or contradict recall from memory. BWCs are currently not widely used by EMS. The hypothesis is that current EMS documentation practices are inaccurate and that BWCs will have a positive effect on documentation accuracy. This prospective, observational study used a convenience sample of paramedics in a simulation lab. The Paramedics wore a BWC and responded to a simulated call of "One Down" (unresponsive from heroin abuse) involving Role Players (RPs). The paramedics received standardized cues from the RPs during the simulation to keep it on track.  The simulation contained many factors of concern (e.g., weapons and drugs in plain view, unattended minors, etc.) and intentional stressors (e.g., distraught family member, uncooperative patient, etc.). Upon completion of the scenario, paramedic documentation occurred from memory on an electronic template.  After initial documentation, paramedics viewed their BWC recording and were allowed to make tabulated changes. Changes were categorized by a priori criteria as minor, moderate, or major.  Ten paramedics participated with an average age of 33.3 years (range 22-43), 8 males and 2 females. The average length of paramedic career experience was 7.7 years (range 2 months to 20 years). There were 71 total documentation changes (7 minor, 51 moderate, 13 major) made after video review. Linear regression (ANCOVA) indicated changes made indirectly correlated with years of experience (coefficient 8.27, 4.22-12.3, 95% CI, p = 0.002), but all made some changes. Current EMS documentation practices demonstrate significant inaccuracy regardless of years of experience. Use of BWC technology appears to significantly improve EMS documentation accuracy in this pilot study.

'Best practice' development and transfer in the NHS: the importance of process as well as product knowledge.

PubMed

Newell, Sue; Edelman, Linda; Scarbrough, Harry; Swan, Jacky; Bresnen, Mike

2003-02-01

A core prescription from the knowledge management movement is that the successful management of organizational knowledge will prevent firms from 'reinventing the wheel', in particular through the transfer of 'best practices'. Our findings challenge this logic. They suggest instead that knowledge is emergent and enacted in practice, and that normally those involved in a given practice have only a partial understanding of the overall practice. Generating knowledge about current practice is therefore a precursor to changing that practice. In this sense, knowledge transfer does not occur independently of or in sequence to knowledge generation, but instead the process of knowledge generation and its transfer are inexorably intertwined. Thus, rather than transferring 'product' knowledge about the new 'best practice' per se, our analysis suggests that it is more useful to transfer 'process' knowledge about effective ways to generate the knowledge of existing practice, which is the essential starting point for attempts to change that practice.

How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

PubMed

Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

2015-09-21

Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money.

Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.

PubMed

Ceci, Christine

2006-03-01

Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.

Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

PubMed Central

Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth

2014-01-01

Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

Translating research into practice in nursing homes: can we close the gap?

PubMed

Rahman, Anna N; Applebaum, Robert A; Schnelle, John F; Simmons, Sandra F

2012-10-01

A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

Groundwater nitrate concentration evolution under climate change and agricultural adaptation scenarios: Prince Edward Island, Canada

NASA Astrophysics Data System (ADS)

Paradis, D.; Vigneault, H.; Lefebvre, R.; Savard, M. M.; Ballard, J.-M.; Qian, B.

2015-08-01

Nitrate (N-NO3) concentration in groundwater, the sole source of potable water in Prince Edward Island (PEI, Canada), currently exceeds the 10 mg L-1 (N-NO3) health threshold for drinking water in 6 % of domestic wells. Increasing climatic and socio-economic pressures on PEI agriculture may further deteriorate groundwater quality. This study assesses how groundwater nitrate concentrations could evolve due to the forecasted climate change and its related potential changes in agricultural practices. For this purpose, a tridimensional numerical groundwater flow and mass transport model was developed for the aquifer system of the entire Island (5660 km2). A number of different groundwater flow and mass transport simulations were made to evaluate the potential impact of the projected climate change and agricultural adaptation. According to the simulations for year 2050, N-NO3 concentration would increase due to two main causes: (1) the progressive attainment of steady-state conditions related to present-day nitrogen loadings, and (2) the increase in nitrogen loadings due to changes in agricultural practices provoked by future climatic conditions. The combined effects of equilibration with loadings, climate and agricultural adaptation would lead to a 25 to 32 % increase in N-NO3 concentration over the Island aquifer system. Climate change alone (practices maintained at their current level) would contribute only 0 to 6 % to that increase according to the various climate scenarios. Moreover, simulated trends in groundwater N-NO3 concentration suggest that an increased number of domestic wells (more than doubling) would exceed the nitrate drinking water criteria. This study underlines the need to develop and apply better agricultural management practices to ensure sustainability of long-term groundwater resources. The simulations also show that observable benefits from positive changes in agricultural practices would be delayed in time due to the slow dynamics of nitrate transport within the aquifer system.

A young surgeon's perspective.

PubMed

Bold, Richard J

2005-03-01

The environment of health care delivery is responding to a variety of external forces that are changing the practice of surgery. Only when we look back at this period can any assessments be made to determine whether the changes were beneficial or detrimental. The observation that surgeons are retiring at an earlier age may be a reflection of the negative effect of the changing culture of surgery on career satisfaction. As a young surgeon who anticipates an additional 20+ years of a surgical career, these changes are important to me and will clearly affect my practice as well as my satisfaction. This special article provides my personal perspective on some of the current and anticipated changes in surgery that are a manifestation of cultural changes in health care delivery.

Diffusion of innovation theory for clinical change.

PubMed

Sanson-Fisher, Robert W

2004-03-15

Maximising the adoption of evidence-based practice has been argued to be a major factor in determining healthcare outcomes. However, there are gaps between evidence-based recommendations and current care. Bridging the evidence gap will not be achieved simply by informing clinicians about the evidence. One theoretical approach to understanding how change may be achieved is Rogers' diffusion model. He argues that certain characteristics of the innovation itself may facilitate its adoption. Other factors influencing acceptance include promotion by influential role models, the degree of complexity of the change, compatibility with existing values and needs, and the ability to test and modify the new procedure before adopting it. The diffusion model may provide valuable insights into why some practices change and others do not, as well as guiding those who try to effect adoption of best-evidence practice.

Preparing the Future Dental Hygiene Workforce: Knowledge, Skills, and Reform.

PubMed

Fried, Jacquelyn L; Maxey, Hannah L; Battani, Kathryn; Gurenlian, JoAnn R; Byrd, Tammi O; Brunick, Ann

2017-09-01

With the health care delivery system in transition, the way in which oral health care services are delivered in 2040 will inevitably change. To achieve the aims of reduced cost, improved access, and higher quality and to advance population wellness, oral health care will likely become a more integrated part of medical care. An integrated primary care system would better meet the needs of an increasingly diverse and aging U.S. population with uneven access to health care services. By 2040, trends suggest that a smaller proportion of dental hygienists will work in traditional solo dental offices; many more will practice with multidisciplinary health care teams in large-group dental and medical practices and in a variety of non-traditional community settings. This integration will require changes in how dental hygienists are educated. To shape the skill sets, clinical judgment, and knowledge of future practitioners, current dental hygiene curricula must be reexamined, redirected, and enhanced. This article examines some of the factors that are likely to shape the future of dental hygiene practice, considers the strengths and weaknesses of current curricula, and proposes educational changes to prepare dental hygienists for practice in 2040. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

A climate-compatible approach to development practice by international humanitarian NGOs.

PubMed

Clarke, Matthew; de Cruz, Ian

2015-01-01

If current climate-change predictions prove accurate, non-linear change, including potentially catastrophic change, is possible and the environments in which international humanitarian NGOs operate will change figuratively and literally. This paper proposes that a new approach to development is required that takes changing climate into account. This 'climate-compatible approach' to development is a bleak shift from some of the current orthodox positions and will be a major challenge to international humanitarian NGOs working with the most vulnerable. However, it is necessary to address the challenges and context such NGOs face, and the need to be resilient and adaptive to these changes. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Leveraging Observation Tools for Instructional Improvement: Exploring Variability in Uptake of Ambitious Instructional Practices

ERIC Educational Resources Information Center

Cohen, Julie; Schuldt, Lorien Chambers; Brown, Lindsay; Grossman, Pamela

2016-01-01

Background/Context: Current efforts to build rigorous teacher evaluation systems has increased interest in standardized classroom observation tools as reliable measures for assessing teaching. However, many argue these instruments can also be used to effect change in classroom practice. This study investigates a model of professional development…

Researching New Literacies: Web 2.0 Practices and Insider Perspectives

ERIC Educational Resources Information Center

Lankshear, Colin; Knobel, Michele

2007-01-01

This article argues that "new literacies" is a useful construct for recognizing and understanding the extent to which changes in the current conjuncture are extending social practices of using codes for making and exchanging meanings in directions that warrant serious rethinking of how and why we research literacies. It provides a…

Emerging Issues II: The Changing Roles and Identities of Teachers and Learners in Higher Education

ERIC Educational Resources Information Center

Higgs, Bettie, Ed.; McCarthy, Marian, Ed.

2008-01-01

This book presents a wide selection of issues currently of interest and concern in higher education institutions in Ireland. The chapters are snapshots of the intersection between theory, practice and research in particular settings; they are not meant to be comprehensive. Nevertheless, they present practice approaches, new theoretical…

Knowledge Gained from Good Agricultural Practices Courses for Iowa Growers

ERIC Educational Resources Information Center

Shaw, Angela; Strohbehn, Catherine; Naeve, Linda; Domoto, Paul; Wilson, Lester

2015-01-01

Good Agricultural Practices (GAP) educational courses provide produce growers with the fundamental information for producing and processing safe produce. To determine the effectiveness of the current 7-hour GAP course provided in Iowa, growers were surveyed before and 7-14 days after the course to determine changes in knowledge and opinions.…

The Changing Dynamics of Health Care: Physician Perceptions of Technology in Medical Practices

ERIC Educational Resources Information Center

Hatton, Jerald D.

2012-01-01

Political, economic, and safety concerns have militated for the adoption of electronic health records (EHR) by physicians in the United States, but current rates of adoption have failed to achieve the expected levels. This qualitative phenomenological study of practicing physicians reveals obstacles to adoption. Maintaining the physicians'…

University Business Models and Online Practices: A Third Way

ERIC Educational Resources Information Center

Rubin, Beth

2013-01-01

Higher Education is in a state of change, and the existing business models do not meet the needs of stakeholders. This article contrasts the current dominant business models of universities, comparing the traditional non-profit against the for-profit online model, examining the structural features and online teaching practices that underlie each.…

A Longitudinal Study of Changes in Marketing Practices at Private Christian Colleges

ERIC Educational Resources Information Center

Vander Schee, Brian A.

2009-01-01

This article presents the results of a longitudinal study investigating current marketing practices at selected church-related, private, four-year compared to those in place in 1997. The role that institutional selectivity plays in the use of marketing activities was also investigated. The researcher surveyed the admissions directors or enrollment…

Future Language Teachers Learning to Become CALL Designers--Methodological Perspectives in Studying Complexity

ERIC Educational Resources Information Center

Keisanen, Tiina; Kuure, Leena

2015-01-01

Language teachers of the future, our current students, live in an increasingly technology-rich world. However, language students do not necessarily see their own digital practices as having relevance for guiding language learning. Research in the fields of CALL and language education more generally indicates that teaching practices change slowly…

Information Distribution Practices of Federal Statistical Agencies: The Census Bureau Example.

ERIC Educational Resources Information Center

Gey, Frederick C.

1993-01-01

Describes the current and historical distribution channels of the U.S. Bureau of the Census within a framework of distribution policies and practices for federal statistical information. The issues of reasonable distribution policies and the impact of technological change are discussed, and guidelines are offered. (Contains 26 references.) (EAM)

From Dissemination to Propagation: A New Paradigm for Education Developers

ERIC Educational Resources Information Center

Froyd, Jeffrey E.; Henderson, Charles; Cole, Renée S.; Friedrichsen, Debra; Khatri, Raina; Stanford, Courtney

2017-01-01

Scholarly studies and national reports document failure of current efforts to achieve broad, sustained adoption of research-based instructional practices, despite compelling bodies of evidence supporting efficacy of many of these practices. The authors of this paper argue that many change agents who are working to promote systemic adoption of…

Report of Task Group on the implications of the implementation of the ICRP recommendations for a revised dose limit to the lens of the eye.

PubMed

Broughton, J; Cantone, M C; Ginjaume, M; Shah, B

2013-12-01

This report was commissioned by the IRPA President to provide an assessment of the impact on members of IRPA Associate Societies of the introduction of ICRP recommendations for a reduced dose limit for the lens of the eye. The report summarises current practice and considers possible changes that may be required. Recommendations for further collaboration, clarification and changes to working practices are suggested.

Cerebrospinal fluid protein and glucose examinations and tuberculosis:
Will laboratory safety regulations force a change of practice?

PubMed

Tormey, William P; O'Hagan, Christopher

2015-01-01

Cerebrospinal fluid (CSF) protein and glucose examinations are usually performed in chemical pathology departments on autoanalysers. Tuberculosis (TB) is a group 3 biological agent under Directive 2000/54/EC of the European Parliament but in the biochemistry laboratory, no extra precautions are taken in its analysis in possible TB cases. The issue of laboratory practice and safety in the biochemical analyses of CSF specimens, when tuberculosis infection is in question is addressed in the context of ambiguity in the implementation of current national and international health and safety regulations. Additional protective measures for laboratory staff during the analysis of CSF TB samples should force a change in current laboratory practice and become a regulatory issue under ISO 15189. Annual Mantoux skin test or an interferon-γ release assay for TB should be mandatory for relevant staff. This manuscript addresses the issue of biochemistry laboratory practice and safety in the biochemical analyses of CSF specimens when tuberculosis infection is in question in the context of the ambiguity of statutory health and safety regulations.

Trust in management, communication and organisational commitment: Factors influencing readiness for change management in organisation

NASA Astrophysics Data System (ADS)

Ahmad, Mohd Hafis; Ismail, Syuhaida; Rani, Wan Nurul Mardiah Wan Mohd; Wahab, Mohammad Hussaini

2017-10-01

Organisational change occurs when an organisation makes a transition from its current state to some desired future state in minimising employee resistance and cost to the organisation while simultaneously maximising the effectiveness of the change effort. This paper, aims at appraising the change management of organisation in Malaysia since limited research has been done to examine readiness for change by the employees in the organisation. This paper is materialising its objectives of (1) investigating the current practice of organisation and employees in the organisation towards change management and (2) assessing the factors influencing readiness of organisation and employees in the organisation towards change management. It is found via literature review that change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented to transitioning individuals, teams, and organisations to a desired future state by focusing on the wider impacts of change, particularly on people, where change does not happen in isolation and it impacts the whole organisation. Furthermore, it is found that current practice of organisation and employees in the organisation towards change management involved in three main factors, namely trust in management, communication and organisational commitment; with the factor for trust in management is the positive vision for the future by management team, meanwhile for communication, it is found that there is good communication between supervisors and employees about the organisation's policy toward the changes. The factor found in organisational commitment is employees enjoying discussing about their organisation with outsiders. The findings of this paper provide a positive impact on change management planning, which ultimately help in ensuring more effective change programme implementation in the organisation in Malaysia.

Current Recruitment Practices in Community Colleges and Other Post Secondary Institutions.

ERIC Educational Resources Information Center

Rinck, Lorna Lee

Research documents, conference presentations, and journal articles are used in a five-part review of recruitment strategies currently being employed at junior colleges. The first section provides background information on the development of the community college movement. The second section focuses on changing student objectives and their…

Partnership, inclusion and innovation in occupational therapy: Essential or optional ingredients to flourish in a changing environment?

PubMed

Gilbert Hunt, Susan

2017-12-01

Historically occupational therapy has evidenced a tenacity to adjust and adapt to societal changes. Currently in Australia we are in the midst of significant change in health, disability and aged care service delivery alongside increasing numbers of new graduates seeking employment. Both of these changes create challenges and opportunities for the profession. How the profession adjusts to new service delivery models and supports new graduates in this changing work environment will influence our future. Using examples from practice the paper explores ways in which partnership, inclusion and innovation can be effective in a changing environment. Doing effective partnership takes time, energy and a shared commitment of all involved and often requires negotiations and compromise. Inclusion can be tricky and requires vigilance and ongoing reflection on actions to determine if the outcomes are what was intended. Innovation can play two roles; it can be used to conserve current practice in new ways or it can offer agency to disrupt and redefine practice. The way in which the profession chooses to enact partnerships and inclusion will play a vital role in shaping the future. Similarly the space and support made for conservative or disruptive innovation will determine how we choose to define ourselves going forward. Moreover, these choices and actions will govern how effective we are in navigating the changing environment and supporting new graduates transitioning into the profession. © 2017 Occupational Therapy Australia.

Modelling climate change, land-use change and phosphorus reduction impacts on phytoplankton in the River Thames (UK)

NASA Astrophysics Data System (ADS)

Bussi, Gianbattista; Whitehead, Paul; Dadson, Simon

2016-04-01

In this study, we assess the impact of changes in precipitation and temperature on the phytoplankton concentration of the River Thames (UK) by means of a physically-based model. A scenario-neutral approach was employed to evaluate the effects of climate variability on flow, phosphorus concentration and phytoplankton concentration. In particular, the impact of uniform changes in precipitation and temperature on five groups of phytoplankton (diatoms and large chlorophytes, other chlorophytes, picoalgae, Microcystis-like cyanobacteria and other cyanobacteria) was assessed under three different land-use/land-management scenarios (1 - current land use and phosphorus reduction practices; 2 - expansion of agricultural land and current phosphorus reduction practices; 3 - expansion of agricultural land and optimal phosphorus reduction practices). The model results were assessed within the framework of future climate projections, using the UK Climate Projections 09 (UKCP09) for the 2030s. The results of the model demonstrate that an increase in average phytoplankton concentration due to climate change is highly likely to occur, and its magnitude varies depending on the river reach. Cyanobacteria show significant increases under future climate change and land-use change. An expansion of intensive agriculture accentuates the growth in phytoplankton, especially in the upper reaches of the River Thames. However, an optimal phosphorus removal mitigation strategy, which combines reduction of fertiliser application and phosphorus removal from wastewater, can help to reduce this increase in phytoplankton concentration, and in some cases, compensate for the effect of rising temperature.

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure.

PubMed

Echevarria, Mercedes

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

Twinning "Practices of Change" with "Theory of Change": Room for Emergence in Advocacy Evaluation

ERIC Educational Resources Information Center

Arensman, Bodille; van Waegeningh, Cornelie; van Wessel, Margit

2018-01-01

Theory of change (ToC) is currently "the" approach for the evaluation and planning of international development programs. This approach is considered especially suitable for complex interventions. We question this assumption and argue that ToC's focus on cause-effect logic and intended outcomes does not do justice to the recursive nature…

Retooling for the future.

PubMed

Andrews, D

1999-04-01

Several trends will accelerate changes in the industry initiated by Medicare's change in payment methodology, including explosive growth fueled by changing demographics, patient preferences, and technological advances; altered customer buying incentives created by managed care organization-provider partnerships; and accelerated consolidation. Home care agencies should "take inventory" of current practices and systems to determine capability gaps for competing in the new environment.

Evaluating best practices for Campylobacter and Salmonella reduction in poultry processing plants.

PubMed

Wideman, N; Bailey, M; Bilgili, S F; Thippareddi, H; Wang, L; Bratcher, C; Sanchez-Plata, M; Singh, M

2016-02-01

Poultry processing plants in the United States were surveyed on their current Campylobacter and Salmonella control practices. Following surveys, data were collected to develop a baseline for prevalence rates of Salmonella and Campylobacter; then changes in practices were implemented and evaluated for improvements in pathogen control. Surveys were sent to the plant Quality Assurance managers to determine production levels, antimicrobial interventions, and current pathogen testing practices. Initial sampling was performed at 6 plants with similar production volumes, at sites that included carcass samples before any pre-evisceration intervention, after exiting the inside-outside bird washer (IOBW), after exiting the pre-chiller, after exiting the primary chiller, and after exiting any post-chill intervention, as well as a water sample from each scalder, pre-chiller, primary chiller, and post-chill dip tank or finishing chiller. Enumerations and enrichments were performed for Campylobacter and Salmonella. Following the baseline sampling, changes in practices were suggested for each plant and a second sampling was conducted to determine their effectiveness. Results demonstrated that peracetic acid (PAA) was the most effective (P < 0.05) antimicrobial currently in use. The use of a post-chill antimicrobial immersion tank and/or use of a cetylpyridinium chloride (CPC) spray cabinet also displayed a further reduction in microbial levels (P < 0.05) when the primary chiller was not sufficient (P > 0.05). Microbial buildup in the immersion tanks demonstrates the need for effective cleaning, sanitation practices, and chiller maintenance to reduce contamination of poultry with Campylobacter and Salmonella. © 2015 Poultry Science Association Inc.

Documentation: Records and Reports.

PubMed

Akers, Michael J

2017-01-01

This article deals with documentation to include the beginning of documentation, the requirements of Good Manufacturing Practice reports and records, and the steps that can be taken to minimize Good Manufacturing Practice documentation problems. It is important to remember that documentation for 503a compounding involves the Formulation Record, Compounding Record, Standard Operating Procedures, Safety Data Sheets, etc. For 503b outsourcing facilities, compliance with Current Good Manufacturing Practices is required, so this article is applicable to them. For 503a pharmacies, one can see the development and modification of Good Manufacturing Practice and even observe changes as they are occurring in 503a documentation requirements and anticipate that changes will probably continue to occur. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Determination of significance in Ecological Impact Assessment: Past change, current practice and future improvements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk

2013-01-15

Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey ofmore » the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring and feedback would rapidly improve practice.« less

Enhancing nurses' empowerment: the role of supervisors' empowering management practices.

PubMed

Montani, Francesco; Courcy, François; Giorgi, Gabriele; Boilard, Amélie

2015-09-01

This study tests a theoretical model where: (a) nurses' dispositional resistance to change is indirectly negatively related to behavioural empowerment through the mediating role of psychological empowerment; and (b) supervisors' empowering management practices buffer both the negative relationship between dispositional resistance to change and psychological empowerment and the indirect negative relationship between resistance to change and behavioural empowerment via psychological empowerment. Promoting a high level of empowerment among nursing personnel is important to ensure their effectiveness in the context of organizational change. It is thus essential to advance our current understanding of the factors that hamper nurses' psychological and behavioural expressions of empowerment and to clarify supervisor practices that can overcome such barriers. A cross-sectional research design. We collected survey data during 2012 from a sample of 197 nurses from a Canadian hospital undergoing a major organizational change. Results from moderated mediation analyses provided evidence for an indirect negative relationship between dispositional resistance to change and behavioural empowerment through psychological empowerment, and for a moderating (buffering) effect of supervisors' empowering management practices on this mediated relationship. These findings provided support for our hypotheses. Supervisors' empowering management practices represent an important contextual buffer against the negative effects of dispositional resistance to change on nurses' empowerment. Organizations should develop empowering management skills among nurses' supervisors to counteract the detrimental effects of dispositional resistance to change and to sustain an empowered nursing workforce. © 2015 John Wiley & Sons Ltd.

Work and retirement preferences of practicing radiologists as a predictor of workforce needs.

PubMed

Moriarity, Andrew K; Brown, Manuel L; Schultz, Lonni R

2014-08-01

The radiology job market has been described as highly variable, and recent practice hiring surveys predict that the number of available jobs will remain flat. Radiologists may be working more hours and retiring later than desired, activities that influence overall job availability. A national survey was performed to determine the desired work rate and retirement preferences of practicing radiologists, and the responses are used to estimate current and potential future work output and future workforce needs. Practicing radiologists were surveyed regarding current and preferred work level and desired and expected retirement age. A model incorporating these preferences and stratified by age was developed using survey responses and American Medical Association full-time equivalent (FTE) estimates. Available FTE radiologists are estimated under four scenarios from 2016 to 2031 in 5-year intervals. The model predicts a total of 26,362 FTE radiologists available in 2011, which corresponds to previous estimates. Participants reported working more hours and expecting to retire later than desired, with younger radiologists and women reporting the greatest desired decrease in FTE hours worked. Under each scenario, there is an initial FTE availability in 2016 ranging from 21,156 to 24,537, which increases to between 27,753 and 31,435 FTE by 2031 depending on work rate and retirement patterns. Practicing radiologists report that they currently work more hours than desired and expect to retire later than they would prefer. If radiologists changed current personal work rate and expected retirement age to meet these preferences, there would be an immediate shortage of FTE radiologists continuing until at least 2020 assuming no other workforce needs changes. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Current good manufacturing practices, quality control procedures, quality factors, notification requirements, and records and reports, for infant formula. Final rule.

PubMed

2014-06-10

The Food and Drug Administration (FDA or we) is issuing a final rule that adopts, with some modifications, the interim final rule (IFR) entitled "Current Good Manufacturing Practices, Quality Control Procedures, Quality Factors, Notification Requirements, and Records and Reports, for Infant Formula'' (February 10, 2014). This final rule affirms the IFR's changes to FDA's regulations and provides additional modifications and clarifications. The final rule also responds to certain comments submitted in response to the request for comments in the IFR.

Sustainability in medicine.

PubMed

George, Ruth; Coffin, Janis; George, Sierra

2013-01-01

Given the current state of the U.S. healthcare system, with increasingly complicated regulations and paperwork and decreasing reimbursements, the question arises: Is it possible to provide safe, high-quality healthcare and reduce costs? Furthermore, is it possible to care for the health of your patients while simultaneously caring for the financial health of your practice and promoting improvement in the overall health of the planet? This article will review some steps currently being taken by various companies and hopefully stimulate ideas for changes you may want to consider for your own practice, hospital, or institution.

An Evidence-Based Public Health Approach to Climate Change Adaptation

PubMed Central

Eidson, Millicent; Tlumak, Jennifer E.; Raab, Kristin K.; Luber, George

2014-01-01

Background: Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Objectives: Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. Methods: We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. Discussion: A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. Conclusions: The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders. Citation: Hess JJ, Eidson M, Tlumak JE, Raab KK, Luber G. 2014. An evidence-based public health approach to climate change adaptation. Environ Health Perspect 122:1177–1186; http://dx.doi.org/10.1289/ehp.1307396 PMID:25003495

COMPARISON OF METHODS FOR ESTIMATING CONTEMPORARY COSTS: AN APPLICATION TO LIVER TRANSPLANTATION IN THE UNITED KINGDOM.

PubMed

Singh, Jeshika; Longworth, Louise

2017-01-01

Our study addresses the important issue of estimating treatment costs from historical data. It is a problem frequently faced by health technology assessment analysts. We compared four approaches used to estimate current costs when good quality contemporary data are not available using liver transplantation as an example. First, the total cost estimates extracted for patients from a cohort study, conducted in the 1990s, were inflated using a published inflation multiplier. Second, resource use estimates from the cohort study were extracted for hepatitis C patients and updated using current unit costs. Third, expert elicitation was carried out to identify changes in clinical practice over time and quantify current resource use. Fourth, routine data on resource use were obtained from National Health Service Blood and Transplant (NHSBT). The first two methods did not account for changes in clinical practice. Also the first was not specific to hepatitis patients. The use of experts confirmed significant changes in clinical practice. However, the quantification of resource use using experts is challenging as clinical specialists may not have a complete overview of clinical pathway. The NHSBT data are the most accurate reflection of transplantation and posttransplantation phase; however, data were not available for the whole pathway of care. The best estimate of total cost, combining NHSBT data and expert elicitation, is £121,211. Observational data from routine care are potentially the most reliable reflection of current resource use. Efforts should be made to make such data readily available and accessible to researchers. Expert elicitation provided reasonable estimates.

A qualitative investigation of specialist orthodontists in New Zealand. Part 1. Orthodontists and orthodontic practice.

PubMed

Soma, Kieran J; Thomson, W Murray; Morgaine, Kate C; Harding, Winifred J

2012-05-01

Current knowledge of orthodontic practice is largely anecdotal and the lack of systematic knowledge can create barriers to better identifying the factors that make a successful orthodontist. The aim of this study was to investigate the routine practising lives of New Zealand orthodontists in order to generate an understanding of the reality of orthodontic specialist practice and its effects on their professional and personal lives. Semi-structured interviews were conducted involving 19 practising orthodontists (four females, 15 males; mean age 50 years) throughout New Zealand.Transcribed interviews were analysed for themes using an applied grounded theory approach. A core category of 'practising orthodontists' was derived, and related themes were grouped under the sub-categories of: (a) NZ orthodontic specialist practice; (b) NZ specialist orthodontists; and (c) work-life balance. The present paper reports on the first two subcategories. Themes elucidated under the specialist practice sub-category included modernisation, changing social norms, practice arrangement, branch practice, staffing, competition, legislation, advertising, the future and the provision of orthodontics by non-specialists. Themes in the orthodontic specialist sub-category were prior experience, postgraduate training, recent graduates, reasons for specialising, generational differences, females in orthodontics, NZ and overseas practice, the ageing profession and the prospect of an orthodontist shortage. This investigation has shed light on orthodontists and the practice of orthodontics in New Zealand and determined aspects rarely discussed in the current or previous literature. It will be valuable to observe how orthodontists and orthodontic practice continue to evolve in response to changes in NZ society.

The evolution of social work education in England: a critical review of its connections and commonalities with nurse education.

PubMed

Manthorpe, Jill; Hussein, Shereen; Moriarty, Jo

2005-07-01

Social work education in England underwent significant change in its move to degree status in 2003. It is hoped that the result will be increased professional standing for social workers, an improvement in the current widespread problems with recruitment, and assurance that all newly qualified social workers meet the National Occupational Standards for Social Work (Available from: http://www.topssengland.net/files/cd/). This change has pre-occupied social work educators and debate within the profession has concentrated on the practicalities and expectations of reform. This paper suggests that those working in nurse education may observe a number of similarities with its own earlier reforms and with current debates on whether nursing should move to an all-graduate profession. It then highlights three aspects of the new requirements for social work training: service user involvement, the place of research-minded practice, and the primacy of practice--that may be of interest and relevance to nursing colleagues.

Teacher Collaboration in Curriculum Design Teams: Effects, Mechanisms, and Conditions

ERIC Educational Resources Information Center

Voogt, Joke M.; Pieters, Jules M.; Handelzalts, Adam

2016-01-01

Collaborative design positively affects both professional development and the implementation of curriculum change, because teachers develop competencies and practice and develop ownership of the change. The current study was aimed to explore what empirical evidence is available about processes that take place when teachers co-design and how these…

Policy, Systems, and Environmental Change in the Mississippi Delta: Considerations for Evaluation Design

ERIC Educational Resources Information Center

Kegler, Michelle C.; Honeycutt, Sally; Davis, Melvin; Dauria, Emily; Berg, Carla; Dove, Cassandra; Gamble, Abigail; Hawkins, Jackie

2015-01-01

Community-level policy, systems, and environmental (PSE) change strategies may offer an economical and sustainable approach to chronic disease prevention. The rapidly growing number of untested but promising PSE strategies currently underway offers an exciting opportunity to establish practice-based evidence for this approach. This article…

Assessment of Subsurface Drainage Management Practices to Reduce Nitrogen Loadings Using AnnAGNPS

EPA Science Inventory

The goal of the Future Midwest Landscape project is to quantify current and future landscape services across the region and examine changes expected to occur as a result of two alternative drivers of future change: the growing demand for biofuels; and hypothetical increases in in...

Postgraduate Research Supervision: A Critical Review of Current Practice

ERIC Educational Resources Information Center

McCallin, Antoinette; Nayar, Shoba

2012-01-01

Changes in the funding and delivery of research programmes at the university level have, in recent years, resulted in significant changes to research supervision. This paper critically reviews key influences effecting postgraduate supervision. Analysis draws on literature spanning 2000-2010 to determine the appropriateness of traditional models of…

76 FR 24881 - Agency Information Collection Activities; 60-Day Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-03

... their provisions regarding rules, rates, charges and practices. Frequency: This information is collected... information collections (extensions with no changes) listed below in this notice. DATES: Written comments must... charterers. Current Actions: There are no changes to this information collection, and it is being submitted...

How the Chemistry Modeling Curriculum Engages Students in Seven Science Practices Outlined by the College Board

ERIC Educational Resources Information Center

Posthuma-Adams, Erica

2014-01-01

As advanced placement (AP) teachers strive to implement the changes outlined in the AP chemistry redesign, they will have the opportunity to reflect on and evaluate their current practices. For many AP teachers, the new focus on conceptual understanding, reasoning, inquiry, and critical thinking over memorization and algorithmic problem solving…

Creative Convergence in Practice and Its Effects on Higher Education: A Mixed-Methods, Neopragmatist Study Examining Media Arts

ERIC Educational Resources Information Center

Rosner, Terre Layng

2017-01-01

This study is a mixed-methods, neopragmatist examination of the systems currently being practiced in creative professional companies and the consequential changes in Higher Education Media Arts curricula, supporting a kind of meta-disciplinary pedagogy emerging from the pressures of content and device convergence in industry. The research…

Historical Analysis of the Division between Clergy and Laity with Particular Reference to Discipleship

ERIC Educational Resources Information Center

Copeland, Janet Eileen

2012-01-01

This dissertation analyzes the change from the New Testament church practice of having the responsibility for ministry rest upon the entire congregation, clergy and laity alike, to the current practice of the responsibility for ministry resting almost exclusively upon the clergy. Chapter 1 introduces the concept of Christians being accountable to…

Employee Engagement and Leadership: Exploring the Convergence of Two Frameworks and Implications for Leadership Development in HRD

ERIC Educational Resources Information Center

Shuck, Brad; Herd, Ann Mogan

2012-01-01

As the use of workplace knowledge economies increases and emerging motivational-state variables such as employee engagement become more widely used, current frameworks of leadership are undergoing changes in perspective and practice. Moreover, while shifts in workplace dynamics have occurred in practice for some time, scholars are now calling for…

Ends in Themselves: Theorizing the Practice of University-School Partnering through Horizontalidad

ERIC Educational Resources Information Center

Campano, Gerald; Honeyford, Michelle A.; Sanchez, Lenny; Zanden, Sarah Vander

2010-01-01

In this article we share our current thinking about the methodology of collaborations for change and make visible our own attempts to theorize the practice of university-school partnering. We suggest that a fruitful new direction for research may involve turning to the Global South and the Latin American idea of horizontalidad [horizontalism],…

Digital Technologies and Dance: Developing Connections between Artistic Practice, Pedagogy, and Future Higher Education Curricular Practices

ERIC Educational Resources Information Center

Alpert, Valerie

2011-01-01

As digital literacy increases in the world and as educational institutions respond, changes are occurring across disciplines, including dance. This study examines the current status of "integrated dance technology curricula" at two universities and one community college in the United States, all of which have differing pedagogical and…

Facing the Challenges of Educational Reform in the Arab World

ERIC Educational Resources Information Center

Karami Akkary, Rima

2014-01-01

This paper pinpoints and discusses key aspects of the current approaches to school reform in the Arab world against the backdrop of what is accepted as the best practice in the international literature on effective school reform and educational change. The main goal of the paper is to highlight deeply ingrained assumptions and practices that are…

Identifying changes in the role of the infection preventionist through the 2014 practice analysis study conducted by the Certification Board of Infection Control and Epidemiology, Inc.

PubMed

Henman, Lita Jo; Corrigan, Robert; Carrico, Ruth; Suh, Kathryn N

2015-07-01

The Certification Board of Infection Control and Epidemiology, Inc (CBIC) is a voluntary autonomous multidisciplinary board that provides direction and administers the certification process for professionals who are responsible for the infection prevention and control program in a health care facility. The CBIC performs a practice analysis approximately every 4-5 years. The practice analysis is an integral part of the certification examination development process and serves as the backbone of the test content outline. In 2013, the CBIC determined that a practice analysis was required and contracted with Prometric to facilitate the process. The practice analysis was carried out in 2014 by a diverse group of subject matter experts from the United States and Canada. The practice analysis results showed a significant change in the number of tasks and associated knowledge required for the competent practice of infection prevention. As authorized by the CBIC, the test committee is currently reclassifying the bank of examination questions as required and is writing and reviewing questions based on the updated test specifications and content outline. The new content outline will be reflected in examinations that are taken beginning in July 2015. This iterative process of assessing and updating the certification examination ensures not only a valid competency tool but a true reflection of current practices. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Prevention of DNA contamination during forensic medical examinations in a clinical forensic medical service: A best practice implementation project.

PubMed

Lutz, Tasha

2015-01-01

Contamination of forensic specimens can have significant and detrimental effects on cases presented in court. In 2010 a wrongful conviction in Australia resulted in an inquiry with 25 recommendations to minimize the risk of DNA contamination of forensic specimens. DNA decontamination practices in a clinical forensic medical service currently attempt to comply with these recommendations. Evaluation of these practices has not been undertaken. The aim of this project was to audit the current DNA decontamination practices of forensic medical and nursing examiners in the forensic medical examination process and implement changes based on the audit findings. A re-audit following implementation would be undertaken to identify change and inform further research. The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used as the audit tool in this project. A baseline audit was conducted; analysis of this audit process was then undertaken. Following education and awareness training targeted at clinicians, a re-audit was completed. There were a total of 24 audit criteria; the baseline audit reflected 20 of these criteria had 100% compliance. The remaining 4 audit criteria demonstrated compliance between 65% and 90%. Education and awareness training resulted in improved compliance in 2 of the 4 audit criteria, with the remaining 2 having unchanged compliance. The findings demonstrated that education and raising awareness can improve clinical practice; however there are also external factors outside the control of the clinicians that influence compliance with best practice.

Testing for Accountability: A Balancing Act That Challenges Current Testing Practices and Theories

ERIC Educational Resources Information Center

Brennan, Robert L.

2015-01-01

Koretz, in his article published in this issue, provides compelling arguments that the high stakes currently associated with accountability testing lead to behavioral changes in students, teachers, and other stakeholders that often have negative consequences, such as inflated scores. Koretz goes on to argue that these negative consequences require…

Determining Effective Teaching Behaviors through the Hiring Process

ERIC Educational Resources Information Center

Schumacher, Gary; Grigsby, Bettye; Vesey, Winona

2015-01-01

Purpose: One bad hiring decision can lead to low student achievement. Research supports that teachers are the most influential factor in student success. As a result, principals' current practice of hiring teachers based on intuition and likeability must change. Given the current high stakes era, principals need reassurance that the teachers they…

Considerations for restoring temperate forests of tomorrow: Forest restoration, assisted migration, and bioengineering

Treesearch

Kas Dumroese; Mary I. Williams; John A. Stanturf; Brad St. Clair

2015-01-01

Tomorrow’s forests face extreme pressures from contemporary climate change, invasive pests, and anthropogenic demands for other land uses. These pressures, collectively, demand land managers to reassess current and potential forest management practices. We discuss three considerations, functional restoration, assisted migration, and bioengineering, which are currently...

A Framework for Action: Intervening to Increase Adoption of Transformative Web 2.0 Learning Resources

ERIC Educational Resources Information Center

Hughes, Joan E.; Guion, James M.; Bruce, Kama A.; Horton, Lucas R.; Prescott, Amy

2011-01-01

Web 2.0 tools have emerged as conducive for innovative pedagogy and transformative learning opportunities for youth. Currently,Web 2.0 is often adopted into teachers' practice to simply replace or amplify traditional instructional approaches rather than to promote or facilitate transformative educational change. Current models of innovation…

Factors influencing behavior guidance: a survey of practicing pediatric dentists.

PubMed

Juntgen, Laura M; Sanders, Brian J; Walker, Laquia A; Jones, James E; Weddell, James A; Tomlin, Angela M; Eckert, George; Maupome, Gerardo

2013-01-01

The purpose of this study was to identify factors influencing behavior guidance technique utilization among practicing pediatric dentists and explore potential barriers to the incorporation of previously unused techniques. The data for this study were obtained from a web-based survey containing 15 multiple choice questions concerning the practitioners' past, current, and anticipated future behavior guidance technique utilization. Most respondents received hands-on training in 10 of the American Academy of Pediatric Dentistry behavior guidance techniques. The type of training was associated with the practitioners' level of comfort using a given technique upon graduation and with the current frequency of technique utilization. Residency type impacted hands-on behavior guidance training, with 39 percent of respondents reporting no intravenous sedation training. The type of practice was associated with the frequency of behavior guidance technique utilization, as was graduation decade. Currently practicing dentists cited legal concerns, parental acceptance to change, and limited resources as perceived obstacles in the incorporation of new techniques. Behavior guidance technique selection and utilization among practicing pediatric dentists was influenced by multiple factors, including advanced education training, residency type, graduation decade, and practice type. Obstacles to the incorporation of previously unused techniques appear to be multifactorial.

Interpretation of Landscape Scale SWAT Model Outputs in the Western Lake Erie Basin: Potential Implications for Conservation Decision-Making

NASA Astrophysics Data System (ADS)

Johnson, M. V. V.; Behrman, K. D.; Atwood, J. D.; White, M. J.; Norfleet, M. L.

2017-12-01

There is substantial interest in understanding how conservation practices and agricultural management impact water quality, particularly phosphorus dynamics, in the Western Lake Erie Basin (WLEB). In 2016, the US and Canada accepted total phosphorus (TP) load targets recommended by the Great Lakes Water Quality Agreement Annex 4 Objectives and Targets Task Team; these were 6,000 MTA delivered to Lake Erie and 3,660 MTA delivered to WLEB. Outstanding challenges include development of metrics to determine achievement of these goals, establishment of sufficient monitoring capacity to assess progress, and identification of appropriate conservation practices to achieve the most cost-effective results. Process-based modeling can help inform decisions to address these challenges more quickly than can system observation. As part of the NRCS-led Conservation Effects Assessment Project (CEAP), the Soil Water Assessment Tool (SWAT) was used to predict impacts of conservation practice adoption reported by farmers on TP loss and load delivery dynamics in WLEB. SWAT results suggest that once the conservation practices in place in 2003-06 and 2012 are fully functional, TP loads delivered to WLEB will average 3,175 MTA and 3,084 MTA, respectively. In other words, SWAT predicts that currently adopted practices are sufficient to meet Annex 4 TP load targets. Yet, WLEB gauging stations show Annex 4 goals are unmet. There are several reasons the model predictions and current monitoring efforts are not in agreement: 1. SWAT assumes full functionality of simulated conservation practices; 2. SWAT does not simulate changing management over time, nor impacts of past management on legacy loads; 3. SWAT assumes WLEB hydrological system equilibrium under simulated management. The SWAT model runs used to construct the scenarios that informed the Annex 4 targets were similarly constrained by model assumptions. It takes time for a system to achieve equilibrium when management changes and it takes time for monitoring efforts to measure meaningful changes over time. Careful interpretation of model outputs is imperative for appropriate application of current scientific knowledge to inform decision making, especially when models are used to set spatial and temporal goals around conservation practice adoption and water quality.

Changing Trends and Practices in Cytopathology.

PubMed

Gonzalez, Maria F; Akhtar, Israh; Manucha, Varsha

2017-01-01

To explore the current and anticipated changes in the practice of cytopathology. The present review is based on a review of recent literature and an evaluation of the authors' personal experiences. In recent years the practice of cytopathology, nationwide and in our institute, has witnessed a major change affecting gynecologic and nongynecologic cytology. There has been a decline in the number of Papanicolaou tests which has affected the utilization of cytotechnologists and provoked a reorganization of their work flow. The "need to do more with less" in the era of targeted therapy/personalized medicine has resulted in an increasing preference for needle core biopsy when performing a rapid on-site evaluation. We feel that this change is unavoidable. It is pertinent that cytopathologists as a group recognize this change and prepare themselves and the trainees not only to become adapt but also to use this as an opportunity to discover the yet unexplored world of cytology. © 2017 S. Karger AG, Basel.

Screening women for intimate partner violence: Creating proper practice habits.

PubMed

Knox, Beth

2018-05-17

Intimate partner violence continues to be a challenge for advanced practice registered nurses to address and manage in their daily practice. This article reviews current healthcare concerns in heterosexual, bisexual, transgender, and lesbian women, and explores screening guidelines and resources for developing successful screening habits. Additionally, the article discusses how the Transtheoretical Model and Stages of Change offers insight into the behavior of women who experience intimate partner violence and provides safety strategies for these women.

Making Research Delicious: An Evaluation of Nurses' Knowledge, Attitudes, and Practice Using the Great American Cookie Experiment With Mobile Device Gaming.

PubMed

Hayes Lane, Susan; Serafica, Reimund; Huffman, Carolyn; Cuddy, Alyssa

2016-01-01

In the current healthcare environment, nurses must have a basic understanding of research to lead change and implement evidence-based practice. The purpose of this study was to evaluate the effectiveness of an educational intervention formulated on the framework of the Great American Cookie Experiment measuring nurses' research knowledge, attitudes, and practice using mobile device gaming. This multisite quantitative study provides insight into promotion of research and information about best practices on innovative teaching strategies for nurses.

Family presence during cardiopulmonary resuscitation: using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines.

PubMed

Doolin, Christopher T; Quinn, Lisa D; Bryant, Lesley G; Lyons, Ann A; Kleinpell, Ruth M

2011-01-01

To provide advanced practice nurses (APNs) with the best available evidence for implementation of policies and procedures to allow family presence during cardiopulmonary resuscitation (CPR) in the acute care environment. A comprehensive review of research-based articles from Ebsco Host, CINAHL, Pre-CINAHL, and Medline Plus, as well as statement alerts from nursing credentialing bodies, and practice guidelines were reviewed. Kolcaba's Theory of Comfort and Lewin's Three Step Change Theory provide a framework for implementation of formal policies and procedures. Best available evidence showed more support in favor of allowing families at the bedside during CPR. Implementation of policies and procedures allowing family presence enables facilities to change and grow in a holistic and family-oriented atmosphere. With this evidence-based knowledge the APN will be able to disseminate information to facilitate collaborative change in current practices surrounding staff education, decision making, and self-governance. The APN can then address controversial changes when developing formal policies and procedures, which will increase patient satisfaction and outcomes. ©2010 The Author Journal compilation ©2010 American Academy of Nurse Practitioners.

Changing landowners, changing ecosystem? Land-ownership motivations as drivers of land management practices.

PubMed

Sorice, Michael G; Kreuter, Urs P; Wilcox, Bradford P; Fox, William E

2014-01-15

Motivations for owning rural land are shifting from an agricultural-production orientation to a preference for natural and cultural amenities. Resultant changes in land management have significant implications for the type and distribution of landscape-level disturbances that affect the delivery of ecosystem services. We examined the relationship between motivations for owning land and the implementation of conservation land management practices by landowners in the Southern Great Plains of the United States. Using a mail survey, we classified landowners into three groups: agricultural production, multiple-objective, and lifestyle-oriented. Cross tabulations of landowner group with past, current, and future use of 12 different land management practices (related to prescribed grazing, vegetation management, restoration, and water management) found that lifestyle-oriented landowners were overall less likely to adopt these practices. To the degree that the cultural landscape of rural lands transitions from production-oriented to lifestyle-oriented landowners, the ecological landscape and the associated flow of ecosystem services will likely change. This poses new challenges to natural resource managers regarding education, outreach, and policy; however, a better understanding about the net ecological consequences of lower rates of adoption of conservation management practices requires consideration of the ecological tradeoffs associated with the changing resource dependency of rural landowners. Copyright © 2013 Elsevier Ltd. All rights reserved.

Dermatology and pathology arrangements: navigating the compliance risks.

PubMed

Wood, Jane Pine; Cougevan, Bridget; McGovern, Jenny

2013-12-01

Purchased service arrangements, establishing in-house professional pathology services, conducting technical component histology within a dermatology practice, and electronic medical records technology donations are ways that dermatology practices are responding to the current health care delivery and payment changes. This article will provide a general framework for navigating the compliance risks and structure considerations associated with these relationships between dermatologists and pathologists.

The Library Is Dead, Long Live the Library! The Practice of Academic Librarianship and the Digital Revolution

ERIC Educational Resources Information Center

Ross, Lyman; Sennyey, Pongracz

2008-01-01

As a direct consequence of the digital revolution, academic libraries today face competition as information providers. Using Richard N. Foster's technology S curves as the analytical model, this article shows that academic libraries are in the midst of discontinuous change by questioning a number of assumptions that support the current practice of…

A code of ethics for nurse educators: revised.

PubMed

Rosenkoetter, Marlene M; Milstead, Jeri A

2010-01-01

Nurse educators have the responsibility of assisting students and their colleagues with understanding and practicing ethical conduct. There is an inherent responsibility to keep codes current and relevant for existing nursing practice. The code presented here is a revision of the Code of ethics for nurse educators originally published in 1983 and includes changes that are intended to provide for that relevancy.

A Multiple-Case Study on the Impact of Teacher Professional Development for Online Teaching on Face-to-Face Classroom Teaching Practices

ERIC Educational Resources Information Center

Parra, Julia Lynn

2010-01-01

Today's teachers need preparation, support, and professional development to help them change their curriculum and teaching practices. One area of potential for this preparation, support, and professional development is currently being evidenced in the field of online teaching and learning. In preparing teachers for teaching online, research…

Towards multidisciplinary assessment of older people: exploring the change process.

PubMed

Ross, Fiona; O'Tuathail, Claire; Stubberfield, Debbie

2005-04-01

This paper discusses the process of change that took place in an intervention study of standardized multidisciplinary assessment guidelines implemented in a female ward for older people in a District General Hospital in South London. This study was one of nine implementation projects in the South Thames Evidence-Based Practice Project. The relationship between the worlds of research and healthcare practice is uneasy and contested and, as such, is a breeding ground for challenging questions about how evidence can be used to foment change in clinical practice. Recent literature on change highlights the importance of understanding complexity, which informed our approach and analysis. A multifaceted approach to change that comprised evidence-based guidelines, leadership (project leader) and change management was evaluated before and after the implementation by telephone interviews with patients, a postal survey of community staff and interviews with ward staff. A diagnostic analysis of current assessment practice informed the change process. The project leader collected data on adherence. This paper draws on descriptive and qualitative data and addresses the links between contextual issues and the processes and pathways of change, informed by theoretical ideas from the change literature. Key themes emerged: working through others and across boundaries, managing uncertainty and unanticipated challenges. Adherence of ward staff to using the multidisciplinary assessment guidelines was high, with evidence of some dissemination to community staff at follow-up. Three years after the project finished the multidisciplinary assessment is still part of routine clinical practice. The analysis contributes to understanding about the nursing leadership of change within an interprofessional arena of practice. It highlights the importance of understanding the context in relation to the impact and sustainability of change and thus the utility of conducting a diagnostic analysis in the early stages of implementation. This has implications for developing approaches to change in nursing and interprofessional practice in other settings. Using research to change practice needs clinical leaders who are supported by the organization and have the skills to implement research evidence, manage uncertainty and build trust with a range of other professionals.

Survey of Irish general practitioners' preferences for continuing professional development.

PubMed

Maher, B; O'Neill, R; Faruqui, A; Bergin, C; Horgan, M; Bennett, D; O'Tuathaigh, C M P

2018-01-01

Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.

Is gerontology ready for anti-racist pedagogy? A survey of educators' practices and perspectives.

PubMed

Karasik, Rona J; Kishimoto, Kyoko

2018-01-01

The older population in the United States is becoming more diverse, bringing increasing attention to the ways in which diversity and multiculturalism are addressed in gerontological education. Although diversity and multiculturalism have long been recognized as important components of the aging experience, our approach to understanding their significance and impact continues to grow and change. Anti-racist pedagogy represents one catalyst to stimulate such change. To evaluate the potential for anti-racist pedagogy in gerontology, this study explored gerontological educators' (N = 121) current practices and perspectives regarding the inclusion of diversity content in their courses, as well as the extent to which they are familiar with and/or use anti-racist pedagogy in their classes. The findings suggest that greater attention to issues of race, ethnicity, and multicultural diversity throughout the gerontological curriculum is needed and wanted. Although respondents were generally unfamiliar with the name anti-racist pedagogy, many indicated that their current teaching practices employed select components of it. Overall, the findings point toward the need for continued exploration of how anti-racist pedagogy may be brought into the gerontological classroom, as well as its implications for future research, policy, and practice.

Technology and Learning: Changing Minds in a Changing World. Schooling and Technology, Volume 4.

ERIC Educational Resources Information Center

Willis, Bernice H.; And Others

This document, the publishers' fourth volume on schooling and technology, explores in detail the mismatch between the historically developed purposes, roles, and practices of the schools and the nature of the new technology. Specifically, it juxtaposes characteristics of today's children and the currently available educational technologies…

Transforming Undergraduate Education: Theory That Compels and Practices That Succeed

ERIC Educational Resources Information Center

Harward, Donald W., Ed.

2011-01-01

For those ready to participate in making transformative changes, "Transforming Undergraduate Education" provides evidence and case studies that suggest how steps can be taken and progress made. For those who are currently leading their campuses through a change in culture, this book offers support and encouragement. And for those who are…

Climate Project Screening Tool

Treesearch

Forest Service U.S. Department of Agriculture

2011-01-01

Climate change poses a challenge for resource managers as they review current management practices. Adaptation is a critical means of addressing climate change in the near future because, due to inherent time lags in climate impacts, the effects of increased atmospheric greenhouse gases will be felt for decades even if effective mitigation begins now. To address the...

Transformation through Expeditionary Change Using Online Learning and Competence-Building Technologies

ERIC Educational Resources Information Center

Norris, Donald M.; Lefrere, Paul

2011-01-01

This paper presents a patterns-based model of the evolution of learning and competence-building technologies, grounded in examples of current practice. The model imagines five simple stages in how institutions use "expeditionary change" to innovate more nimbly. It builds upon three assertions. First, the pervasiveness of web-based…

Changing roles of academic societies due to globalization.

PubMed

Ehara, Shigeru; Aoki, Shigeki; Honda, Hiroshi

2016-10-01

Because of the globalization of environment around the academic society, the expected roles have changed significantly. In this short communication, we present the current situation in our international activities of the Japan Radiological Society, particularly in the academic activities and clinical practice. Establishing and reinforcing international network is one process of their promotion.

[The illegal synthetic cannabinoid drug market in Israel - evolution and new challenges].

PubMed

Shapira, Barak; Poperno, Alina; Berkovitz, Ronny

2016-09-01

This article represents a short review of the current knowledge on the abuse of synthetic cannabinoids from the perspective of the Division of Enforcement and Inspection of the Israeli Ministry of Health - a body in charge of providing professional assistance to law enforcement bodies in the fields of drug abuse. We describe the principal changes observed in the synthetic cannabinoid market and the Israeli legislators' and enforcement bodies' attempts to cope with these phenomena. These changes relate to the types of synthetic cannabinoids being trafficked, with many structural variations between substances, and a new legal framework which allows for the rapid, temporary scheduling of synthetic cannabinoids using both individual and generic definitions. Despite changes in legislation, we are currently witnessing the adaptation of the synthetic cannabinoid drug market to the new legal reality and enforcement practices. A considerable part of synthetic cannabinoid trafficking is carried out using phone orders, or has moved to the internet and social networks, thus making its detection difficult for enforcement bodies. Current trafficking practices represent a growing challenge for enforcement bodies. Hence, there is a need for cooperation between enforcement bodies, the Israeli Ministry of Health and health practitioners in identifying new substances, and characterizing their harms.

Anesthesiology and competitive strategy.

PubMed

Gross, Wendy L; Gold, Barbara

2009-03-01

Whether we like it or not, medicine is big business. The argument is sometimes made that standard management strategies from the business world do not apply to medicine because the economics and practice of medicine are unique--driven by science and rapid rates of change. But an exploding knowledge base, light-speed technological development, and ever-changing reimbursement schemes are not exclusive to medicine and health care. Some fundamental principles of finance, business management, and strategic development have evolved to deal with problems of rapid change. These principles do apply to modern medicine. The business side of anesthesia practice is off-putting to many clinicians. However, knowledge of the market forces at play can help enhance patient care, improve service, expand opportunities, and extend the perimeter of the discipline. The mission and current market position of anesthesiology practice are considered here.

Evaluating the impact of irrigation on surface water - groundwater interaction and stream temperature in an agricultural watershed.

PubMed

Essaid, Hedeff I; Caldwell, Rodney R

2017-12-01

Changes in groundwater discharge to streams caused by irrigation practices can influence stream temperature. Observations along two currently flood-irrigated reaches in the 640-square-kilometer upper Smith River watershed, an important agricultural and recreational fishing area in west-central Montana, showed a downstream temperature decrease resulting from groundwater discharge to the stream. A watershed-scale coupled surface water and groundwater flow model was used to examine changes in streamflow, groundwater discharge to the stream and stream temperature resulting from irrigation practices. The upper Smith River watershed was used to develop the model framework including watershed climate, topography, hydrography, vegetation, soil properties and current irrigation practices. Model results were used to compare watershed streamflow, groundwater recharge, and groundwater discharge to the stream for three scenarios: natural, pre-irrigation conditions (PreIrr); current irrigation practices involving mainly stream diversion for flood and sprinkler irrigation (IrrCurrent); and a hypothetical scenario with only groundwater supplying sprinkler irrigation (IrrGW). Irrigation increased groundwater recharge relative to natural PreIrr conditions because not all applied water was removed by crop evapotranspiration. Groundwater storage and groundwater discharge to the stream increased relative to natural PreIrr conditions when the source of irrigation water was mainly stream diversion as in the IrrCurrent scenario. The hypothetical IrrGW scenario, in which groundwater withdrawals were the sole source of irrigation water, resulted in widespread lowering of the water table and associated decreases in groundwater storage and groundwater discharge to the stream. A mixing analysis using model predicted groundwater discharge along the reaches suggests that stream diversion and flood irrigation, represented in the IrrCurrent scenario, has led to cooling of stream temperatures relative to natural PreIrr conditions improving fish thermal habitat. However, the decrease in groundwater discharge in the IrrGW scenario resulting from large-scale groundwater withdrawal for irrigation led to warmer than natural stream temperatures and possible degradation of fish habitat. Published by Elsevier B.V.

Evaluating the impact of irrigation on surface water – groundwater interaction and stream temperature in an agricultural watershed

USGS Publications Warehouse

Essaid, Hedeff I.; Caldwell, Rodney R.

2017-01-01

Changes in groundwater discharge to streams caused by irrigation practices can influence stream temperature. Observations along two currently flood-irrigated reaches in the 640-square-kilometer upper Smith River watershed, an important agricultural and recreational fishing area in west-central Montana, showed a downstream temperature decrease resulting from groundwater discharge to the stream. A watershed-scale coupled surface water and groundwater flow model was used to examine changes in streamflow, groundwater discharge to the stream and stream temperature resulting from irrigation practices. The upper Smith River watershed was used to develop the model framework including watershed climate, topography, hydrography, vegetation, soil properties and current irrigation practices. Model results were used to compare watershed streamflow, groundwater recharge, and groundwater discharge to the stream for three scenarios: natural, pre-irrigation conditions (PreIrr); current irrigation practices involving mainly stream diversion for flood and sprinkler irrigation (IrrCurrent); and a hypothetical scenario with only groundwater supplying sprinkler irrigation (IrrGW). Irrigation increased groundwater recharge relative to natural PreIrr conditions because not all applied water was removed by crop evapotranspiration. Groundwater storage and groundwater discharge to the stream increased relative to natural PreIrr conditions when the source of irrigation water was mainly stream diversion as in the IrrCurrent scenario. The hypothetical IrrGW scenario, in which groundwater withdrawals were the sole source of irrigation water, resulted in widespread lowering of the water table and associated decreases in groundwater storage and groundwater discharge to the stream. A mixing analysis using model predicted groundwater discharge along the reaches suggests that stream diversion and flood irrigation, represented in the IrrCurrent scenario, has led to cooling of stream temperatures relative to natural PreIrr conditions improving fish thermal habitat. However, the decrease in groundwater discharge in the IrrGW scenario resulting from large-scale groundwater withdrawal for irrigation led to warmer than natural stream temperatures and possible degradation of fish habitat.

Leadership of Education Psychological Services: Fit for Purpose?

ERIC Educational Resources Information Center

Booker, Roger

2013-01-01

At a time of great change for educational psychology services in England, this paper reviews current theories of leadership and proposes how an integration of key aspects of these can be applied to support a self review of leadership practice, both by individual leaders and by services. The message from current theory is that in the midst of…

The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments.

PubMed

Tai, Sara; Turkington, Douglas

2009-09-01

Cognitive behavior therapy (CBT) evolved from behavioral theory and developed to focus more on cognitive models that incorporated reappraisal of thinking errors and schema change strategies. This article will describe the key elements of CBT for schizophrenia and the current evidence of its efficacy and effectiveness. We conclude with a description of recent concepts that extend the theoretical basis of practice and expand the range of CBT strategies for use in schizophrenia. Mindfulness, meta-cognitive approaches, compassionate mind training, and method of levels are postulated as useful adjuncts for CBT with psychotic patients.

The Evolution of Cognitive Behavior Therapy for Schizophrenia: Current Practice and Recent Developments

PubMed Central

Tai, Sara; Turkington, Douglas

2009-01-01

Cognitive behavior therapy (CBT) evolved from behavioral theory and developed to focus more on cognitive models that incorporated reappraisal of thinking errors and schema change strategies. This article will describe the key elements of CBT for schizophrenia and the current evidence of its efficacy and effectiveness. We conclude with a description of recent concepts that extend the theoretical basis of practice and expand the range of CBT strategies for use in schizophrenia. Mindfulness, meta-cognitive approaches, compassionate mind training, and method of levels are postulated as useful adjuncts for CBT with psychotic patients. PMID:19661198

Developing Best Practices for Detecting Change at Marine Renewable Energy Sites

NASA Astrophysics Data System (ADS)

Linder, H. L.; Horne, J. K.

2016-02-01

In compliance with the National Environmental Policy Act (NEPA), an evaluation of environmental effects is mandatory for obtaining permits for any Marine Renewable Energy (MRE) project in the US. Evaluation includes an assessment of baseline conditions and on-going monitoring during operation to determine if biological conditions change relative to the baseline. Currently, there are no best practices for the analysis of MRE monitoring data. We have developed an approach to evaluate and recommend analytic models used to characterize and detect change in biological monitoring data. The approach includes six steps: review current MRE monitoring practices, identify candidate models to analyze data, fit models to a baseline dataset, develop simulated scenarios of change, evaluate model fit to simulated data, and produce recommendations on the choice of analytic model for monitoring data. An empirical data set from a proposed tidal turbine site at Admiralty Inlet, Puget Sound, Washington was used to conduct the model evaluation. Candidate models that were evaluated included: linear regression, time series, and nonparametric models. Model fit diagnostics Root-Mean-Square-Error and Mean-Absolute-Scaled-Error were used to measure accuracy of predicted values from each model. A power analysis was used to evaluate the ability of each model to measure and detect change from baseline conditions. As many of these models have yet to be applied in MRE monitoring studies, results of this evaluation will generate comprehensive guidelines on choice of model to detect change in environmental monitoring data from MRE sites. The creation of standardized guidelines for model selection enables accurate comparison of change between life stages of a MRE project, within life stages to meet real time regulatory requirements, and comparison of environmental changes among MRE sites.

Music therapy services for individuals with autism spectrum disorder: a survey of clinical practices and training needs.

PubMed

Kern, Petra; Rivera, Nicole R; Chandler, Alie; Humpal, Marcia

2013-01-01

Over the past decade, the definitions, diagnoses, prevalence rates, theories about the causes, evidence-based treatment options, and practice guidelines pertaining to Autism Spectrum Disorder (ASD) have undergone numerous changes. While several recent studies evaluate the effects of music therapy interventions for individuals with ASD, no current review reflects the latest music therapy practices and trends. The purpose of this study was to evaluate the status of music therapy practices for serving clients with ASD, the implementation of national ASD standards and guidelines, the awareness of recent developments, and training needs of music therapists. Professional members of the American Music Therapy Association who are working with individuals with ASD served as the sample for this national cross-sectional survey study (N = 328). A 45-item online questionnaire was designed and distributed through email and social media. Participants accessed the online survey through SurveyMonkey®. Findings suggest music therapy practices and services for individuals with ASD have shifted and now reflect a slightly higher percentage of caseload, a broader age range of clients, and a trend to serve clients in home and community settings. Most therapeutic processes align with recommended practices for ASD and incorporate several of the recognized evidence-based practices. Less understood or recognized are inclusion practices and latest developments in the field of ASD. Music therapists have a solid understanding of providing services for individuals with ASD, but would benefit from advanced online training and improved information dissemination to stay current with the rapidly changing aspects pertinent to this population. © 2013 by the American Music Therapy Association.

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics.

PubMed

Li, Zhaoyang; Easton, Rachael

2018-01-01

The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field.

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics

PubMed Central

Easton, Rachael

2018-01-01

ABSTRACT The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field. PMID:29035675

Academic-Practice Partnerships: The Interdependence Between Leadership and Followership.

PubMed

Everett, Linda Q

2016-04-01

In this article, there is a discussion focused on three contemporary nursing topics: leadership, followership, and academic-practice partnerships. These comments are framed within the context of the current healthcare system transformation. There is a focus on why each of these topics is relevant to the nursing profession in leading change and advancing health. Finally, there is a description about the interdependence of leadership and followership and the significance these hold for the interdependence between nursing education and nursing practice. © The Author(s) 2016.

Trends in a changing vascular practice environment for members of the Society for Vascular Surgery

PubMed Central

Matthews, Mika A. B.; Satiani, Bhagwan; Lohr, Joann M.

2013-01-01

Objective To survey the Society for Vascular Surgery (SVS) membership with regard to practice trends related to work effort, employment status, practice ownership, endovascular cases, and anticipated changes in practice in the near future. Methods A survey questionnaire was developed to gather information about member demographics and practice, hours worked, full-time (FT) or part-time status, employment status, practice ownership, competition for referrals, proportion of endovascular vs open procedures, and anticipated changes in practice in the next 3 years. We used SurveyMonkey and distributed the survey to all active vascular surgeon (VS) members of the SVS. Results The response rate was 207 of 2230 (10.7%). Two thirds were in private practice, and 21% were in solo practice. Twenty-four percent were employed by hospitals/health systems. Those VS under the age of 50 years were more likely to exclusively practice vascular surgery compared with VS over the age of 50 years (P = .0003). Sixty-eight of the physicians (32.7%) were between 50 and 59 years old, 186 (90.3%) were men, 192 (92.8%) worked FT (>36 hours of patient care per week), and almost two thirds worked >60 hours per week. Those in physician-owned practices worked >40 hours of patient care per week more often than did FT employed VS (P = .012). Younger VS (age <50 years) more frequently reported >50% of their workload being endovascular compared with older VS (age ≥50 years; P < .001). Eighty percent of FT VS planned to continue their current practice over the next 3 years. Of the 43.6% indicating loss of referrals, 82% pointed to cardiologists as the competition. Conclusions The current workforce is predominately male and works FT; one-third is between the ages of 50 and 59 years. Younger VS (age <50 years) are more likely to exclusively practice VS and have a higher caseload of endovascular procedures. Those in physician-owned practices are more likely to put in >40 hours of patient care per week than are FT employed VS. Longitudinal surveys of SVS members are imperative to help tailor educational, training, and practice management offerings, guide governmental activities, advocate for issues important to members, improve branding initiatives, and sponsor workforce analyses. PMID:23254185

Transfusion medicine and solid organ transplant - Update and review of some current issues.

PubMed

Sarkar, R S; Philip, J; Yadav, Pramod

2013-04-01

Transfusion medicine holds a place of prime importance in organ transplant surgeries. There is a huge demand of organs worldwide with long waiting periods before the organ is available for transplant. Currently the dependency on ABO and HLA matching has decreased considerably with the use of modern immunosuppressant drugs and transplant techniques. The greatest advance in clinical implementation of ABO-incompatible transplants came about through desensitization and isoagglutinin elimination techniques with immunoadsorption and anti-CD20 antibodies becoming the norm, and spleenectomy fading out. The implications and practices of transfusion medicine in organ transplant are also undergoing drastic changes. The practice of infusion of one unit of donor's blood preoperatively for immunomodulation is no longer practiced. Use of leuco-reduced products has shown decreasing trends of alloimmunization and graft rejection in cases of multiple surgeries related to organ transplants. Worldwide donor and recipient registry programmes are being setup and existing ones are being upgraded. Such a registry system has been opened in India for kidney transplant cases very recently. Due to such registry programmes the dependency on siblings and directed donations have decreased considerably. This review deals with some of the current issues contributing to the successful outcome of mismatched transplants and the changing concepts of transfusion medicine related to it.

Putting principals back into practice: an evaluation of a re-entry course for vocationally trained doctors.

PubMed Central

Baker, M; Williams, J; Petchey, R

1997-01-01

BACKGROUND: Current recruitment difficulties in general practice have sharpened the interest of the profession in non-principals. No re-entry course for general practice has previously been run in the UK. AIM: To design and evaluate a re-entry course for general practice. METHOD: A re-entry course was developed to help doctors return to general practice as principals. A telephone interview was carried out with each delegate prior to their attendance on the course and was repeated one month and six months after the course to measure any change in career intentions and the perceived benefit of attending the course. RESULTS: Six months after the course, 11 out of 14 delegates had taken positive steps to return to general practice or had increased their time commitment to medicine. This contrasts with only one of the control group having made any steps to change career. CONCLUSION: The course was evaluated and found to be beneficial, particularly in terms of increasing the confidence of the delegates. PMID:9463984

The business of interventional pulmonology.

PubMed

Erb, Christopher T; Ernst, Armin; Michaud, Gaëtane C

2013-09-01

Interventional pulmonologists are regularly asked to perform more complicated and advanced procedures, but reimbursement for the time, effort and skill involved in these procedures has not kept up with other procedural specialties. Further changes in funding and reimbursement are likely under the Affordable Care Act. Understanding and effectively using the current system of funding for interventional pulmonology practices are imperative as we adapt to changing medical needs, legislative mandates, and reimbursement policy. This article reviews the current landscape of insurance and reimbursement in health care and anticipates some changes that might be expected from implementation of the Affordable Care Act. Copyright © 2013 Elsevier Inc. All rights reserved.

Exploring the relationship between client perspectives, clinical expertise and research evidence.

PubMed

Roulstone, Sue

2015-06-01

This paper examines the relationship between components of evidence-based practice (clinical expertise, patient perspective and research evidence). Findings are examined from two research programs: the Better Communication Research Program and Child Talk, including exploratory studies of the views of parents and children regarding speech-language pathology and studies of current practice by SLPs in England. Systematic reviews of the research literature were also undertaken. The paper analyses relationships between outcomes valued by children and parents and those reported in the literature and in practice, parents' perspectives regarding intervention in comparison with clinicians' reports of practice and the extent to which research evidence underpins current practice is examined. Parents and children value functional outcomes and positive experiences; these are not routinely measured in research or practice. Therapy is perceived positively by most parents; however, some are ambivalent and less clear about the rationale. Commonly used interventions are supported by evidence, but there are gaps regarding some critical therapy components. The paper discusses four challenges to evidence-based practice: the consistency and clarity of descriptions of interventions; consensus based models of practice; understanding of the mechanisms of change; and, finally, the operationalization of client preferences within an evidence-based practice framework.

The Problem of Rarity: Estimation of Prevalence in Rare Disease.

PubMed

Auvin, Stéphane; Irwin, John; Abi-Aad, Paul; Battersby, Alysia

2018-05-01

From a disease's first description to its wider recognition, factors such as changes over time in diagnostic criteria, available therapies, and subsequent mortality rates may influence diagnosed prevalence of rare diseases. To propose a novel methodology for estimating the true prevalence of rare diseases using current incidence adjusted to changing diagnostic practice over time. This article focuses on rare diseases whose diagnosis may have changed over time, and raises the hypothesis that prevalence calculated from current incidence may be higher than diagnosed prevalence, which may lag behind the current disease definition and diagnostic methods. A rare epileptic encephalopathy, Dravet syndrome (DS), is explored as an illustrative example. A targeted literature review was performed for DS to identify all reported incidence, prevalence, and mortality and depict how diagnostic practice has evolved over time. A conceptual model was developed to calculate prevalence derived from current incidence figures alone (incidence-derived prevalence) or incidence adjusted with factors that cause a diagnostic drag (diagnostic awareness-adjusted prevalence). We identified sufficient publications of incidence and prevalence to test the conceptual model. For pediatric patients with DS, diagnosed prevalence in the field (as reported in current literature) matches incidence-derived prevalence, whereas for adult patients, it is overestimated by incidence-derived prevalence, but not by diagnostic awareness-adjusted prevalence. Care should be taken with current incidence-derived prevalence figures to not overstate the prevalence in rare diseases, as methodological challenges in counting small populations, coupled with advances in rare disease discovery, may cause discrepancies. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Current practice of preoperative fasting: a nationwide survey in Japanese anesthesia-teaching hospitals.

PubMed

Shime, Nobuaki; Ono, Akira; Chihara, Eiichi; Tanaka, Yoshifumi

2005-01-01

We conducted a nationwide survey to investigate the current practice of the preoperative fasting period in Japanese anesthesia-teaching hospitals. Acceptance of the clinical practice guideline published by the American Society of Anesthesiologists (ASA) was also surveyed. A written type of questionnaire was mailed to 795 teaching hospitals. The response rate of the questionnaires was 57%. Most (>90%) of the respondents had been applying a longer fasting period than the ASA-recommended minimum period specifically in adults; the median duration of fasting was 12-13 h for solids and 6-9 h for liquids. Children or infants were allowed a more liberalized fasting period, frequently being permitted an oral intake of clear fluids up to 3 h before anesthesia. The incidence of pulmonary aspiration was 1/12,500 general anesthesia cases, and application of the ASA guideline appeared not to affect the incidence. Japanese anesthesiologists were still reluctant to depart from their traditional long fasting periods, as most of them could find little benefit in reducing the fasting periods. The long preoperative fasting period is still common practice in Japanese anesthesia-teaching hospitals. A national guideline for a preoperative fasting policy is worth exploring to change the current practice.

Insight, working through, and practice: the role of procedural knowledge.

PubMed

Rosenblatt, Allan

2004-01-01

A conception of insight is proposed, based on a systems and information-processing framework and using current neuroscience concepts, as an integration of information that results in a new symbolization of experience with a significant change in self-image and a transformation of non-declarative procedural knowledge into declarative knowledge. Since procedural memory and knowledge, seen to include emotional and relationship issues, is slow to change, durable emotional and behavioral change often requires repeated practice, a need not explicitly addressed in standard psychoanalytic technique. Working through is thus seen as also encompassing nondynamic factors. The application of these ideas to therapeutic technique suggests possible therapeutic interventions beyond interpretation. An illustrative clinical vignette is presented.

The Future of Medical Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adams, Robert D., E-mail: robert_adams@med.unc.edu

2015-07-01

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values.more » Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given.« less

Australasian Society for Parenteral and Enteral Nutrition guidelines for supplementation of trace elements during parenteral nutrition.

PubMed

Osland, Emma J; Ali, Azmat; Isenring, Elizabeth; Ball, Patrick; Davis, Melvyn; Gillanders, Lyn

2014-01-01

This work represents the first part of a progressive review of AuSPEN's 1999 Guidelines for Provision of Micronutrient Supplementation in Adult Patients receiving Parenteral Nutrition, in recognition of the developments in the literature on this topic since that time. A systematic literature review was undertaken and recommendations were made based on the available evidence and with consideration to specific elements of the Australian and New Zealand practice environment. The strength of evidence underpinning each recommendation was assessed. External reviewers provided feedback on the guidelines using the AGREE II tool. Reduced doses of manganese, copper, chromium and molybdenum, and an increased dose of selenium are recommended when compared with the 1999 guidelines. Currently the composition of available multi-trace element formulations is recognised as an obstacle to aligning these guidelines with practice. A paucity of available literature and limitations with currently available methods of monitoring trace element status are acknowledged. The currently unknown clinical impact of changes to trace element contamination of parenteral solutions with contemporary practices highlights need for research and clinical vigilance in this area of nutrition support practice. Trace elements are essential and should be provided daily to patients receiving parenteral nutrition. Monitoring is generally only required in longer term parenteral nutrition, however should be determined on an individual basis. Industry is encouraged to modify existing multi-trace element solutions available in Australia and New Zealand to reflect changes in the literature outlined in these guidelines. Areas requiring research are highlighted.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ha, Kyoo-Man, E-mail: ha1999@hotmail.com

In Korea, there is a pervasive feeling of invincibility to the point that people and organizations do not believe that disasters can strike them. This has impact on the level of preparedness for disasters. This study aims to delve into how Korea has to change its governmental policies/practices with some private partners' efforts to mitigate disaster risks. A case study was utilized as the major methodology by comparing exclusive management with inclusive management. These two approaches have been comparatively analyzed via four variables, namely the central government, the local governments, the incident commander, and other stakeholders. The major finding ismore » that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management. Moreover, the importance of communication, cooperation, collaboration, and multi-discipline coordination is discussed. Additionally, the problem of reductionism and equal participation among all stakeholders, as well as the resistance from vested interests, are recognized and elaborated for Korea and the international community. - Highlights: • Only a few stakeholders in Korea believe that disaster can happen to anyone. This study aims to delve into how Korea has to change its current practices to mitigate disaster risks. • To compare exclusive management with inclusive management, we have examined four comparative variables, namely the central government's policy, local government's strategy, the incident commander's post, and other stakeholders' efforts. • The major finding is that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management.« less

Training vs practice: A tale of opposition in acute cholecystitis.

PubMed

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-10-18

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

Training vs practice: A tale of opposition in acute cholecystitis

PubMed Central

Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

2015-01-01

Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations. PMID:26483868

Analyses of Recruit Training Practices Related to the Military Performance of Enlisted Navy Women

DTIC Science & Technology

1983-12-01

currently addresses pregnancy and child care issues indirectly through instruction in birth control . 20 Technical Note 10-83 policy change will increase...recruit, lacking sufficient experience, is unlikely to associate the information, and a learning opportunity is diminished. BIRTH CONTROL . This...hygiene practices necessary in communal living environments, venereal diseases, birth control , and cancer detection. Two training periods are allotted

Reflective Practice and Readiness for Self-Directed Learning in Anesthesiology Residents Training in the United States

ERIC Educational Resources Information Center

Miller Juve, Amy Katrina

2012-01-01

The science and technology of medicine is evolving and changing at a fast pace. With these rapid advances, it is paramount that physicians maintain a level of medical knowledge that is current and relevant to their practice in order to address the challenges of patient care and safety. One way physicians can maintain a level of medical knowledge…

In Search of How Principals Change: A Qualitative Study of Events That Help and Hinder Administrator Support for School-Wide PBIS

ERIC Educational Resources Information Center

McIntosh, Kent; Kelm, Joanna L.; Canizal Delabra, Alondra

2016-01-01

Research has shown principal support to be a critical variable for implementing and sustaining evidence-based practices. However, there remains little understanding of the factors that may influence a principal's personal decision to support a practice. The purpose of the current study was to examine events that influenced principals' support for…

Race and Racism in Counseling Psychology Research, Training, and Practice: A Critical Review, Current Trends, and Future Directions

ERIC Educational Resources Information Center

Neville, Helen A.; Carter, Robert T.

2005-01-01

The modern civil rights movement of the 1950s and 1960s radically transformed practice and research in applied psychology, at least in terms of its understanding of race and racism. Rapid changes in psychology generally and in counseling psychology specifically occurred on the coattails of the Black, Brown, and women power activities during the…

How To Make a Curriculum: The 1987 Guidelines for Curriculum Development in the Norwegian High School--A New Paradigma in Curriculum Development Practice?

ERIC Educational Resources Information Center

Gundem, Bjorg B.

This paper relates to a research project on the history and current practice of curriculum administration in Norway. An elaboration is provided on the changing high school system and the growing impact of curriculum scholarship on curriculum development. The discussion revolves around three objectives: (1) to determine if the newly formulated set…

Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol.

PubMed

Gould, Natalie J; Lorencatto, Fabiana; Stanworth, Simon J; Michie, Susan; Prior, Maria E; Glidewell, Liz; Grimshaw, Jeremy M; Francis, Jill J

2014-07-29

Audits of blood transfusion demonstrate around 20% transfusions are outside national recommendations and guidelines. Audit and feedback is a widely used quality improvement intervention but effects on clinical practice are variable, suggesting potential for enhancement. Behavioural theory, theoretical frameworks of behaviour change and behaviour change techniques provide systematic processes to enhance intervention. This study is part of a larger programme of work to promote the uptake of evidence-based transfusion practice. The objectives of this study are to design two theoretically enhanced audit and feedback interventions; one focused on content and one on delivery, and investigate the feasibility and acceptability. Study A (Content): A coding framework based on current evidence regarding audit and feedback, and behaviour change theory and frameworks will be developed and applied as part of a structured content analysis to specify the key components of existing feedback documents. Prototype feedback documents with enhanced content and also a protocol, describing principles for enhancing feedback content, will be developed. Study B (Delivery): Individual semi-structured interviews with healthcare professionals and observations of team meetings in four hospitals will be used to specify, and identify views about, current audit and feedback practice. Interviews will be based on a topic guide developed using the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Analysis of transcripts based on these frameworks will form the evidence base for developing a protocol describing an enhanced intervention that focuses on feedback delivery. Study C (Feasibility and Acceptability): Enhanced interventions will be piloted in four hospitals. Semi-structured interviews, questionnaires and observations will be used to assess feasibility and acceptability. This intervention development work reflects the UK Medical Research Council's guidance on development of complex interventions, which emphasises the importance of a robust theoretical basis for intervention design and recommends systematic assessment of feasibility and acceptability prior to taking interventions to evaluation in a full-scale randomised study. The work-up includes specification of current practice so that, in the trials to be conducted later in this programme, there will be a clear distinction between the control (usual practice) conditions and the interventions to be evaluated.

Paramedic specialization: a strategy for better out-of-hospital care.

PubMed

Caffrey, Sean M; Clark, John R; Bourn, Scott; Cole, Jim; Cole, John S; Mandt, Maria; Murray, Jimm; Sibold, Harry; Stuhlmiller, David; Swanson, Eric R

2014-01-01

Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs. Currently, there is limited support for specialty certifications that demand appropriate education, training, or experience standards before specialized practice by paramedics. A fragmented approach to specialty paramedic practice currently exists across our country in which states, regulators, nonprofit organizations, and other health care professions influence and regulate the practice of paramedicine. Multiple other medical professions, however, have already developed effective systems over the last century that can be easily adapted to the practice of paramedicine. Paramedicine practitioners need to organize a profession-based specialty board to organize and standardize a specialty certification system that can be used on a national level. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Inside Moves: As Technologies and Job Descriptions Change, Communications and Marketing Offices Opt for Strategic Realignment

ERIC Educational Resources Information Center

Scully, Maura King

2011-01-01

Realists recognize reorganizations for what they are: opportunities to do things better--to change business as usual to reflect best practices, new tools and technologies, and current challenges in the marketplace. At educational institutions, perhaps no area is as sensitive to those shifts as communications and marketing offices. The advances in…

The i-Map: A Process-Centered Response to Plagiarism

ERIC Educational Resources Information Center

Walden, Kim; Peacock, Alan

2006-01-01

In recent years there has been a marked change in our cultural relationship with information which has implications for our teaching and learning practices. Current concerns about the identification of, and responses to, plagiarism are grounded in that process of change. In this paper we take the position that it is better to address and respond…

Changing academic culture to improve undergraduate STEM education.

PubMed

Suchman, Erica L

2014-12-01

Improving undergraduate science, technology, engineering, and math (STEM) education requires faculty with the skills, resources, and time to create active learning environments that foster student engagement. Current faculty hiring, promotion, and tenure practices at many universities do not measure, reward, nor encourage faculty pursuit of these skills. A cultural change is needed to foster improvement. Published by Elsevier Ltd.

Learning and Developing as a University Teacher: Narratives of Early Career Academics in Estonia

ERIC Educational Resources Information Center

Remmik, Marvi; Karm, Mari; Lepp, Liina

2013-01-01

In recent years the higher education context in Estonia, as in most European countries, has changed a lot. All changes have an impact on university teachers' practice and their work organisation, and are presenting new challenges. The current research aims at developing an understanding of Estonian early career academics' professional identity by…

Measuring the mechanical behavior of paperboard in a changing humidity environment

Treesearch

Dennis E. Gunderson; John M. Considine

1986-01-01

“Both the strength and stability of compressively loaded paperboard are known to be adversely affected by cyclic changes in relative humidity. Current research at the Forest Products Laboratory (FPL) seeks to observe and explain this phenomenon and to develop a simple, practical test to determine allowable "working loads" in cyclicmoisture environments. A new...

A Study of Changes in the Library and Information Science Curriculum with Evaluation of Its Practicality

ERIC Educational Resources Information Center

Noh, Younghee; Ahn, In-Ja; Choi, Sang-Ki

2012-01-01

Purpose: This study analyzed the process of changes in Korean Library and Information Science curriculum and evaluated the courses currently available by using a perception survey of librarians in the field. It also explored a possible demand for new courses, while suggesting compulsory, core, and optional courses for Bachelor's degree curriculum…

Improving Academic Management: A Handbook of Planning and Institutional Research.

ERIC Educational Resources Information Center

Jedamus, Paul, Ed.; Peterson, Marvin W., Ed.

A guide to the practice of institutional research and planning in American higher education in the 1980s is presented. Attention is directed to the impact of current changes in the external environment on higher education and implications of these changes for institutional research and planning. Topics include national issues crucial to the future…

Trash Conflicts: An Integrated Science and Social Studies Curriculum on the Ethics of Disposal.

ERIC Educational Resources Information Center

Balin, Amy; And Others

Education is the first step toward making changes in habits and practices that are currently threatening the environment. Across the country, evidence is abundant that people are willing to change their habits once they understand the consequences of their choices. Greater numbers of communities are instituting recycling programs. This book is…

The Future of General Surgery: Evolving to Meet a Changing Practice.

PubMed

Webber, Eric M; Ronson, Ashley R; Gorman, Lisa J; Taber, Sarah A; Harris, Kenneth A

2016-01-01

Similar to other countries, the practice of General Surgery in Canada has undergone significant evolution over the past 30 years without major changes to the training model. There is growing concern that current General Surgery residency training does not provide the skills required to practice the breadth of General Surgery in all Canadian communities and practice settings. Led by a national Task Force on the Future of General Surgery, this project aimed to develop recommendations on the optimal configuration of General Surgery training in Canada. A series of 4 evidence-based sub-studies and a national survey were launched to inform these recommendations. Generalized findings from the multiple methods of the project speak to the complexity of the current practice of General Surgery: (1) General surgeons have very different practice patterns depending on the location of practice; (2) General Surgery training offers strong preparation for overall clinical competence; (3) Subspecialized training is a new reality for today's general surgeons; and (4) Generation of the report and recommendations for the future of General Surgery. A total of 4 key recommendations were developed to optimize General Surgery for the 21st century. This project demonstrated that a high variability of practice dependent on location contrasts with the principles of implementing the same objectives of training for all General Surgery graduates. The overall results of the project have prompted the Royal College to review the training requirements and consider a more "fit for purpose" training scheme, thus ensuring that General Surgery residency training programs would optimally prepare residents for a broad range of practice settings and locations across Canada. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Strategic planning: how medical practices can succeed in a post-healthcare-reform world.

PubMed

Howrigon, Ron

2013-01-01

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

An Overview of Practice Facilitation Programs in Canada: Current Perspectives and Future Directions

PubMed Central

Liddy, Clare; Laferriere, Dianne; Baskerville, Bruce; Dahrouge, Simone; Knox, Lyndee; Hogg, William

2013-01-01

Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field. PMID:23968627

Areas for improvement in community optometry: flashes and floaters take priority.

PubMed

Duncan, Eilidh M; Cassie, Heather; Pooley, Janet; Elouafakoui, Paula; Prior, Maria; Gibb, Elizabeth; Ramsay, Craig; Young, Linda

2018-07-01

A common response to rising demand for healthcare is to extend the role of health professionals and the range of their service provision. Community optometry in Scotland is a recent example of this. Within this context of innovation and change there are challenges to ensuring quality in optometry practice. The purpose of this research is to establish what the priorities are for practice improvement within community optometry and to start a programme to inform strategies to improve practice. A four stage study was conducted: (1) a service-driven topic prioritisation exercise to identify priorities for optometry practice improvement; (2) a review of national and international guidance and UK protocols relating to the identified priority topic; (3) a national theory-based survey identifying current practice and the barriers and facilitators to the target behaviour; and (4) the identification of theory-based intervention options to improve practice. The Behaviour Change Wheel approach to behaviour change intervention development and Theoretical Domains Framework (TDF) provided the underlying theoretical framework. Stakeholders identified 'patients presenting with flashes and floaters' as an important priority for practice improvement. The decision about whether or not to refer patients on to secondary care for further examination is the target behaviour. Guidance for optometrists on this topic is lacking. Six TDF domains were related to the decision about whether or not to refer patients with flashes and floaters to secondary care - 'social influences', 'emotion', 'beliefs about capabilities', 'beliefs about consequences', 'behavioural regulation' and 'reinforcement'. This study has examined current practice in relation to the management of patients with flashes and floaters, identified the most salient targets for future strategies to improve optometry practice and highlighted what form these strategies may take. It demonstrates the use of a flexible, theory-informed approach, which can be used to engage with stakeholders and professionals to inform the design and development of efforts to improve practice in a variety of healthcare settings. © 2018 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.

Communicating the wildland fire message: Influences on knowledge and attitude change in two case studies

Treesearch

Eric Toman; Bruce Shindler

2006-01-01

Current wildland fire policy calls for citizen involvement in planning and management. To be effective in their efforts to engage outside stakeholders, resource professionals need to understand citizens’ understanding and attitudes toward current practices as well as how to best communicate about proposed actions. A variety of outreach methods have been used to...

Everyone's business: developing an integrated model of care to respond to child abuse in a pediatric hospital setting.

PubMed

Connolly, Sarah

2012-01-01

In pediatric hospitals, social work plays a central role in the prevention, identification, and management of child abuse. Children who are suspected of having been abused or neglected require an evaluation of their psychosocial situation. As an integral member of the health care team, the social worker is well placed to undertake comprehensive psychosocial assessments including information on the child's development, parental capacity, family, and community supports. Current practice approaches have seen a shift away from a narrow, "expert" approach to child protection. This article describes the development of an integrated model of social work service delivery to better respond to vulnerable and at-risk children in a pediatric hospital setting. Developing a new model of service required strategic planning, consultation, and endorsement from senior hospital management. The new model aimed to ensure a high quality, responsive social work service to children at risk of physical abuse, neglect, or cumulative harm. The change necessitated understanding of current research evidence, development of best practice guidelines, and effective communication with staff and external stakeholders. Policy development, implementation of practice guidelines, staff training, data collection, and service evaluation are described. The role of social work management and leadership were central in creating change. Visionary leadership is widely regarded as key to successful organizational change. The management approach included consultation with staff, building commitment to the need for change, addressing staff concerns, and providing a vision of enhanced client outcomes as a result of the change process. This article provides a candid overview of challenges and barriers to change. Change strategies described are easily transferable to other social work settings. Copyright © Taylor & Francis Group, LLC

The evolution of practice changes in the use of special observations.

PubMed

Ray, Richard; Perkins, Evelyn; Meijer, Barbara

2011-04-01

In acute psychiatric settings, it is common practice to increase the intensity of observations of patients who present with self-injurious thoughts, who are at risk of injuring others, or who exhibit behaviors that adversely impact the overall milieu. These intense observations are intrusive and may result in untoward stimulation of the patient. Nurses at an urban academic medical center addressed the problem of intrusive and overstimulating levels of observation by developing two practice changes using intuitive knowledge combined with input from current nursing literature. The first change was designed to move from observation to engagement. The second change was designed to decrease patient agitation related to intense observation. This article discusses the potential adverse consequences associated with the use of intense levels of observation and describes two protocols that have contributed to a reduction in the use of seclusion and restraints, as well as staff members' reported perceptions of feeling safer and experiencing improved job satisfaction. Copyright © 2011 Elsevier Inc. All rights reserved.

How critical cost analysis can save money in today’s NHS: a review of carpal tunnel surgery in a district general hospital

PubMed Central

Williamson, Mark; Sehjal, Ranjit; Jones, Mark; James, Chris; Smith, Andrew

2018-01-01

With today’s National Health Service (NHS) facing huge financial pressures the healthcare profession cannot afford to carry on spending at the current rate. Individual clinicians should be encouraged to critically appraise their own practices to bring about a more efficient and cost-effective service. The purpose of this project was to analyse the way that carpal tunnel surgery was being performed within our institution and bring about safe changes to practice that reduce expenditure. By critiquing our practices and applying simple changes based around sound evidence an annual saving of over £15 500 to the department was made. The changes instigated are simple, sustainable and safe to implement while providing improved patient satisfaction. They are also easily transferrable across institutions and to other minor hand surgical procedures to afford even greater ongoing savings to the NHS. PMID:29946571

From Index Catalogue to Gopher space: changes in our profession as reflected in the Handbook and CPHSL.

PubMed Central

Bunting, A

1994-01-01

A fifty-year review of the history of health sciences librarianship, as reflected in four editions of the Handbook of Medical Library Practice and its successor, Current Practice in Health Sciences Librarianship, illustrates the significant changes our profession has undergone. Publication in 1943 of the first edition of the Handbook marked an important milestone in the development of the Medical Library Association, as a group of dedicated volunteers documented standard practice and recorded useful data. Administration of health sciences libraries has moved from art to science. Responsibility for the development of collections is now the sole purview of professional librarians. Automation and bibliographic standards have revolutionized the methods for controlling and providing access to information resources. And, the means by which assistance is provided to library users, through the use of computer and telecommunications technology, has changed dramatically. PMID:8136754

How critical cost analysis can save money in today's NHS: a review of carpal tunnel surgery in a district general hospital.

PubMed

Williamson, Mark; Sehjal, Ranjit; Jones, Mark; James, Chris; Smith, Andrew

2018-01-01

With today's National Health Service (NHS) facing huge financial pressures the healthcare profession cannot afford to carry on spending at the current rate. Individual clinicians should be encouraged to critically appraise their own practices to bring about a more efficient and cost-effective service. The purpose of this project was to analyse the way that carpal tunnel surgery was being performed within our institution and bring about safe changes to practice that reduce expenditure. By critiquing our practices and applying simple changes based around sound evidence an annual saving of over £15 500 to the department was made. The changes instigated are simple, sustainable and safe to implement while providing improved patient satisfaction. They are also easily transferrable across institutions and to other minor hand surgical procedures to afford even greater ongoing savings to the NHS.

The constant current loop: A new paradigm for resistance signal conditioning

NASA Astrophysics Data System (ADS)

Anderson, Karl F.

1994-02-01

A practical single constant current loop circuit for the signal conditioning of variable-resistance transducers has been synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature detector are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. Theoretical predictions supported by laboratory testing confirm the following features of the approach: (1) dc response; (2) the electrical output is unaffected by extremely large variation in the resistance of any or all lead wires; (3) the electrical output remains zero for no change in gage resistance; (4) the electrical output is inherently linear with respect to gage resistance change; (5) the sensitivity is double that of a Wheatstone bridge circuit; and (6) the same excitation wires can serve multiple independent gages. An adaptation of current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations. These innovations are the subject of NASA patent applications.

The constant current loop: A new paradigm for resistance signal conditioning

NASA Astrophysics Data System (ADS)

Anderson, Karl F.

1992-10-01

A practical single constant current loop circuit for the signal conditioning of variable resistance transducers has been synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature device are examples of variable resistance sensors. Lead wires connect variable resistance sensors to remotely located signal conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. Theoretical predictions supported by laboratory testing confirm the following features of the approach: (1) dc response; (2) the electrical output is unaffected by extremely large variations in the resistance of any or all lead wires; (3) the electrical output remains zero for no change in gage resistance; (4) the electrical output is inherently linear with respect to gage resistance change; (5) the sensitivity is double that of a Wheatstone bridge circuit; and (6) the same excitation wires can serve multiple independent gages. An adaptation of current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations. These innovations are the subject of NASA patent applications.

The constant current loop: A new paradigm for resistance signal conditioning

NASA Astrophysics Data System (ADS)

Anderson, Karl F.

A practical, single, constant-current loop circuit for the signal conditioning of variable-resistance transducers was synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature device are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. Theoretical predictions supported by laboratory testing confirm the following features of the approach: (1) the dc response; (2) the electrical output is unaffected by extremely large variations in the resistance of any or all lead wires; (3) the electrical output remains zero for no change in gage resistance; (4) the electrical output is inherently linear with respect to gage resistance change; (5) the sensitivity is double that of a Wheatstone bridge circuit; and (6) the same excitation and sense wires can serve multiple independent gages. An adaptation of the current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations. These innovations are the subject of NASA patent applications.

The constant current loop: A new paradigm for resistance signal conditioning

NASA Technical Reports Server (NTRS)

Anderson, Karl F.

1994-01-01

A practical single constant current loop circuit for the signal conditioning of variable-resistance transducers has been synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature detector are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. Theoretical predictions supported by laboratory testing confirm the following features of the approach: (1) dc response; (2) the electrical output is unaffected by extremely large variation in the resistance of any or all lead wires; (3) the electrical output remains zero for no change in gage resistance; (4) the electrical output is inherently linear with respect to gage resistance change; (5) the sensitivity is double that of a Wheatstone bridge circuit; and (6) the same excitation wires can serve multiple independent gages. An adaptation of current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations. These innovations are the subject of NASA patent applications.

The constant current loop: A new paradigm for resistance signal conditioning

NASA Technical Reports Server (NTRS)

Anderson, Karl F.

1993-01-01

A practical, single, constant-current loop circuit for the signal conditioning of variable-resistance transducers was synthesized, analyzed, and demonstrated. The strain gage and the resistance temperature device are examples of variable-resistance sensors. Lead wires connect variable-resistance sensors to remotely located signal-conditioning hardware. The presence of lead wires in the conventional Wheatstone bridge signal-conditioning circuit introduces undesired effects that reduce the quality of the data from the remote sensors. A practical approach is presented for suppressing essentially all lead wire resistance effects while indicating only the change in resistance value. Theoretical predictions supported by laboratory testing confirm the following features of the approach: (1) the dc response; (2) the electrical output is unaffected by extremely large variations in the resistance of any or all lead wires; (3) the electrical output remains zero for no change in gage resistance; (4) the electrical output is inherently linear with respect to gage resistance change; (5) the sensitivity is double that of a Wheatstone bridge circuit; and (6) the same excitation and sense wires can serve multiple independent gages. An adaptation of the current loop circuit is presented that simultaneously provides an output signal voltage directly proportional to transducer resistance change and provides temperature information that is unaffected by transducer and lead wire resistance variations. These innovations are the subject of NASA patent applications.

The BLISS cluster randomised controlled trial of the effect of 'active dissemination of information' on standards of care for premature babies in England (BEADI) study protocol [ISRCTN89683698].

PubMed

Acolet, Dominique; Jelphs, Kim; Davidson, Deborah; Peck, Edward; Clemens, Felicity; Houston, Rosie; Weindling, Michael; Lavis, John; Elbourne, Diana

2007-10-08

Gaps between research knowledge and practice have been consistently reported. Traditional ways of communicating information have limited impact on practice changes. Strategies to disseminate information need to be more interactive and based on techniques reported in systematic reviews of implementation of changes. There is a need for clarification as to which dissemination strategies work best to translate evidence into practice in neonatal units across England. The objective of this trial is to assess whether an innovative active strategy for the dissemination of neonatal research findings, recommendations, and national neonatal guidelines is more likely to lead to changes in policy and practice than the traditional (more passive) forms of dissemination in England. Cluster randomised controlled trial of all neonatal units in England (randomised by hospital, n = 182 and stratified by neonatal regional networks and neonatal units level of care) to assess the relative effectiveness of active dissemination strategies on changes in local policies and practices. Participants will be mainly consultant lead clinicians in each unit. The intervention will be multifaceted using: audit and feedback; educational meetings for local staff (evidence-based lectures on selected topics, interactive workshop to examine current practice and draw up plans for change); and quality improvement and organisational changes methods. Policies and practice outcomes for the babies involved will be collected before and after the intervention. Outcomes will assess all premature babies born in England during a three month period for timing of surfactant administration at birth, temperature control at birth, and resuscitation team (qualification and numbers) present at birth.

Antibiotics in urinary-tract infections. Sustained change in prescribing habits by practice test and self-reflection: a mixed methods before-after study.

PubMed

Kuehlein, T; Goetz, K; Laux, G; Gutscher, A; Szecsenyi, J; Joos, S

2011-06-01

BACKGROUND The German guideline recommends trimethoprim (TMP) for the treatment of uncomplicated lower-urinary-tract infections (uLUTI) in primary care. In the authors' research network, the participating general practitioners (GPs) were asked why they prescribe mostly quinolones instead. The GPs stated the perception of a high rate of therapy failure of TMP and strongly rejected the guideline. OBJECTIVE To examine prescribing behaviour for uLUTI and whether a practice test of TMP might effect a change in prescribing habits. METHODS The study was conducted using observational and qualitative elements. A first focus-group (n=6) assessed reasons for current prescribing behaviour. In a 3-month practice test, patients with uLUTI were prescribed TMP (150 mg twice for 3 days). In a second focus group, the GPs (n=12) were presented with the results of the practice test. RESULTS The first focus group revealed that prescribing was mainly driven by former hospital training and what was perceived as common therapy. GPs felt no need to change a successful regimen. In the practice test, TMP had a success rate of 94% (84 episodes of uLUTI). The second focus group revealed that the practice test had strongly changed opinions in favour of TMP. Self-reflection and ownership of data acquisition were seen as major contributions for change in prescribing. After the test period, TMP remained the antibiotic most often prescribed. CONCLUSION Internal evidence and peer-group opinion are strong determinants for clinical decisions. A self-conducted practice test, together with self-reflection in a peer group, strongly supports the process of change.

Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation.

PubMed

Wilkinson, Dominic; Savulescu, Julian

2012-01-01

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. © 2010 Blackwell Publishing Ltd.

SHOULD WE ALLOW ORGAN DONATION EUTHANASIA? ALTERNATIVES FOR MAXIMIZING THE NUMBER AND QUALITY OF ORGANS FOR TRANSPLANTATION

PubMed Central

Wilkinson, Dominic; Savulescu, Julian

2012-01-01

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives. PMID:20459428

The "wins" of change: evaluating the impact of predicted changes on case management practice.

PubMed

Stanton, Marietta P; Barnett Lammon, Carol Ann

2008-01-01

A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

Critical leadership and management skills for pathology practice.

PubMed

Brimhall, Bradley B; Wright, Louis D; McGregor, Kelli L; Hernandez, James S

2007-10-01

Managed care has changed the nature of medical practice. The practice of pathology has also changed and is likely to undergo further modification. Additional skills in leadership and management are needed to perform optimally in the current medical marketplace. To determine whether pathologists view business and informatics skills as being important and valuable in their practices. A survey was sent electronically (via e-mail) to 2566 pathologists and pathology administrators. Two hundred sixteen survey recipients (8.4%) responded to the survey. The response rate to individual questions ranged from 86% to 99% (186 to 214 of 216 total respondents). Most who took the survey ranked communication (203/209; 97%), leadership skills (165/209; 79%), and systems thinking skills (155/209; 74%) as either "very important" or "essential." Fewer respondents were willing to offer salary premiums for marketing (108/196; 55%), business or finance (92/196; 47%), or staff leadership (95/196; 48%) skills unless the candidate had a track record of measurable achievement using these skills. Those practicing in academia as well as those making hiring decisions by themselves were more likely to value leadership and management skills. Fewer than 1% of respondents in any category considered current pathology residency training in leadership and management to be adequate. Prospective employers value leadership and management skills. Pathology residency programs must include meaningful training in pathology practice management and informatics to satisfy the demand for these skills in the modern pathology marketplace.

Clinical Opinion: "Doing Something" About the Cesarean Delivery Rate.

PubMed

Clark, S L; Garite, T J; Hamilton, E J; Belfort, M A; Hankins, G D

2018-05-04

There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful. We examine both the recent ACOG/SMFM Care Consensus Statement "Safe Prevention of Primary Cesarean Delivery" document and the various iterations of the ACOG guidelines for vaginal birth after cesarean delivery in this context. Adherence to arbitrary time limits for active phase or second stage arrest without incorporating other clinical factors into the decision making process is unwise. In a similar manner, ever-changing practice standards for vaginal birth after cesarean driven by factors other than changing data are unlikely to be effective in lowering the cesarean delivery rate. Whether too high or too low, the current U.S. cesarean delivery rate is the expected result of the unique demographic, geographic and social forces driving it and is unlikely to change significantly given the limitations of current technology to otherwise satisfy the demands of these forces. Copyright © 2018 Elsevier Inc. All rights reserved.

Efficient and Effective Change Principles in Active Videogames

PubMed Central

Fenner, Ashley A.; Howie, Erin K.; Feltz, Deborah L.; Gray, Cindy M.; Lu, Amy Shirong; Mueller, Florian “Floyd”; Simons, Monique; Barnett, Lisa M.

2015-01-01

Abstract Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human–computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity. PMID:26181680

Efficient and Effective Change Principles in Active Videogames.

PubMed

Straker, Leon M; Fenner, Ashley A; Howie, Erin K; Feltz, Deborah L; Gray, Cindy M; Lu, Amy Shirong; Mueller, Florian Floyd; Simons, Monique; Barnett, Lisa M

2015-02-01

Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human-computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity.

The effectiveness and resilience of phosphorus management practices in the Lake Simcoe watershed, Ontario, Canada

NASA Astrophysics Data System (ADS)

Crossman, J.; Futter, M. N.; Palmer, M.; Whitehead, P. G.; Baulch, H. M.; Woods, D.; Jin, L.; Oni, S. K.; Dillon, P. J.

2016-09-01

Uncertainty surrounding future climate makes it difficult to have confidence that current nutrient management strategies will remain effective. This study used monitoring and modeling to assess current effectiveness (% phosphorus reduction) and resilience (defined as continued effectiveness under a changing climate) of best management practices (BMPs) within five catchments of the Lake Simcoe watershed, Ontario. The Integrated Catchment Phosphorus model (INCA-P) was used, and monitoring data were used to calibrate and validate a series of management scenarios. To assess current BMP effectiveness, models were run over a baseline period 1985-2014 with and without management scenarios. Climate simulations were run (2070-2099), and BMP resilience was calculated as the percent change in effectiveness between the baseline and future period. Results demonstrated that livestock removal from water courses was the most effective BMP, while manure storage adjustments were the least. Effectiveness varied between catchments, influenced by the dominant hydrological and nutrient transport pathways. Resilience of individual BMPs was associated with catchment sensitivity to climate change. BMPs were most resilient in catchments with high soil water storage capacity and small projected changes in frozen-water availability and in soil moisture deficits. Conversely, BMPs were less resilient in catchments with larger changes in spring melt magnitude and in overland flow proportions. Results indicated that BMPs implemented are not always those most suited to catchment flow pathways, and a more site-specific approach would enhance prospects for maintaining P reduction targets. Furthermore, BMP resilience to climate change can be predicted from catchment physical properties and present-day hydrochemical sensitivity to climate forcing.

Current issues in billing and coding in interventional pain medicine.

PubMed

Manchikanti, L

2000-10-01

Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.

Self-Reported Long-Term Benefits of Mindfulness-Based Cognitive Therapy in Patients with Bipolar Disorder.

PubMed

Weber, Béatrice; Sala, Loretta; Gex-Fabry, Marianne; Docteur, Aurélie; Gorwood, Philip; Cordera, Paolo; Bondolfi, Guido; Jermann, Françoise; Aubry, Jean-Michel; Mirabel-Sarron, Christine

2017-07-01

This study focused on patients with bipolar disorder (BD), several years after their participation in mindfulness-based cognitive therapy (MBCT). It aimed at documenting sustained mindfulness practice, perceived long-term benefit from the program, and changes regarded as direct consequences of the intervention. This cross-sectional survey took place at least 2 years after MBCT for 70.4% of participants. It was conducted in two specialized outpatient units for BDs that are part of the Geneva University Hospitals (Switzerland) and the Sainte-Anne Hospital in Paris (France). Eligibility criteria were a diagnosis of BD according to DSM-IV and participation in at least four MBCT sessions. Response rate was 66.4%. The final sample included 71 outpatients (71.8% bipolar I, 28.2% bipolar II). A questionnaire retrospectively assessed patient-perceived change, benefit from MBCT, and current mindfulness practice. Proportions of respondents who practiced mindfulness at least once a week were 54.9% for formal practice (body scan, sitting meditation, mindful walking, or movements) and 57.7% for informal practice (mindful daily activities). Perceived benefit for the prevention of relapse was moderate, but patients acknowledged long-lasting effects and persistent changes in their way of life. Formal mindfulness practice at least once a week tended to be associated with increased long-lasting effects (p = 0.052), whereas regular informal practice and mindful breathing were significantly associated with persistent changes in daily life (p = 0.038) and better prevention of depressive relapse (p = 0.035), respectively. The most frequently reported positive change was increased awareness of being able to improve one's health. Despite methodological limitations, this survey allowed documenting mindfulness practice and perceived sustained benefit from MBCT in patients with BD. Participants particularly valued increased awareness that they can influence their own health. Both informal and formal practices, when sustained in the long term, might promote long-lasting changes.

Subject cataloging practices in North American medical school libraries.

PubMed Central

Fredericksen, R B; Michael, H N

1976-01-01

A survey of North American medical school libraries was made to determine current trends in subject cataloging practices. First, responses from 114 of these libraries are recorded and analyzed in the following areas: subject heading authority lists employed; use of the divided versus the dictionary catalog; and the form in which local subject authority files are kept. Then, focusing on 78 libraries that use MeSH in combination with a divided catalog, a further analysis of responses is made concerning issues relating to subject cataloging practices: updating the subject catalog to conform to annual MeSH changes; use of guide cards in the catalog; use of MeSH subheadings; filing conventions; and related issues. An attempt is made to analyze the extent to which these libraries vary from NLM practices. Suggestions are offered for formulating subject cataloging practices for an individual library. Finally, while it is concluded that MeSH and the Current Catalog are useful tools, a more detailed explication of the use of MeSH and NLM cataloging practices would be beneficial. PMID:989741

Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association.

PubMed

Gans, Itai; Jain, Amit; Sirisreetreerux, Norachart; Haut, Elliott R; Hasenboehler, Erik A

2017-01-01

The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. However, there is no agreement on the superiority of a single- or multiple-dose perioperative regimen of antibiotic prophylaxis. The purpose of this study is to determine the following: 1) What are the current practice patterns of orthopaedic trauma surgeons in using perioperative antibiotics for closed long bone fractures? 2) What is the current knowledge of published antibiotic prophylaxis guidelines among orthopaedic trauma surgeons? 3) Are orthopaedic surgeons willing to change their current practices? A questionnaire was distributed via email between September and December 2015 to 955 Orthopaedic Trauma Association members, of whom 297 (31%) responded. Most surgeons (96%) use cefazolin as first-line infection prophylaxis. Fifty-nine percent used a multiple-dose antibiotic regimen, 39% used a single-dose regimen, and 2% varied this decision according to patient factors. Thirty-six percent said they were unfamiliar with Centers for Disease Control and Prevention (CDC) antibiotic prophylaxis guidelines; only 30% were able to select the correct CDC recommendation from a multiple-choice list. However, 44% of surgeons said they followed CDC recommendations. Fifty-six percent answered that a single-dose antibiotic prophylaxis regimen was not inferior to a multiple-dose regimen. If a level-I study comparing a single preoperative dose versus multiple perioperative antibiotic dosing regimen for treatment of closed long bone fractures were published, most respondents (64%) said they would fully follow these guidelines, and 22% said they would partially change their practice to follow these guidelines. There is heterogeneity in the use of single- versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single- versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures.

The Ontario printed educational message (OPEM) trial to narrow the evidence-practice gap with respect to prescribing practices of general and family physicians: a cluster randomized controlled trial, targeting the care of individuals with diabetes and hypertension in Ontario, Canada

PubMed Central

Zwarenstein, Merrick; Hux, Janet E; Kelsall, Diane; Paterson, Michael; Grimshaw, Jeremy; Davis, Dave; Laupacis, Andreas; Evans, Michael; Austin, Peter C; Slaughter, Pamela M; Shiller, Susan K; Croxford, Ruth; Tu, Karen

2007-01-01

Background There are gaps between what family practitioners do in clinical practice and the evidence-based ideal. The most commonly used strategy to narrow these gaps is the printed educational message (PEM); however, the attributes of successful printed educational messages and their overall effectiveness in changing physician practice are not clear. The current endeavor aims to determine whether such messages change prescribing quality in primary care practice, and whether these effects differ with the format of the message. Methods/design The design is a large, simple, factorial, unblinded cluster-randomized controlled trial. PEMs will be distributed with informed, a quarterly evidence-based synopsis of current clinical information produced by the Institute for Clinical Evaluative Sciences, Toronto, Canada, and will be sent to all eligible general and family practitioners in Ontario. There will be three replicates of the trial, with three different educational messages, each aimed at narrowing a specific evidence-practice gap as follows: 1) angiotensin-converting enzyme inhibitors, hypertension treatment, and cholesterol lowering agents for diabetes; 2) retinal screening for diabetes; and 3) diuretics for hypertension. For each of the three replicates there will be three intervention groups. The first group will receive informed with an attached postcard-sized, short, directive "outsert." The second intervention group will receive informed with a two-page explanatory "insert" on the same topic. The third intervention group will receive informed, with both the above-mentioned outsert and insert. The control group will receive informed only, without either an outsert or insert. Routinely collected physician billing, prescription, and hospital data found in Ontario's administrative databases will be used to monitor pre-defined prescribing changes relevant and specific to each replicate, following delivery of the educational messages. Multi-level modeling will be used to study patterns in physician-prescribing quality over four quarters, before and after each of the three interventions. Subgroup analyses will be performed to assess the association between the characteristics of the physician's place of practice and target behaviours. A further analysis of the immediate and delayed impacts of the PEMs will be performed using time-series analysis and interventional, auto-regressive, integrated moving average modeling. Trial registration number Current controlled trial ISRCTN72772651. PMID:18039361

Year in Review 2015: Neonatal Respiratory Care.

PubMed

Courtney, Sherry E

2016-04-01

Neonatal respiratory care practices have changed with breathtaking speed in the past few years. It is critical for the respiratory therapist and others caring for neonates to be up to date with current recommendations and evolving care practices. The purpose of this article is to review papers of particular note that were published in 2015 and address important aspects of newborn respiratory care. Copyright © 2016 by Daedalus Enterprises.

Critical evaluation of international health programs: Reframing global health and evaluation.

PubMed

Chi, Chunhuei; Tuepker, Anaïs; Schoon, Rebecca; Núñez Mondaca, Alicia

2018-04-01

Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research. Copyright © 2018 John Wiley & Sons, Ltd.

Implications of global climate change for the assessment and management of human health risks of chemicals in the natural environment.

PubMed

Balbus, John M; Boxall, Alistair B A; Fenske, Richard A; McKone, Thomas E; Zeise, Lauren

2013-01-01

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Copyright © 2012 SETAC.

After the Gap Analysis: Education and Practice Changes to Prepare Nurses of the Future.

PubMed

Beauvais, Audrey Marie; Kazer, Meredith Wallace; Aronson, Barbara; Conlon, Suzanne E; Forte, Pamela; Fries, Kathleen S; Hahn, Judith M; Hullstrung, Russell; Levvis, Meg; McCauley, Paula; Morgan, Patricia Padula; Perfetto, Linda; Rebeschi, Lisa M; Solernou, Sheila B; Span, Patricia; Sundean, Lisa J

The purpose of the study was to describe the Connecticut Nursing Collaborative-Action Coalition's work in identifying and addressing gaps between nursing education and practice based on the Institute of Medicine's Future of Nursing report. Massachusetts Nurse of the Future (NOF) Competencies highlight the knowledge, skills, and attitudes/behaviors required for professional nurses. Integrating these concepts into the educational system will prepare the nursing workforce to respond to current/future health care needs and population health issues. Education and practice partners in four regions conducted a gap analysis of the education to practice transition for new graduate nurses using NOF as a framework for assessment. Gaps in competencies were similar across regions. However, each organization uniquely addressed curricular gaps to best prepare nurses of the future. Curriculum improvements will provide students the advantage of being prepared for the rapid changes happening in health care.

Feedback about Teaching in Higher Ed: Neglected Opportunities to Promote Change

PubMed Central

Evans, Mara; Brickman, Peggy

2014-01-01

Despite ongoing dissemination of evidence-based teaching strategies, science teaching at the university level is less than reformed. Most college biology instructors could benefit from more sustained support in implementing these strategies. One-time workshops raise awareness of evidence-based practices, but faculty members are more likely to make significant changes in their teaching practices when supported by coaching and feedback. Currently, most instructional feedback occurs via student evaluations, which typically lack specific feedback for improvement and focus on teacher-centered practices, or via drop-in classroom observations and peer evaluation by other instructors, which raise issues for promotion, tenure, and evaluation. The goals of this essay are to summarize the best practices for providing instructional feedback, recommend specific strategies for providing feedback, and suggest areas for further research. Missed opportunities for feedback in teaching are highlighted, and the sharing of instructional expertise is encouraged. PMID:26086652

National continuous surveys on internal quality control for HbA1c in 306 clinical laboratories of China from 2012 to 2016: Continual improvement.

PubMed

Li, Tingting; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2017-09-01

This study aimed to evaluate whether the quality performance of clinical laboratories in China has been greatly improved and whether Internal Quality Control (IQC) practice of HbA1c has also been changed since National Center for Clinical Laboratories (NCCL) of China organized laboratories to report IQC data for HbA1c in 2012. Internal Quality Control information of 306 External Quality Assessment (EQA) participant laboratories which kept reporting IQC data in February from 2012 to 2016 were collected by Web-based EQA system. Then percentages of laboratories meeting four different imprecision specifications for current coefficient of variations (CVs) of HbA1c measurements were calculated. Finally, we comprehensively analyzed analytical systems and IQC practice of HbA1c measurements. The current CVs of HbA1c tests have decreased significantly from 2012 to 2016. And percentages of laboratories meeting four imprecision specifications for CVs all showed the increasing tendency year by year. As for analytical system, 52.1% (159/306) laboratories changed their systems with the change in principle of assay. And many laboratories began to use cation exchange high-performance liquid chromatography (CE-HPLC) instead of Immunoturbidimetry, because CE-HPLC owed a lower intra-laboratory CVs. The data of IQC practice, such as IQC rules and frequency, also showed significant variability among years with overall tendency of meeting requirements. The imprecision performance of HbA1c tests has been improved in these 5 years with the change in IQC practice, but it is still disappointing in China. Therefore, laboratories should actively find existing problems and take action to promote performance of HbA1c measurements. © 2016 Wiley Periodicals, Inc.

Mission operations management

NASA Technical Reports Server (NTRS)

Rocco, David A.

1994-01-01

Redefining the approach and philosophy that operations management uses to define, develop, and implement space missions will be a central element in achieving high efficiency mission operations for the future. The goal of a cost effective space operations program cannot be realized if the attitudes and methodologies we currently employ to plan, develop, and manage space missions do not change. A management philosophy that is in synch with the environment in terms of budget, technology, and science objectives must be developed. Changing our basic perception of mission operations will require a shift in the way we view the mission. This requires a transition from current practices of viewing the mission as a unique end product, to a 'mission development concept' built on the visualization of the end-to-end mission. To achieve this change we must define realistic mission success criteria and develop pragmatic approaches to achieve our goals. Custom mission development for all but the largest and most unique programs is not practical in the current budget environment, and we simply do not have the resources to implement all of our planned science programs. We need to shift our management focus to allow us the opportunity make use of methodologies and approaches which are based on common building blocks that can be utilized in the space, ground, and mission unique segments of all missions.

Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

PubMed

Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

2015-01-01

Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics.

Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States.

PubMed

Wentzensen, Nicolas; Massad, L Stewart; Mayeaux, Edward J; Khan, Michelle J; Waxman, Alan G; Einstein, Mark H; Conageski, Christine; Schiffman, Mark H; Gold, Michael A; Apgar, Barbara S; Chelmow, David; Choma, Kim K; Darragh, Teresa M; Gage, Julia C; Garcia, Francisco A R; Guido, Richard S; Jeronimo, Jose A; Liu, Angela; Mathews, Cara A; Mitchell, Martha M; Moscicki, Anna-Barbara; Novetsky, Akiva P; Papasozomenos, Theognosia; Perkins, Rebecca B; Silver, Michelle I; Smith, Katie M; Stier, Elizabeth A; Tedeschi, Candice A; Werner, Claudia L; Huh, Warner K

2017-10-01

The American Society for Colposcopy and Cervical Pathology (ASCCP) Colposcopy Standards recommendations address the role of colposcopy and directed biopsy for cervical cancer prevention in the United States (US). The recommendations were developed by an expert working group appointed by ASCCP's Board of Directors. An extensive literature review was conducted and supplemented by a systematic review and meta-analysis of unpublished data. In addition, a survey of practicing colposcopists was conducted to assess current colposcopy practice in the US. Recommendations were approved by the working group members, and the final revisions were made based on comments received from the public. The recommendations cover terminology, risk-based colposcopy, colposcopy procedures, and colposcopy adjuncts. The ASCCP Colposcopy Standards recommendations are an important step toward raising the standard of colposcopy services delivered to women in the US. Because cervical cancer screening programs are currently undergoing important changes that may affect colposcopy performance, updates to some of the current recommendations may be necessary in the future.

Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada.

PubMed

Sibley, Kathryn M; Straus, Sharon E; Inness, Elizabeth L; Salbach, Nancy M; Jaglal, Susan B

2013-03-20

Balance impairment is common in multiple clinical populations, and comprehensive assessment is important for identifying impairments, planning individualized treatment programs, and evaluating change over time. However, little information is available regarding whether clinicians who treat balance are satisfied with existing assessment tools. In 2010 we conducted a cross-sectional survey of balance assessment practices among physiotherapists in Ontario, Canada, and reported on the use of standardized balance measures (Sibley et al. 2011 Physical Therapy; 91: 1583-91). The purpose of this study was to analyse additional survey data and i) evaluate satisfaction with current balance assessment practices and standardized measures among physiotherapists who treat adult or geriatric populations with balance impairment, and ii) identify factors associated with satisfaction. The questionnaire was distributed to 1000 practicing physiotherapists. This analysis focuses on questions in which respondents were asked to rate their general perceptions about balance assessment, the perceived utility of individual standardized balance measures, whether they wanted to improve balance assessment practices, and why. Data were summarized with descriptive statistics and utility of individual measures was compared across clinical practice areas (orthopaedic, neurological, geriatric or general rehabilitation). The questionnaire was completed by 369 respondents, of which 43.4% of respondents agreed that existing standardized measures of balance meet their needs. In ratings of individual measures, the Single Leg Stance test and Berg Balance Scale were perceived as useful for clinical decision-making and evaluating change over time by over 70% of respondents, and the Timed Up-and-Go test was perceived as useful for decision-making by 56.9% of respondents and useful for evaluating change over time by 62.9% of respondents, but there were significant differences across practice groups. Seventy-nine percent of respondents wanted to improve their assessments, identifying individual, environmental and measure-specific barriers. The most common barriers were lack of time and knowledge. This study offers new information on issues affecting the evaluation of balance in clinical settings from a broad sample of physiotherapists. Continued work to address barriers by specific practice area will be critical for the success of any intervention attempting to implement optimal balance assessment practices in the clinical setting.

Including Families and Communities in Urban Education. Issues in the Research, Theory, Policy, and Practice of Urban Education

ERIC Educational Resources Information Center

Hands, Catherine, Ed.; Hubbard, Lea, Ed.

2011-01-01

The work of school, family and community partnerships is complex and messy and demands a thoughtful and deep investigation. Currently, parent and community involvement does not draw on school reform and educational change literature and conversely the school change literature often ignores the crucial role that communities play in educational…

What Elements in a Sustainability Course Contribute to Paradigm Change and Action Competence? A Study at Lincoln University, New Zealand

ERIC Educational Resources Information Center

Piasentin, Flora Bonazzi; Roberts, Lin

2018-01-01

A significant shift in the dominant paradigm governing the relationship of humans with nature and society is crucial in order to change the current unsustainable practices. This article describes a pilot-study based on a Masters level sustainability course, which explored what specific content, activities and resources may contribute to promoting…

Developing Competencies for Education for Sustainable Development: A Case Study of Canadian Faculties of Education

ERIC Educational Resources Information Center

Sims, Laura; Falkenberg, Thomas

2013-01-01

Education is paramount when trying to enable a change in values and attitudes towards sustainability. Higher education in faculties of education plays an important role in working toward this change because of its impact on future and practicing teachers in the school systems. This study inquires into the current role of education for sustainable…

Optimizing Language Instruction at the Tertiary Level: Student Needs Analysis toward Educational Change

ERIC Educational Resources Information Center

Sieglová, Dagmar; Stejskalová, Lenka; Kocurová-Giurgiu, Ioana

2017-01-01

The job expectations and requirements of the information age bring with them a need for a change in teaching and studying. A quantitative approach to working with information and a frontal style of teaching, still a wide practice in many institutions, no longer seem to be suitable preparation for current students' needs. One of the areas affected…

Challenging the Presumption of Diminished Capacity to Parent: Does Divorce Really Change Parenting Practices?

ERIC Educational Resources Information Center

Strohschein, Lisa

2007-01-01

The purpose of this paper is to determine whether divorced parents exhibit a diminished capacity to parent in the period following divorce. Using 2 waves of data from a national survey of Canadian children, the current study prospectively follows 5,004 children living in 2-biological parent households at initial interview and compares changes in…

Maximizing the Prospects for Progress Against Cancer

Cancer.gov

The 2018 American Society of Clinical Oncology annual meeting featured numerous, potentially practice changing research findings, according to NCI Director Dr. Norman Sharpless. In this Cancer Currents post, Dr. Sharpless discusses the rapid pace of progress in cancer research.

Center/TRACON Automation System: Development and Evaluation in the Field

DOT National Transportation Integrated Search

1993-10-01

Technological advances are changing the way that advanced air traffic control : automation should be developed and assessed. Current standards and practices of : system development place field testing at the end of the development process. : While su...

Gender matters in medical education.

PubMed

Bleakley, Alan

2013-01-01

Women are in the majority in terms of entry to medical schools worldwide and will soon represent the majority of working doctors. This has been termed the 'feminising' of medicine. In medical education, such gender issues tend to be restricted to discussions of demographic changes and structural inequalities based on a biological reading of gender. However, in contemporary social sciences, gender theory has moved beyond both biology and demography to include cultural issues of gendered ways of thinking. Can contemporary feminist thought drawn from the social sciences help medical educators to widen their appreciation and understanding of the feminising of medicine? Post-structuralist feminist critique, drawn from the social sciences, focuses on cultural practices, such as language use, that support a dominant patriarchy. Such a critique is not exclusive to women, but may be described as supporting a tender-minded approach to practice that is shared by both women and men. The demographic feminising of medicine may have limited effect in terms of changing both medical culture and medical education practices without causing radical change to entrenched cultural habits that are best described as patriarchal. Medical education currently suffers from male biases, such as those imposed by 'andragogy', or adult learning theory, and these can be positively challenged through post-structuralist feminist critique. Women doctors entering the medical workforce can resist and reformulate the current dominant patriarchy rather than reproducing it, supported by male feminists. Such a feminising of medicine can extend to medical education, but will require an appropriate theoretical framework to make sense of the new territory. The feminising of medical education informed by post-structuralist frameworks may provide a platform for the democratisation of medical culture and practices, further informing authentic patient-centred practices of care. © Blackwell Publishing Ltd 2013.

Design and construction of a Faraday cup for measurement of small electronic currents

NASA Technical Reports Server (NTRS)

Veyssiere, A.

1985-01-01

The design of a device to measure and integrate very small currents generated by the impact of a charged particle beam upon a Faraday cut is described. The main component is a graphite block capable of stopping practically all the incident changes. The associated electronic apparatus required to measure better than 10/13 ampere with a precision of 10/0 is described.

[Challenges in geriatric rehabilitation: the development of an integrated care pathway].

PubMed

Everink, Irma Helga Johanna; van Haastregt, Jolanda C M; Kempen, Gertrudis I J M; Dielis, Leen M J; Maessen, José M C; Schols, Jos M G A

2015-04-01

Coordination and continuity of care within geriatric rehabilitation is challenging. To tackle these challenges, an integrated care pathway within geriatric rehabilitation care (hospital, geriatric rehabilitation and follow-up care in the home situation) has been developed. The aim of this article is to expound the process of developing the integrated care pathway, and to describe and discuss the results of this process (which is the integrated care pathway). Developing the integrated care pathway was done by the guidance of the first four steps of the theoretical framework for implementation of change from Grol and Wensing: (1) development of a specific proposal for change in practice; (2) analysis of current care practice; (3) analysis of the target group and setting; and (4) development and selection of interventions/strategies for change. The organizations involved in geriatric rehabilitation argued that the integrated care pathway should focus on improving the process of care, including transfer of patients, handovers and communication between care organizations. Current practice, barriers and incentives for change were analyzed through literature research, expert consultation, and interviews with the involved caregivers and by establishing working groups of health care professionals, patients and informal caregivers. This resulted in valuable proposals for improvement of the care process, which were gathered and combined in the integrated care pathway. The integrated care pathway entails agreements on (a) the triage process in the hospital; (b) active engagement of patients and informal caregivers in the care process; (c) timely and high quality handovers; and (d) improved communication between caregivers.

The medical practice as business organization.

PubMed

Bender, A D; Aaronson, W E; Krasnick, C J; Bender, J G

1996-03-01

Medical practices historically have not been examined in terms of their organizational structures and of the appropriateness of their structures for survival as business entities. In this paper, we propose a model for the typical medical practice and discuss its fit with current organizational theory. It is apparent that the medical practice organization does not fit with the demands of a rapidly changing and complex environment. To survive and grow, the medical practice organization must align itself with others that have an interest and stake in the health care system, develop teamwork among physicians, bridge the gap between physicians and others in the organization, and recognize that the work done in the organization depends on other components of the organization.

Re-defining nursing expertise in the United kingdom.

PubMed

Hardy, Sally; Titchen, Angie; Manley, Kim; McCormack, Brendan

2006-07-01

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

Changing corporate practices to reduce cancer disparities.

PubMed

Freudenberg, Nicholas; Galea, Sandro; Fahs, Marianne

2008-02-01

While reducing racial/ethnic and socioeconomic disparities in cancer mortality has been identified as a national goal, current policies are unlikely to achieve it. In order to advance the development of policies for the primary prevention of cancer and cancer disparities, we propose that the practices of the tobacco, alcohol, and food industries be considered as modifiable social determinants of health. We review evidence that the practices of these industries in product design, marketing, retail distribution, and pricing contribute to cancer risk behavior, incidence, and disparities, then examine public health strategies designed to reduce health-damaging practices of these industries and encourage healthier alternatives. We conclude with recommendations for research, practice, and policy that could contribute to the development of less carcinogenic corporate practices.

Design and implementation of a Windows NT network to support CNC activities

NASA Technical Reports Server (NTRS)

Shearrow, C. A.

1996-01-01

The Manufacturing, Materials, & Processes Technology Division is undergoing dramatic changes to bring it's manufacturing practices current with today's technological revolution. The Division is developing Computer Automated Design and Computer Automated Manufacturing (CAD/CAM) abilities. The development of resource tracking is underway in the form of an accounting software package called Infisy. These two efforts will bring the division into the 1980's in relationship to manufacturing processes. Computer Integrated Manufacturing (CIM) is the final phase of change to be implemented. This document is a qualitative study and application of a CIM application capable of finishing the changes necessary to bring the manufacturing practices into the 1990's. The documentation provided in this qualitative research effort includes discovery of the current status of manufacturing in the Manufacturing, Materials, & Processes Technology Division including the software, hardware, network and mode of operation. The proposed direction of research included a network design, computers to be used, software to be used, machine to computer connections, estimate a timeline for implementation, and a cost estimate. Recommendation for the division's improvement include action to be taken, software to utilize, and computer configurations.

Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current U.K. specialist practice and a call for clinical guidelines.

PubMed

Titchener, Andrew G; Booker, Simon J; Bhamber, Nivraj S; Tambe, Amol A; Clark, David I

2015-11-01

Tennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice. Cross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH). 271 of 1047 eligible members responded (25.9%); consultant surgeons constituted the largest group (232/271, 85%). 131 respondents (48%) use corticosteroid injections as their first-line treatment for tennis elbow. 206 respondents (77%) believed that corticosteroid injections are not potentially harmful in the treatment of tennis elbow, while 31 (11%) did not use them in their current practice. In light of recent evidence of the potential harmful effects of corticosteroid therapy, 136 (50%) had not changed their practice while 108 (40.1%) had reduced or discontinued their use. 43 respondents (16%) reported having used platelet-rich plasma injections. Recent high-quality evidence that corticosteroids may delay recovery in tennis elbow appears to have had a limited effect on current practice. Treatment is not uniform among specialists and a proportion of them use platelet-rich plasma injections. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Health sector leadership in mitigating climate change: experience from the UK and NSW.

PubMed

Pencheon, David; Rissel, Chris E; Hadfield, Glen; Madden, D Lynne

2009-01-01

The threat to human health from climate change means that all levels of government and private and public agencies will need to change their current practices to reduce carbon emissions. The health sector will also need to respond and change practice. The National Health Service in the United Kingdom is developing a systematic and strategic approach to reduce its carbon footprint, as described in the recently released NHS Carbon Reduction Strategy for England. The work is being led by the Service's new Sustainable Development Unit. While the Australian health care system has not yet embraced a shared vision for carbon reduction, there are examples emerging of how the sector is contributing to reduce greenhouse gas production. Examples from two NSW area health services to reduce energy use and promote active transport are presented. In both countries, these changes are supported by new legislation and policy.

Improving Public Engagement With Climate Change: Five "Best Practice" Insights From Psychological Science.

PubMed

van der Linden, Sander; Maibach, Edward; Leiserowitz, Anthony

2015-11-01

Despite being one of the most important societal challenges of the 21st century, public engagement with climate change currently remains low in the United States. Mounting evidence from across the behavioral sciences has found that most people regard climate change as a nonurgent and psychologically distant risk-spatially, temporally, and socially-which has led to deferred public decision making about mitigation and adaptation responses. In this article, we advance five simple but important "best practice" insights from psychological science that can help governments improve public policymaking about climate change. Particularly, instead of a future, distant, global, nonpersonal, and analytical risk that is often framed as an overt loss for society, we argue that policymakers should (a) emphasize climate change as a present, local, and personal risk; (b) facilitate more affective and experiential engagement; (c) leverage relevant social group norms; (d) frame policy solutions in terms of what can be gained from immediate action; and (e) appeal to intrinsically valued long-term environmental goals and outcomes. With practical examples we illustrate how these key psychological principles can be applied to support societal engagement and climate change policymaking. © The Author(s) 2015.

The Influence of Field Teaching Practice on Pre-service Teachers' Professional Identity: A Mixed Methods Study.

PubMed

Zhao, Hongyu; Zhang, Xiaohui

2017-01-01

The current study used mixed methods to research pre-service teachers' professional identity. Ninety-eight pre-service teachers were investigated and twelve teachers were interviewed in China. The results were as follows: (1) The results of quantitative data showed that compared with before the field teaching practice, pre-service teachers' professional identity increased after the field teaching practice-specifically, intrinsic value identity increased, and extrinsic value identity did not significantly change; (2) The results of qualitative data validated and elaborated the results of quantitative data in more detail with regard to changes in professional identity. Specifically, compared with before the field teaching practice, intrinsic value identity including work content, work pattern, etc., increased and extrinsic value identity including work environment, income, and social status, etc., did not significantly change after experiencing teaching practice; (3) The results of qualitative data also showed that mentor support at field school promoted the development of pre-service teachers' professional identity. Moreover, the development of pre-service teachers' professional identity during field teaching practice further promoted their professional commitment; that is, it promoted their emotional evaluation and belief in the teaching profession. The study discussed these results and proposed solutions and suggestions for future studies.

Maximizing the Patient-Centered Medical Home (PCMH) by Choosing Words Wisely.

PubMed

Howard, Jenna; Etz, Rebecca S; Crocker, J Benjamin; Skinner, Daniel; Kelleher, Kelly J; Hahn, Karissa A; Miller, William L; Crabtree, Benjamin F

2016-01-01

Culture is transmitted through language and reflects a group's values, yet much of the current language used to describe the new patient-centered medical home (PCMH) is a carryover from the traditional, physician-centric model of care. This language creates a subtle yet powerful force that can perpetuate the status quo, despite transformation efforts. This article describes new terminology that some innovative primary care practices are using to support the transformational culture of the PCMH. Data come from the Agency for Healthcare Research and Quality-funded Working Conference for PCMH Innovation 2013, which convened 10 innovative practices and interdisciplinary content experts to discuss innovative practice redesign. Session and interview transcripts were analyzed using a grounded theory approach to identify patterns and explore their significance. Language innovations are used by 5 practices. Carefully selected terms facilitate creative reimagining of traditional roles and spaces through connotations that highlight practice goals. Participants felt that the language used was important for reinforcing substantive changes. Reworking well-established vernacular requires openness to change. True transformation does not, however, occur through a simple relabeling of old concepts. New terminology must represent values to which practices genuinely aspire, although caution is advised when using language to support cultural and clinical change. © Copyright 2016 by the American Board of Family Medicine.

Leadership of education psychological services: fit for purpose?

PubMed

Booker, Roger

2013-06-01

At a time of great change for educational psychology services in England, this paper reviews current theories of leadership and proposes how an integration of key aspects of these can be applied to support a self review of leadership practice, both by individual leaders and by services. The message from current theory is that in the midst of complexity and rapid change, a primary focus on the head of service is outdated; there should instead be a focus to develop the leadership capacity of the service as a whole. Key constructs considered are systems thinking, social identity, authenticity, and leadership as social construction.

Paradigm shifts: using a participatory leadership process to redesign health systems.

PubMed

Saleeby, Erin; Holschneider, Christine H; Singhal, Rita

2014-12-01

Physicians have increasingly given up private practices to become members of, and key stakeholders in, large healthcare systems. These systems are currently transforming to meet the Triple Aim: guaranteeing the equitable provision of high-quality, evidence-based care at a reasonable cost. Participatory leadership is an organizational change theory that engages key stakeholders as architects in the transformation process. This review highlights the utility of this leadership strategy in designing care for women's health. Our blueprint describing participatory leadership theory in women's health systems change is discussed in three case studies, highlighting what we call the six Ps of participatory leadership: participants, principles, purpose, process, and power. The 'sixth P', product, can then be substantially influential in changing the paradigm of care. Obstetrics and gynecology is increasingly practiced in large health systems responsible for the health of populations. Innovations in clinical practice impact care at the level of the individual. In order for advances in clinical practice to reach broad populations of women, they must be integrated into a delivery system. Physician engagement in leadership during this time of system transformation is of critical importance.

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings.

PubMed

Chilenski, Sarah M; Olson, Jonathan R; Schulte, Jill A; Perkins, Daniel F; Spoth, Richard

2015-02-01

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.

A Multi-level Examination of how the Organizational Context Relates to Readiness to Implement Prevention and Evidence-Based Programming in Community Settings

PubMed Central

Chilenski, Sarah M.; Olson, Jonathan R.; Schulte, Jill A.; Perkins, Daniel F.; Spoth, Richard

2015-01-01

Prior theoretical and empirical research suggests that multiple aspects of an organization’s context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization’s readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization’s readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization’s morale was also found to be a strong predictor of an organization’s readiness. The findings of the current study are discussed in terms of implications for prevention and intervention. PMID:25463014

Adapting Infrastructure and Civil Engineering Practice to a Changing Climate: Developing a Manual of Practice

NASA Astrophysics Data System (ADS)

Walker, D.; Ayyub, B. M.

2017-12-01

According to U.S. Census, new construction spending in the U.S. for 2014 was $993 Billion (roughly 6 percent of U.S. GDP). Informing the development of standards of engineering practice related to design and maintenance thus represents a significant opportunity to promote climate adaptation and mitigation, as well as community resilience. The climate science community informs us that extremes of climate and weather are changing from historical values and that the changes are driven substantially by emissions of greenhouse gases caused by human activities. Civil infrastructure systems traditionally have been designed, constructed, operated and maintained for appropriate probabilities of functionality, durability and safety while exposed to climate and weather extremes during their full service lives. Because of uncertainties in future greenhouse gas emissions and in the models for future climate and weather extremes, neither the climate science community nor the engineering community presently can define the statistics of future climate and weather extremes. The American Society for Civil Engineering's (ASCE) Committee on Adapting to a Changing Climate is actively involved in efforts internal and external to ASCE to promote understanding of the challenges climate change represents in engineering practice and to promote a re-examination of those practices that may need to change in light of changing climate. In addition to producing an ASCE e-book, as well as number of ASCE webinars, the Committee is currently developing a Manual of Practice intended to provide guidance for the development or enhancement of standards for infrastructure analysis and design in a world in which risk profiles are changing (non-stationarity) and climate change is a reality, but cannot be projected with a high degree of certainty. This presentation will explore both the need for such guidance as well as some of the challenges and opportunities facing its implementation.

Evaluating the impact of abrupt changes in forest policy and management practices on landscape dynamics: analysis of a Landsat image time series in the Atlantic Northern Forest.

PubMed

Legaard, Kasey R; Sader, Steven A; Simons-Legaard, Erin M

2015-01-01

Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology.

Evaluating the Impact of Abrupt Changes in Forest Policy and Management Practices on Landscape Dynamics: Analysis of a Landsat Image Time Series in the Atlantic Northern Forest

PubMed Central

Legaard, Kasey R.; Sader, Steven A.; Simons-Legaard, Erin M.

2015-01-01

Sustainable forest management is based on functional relationships between management actions, landscape conditions, and forest values. Changes in management practices make it fundamentally more difficult to study these relationships because the impacts of current practices are difficult to disentangle from the persistent influences of past practices. Within the Atlantic Northern Forest of Maine, U.S.A., forest policy and management practices changed abruptly in the early 1990s. During the 1970s-1980s, a severe insect outbreak stimulated salvage clearcutting of large contiguous tracts of spruce-fir forest. Following clearcut regulation in 1991, management practices shifted abruptly to near complete dependence on partial harvesting. Using a time series of Landsat satellite imagery (1973-2010) we assessed cumulative landscape change caused by these very different management regimes. We modeled predominant temporal patterns of harvesting and segmented a large study area into groups of landscape units with similar harvest histories. Time series of landscape composition and configuration metrics averaged within groups revealed differences in landscape dynamics caused by differences in management history. In some groups (24% of landscape units), salvage caused rapid loss and subdivision of intact mature forest. Persistent landscape change was created by large salvage clearcuts (often averaging > 100 ha) and conversion of spruce-fir to deciduous and mixed forest. In groups that were little affected by salvage (56% of landscape units), contemporary partial harvesting caused loss and subdivision of intact mature forest at even greater rates. Patch shape complexity and edge density reached high levels even where cumulative harvest area was relatively low. Contemporary practices introduced more numerous and much smaller patches of stand-replacing disturbance (typically averaging <15 ha) and a correspondingly large amount of edge. Management regimes impacted different areas to different degrees, producing different trajectories of landscape change that should be recognized when studying the impact of policy and management practices on forest ecology. PMID:26106893

Field of Psychiatry: Current Trends and Future Directions: An Indian Perspective.

PubMed

Dave, Kishore P

2016-01-01

Attempting to predict future is dangerous. This is particularly true in medical science where change is a result of chance discoveries. Currently, practicing psychiatrists are aware of deficiencies in psychiatric practice. However, we have a number of genuine reasons for optimism and excitement. Genetics, novel treatment approaches, new investigative techniques, large-scale treatment trials, and research in general medicine and neurology will give better insights in psychiatric disorders and its management. Psychiatric services in rural India can be reached by telemedicine. There are some threat perceptions which require solving and remedying. Subspecialties in psychiatry are the need of the hour. There is also a requirement for common practice guidelines. Mental Health Care Bill, 2013, requires suitable amendments before it is passed in the Indian Parliament. Research in psychiatry is yet to be developed as adequate resources are not available.

A manpower calculus: the implications of SUO fellowship expansion on oncologic surgeon case volumes.

PubMed

See, William A

2014-01-01

Society of Urologic Oncology (SUO)-accredited fellowship programs have undergone substantial expansion. This study developed a mathematical model to estimate future changes in urologic oncologic surgeon (UOS) manpower and analyzed the effect of those changes on per-UOS case volumes. SUO fellowship program directors were queried as to the number of positions available on an annual basis. Current US UOS manpower was estimated from the SUO membership list. Future manpower was estimated on an annual basis by linear senescence of existing manpower combined with linear growth of newly trained surgeons. Case-volume estimates for the 4 surgical disease sites (prostate, kidney/renal pelvis, bladder, and testes) were obtained from the literature. The future number of major cases was determined from current volumes based upon the US population growth rates and the historic average annual change in disease incidence. Two models were used to predict future per-UOS major case volumes. Model 1 assumed the current distribution of cases between nononcologic surgeons and UOS would continue. Model 2 assumed a progressive redistribution of cases over time such that in 2043 100% of major urologic cancer cases would be performed by UOSs. Over the 30-year period to "manpower steady-state" SUO-accredited UOSs practicing in the United States have the potential to increase from approximately 600 currently to 1,650 in 2043. During this interval, case volumes are predicted to change 0.97-, 2.4-, 1.1-, and 1.5-fold for prostatectomy, nephrectomy, cystectomy, and retroperitoneal lymph node dissection, respectively. The ratio of future to current total annual case volumes is predicted to be 0.47 and 0.9 for models 1 and 2, respectively. The number of annual US practicing graduates necessary to achieve a future to current case-volume ratio greater than 1 is 25 and 49 in models 1 and 2, respectively. The current number of SUO fellowship trainees has the potential to decrease future per-UOS case volumes relative to current levels. Redistribution of existing case volume or a decrease in the annual number of trainees or both would be required to insure sufficient surgical volumes for skill maintenance and optimal patient outcomes. Published by Elsevier Inc.

Responsible Mothers and Invisible Men: Child Protection in the Case of Adult Domestic Violence.

ERIC Educational Resources Information Center

Edelson, Jeffrey L.

1998-01-01

This commentary identifies critical issues regarding social interventions with families in which both child maltreatment and woman battering are suspected. Addresses several common assumptions of service providers and suggests changes in current practice. (Author)

Art Education in the Union of Soviet Socialist Republics

ERIC Educational Resources Information Center

Yusov, Boris

1978-01-01

Describes different systems of art education for different student populations, professional art training, historical changes in art education, art education research, aesthetic education, and art education as it is currently practiced in the Union of Soviet Socialist Republics. (RK)

Social work, technology, and ethical practices: a review and evaluation of the national association of social workers' technology standards.

PubMed

Lopez, Amy

2014-10-01

Information and communication technologies (ICTs) are becoming essential to social work practice by providing increased treatment possibilities and reducing barriers to service. While recognizing the importance of ICTs in practice, social work practitioners have had concerns about ethical use. In response, NASW compiled the Standards for Technology and Social Work Practice. While the guidelines set the groundwork, they were not embedded in a process that would allow them to adapt to the swift pace of ICT changes. This article reviews the current Standards, evaluates how these have been implemented by practitioners, and offers suggestions for updates.

After a Cesarean…What's a Birth Professional to Do?

PubMed Central

Andrews, Desirre; Humphries, Gretchen

2010-01-01

The discrepancy between the evidence supporting vaginal birth after cesarean and actual medical practice illuminates the larger issues of evidence-based care versus current obstetrical practice. Although the reasons for the disconnect between what we know to be healthy birth practices and what women actually experience are multiple and complex, a commitment to providing accurate education, truly client-centered support, and active patient advocacy will give women the ability to insist on best practice care for themselves and their babies. The International Cesarean Awareness Network believes that all childbirth professionals and advocates share a responsibility to promote change and must work together to be effective. PMID:21358830

Marine mammal harvests and other interactions with humans.

PubMed

Hovelsrud, Grete K; McKenna, Meghan; Huntington, Henry P

2008-03-01

The Arctic is currently undergoing rapid social and environmental changes, and while the peoples of the north have a long history of adapting, the current changes in climate pose unprecedented challenges to the marine mammal-human interactions in the Arctic regions. Arctic marine mammals have been and remain an important resource for many of the indigenous and nonindigenous people of the north. Changes in climate are likely to bring about profound changes to the environment in which these animals live and subsequently to the hunting practices and livelihoods of the people who hunt them. Climate change will lead to reduction in the sea ice extent and thickness and will likely increase shipping through the Northern Sea Route and the Northwest Passage and oil and gas activities in Arctic areas previously inaccessible. Such activities will lead to more frequent interactions between humans and marine mammals. These activities may also change the distribution of marine mammals, affecting the hunters. This paper has three parts. First, an overview of marine mammal harvesting activities in the different circumpolar regions provides a snapshot of current practices and conditions. Second, case studies of selected Arctic regions, indigenous groups, and species provide insight into the manner in which climate change is already impacting marine mammal harvesting activities in the Arctic. Third, we describe how climate change is likely to affect shipping and oil and gas exploration and production activities in the Arctic and describe the possible implications of these changes for the marine mammal populations. We conclude that many of the consequences of climate change are likely to be negative for marine mammal hunters and for marine mammals. Lack of adequate baseline data, however, makes it difficult to identify specific causal mechanisms and thus to develop appropriate conservation measures. Nonetheless, the future of Arctic marine mammals and human uses of them depends on addressing this challenge successfully.

To Meet or Not To Meet Physical vs. Virtual Configuration Control Board

NASA Technical Reports Server (NTRS)

Rice, Shelley

2017-01-01

This presentation will define the CCB, discuss its functions and members. We will look into traditional processes of managing change control via the CCB meeting and advanced practices utilizing enhanced product tools and technologies. Well step through a summary of the feedback from the community of CM professionals at NASA Goddard Space Flight Center of best practices as well as pros and cons for facilitating both a physical CCB and managing stakeholder approvals in a virtual environment. Attendees will come away with current industry strategies to determine if process for managing change control and approvals can be streamlined within their local work environments.

Transformation and Transformational Leadership: A Review of the Current and Relevant Literature for Academic Radiologists.

PubMed

Thomson, Norman B; Rawson, James V; Slade, Catherine P; Bledsoe, Martin

2016-05-01

With the US healthcare system on an unsustainable course, change is inevitable. Changes in the healthcare landscape impacting radiology include changing payment models, rapid adoption of digital technology, changes in radiology resident certifying exams, and the rise of consumerism in health care. Academic Radiology will be part of that change with none of its missions spared. What matters is not that change is coming but how Academic Radiology responds to change. Do we ignore, adapt, adopt others' practices, or lead change? Change management or transformation is a management skill set that can be learned and developed. Transformational leadership is a leadership style defined by the relationships between the leaders and the followers and the results they are able to achieve together to meet organizational goals. In this paper, we provide a review of key change management theories, as well as practical advice for self-reflection and development of leadership behaviors that promote effective change management and organizational transformation, particularly in a complex industry like Academic Radiology. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Adaptation or Resistance: a classification of responses to sea-level rise

NASA Astrophysics Data System (ADS)

Cooper, J. A.

2016-02-01

Societal responses to sea level rise and associated coastal change are apparently diverse in nature and motivation. Most are commonly referred to as 'adaptation'. Based on a review of current practice, however, it is argued that many of these responses do not involve adaptation, but are rather resisting change. There are several instances where formerly adaptive initiatives involving human adaptability are being replaced by initiatives that resist change. A classification is presented that recognises a continuum of responses ranging from adaptation to resistance, depending upon the willingness to change human activities to accommodate environmental change. In many cases climate change adaptation resources are being used for projects that are purely resistant and which foreclose future adaptation options. It is argued that a more concise definition of adaptation is needed if coastal management is to move beyond the current position of holding the shoreline, other tah n in a few showcase examples.

Bidirectional Relations between Parenting Practices and Child Externalizing Behavior: A Cross-Lagged Panel Analysis in the Context of a Psychosocial Treatment and 3-Year Follow-up

ERIC Educational Resources Information Center

Shaffer, Anne; Lindhiem, Oliver; Kolko, David J.; Trentacosta, Christopher J.

2013-01-01

In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or…

Didactic CME and practice change: don't throw that baby out quite yet.

PubMed

Olson, Curtis A; Tooman, Tricia R

2012-08-01

Skepticism exists regarding the role of continuing medical education (CME) in improving physician performance. The harshest criticism has been reserved for didactic CME. Reviews of the scientific literature on the effectiveness of CME conclude that formal or didactic modes of education have little or no impact on clinical practice. This has led some to argue that didactic CME is a highly questionable use of organizational and financial resources, and a cause of lost opportunities for physicians to engage in meaningful learning. The authors' current program of research has forced them to reconsider the received wisdom regarding the relationship between didactic modes of education and learning, and the role frank dissemination can play in bringing about practice change. The authors argued that the practice of assessing and valuing educational methods based only on their capacity to directly influence practice reflects an impoverished understanding of how change in clinical practice actually occurs. Drawing on case studies research, examples were given of the functions didactic CME served in the interest of improved practice. Reasons were then explored as to why the contribution of didactic CME is often missed or dismissed. The goal was not to advocate for a return to the status quo ante where lecture-based education is the dominant modality, but rather to acknowledge both the limits and potential of this longstanding approach to delivering continuing education.

Methods And Devices For Characterizing Duplex Nucleic Acid Molecules

DOEpatents

Akeson, Mark; Vercoutere, Wenonah; Haussler, David; Winters-Hilt, Stephen

2005-08-30

Methods and devices are provided for characterizing a duplex nucleic acid, e.g., a duplex DNA molecule. In the subject methods, a fluid conducting medium that includes a duplex nucleic acid molecule is contacted with a nanopore under the influence of an applied electric field and the resulting changes in current through the nanopore caused by the duplex nucleic acid molecule are monitored. The observed changes in current through the nanopore are then employed as a set of data values to characterize the duplex nucleic acid, where the set of data values may be employed in raw form or manipulated, e.g., into a current blockade profile. Also provided are nanopore devices for practicing the subject methods, where the subject nanopore devices are characterized by the presence of an algorithm which directs a processing means to employ monitored changes in current through a nanopore to characterize a duplex nucleic acid molecule responsible for the current changes. The subject methods and devices find use in a variety of applications, including, among other applications, the identification of an analyte duplex DNA molecule in a sample, the specific base sequence at a single nulceotide polymorphism (SNP), and the sequencing of duplex DNA molecules.

Parallel Approach Separation and Controller Performance

DTIC Science & Technology

1989-11-01

adjacent runways from the current minimum of 2.0 to 1.5 nautical miles (nmi). The possible impact of this alteration included changes in the nature and...for aircraft in trail on the same approach. 4. Determine if a change in separation standard affects controller work effort and if so, how. SIMULATION...practice effects should be minimal. 2. They can evaluate the realism of the simulation. 3. They are better able to evaluate the impact of any changes

Robust Engineering Designs for Infrastructure Adaptation to a Changing Climate

NASA Astrophysics Data System (ADS)

Samaras, C.; Cook, L.

2015-12-01

Infrastructure systems are expected to be functional, durable and safe over long service lives - 50 to over 100 years. Observations and models of climate science show that greenhouse gas emissions resulting from human activities have changed climate, weather and extreme events. Projections of future changes (albeit with uncertainties caused by inadequacies of current climate/weather models) can be made based on scenarios for future emissions, but actual future emissions are themselves uncertain. Most current engineering standards and practices for infrastructure assume that the probabilities of future extreme climate and weather events will match those of the past. Climate science shows that this assumption is invalid, but is unable, at present, to define these probabilities over the service lives of existing and new infrastructure systems. Engineering designs, plans, and institutions and regulations will need to be adaptable for a range of future conditions (conditions of climate, weather and extreme events, as well as changing societal demands for infrastructure services). For their current and future projects, engineers should: Involve all stakeholders (owners, financers, insurance, regulators, affected public, climate/weather scientists, etc.) in key decisions; Use low regret, adaptive strategies, such as robust decision making and the observational method, comply with relevant standards and regulations, and exceed their requirements where appropriate; Publish design studies and performance/failure investigations to extend the body of knowledge for advancement of practice. The engineering community should conduct observational and modeling research with climate/weather/social scientists and the concerned communities and account rationally for climate change in revised engineering standards and codes. This presentation presents initial research on decisionmaking under uncertainty for climate resilient infrastructure design.

Impacts of agricultural management and climate change on future soil organic carbon dynamics in North China Plain.

PubMed

Wang, Guocheng; Li, Tingting; Zhang, Wen; Yu, Yongqiang

2014-01-01

Dynamics of cropland soil organic carbon (SOC) in response to different management practices and environmental conditions across North China Plain (NCP) were studied using a modeling approach. We identified the key variables driving SOC changes at a high spatial resolution (10 km × 10 km) and long time scale (90 years). The model used future climatic data from the FGOALS model based on four future greenhouse gas (GHG) concentration scenarios. Agricultural practices included different rates of nitrogen (N) fertilization, manure application, and stubble retention. We found that SOC change was significantly influenced by the management practices of stubble retention (linearly positive), manure application (linearly positive) and nitrogen fertilization (nonlinearly positive) - and the edaphic variable of initial SOC content (linearly negative). Temperature had weakly positive effects, while precipitation had negligible impacts on SOC dynamics under current irrigation management. The effects of increased N fertilization on SOC changes were most significant between the rates of 0 and 300 kg ha-1 yr-1. With a moderate rate of manure application (i.e., 2000 kg ha-1 yr-1), stubble retention (i.e., 50%), and an optimal rate of nitrogen fertilization (i.e., 300 kg ha-1 yr-1), more than 60% of the study area showed an increase in SOC, and the average SOC density across NCP was relatively steady during the study period. If the rates of manure application and stubble retention doubled (i.e., manure application rate of 4000 kg ha-1 yr-1 and stubble retention rate of 100%), soils across more than 90% of the study area would act as a net C sink, and the average SOC density kept increasing from 40 Mg ha-1 during 2010s to the current worldwide average of ∼ 55 Mg ha-1 during 2060s. The results can help target agricultural management practices for effectively mitigating climate change through soil C sequestration.

Impacts of Agricultural Management and Climate Change on Future Soil Organic Carbon Dynamics in North China Plain

PubMed Central

Wang, Guocheng; Li, Tingting; Zhang, Wen; Yu, Yongqiang

2014-01-01

Dynamics of cropland soil organic carbon (SOC) in response to different management practices and environmental conditions across North China Plain (NCP) were studied using a modeling approach. We identified the key variables driving SOC changes at a high spatial resolution (10 km×10 km) and long time scale (90 years). The model used future climatic data from the FGOALS model based on four future greenhouse gas (GHG) concentration scenarios. Agricultural practices included different rates of nitrogen (N) fertilization, manure application, and stubble retention. We found that SOC change was significantly influenced by the management practices of stubble retention (linearly positive), manure application (linearly positive) and nitrogen fertilization (nonlinearly positive) – and the edaphic variable of initial SOC content (linearly negative). Temperature had weakly positive effects, while precipitation had negligible impacts on SOC dynamics under current irrigation management. The effects of increased N fertilization on SOC changes were most significant between the rates of 0 and 300 kg ha−1 yr−1. With a moderate rate of manure application (i.e., 2000 kg ha−1 yr−1), stubble retention (i.e., 50%), and an optimal rate of nitrogen fertilization (i.e., 300 kg ha−1 yr−1), more than 60% of the study area showed an increase in SOC, and the average SOC density across NCP was relatively steady during the study period. If the rates of manure application and stubble retention doubled (i.e., manure application rate of 4000 kg ha−1 yr−1 and stubble retention rate of 100%), soils across more than 90% of the study area would act as a net C sink, and the average SOC density kept increasing from 40 Mg ha−1 during 2010s to the current worldwide average of ∼55 Mg ha−1 during 2060s. The results can help target agricultural management practices for effectively mitigating climate change through soil C sequestration. PMID:24722689

Special Educational Needs and Disability Co-Ordination in a Changing Policy Landscape: Making Sense of Policy from a SENCo's Perspective

ERIC Educational Resources Information Center

Robertson, Christopher

2012-01-01

In this article, recent legislative changes that have raised the profile of SENCos in English schools are outlined. Key aspects of the current Government's proposals to reform SEND policy, provision and practice and the possible implications of these for SENCos and the schools they work in are discussed. The view that radical reforms outlined in…

Long-term personality data collection in support of spaceflight and analogue research.

PubMed

Musson, David M; Helmreich, Robert L

2005-06-01

This is a review of past and present research into personality and performance at the University of Texas (UT) Human Factors Research Project. Specifically, personality trait data collected from astronauts, pilots, Antarctic personnel, and other groups over a 15-yr period is discussed with particular emphasis on research in space and space analogue environments. The UT Human Factors Research Project conducts studies in personality and group dynamics in aviation, space, and medicine. Current studies include personality determinants of professional cultures, team effectiveness in both medicine and aviation, and personality predictors of long-term astronaut performance. The Project also studies the design and effectiveness of behavioral strategies used to minimize error and maximize team performance in safety-critical work settings. A multi-year personality and performance dataset presents many opportunities for research, including long-term and follow-up studies of human performance, analyses of trends in recruiting and attrition, and the ability to adapt research design to operational changes and methodological advances. Special problems posed by such long-duration projects include issues of confidentiality and security, as well as practical limitations imposed by current peer-review and short-term funding practices. Practical considerations for ongoing dataset management include consistency of assessment instruments over time, variations in data acquisition from one year to the next, and dealing with changes in theory and practice that occur over the life of the project. A fundamental change in how research into human performance is funded would be required to ensure the ongoing development of such long-duration research databases.

Canadian anesthesia physician resources: 1996 and beyond.

PubMed

Donen, N; King, F; Reid, D; Blackstock, D

1999-10-01

To report physician resource information from the 1996 national anesthesia physician and residency programme surveys in Canada. The findings are used to discuss the potential effects on availability of future specialist anesthesia services in Canada. Twenty-six hundred and ninety-three physicians (2,206 specialists, 487 family physicians) providing anesthesia services were surveyed. Information on demographics and patterns of clinical practice were sought. Anesthesia programme directors provided trainee information. Projections of the potential number of practicing anesthesiologists to 2026 were made based on the number of available training positions and age distribution of anesthesiologists. There was a 58.3% response rate to the national survey. Since 1986 there has been a 10% increase in the number of specialist anesthesiologists. Marked regional variations in age distribution and changes in the number of specialist anesthesiologists were noted. Most specialists remain in the region or province of postgraduate training. Sixty percent of specialists were either re-entry trainees or international medical graduates. Changes in anesthesia practice patterns have resulted in 40% of the anesthesiologist's work now occurring outside of the operating room. Anesthesia training positions have decreased by at least 15%. The population of Canada is projected to increase by 33.8% between 1996 and 2026. If current government and position allocation policies continue, it is projected there will be 0% increase in the number of specialist anesthesiologists over the same time period. Changes in anesthesia practices have exacerbated the current shortages of anesthesiologists. These shortages will worsen if the number of, and restrictions to, available residency positions is unchanged.

NASA Goddard Space Flight Center presents Enhancing Standards Based Science Curriculum through NASA Content Relevancy: A Model for Sustainable Teaching-Research Integration Dr. Robert Gabrys, Raquel Marshall, Dr. Evelina Felicite-Maurice, Erin McKinley

NASA Astrophysics Data System (ADS)

Marshall, R. H.; Gabrys, R.

2016-12-01

NASA Goddard Space Flight Center has developed a systemic educator professional development model for the integration of NASA climate change resources into the K-12 classroom. The desired outcome of this model is to prepare teachers in STEM disciplines to be globally engaged and knowledgeable of current climate change research and its potential for content relevancy alignment to standard-based curriculum. The application and mapping of the model is based on the state education needs assessment, alignment to the Next Generation Science Standards (NGSS), and implementation framework developed by the consortium of district superintendents and their science supervisors. In this presentation, we will demonstrate best practices for extending the concept of inquiry-based and project-based learning through the integration of current NASA climate change research into curriculum unit lessons. This model includes a significant teacher development component focused on capacity development for teacher instruction and pedagogy aimed at aligning NASA climate change research to related NGSS student performance expectations and subsequent Crosscutting Concepts, Science and Engineering Practices, and Disciplinary Core Ideas, a need that was presented by the district steering committee as critical for ensuring sustainability and high-impact in the classroom. This model offers a collaborative and inclusive learning community that connects classroom teachers to NASA climate change researchers via an ongoing consultant/mentoring approach. As a result of the first year of implementation of this model, Maryland teachers are implementing NGSS unit lessons that guide students in open-ended research based on current NASA climate change research.

The transition to digital media in biocommunications.

PubMed

Lynch, P J

1996-01-01

As digital audiovisual media become dominant in biomedical communications, the skills of human interface design and the technology of client-server multimedia data networks will underlie and influence virtually every aspect of biocommunications professional practice. The transition to digital communications media will require financial, organizational, and professional changes in current biomedical communications departments, and will require a multi-disciplinary approach that will blur the boundaries of the current biocommunications professions.

Education for the Aging; Living with a Purpose as Older Adults through Education: An Overview of Current Developments.

ERIC Educational Resources Information Center

Grabowski, Stanley M., Ed.; Mason, W. Dean, Ed.

Directed toward the practitioner, the book is a compilation by 18 knowledgeable, experienced authors of some of the recent literature and current practices in the field relating to aging. The book consists of seven parts: (1) The Older Adult as Learner, (2) The Role of Education in an Aging Society, (3) The Aging Individual and the Changing Nature…

The development of professional practice standards for Australian general practice nurses.

PubMed

Halcomb, Elizabeth; Stephens, Moira; Bryce, Julianne; Foley, Elizabeth; Ashley, Christine

2017-08-01

The aim of this study was to explore the current role of general practice nurses and the scope of nursing practice to inform the development of national professional practice standards for Australian general practice nurses. Increasing numbers of nurses have been employed in Australian general practice to meet the growing demand for primary care services. This has brought significant changes to the nursing role. Competency standards for nurses working in general practice were first developed in Australia in 2005, but limited attention has been placed on articulating the contemporary scope of practice for nurses in this setting. Concurrent mixed methods design. Data collection was conducted during 2013-2014 and involved two online surveys of Registered and Enrolled Nurses currently working in general practice, a series of 14 focus groups across Australia and a series of consultations with key experts. Data collection enabled the development of 22 Practice Standards separated into four domains: (i) Professional Practice; (ii) Nursing Care; (iii) General Practice Environment and (iv) Collaborative Practice. To differentiate the variations in enacting these Standards, performance indicators for the Enrolled Nurse, Registered Nurse and Registered Nurse Advanced Practice are provided under each Standard. The development of national professional practice standards for nurses working in Australian general practice will support ongoing workforce development. These Standards are also an important means of articulating the role and scope of the nurses' practice for both consumers and other health professionals, as well as being a guide for curriculum development and measurement of performance. © 2017 John Wiley & Sons Ltd.

Mandate for the Nursing Profession to Address Climate Change Through Nursing Education.

PubMed

Leffers, Jeanne; Levy, Ruth McDermott; Nicholas, Patrice K; Sweeney, Casey F

2017-11-01

The adverse health effects from climate change demand action from the nursing profession. This article examines the calls to action, the status of climate change in nursing education, and challenges and recommendations for nursing education related to climate change and human health. Discussion paper. The integration of climate change into nursing education is essential so that knowledge, skills, and insights critical for clinical practice in our climate-changing world are incorporated in curricula, practice, research, and policy. Our Ecological Planetary Health Model offers a framework for nursing to integrate relevant climate change education into nursing curricula and professional nursing education. Nursing education can offer a leadership role to address the mitigation, adaptation, and resilience strategies for climate change. An ecological framework is valuable for nursing education regarding climate change through its consideration of political, cultural, economic, and environmental interrelationships on human health and the health of the planet. Knowledge of climate change is important for integration into basic and advanced nursing education, as well as professional education for nurses to address adverse health impacts, climate change responses policy, and advocacy roles. For current and future nurses to provide care within a climate-changing environment, nursing education has a mandate to integrate knowledge about climate change issues across all levels of nursing education. Competence in nursing practice follows from knowledge and skill acquisition gained from integration of climate change content into nursing education. © 2017 Sigma Theta Tau International.

Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia.

PubMed

Martis, Ruth; Ho, Jacqueline J; Crowther, Caroline A

2008-08-05

Evidence-based practice (EBP) can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia. Questionnaires about IT access for health information and evidence-based practice were administered during August to December 2005 to health care professionals working at the nine hospitals participating in the South East Asia Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project in Indonesia, Malaysia, Thailand and The Philippines. The survey was completed by 660 staff from six health professional groups. Overall, easy IT access for health care information was available to 46% of participants. However, over a fifth reported no IT access was available and over half of nurses and midwives never used IT health information. Evidence-based practice had been heard of by 58% but the majority did not understand the concept. The most frequent sites accessed were Google and PubMed. The Cochrane Library had been heard of by 47% of whom 51% had access although the majority did not use it or used it less than monthly. Only 27% had heard of the WHO Reproductive Health Library and 35% had been involved in a clinical practice change and were able to identify enablers and barriers to change. Only a third of participants had been actively involved in practice change with wide variation between the countries. Willingness to participate in professional development workshops on evidence-based practice was high. This survey has identified the need to improve IT access to health care information and health professionals' knowledge of evidence-based health care to assist in employing evidence base practice effectively.

Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia

PubMed Central

Martis, Ruth; Ho, Jacqueline J; Crowther, Caroline A

2008-01-01

Background Evidence-based practice (EBP) can provide appropriate care for women and their babies; however implementation of EBP requires health professionals to have access to knowledge, the ability to interpret health care information and then strategies to apply care. The aim of this survey was to assess current knowledge of evidence-based practice, information seeking practices, perceptions and potential enablers and barriers to clinical practice change among maternal and infant health practitioners in South East Asia. Methods Questionnaires about IT access for health information and evidence-based practice were administered during August to December 2005 to health care professionals working at the nine hospitals participating in the South East Asia Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project in Indonesia, Malaysia, Thailand and The Philippines. Results The survey was completed by 660 staff from six health professional groups. Overall, easy IT access for health care information was available to 46% of participants. However, over a fifth reported no IT access was available and over half of nurses and midwives never used IT health information. Evidence-based practice had been heard of by 58% but the majority did not understand the concept. The most frequent sites accessed were Google and PubMed. The Cochrane Library had been heard of by 47% of whom 51% had access although the majority did not use it or used it less than monthly. Only 27% had heard of the WHO Reproductive Health Library and 35% had been involved in a clinical practice change and were able to identify enablers and barriers to change. Only a third of participants had been actively involved in practice change with wide variation between the countries. Willingness to participate in professional development workshops on evidence-based practice was high. Conclusion This survey has identified the need to improve IT access to health care information and health professionals' knowledge of evidence-based health care to assist in employing evidence base practice effectively. PMID:18680603

Current good manufacturing practice in manufacturing, processing, packing, or holding of drugs; revision of certain labeling controls--FDA. Final rule.

PubMed

1993-08-03

The Food and Drug Administration (FDA) is amending the current good manufacturing practice (CGMP) regulations for human and veterinary drug products to revise certain labeling control provisions. Specifically, the final rule defines the term "gang-printed labeling," specifies conditions for the use of gang-printed or cut labeling, exempts manufacturers that employ automated 100-percent labeling inspection systems from CGMP labeling reconciliation requirements, and requires manufacturers to identify filled drug product containers that are set aside and held in an unlabeled condition for future labeling operations. These changes are intended to reduce the frequency of drug product mislabeling and associated drug product recalls.

21 CFR 211.160 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... drafted by the appropriate organizational unit and reviewed and approved by the quality control unit. The...: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS Laboratory Controls § 211.160... procedures, or other laboratory control mechanisms required by this subpart, including any change in such...

Less Therapy Okay for Some with Wilms Tumor?

Cancer.gov

Some children with advanced Wilms tumor, a form of kidney cancer, may be able to skip radiation therapy, findings from an NCI-funded clinical trial show. It’s unclear if the finding will change clinical practice, as this Cancer Currents post reports.

What If.

ERIC Educational Resources Information Center

Bingler, Steven

This paper addresses the growing population trends in California; the need to counteract the current model of community sprawl by designing smarter schools and community growth strategies; and the changes in planning, policies, and practices needed to achieve these goals. Recommended strategies described support the following actions: more…

Water Resources and Supply Adaptation: A paradigm Shifting for Future Climate?

EPA Science Inventory

Climate change adds another layer of complexity in planning, engineering and management of water resources and urban water infrastructures. Yet our current practice is confined to the traditional approach that evaluates developmental scenarios and their sustainability mostly by a...

'Getting things done': an everyday-life perspective towards bridging the gap between intentions and practices in health-related behavior.

PubMed

van Woerkum, Cees; Bouwman, Laura

2014-06-01

In this paper, we aim to add a new perspective to supporting health-related behavior. We use the everyday-life view to point at the need to focus on the social and practical organization of the concerned behavior. Where most current approaches act disjointedly on clients and the social and physical context, we take the clients' own behavior within the dynamics of everyday context as the point of departure. From this point, healthy behavior is not a distinguishable action, but a chain of activities, often embedded in other social practices. Therefore, changing behavior means changing the social system in which one lives, changing a shared lifestyle or changing the dominant values or existing norms. Often, clients experience that this is not that easy. From the everyday-life perspective, the basic strategy is to support the client, who already has a positive intention, to 'get things done'. This strategy might be applied to those cases, where a gap is found between good intentions and bad behavior.

Using Hybrid Change Strategies to Improve the Patient Experience in Outpatient Specialty Care.

PubMed

Miranda, Rafael; Glenn, Sean W; Leighton, Jonathan A; Pasha, Shabana E; Gurudu, Suryakanth R; Teaford, Harry G; Mertz, Lester E; Lee, Howard R; Mamby, Sylvia A; Johnson, Margaret F; Raghu, T S

2015-01-01

The emerging changes in healthcare impose significant burdens on integrated outpatient specialty services with respect to setting patient expectations, handling outside medical records; and coordinating specialty appointments scheduling. Moreover, because of the evolution of the electronic health record and its widespread use, it is critical that patient and physician interaction is maintained and clerical tasks are minimized. In the context of increased government regulation, declining reimbursement, and the rise of new payment models, outpatient practices need to be reimagined so that they are more efficient for the patient and the provider. The redesign of integrated outpatient specialty services can be accomplished only through teamwork, innovation, and efficient use of technology. To address these challenges, the Department of Medicine at Mayo Clinic in Scottsdale, Arizona, implemented an ideal practice design initiative that leveraged a hybrid set of change strategies. The change strategy, which was initiated after examination of current practices and design options, engaged key stakeholders and patients. A number of enablers and barriers to adoption were identified as a result of the implementation experience.

Enhancing the quality of antibiotic prescribing in Primary Care: Qualitative evaluation of a blended learning intervention

PubMed Central

2010-01-01

Background The Stemming the Tide of Antibiotic Resistance (STAR) Educational Program aims to enhance the quality of antibiotic prescribing and raise awareness about antibiotic resistance among general medical practitioners. It consists of a seven part, theory-based blended learning program that includes online reflection on clinicians' own practice, presentation of research evidence and guidelines, a practice-based seminar focusing on participants' own antibiotic prescribing and resistance rates in urine samples sent from their practice, communication skills training using videos of simulated patients in routine surgeries, and participation in a web forum. Effectiveness was evaluated in a randomised controlled trial in which 244 GPs and Nurse Practitioners and 68 general practices participated. This paper reports part of the process evaluation of that trial. Methods Semi-structured, digitally recorded, and transcribed telephone interviews with 31 purposively sampled trial participants analysed using thematic content analysis. Results The majority of participants reported increased awareness of antibiotic resistance, greater self-confidence in reducing antibiotic prescribing and at least some change in consultation style and antibiotic prescribing behaviour. Reported practical changes included adopting a practice-wide policy of antibiotic prescription reduction. Many GPs also reported increased insight into patients' expectations, ultimately contributing to improved doctor-patient rapport. The components of the intervention put forward as having the greatest influence on changing clinician behaviour were the up-to-date research evidence resources, simple and effective communication skills presented in on-line videos, and presentation of the practice's own antibiotic prescribing levels combined with an overview of local resistance data. Conclusion Participants regarded this complex blended learning intervention acceptable and feasible, and reported wide-ranging, positive changes in attitudes and clinical practice as a result of participating in the STAR Educational Program. Trial registration Current Controlled Trials ISRCTN63355948 PMID:20459655

Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation.

PubMed

Connell, Louise A; McMahon, Naoimh E; Tyson, Sarah F; Watkins, Caroline L; Eng, Janice J

2016-12-01

Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise. The purposes of this case series are: (1) to provide an illustrative example of how a research-informed process changed clinical practice and (2) to report on staff members' and patients' perceptions of the utility of the developed intervention. A participatory action research approach was used in 3 stroke rehabilitation units in the United Kingdom. The intervention aimed to change 4 therapist-level behaviors: (1) screening patients for suitability for supplementary self-directed arm exercise, (2) provision of exercises, (3) involving family and caregivers in assisting with exercises, and (4) monitoring and progressing exercises. Data on changes in practice were collected by therapy teams using a bespoke audit tool. Utility of the intervention was explored in qualitative interviews with patients and staff. Components of the intervention were successfully embedded in 2 of the 3 stroke units. At these sites, almost all admitted patients were screened for suitability for supplementary self-directed exercise. Exercises were provided to 77%, 70%, and 88% of suitable patients across the 3 sites. Involving family and caregivers and monitoring and progressing exercises were not performed consistently. This case series is an example of how a rigorous research-informed knowledge translation process resulted in practice change. Research is needed to demonstrate that these changes can translate into increased intensity of upper limb exercise and affect patient outcomes. © 2016 American Physical Therapy Association.

IMPLICATIONS OF GLOBAL CLIMATE CHANGE FOR THE ASSESSMENT AND MANAGEMENT OF HUMAN HEALTH RISKS OF CHEMICALS IN THE NATURAL ENVIRONMENT

PubMed Central

Balbus, John M; Boxall, Alistair BA; Fenske, Richard A; McKone, Thomas E; Zeise, Lauren

2013-01-01

Global climate change (GCC) is likely to alter the degree of human exposure to pollutants and the response of human populations to these exposures, meaning that risks of pollutants could change in the future. The present study, therefore, explores how GCC might affect the different steps in the pathway from a chemical source in the environment through to impacts on human health and evaluates the implications for existing risk-assessment and management practices. In certain parts of the world, GCC is predicted to increase the level of exposure of many environmental pollutants due to direct and indirect effects on the use patterns and transport and fate of chemicals. Changes in human behavior will also affect how humans come into contact with contaminated air, water, and food. Dietary changes, psychosocial stress, and coexposure to stressors such as high temperatures are likely to increase the vulnerability of humans to chemicals. These changes are likely to have significant implications for current practices for chemical assessment. Assumptions used in current exposure-assessment models may no longer apply, and existing monitoring methods may not be robust enough to detect adverse episodic changes in exposures. Organizations responsible for the assessment and management of health risks of chemicals therefore need to be more proactive and consider the implications of GCC for their procedures and processes. Environ. Toxicol. Chem. 2013;32:62–78. © 2012 SETAC PMID:23147420

Practice expenses in the MFS (Medicare fee schedule): the service-class approach.

PubMed

Latimer, E A; Kane, N M

1995-01-01

The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

Use of atropine penalization to treat amblyopia in UK orthoptic practice.

PubMed

Piano, Marianne; O'Connor, Anna R; Newsham, David

2014-01-01

To compare clinical practice patterns regarding atropine penalization use by UK orthoptists to the current evidence base and identify any existing barriers against use of AP as first-line treatment. An online survey was designed to assess current practice patterns of UK orthoptists using atropine penalization. They were asked to identify issues limiting their use of atropine penalization and give opinions on its effectiveness compared to occlusion. Descriptive statistics and content analysis were applied to the results. Responses were obtained from 151 orthoptists throughout the United Kingdom. The main perceived barriers to use of atropine penalization were inability to prescribe atropine and supply difficulties. However, respondents also did not consider atropine penalization as effective as occlusion in treating amblyopia, contrary to recent research findings. Patient selection criteria and treatment administration largely follow current evidence. More orthoptists use atropine penalization as first-line treatment than previously reported. Practitioners tend to closely follow the current evidence base when using atropine penalization, but reluctance in offering it as first-line treatment or providing a choice for parents between occlusion and atropine still remains. This may result from concerns regarding atropine's general efficacy, side effects, and risk of reverse amblyopia. Alternatively, as demonstrated in other areas of medicine, it may reflect the inherent delay of research findings translating to clinical practice changes. Copyright 2014, SLACK Incorporated.

Evidence-Based Indicators of Neuropsychological Change in the Individual Patient: Relevant Concepts and Methods

PubMed Central

Duff, Kevin

2012-01-01

Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms) and methods (e.g., reliable change index, standardized based regression) that are used in repeated neuropsychological evaluations. The focus will be on the understanding and application of these concepts and methods in the evaluation of the individual patient through examples. Finally, some future directions for assessing change will be described. PMID:22382384

Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy

PubMed Central

Newhouse, Robin P.; Spring, Bonnie

2010-01-01

Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform. PMID:21074648

Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

PubMed

Hulscher, M E J L; Prins, J M

2017-11-01

Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice. To summarize the evidence base of both appropriate antibiotic use recommendations (the 'what') and behavioural change interventions (the 'how') in hospital practice. Published systematic reviews/Medline. The literature shows low-quality evidence of the positive effects of appropriate antibiotic use in hospital patients. The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions. The literature showed a clear need for studies that apply appropriate study designs- (randomized) controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences. The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.

PubMed

Fusco, Matthew R; Fisher, Winfield S; McGrew, Benjamin M; Walters, Beverly C

2014-12-01

Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada. Copyright © 2014 Elsevier B.V. All rights reserved.

Opening our eyes to a critical approach to medicine: The humanities in medical education.

PubMed

Liao, Lester

2017-02-01

This paper examines a recent medical graduate's perspective on how undergraduate education tends to focus on imparting medical knowledge with little reference to the human aspects in clinical medicine. This is problematic because medicine is both about people and practiced by people. Students often have minimal exposure to the humanities prior to and in medical school and are frequently unaware of the societal trends that impact their view of medical practice. Familiarity with the humanities is a crucial means to understanding human nature, recognizing personal sociocultural biases, and practicing patient-centered medicine. This gap in knowledge may be due to the increase in medical information and optimistic ideologies related to medical progress. Philosophical paradigms and historical examples are considered to demonstrate the relevance of both fields in the humanities in understanding the role of moral human agents in applying medical knowledge. Educational changes in the humanities are proposed as a potential solution to our current deficits. Informal changes include mentorship relationships and shifting the general underpinning attitude in medical culture. Formal changes include specific courses teaching a critical approach to medicine. Changes in competency-based education and admissions are also suggested. These amendments are proposed to practice a fuller, truly human medicine.

Student-Centered Classrooms: Past Initiatives, Future Practices

ERIC Educational Resources Information Center

Hansen, Dee; Imse, Leslie A.

2016-01-01

Music teacher evaluations traditionally examine how teachers develop student music-learning objectives, assess cognitive and performance skills, and direct classroom learning experiences and behavior. A convergence of past and current educational ideas and directives is changing how teachers are evaluated on their use of student-centered…

Child rights and Child and Adolescent Mental Health Services (CAMHS) in Ireland.

PubMed

Damodaran, J; Sherlock, C

2013-12-01

This paper explores children's rights in the child and adolescent mental health arena in Ireland. It begins by outlining the legal and policy contexts of both children's services and mental health policy and practice. It specifically focuses on the notion of participation as a key factor in addressing rights-based approaches in the provision of services. The article explores current practice in Child and Adolescent Mental Health Services, highlights some of the disparities in services, which result in questions about human rights. Mainly reflective in its approach, it does, however, provide data from a small scale qualitative study carried out in relation to young people diagnosed with ADHD and their perceptions of psychopharmacological approach. The issue of consent is explored as an example of how current practice approaches fall short of a rights-based framework. It concludes with recommendations for changes incorporating a more participatory and collaborative approach.

Occupation emerges in the process of therapy.

PubMed

Price, Pollie; Miner, Stephanie

2007-01-01

The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming. The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah's goals of going to preschool and becoming a friend. Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person-task-social context, pushing participation, and engaging in narrative micronegotiations. Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.

Alcohol-related problems: emergency physicians' current practice and attitudes.

PubMed

O'Rourke, Maria; Richardson, Lynne D; Wilets, Ilene; D'Onofrio, Gail

2006-04-01

To determine whether emergency physicians' (EPs) attitudes affect their support and practice of brief intervention in the Emergency Department (ED), EPs completed an anonymous survey. EPs were asked about their attitudes toward patients with alcohol problems, current ED screening, use of brief intervention, and barriers to use of brief intervention. Chi-square analysis was used and a step-wise regression model was constructed. Respondents reported a high prevalence of patients with alcohol-related problems: 18% in a typical shift. Eighty-one percent said it is important to advise patients to change behavior; half said using a brief intervention is important. Attending physicians had significantly less alcohol education than residents, but were significantly more likely to support the use of brief intervention. Support was not associated with gender, race, census, hours of education, or personal experience. EPs who felt that brief intervention was an integral part of their job were more likely to use it in their daily practice.

[The ethic dimension of daily tasks in the formation process of nurses].

PubMed

Fernandes, Josicélia Dumêt; Rosa, Darci de Oliveira Santa; Vieira, Therezinha Teixeira; Sadigursky, Dora

2008-06-01

This theoretical article had as its object of study the ethic dimension of the formation process of nurses taking in consideration the National Curricular Directives for Nursing Courses. It was based on the presuppositions of ethics and their relationship with the implementation of changes in the formation process of nurses, using as reference elements of ethical behavior in the formation and attempting to bring the reflection to current times and thus contribute to define a direction to Nursing education. It was concluded that the ethical dimension in the formation of nurses involves values that permeate the relations between the subjects of this process and nature itself. The study points out the need to transform the practices of students and teachers and change the current curriculum framework, highlighting elements that indicate that the concern with ethics when developing the curriculum framework is not limited to how a discipline is taught, but pass through as practices that take place in the education process.

Preference for practice: a Danish study on young doctors' choice of general practice using a discrete choice experiment.

PubMed

Pedersen, Line Bjørnskov; Gyrd-Hansen, Dorte

2014-07-01

This study examines the preferences of general practitioners (GPs) in training for organizational characteristics in general practice with focus on aspects that can mitigate problems with GP shortages. A discrete choice experiment was used to investigate preferences for the attributes practice type, number of GPs in general practice, collaboration with other practices, change in weekly working hours (administrative versus patient related), and change in yearly surplus. In May 2011, all doctors actively engaged in the family medicine program in Denmark were invited to participate in a web-based survey. A total of 485 GPs in training responded to the questionnaire, resulting in a response rate of 56%. A mixed logit model showed that GPs in training prefer to work in smaller shared practices (2 GPs). This stands in contrast to the preferences of current GPs. Hence, a generational change in the GP population is likely to introduce more productive practice forms, and problems with GP shortages are likely to be mitigated over the coming years. Results further showed that a majority of the respondents are willing to work in larger shared practices (with 3-4 GPs) if they receive an increase in surplus (approximately 50,000 DKK/6,719 EUR per year) and that they may be willing to take in more patient-related work if the increase in surplus is sufficient (approximately 200,000 DKK/26,875 EUR per year for 5 extra hours per week). Monetary incentives may therefore be an effective tool for further improving productivity.

Considering the health care entity C corporation conversion to tax pass-through entity status.

PubMed

Reilly, Robert F

2012-01-01

The double taxation of C corporation income from operations and from the ultimate sale of its assets makes the C corporation an inefficient tax status for many health care entities. At the time of this writing, the changes in the federal tax law that are scheduled to take effect in 2013 will increase this level of double-taxation inefficiency. The owners of a C corporation practice can avoid the C corporation status tax inefficiency by converting the practice to either (1) S corporation status or (2) LLC status. The conversion of the health care C corporation to an S corporation may be accomplished without a current tax cost. However, the conversion of a health care C corporation to an LLC status can result in a current tax at both the corporation level and the shareholder level. Nonetheless, the current conversion tax cost may be less than the future tax cost (1) of operating the practice as a C corporation and incurring double taxation at what may be higher tax rates or (2) of incurring the higher tax cost (or reduced price) on the ultimate disposition of the practice assets and the attendant double taxation of the appreciation in the value of the practice assets. Since individual income tax rates on qualifying dividends from C corporations and on capital gains are currently at very low rates, this may be a good time for C corporation practice owners to consider the costs and benefits of a conversion to either S corporation status or LLC status. The practice owners should consult with their accounting, legal, and valuation advisors in order to consider all of the costs and benefits of a possible corporate tax status conversion. An estimation of both the costs and benefits of the corporate tax status conversion depends on the concluded fair market values of the medical practice, dental practice, or other health care entity assets. And, that practice asset appraisal should encompass all of the practice assets, both tangible assets and intangible assets.

Molecular testing for cystic fibrosis carrier status practice guidelines: recommendations of the National Society of Genetic Counselors.

PubMed

Langfelder-Schwind, Elinor; Karczeski, Barbara; Strecker, Michelle N; Redman, Joy; Sugarman, Elaine A; Zaleski, Christina; Brown, Trisha; Keiles, Steven; Powers, Amy; Ghate, Sumheda; Darrah, Rebecca

2014-02-01

To provide practice recommendations for genetic counselors whose clients are considering cystic fibrosis (CF) carrier testing or seeking information regarding CF molecular test results. The goals of these recommendations are to: 1) Provide updated information about the natural history, diagnosis, and treatment of CF and related conditions. 2) Supplement genetic counselors' knowledge and understanding of the available carrier screening and diagnostic testing options. 3) Describe the current state of genotype/phenotype correlations for CFTR mutations and an approach to interpreting both novel and previously described variants. 4) Provide a framework for genetic counselors to assist clients' decision-making regarding CF carrier testing, prenatal diagnosis, and pregnancy management. Disclaimer The practice guidelines of the National Society of Genetic Counselors (NSGC) are developed by members of the NSGC to assist genetic counselors and other health care providers in making decisions about appropriate management of genetic concerns; including access to and/or delivery of services. Each practice guideline focuses on a clinical or practice-based issue, and is the result of a review and analysis of current professional literature believed to be reliable. As such, information and recommendations within the NSGC practice guidelines reflect the current scientific and clinical knowledge at the time of publication, are only current as of their publication date, and are subject to change without notice as advances emerge.In addition, variations in practice, which take into account the needs of the individual patient and the resources and limitations unique to the institution or type of practice, may warrant approaches, treatments and/or procedures that differ from the recommendations outlined in this guideline. Therefore, these recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. Genetic counseling practice guidelines are never intended to displace a health care provider's best medical judgment based on the clinical circumstances of a particular patient or patient population.Practice guidelines are published by NSGC for educational and informational purposes only, and NSGC does not "approve" or "endorse" any specific methods, practices, or sources of information.

Medical Education and Health Care Delivery: A Call to Better Align Goals and Purposes.

PubMed

Sklar, David P; Hemmer, Paul A; Durning, Steven J

2018-03-01

The transformation of the U.S. health care system is under way, driven by the needs of an aging population, rising health care spending, and the availability of health information. However, the speed and effectiveness of the transformation of health care delivery will depend, in large part, upon engagement of the health professions community and changes in clinicians' practice behaviors. Current efforts to influence practice behaviors emphasize changes in the health payment system with incentives to move from fee-for-service to alternative payment models.The authors describe the potential of medical education to augment payment incentives to make changes in clinical practice and the importance of aligning the purpose and goals of medical education with those of the health care delivery system. The authors discuss how curricular and assessment changes and faculty development can align medical education with the transformative trends in the health care delivery system. They also explain how the theory of situated cognition offers a shared conceptual framework that could help address the misalignment of education and clinical care. They provide examples of how quality improvement, health care innovation, population care management, and payment alignment could create bridges for joining health care delivery and medical education to meet the health care reform goals of a high-performing health care delivery system while controlling health care spending. Finally, the authors illustrate how current payment incentives such as bundled payments, value-based purchasing, and population-based payments can work synergistically with medical education to provide high-value care.

Bladder catheterization in Greek nursing education: An audit of the skills taught.

PubMed

Theofanidis, Dimitrios; Fountouki, Antigoni

2011-02-01

The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is the teaching of male catheterization. To assess the current educational model regarding male bladder catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse undergraduate training by implementing appropriate recommendations for change to the current educational module and support these changes in the long term. A systematic search of international databases for guidelines or best practice regarding bladder catheterization was conducted. Audit measures included direct observation of the teaching process and compilation of a checklist. The shortcomings are discussed under the following headings: patient pre-preparation, choice and quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the educational experience. The main problem with the teaching process exposed by the audit is entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence base practices. Copyright © 2010 Elsevier Ltd. All rights reserved.

The future of optometric practice? The results of a survey of optometrists and optometry students.

PubMed

Silverman, Morton W; Woodruff, Chris; Hardigan, Patrick C

2004-10-01

There is an apparent increase in the number of private optometry practices that are closing due to a lack of interested buyers. We examined some of the factors that influence the market for optometry practices in a survey of practicing optometrists and third- and fourth-year optometry students. Optometrists in six states, and students at four schools and colleges of optometry, completed a mailed or faxed survey regarding attitudes toward optometric practice, including fair/reasonable compensation for a new optometrist, the value of optometric practices, and preferred mode of practice on graduation. Doctors and students differed significantly in the amount of money they reported as fair/reasonable compensation for a recently graduated optometrist joining a practice. Comparing students to doctors in specific categories of compensation, students chose a higher fair/reasonable compensation compared to doctors. Students were more likely than doctors to choose >$70,000 as fair/reasonable compensation, while doctors were more likely than students to choose $40,000 to $69,000. Doctors tended to overvalue their practices for the purpose of selling the practice when using percentage of gross income as a valuation method. Students' choices for mode of practice changed dramatically from their ideal when taking their current financial situation into consideration. Students were more likely to choose corporate practice as their preferred practice mode when considering their current financial situation than when not restricted. There are many factors that affect the value and marketability of an optometric practice. In order to sell a practice, the owner must consider the effects of the needs and desires of recently graduated optometrists.

Widow inheritance and HIV/AIDS in rural Uganda.

PubMed

Mabumba, E D; Mugyenyi, P; Batwala, V; Mulogo, E M; Mirembe, J; Khan, F A; Liljestrand, J

2007-10-01

Despite current efforts to combat HIV/AIDS through behavioural change, ingrained socio-cultural practices such as widow inheritance in south-western Uganda has not changed. Low education, unemployment, dowry, widows' socioeconomic demands and the inheritor's greed for the deceased's wealth, influence widow inheritance. Voluntary counselling and testing is needed for the widows and their inheritors; formal dowry should be removed from marriage and widow inheritance stripped of its sexual component.

A change management approach to improving safety and preventing needle stick injuries.

PubMed

Aziz, Ann-Marie

2017-09-01

Key drivers for preventing healthcare-associated infection (HCAI) include evidence-based practices and procedures that prevent infection. Among the current guidance for preventing HCAIs is evidence and mandatory requirements for reducing needle stick injuries (NSIs). This article highlights how John Kotter's model for change could help healthcare workers plan for successful and sustained deployment of needle safety devices (NSDs) and ultimately reduce the risk of a NSI.

Strategies for the municipal waste management system to take advantage of carbon trading under competing policies: The role of energy from waste in Sydney

DOE Office of Scientific and Technical Information (OSTI.GOV)

El Hanandeh, Ali; El-Zein, Abbas

2009-07-15

Climate change is a driving force behind some recent environmental legislation around the world. Greenhouse gas emission reduction targets have been set in many industrialised countries. A change in current practices of almost all greenhouse-emitting industrial sectors is unavoidable, if the set targets is to be achieved. Although, waste disposal contributes around 3% of the total greenhouse gas emissions in Australia (mainly due to fugitive methane emissions from landfills), the carbon credit and trading scheme set to start in 2010 presents significant challenges and opportunities to municipal solid waste practitioners. Technological advances in waste management, if adopted properly, allow themore » municipal solid waste sector to act as carbon sink, hence earning tradable carbon credits. However, due to the complexity of the system and its inherent uncertainties, optimizing it for carbon credits may worsen its performance under other criteria. We use an integrated, stochastic multi-criteria decision-making tool that we developed earlier to analyse the carbon credit potential of Sydney municipal solid waste under eleven possible future strategies. We find that the changing legislative environment is likely to make current practices highly non-optimal and increase pressures for a change of waste management strategy.« less

Leadership of education psychological services: fit for purpose?

PubMed Central

Booker, Roger

2013-01-01

At a time of great change for educational psychology services in England, this paper reviews current theories of leadership and proposes how an integration of key aspects of these can be applied to support a self review of leadership practice, both by individual leaders and by services. The message from current theory is that in the midst of complexity and rapid change, a primary focus on the head of service is outdated; there should instead be a focus to develop the leadership capacity of the service as a whole. Key constructs considered are systems thinking, social identity, authenticity, and leadership as social construction. PMID:26157196

Succession planning.

PubMed

Catanzaro, Thomas E

2006-03-01

This article provides the reader with an appreciation of the diverse elements that go into a buy-sell, affiliation, or merger situation for veterinary practices. In the changing market place of American veterinary medicine, old paradigms no longer hold comfort. The generational differences are briefly explored herein as well as the new economic realities. A few examples are offered to illustrate just how much variability exists in the current business of veterinary medicine and the subsequent practice transitions needed to enhance value. Functioning models are explored, as well as affiliation and merger options. Practice valuation is discussed in general terms, referencing the cutting-edge factors. The six-point summary provides almost all practices a solid operational base for daily operations and succession planning.

Terminal Area Productivity Program: Dynamic Spacing Human Factors

NASA Technical Reports Server (NTRS)

Kanki, Barbara G.

1997-01-01

Dynamic spacing human factors deals with the following human factors issues: define controller limits to incorporating dynamic changes in separation standards; identify timing, planning, and coordination strategies; and consider consistency with current practices, policies, and regulations. The AVOSS technologies will make it possible to reduce separation standards in the terminal area under certain meteorological conditions. This paper contains the following sections: Dynamic space human factors overview, Preliminary tests, and current research status & plans.

A Cost Benefit - Analysis of Establishing a Warehouse Facility for the Services Division of the Directorate of Personnel and Community Activities at Fort Ord, California

DTIC Science & Technology

1990-06-01

Thomas J. Strel Approved by: , . ,, William R. Gates, Thesis Advisor Paul M. Carrick, Second Reader y David R. Wh pl e , Chairman Department of...AFFAIRS DEPARTM ENT .................................. 2 B. CURRENT PROCUREMENT PROCEDURES ................. 4 C. REASONS TO CHANGE CURRENT PRACTICES...Storage, Handling and Distribution Requirements and Cost . 32 e . Inventory - Ordering and Holding Costs and Order Quantity

The Influence of Field Teaching Practice on Pre-service Teachers’ Professional Identity: A Mixed Methods Study

PubMed Central

Zhao, Hongyu; Zhang, Xiaohui

2017-01-01

The current study used mixed methods to research pre-service teachers’ professional identity. Ninety-eight pre-service teachers were investigated and twelve teachers were interviewed in China. The results were as follows: (1) The results of quantitative data showed that compared with before the field teaching practice, pre-service teachers’ professional identity increased after the field teaching practice—specifically, intrinsic value identity increased, and extrinsic value identity did not significantly change; (2) The results of qualitative data validated and elaborated the results of quantitative data in more detail with regard to changes in professional identity. Specifically, compared with before the field teaching practice, intrinsic value identity including work content, work pattern, etc., increased and extrinsic value identity including work environment, income, and social status, etc., did not significantly change after experiencing teaching practice; (3) The results of qualitative data also showed that mentor support at field school promoted the development of pre-service teachers’ professional identity. Moreover, the development of pre-service teachers’ professional identity during field teaching practice further promoted their professional commitment; that is, it promoted their emotional evaluation and belief in the teaching profession. The study discussed these results and proposed solutions and suggestions for future studies. PMID:28790956

Spectators & spectacles: nurses, midwives and visuality.

PubMed

Barnard, Alan G; Sinclair, Marlene

2006-09-01

In this paper we reflect on how linear perspective vision influences the practice of nurses and midwives and to advance understanding of clinical practice in technologically intensive environments through examination of drawings by nurses and midwives and through critical analysis. There is increasing emphasis on vision in Western culture, and both nurses and midwives spend a great deal of time observing their clinical environment(s). Healthcare practitioners work increasingly in image-based realities and nurses rely on visual skills. Vision and visual representation are central to our practice and are important to examine because we look often at technology to assess people and care. The world in which we practise is one of meaning(s). Technological development is transformative in nature and produces changes that alter the way(s) we give care. Amongst all this change, it is unclear how we practise in environments characterized by increasing technology and it is unknown how nursing and midwifery practice alter as a result. Simple drawings included in this paper highlight an important and shared experience of clinical practice(s). They emphasize the importance and scope of the visual sense and expose practitioner behaviour that has enormous implications for current and future professional development and person-focussed care provision. Experiences described in this paper require further examination and highlight substantial changes to nurse-patient relationships, health care and the way we practise.

Improving medical students’ knowledge of genetic disease: a review of current and emerging pedagogical practices

PubMed Central

Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

2015-01-01

Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

Reconsidering acculturation in dietary change research among Latino immigrants: challenging the preconditions of US migration

PubMed Central

Martínez, Airín D.

2012-01-01

BACKGROUND Dietary changes among Latino immigrants are often attributed to acculturation. Acculturation-diet research typically assumes that migration to the US is necessary for negative dietary changes to occur in Latino immigrants’ diets. OBJECTIVE The goal of this article is to demonstrate that extant acculturation research is not adequate in capturing changes in Latino immigrants’ diets. This is due to the role of globalization and transnational processes in modernizing their diets in Latin America. DESIGN Utilizing an interactionist cultural studies approach, this exploratory situational analysis based on 27 in-depth interviews with Latino immigrants, nutrition reports, and transnational food companies’ websites, examines how Latino immigrants were already engaging in negative dietary practices in their former country. RESULTS Latino immigrants who resided in urban areas in their former countries and migrated to the US on or after 2000 were fully engaged in negative dietary practices prior to migration. Such practices included consuming food outside of the home and integrating processed food into their cooking. Their dietary practices were also informed by nutrition discourses. The modernization of food production and consumption and the transnational transmission of nutrition are transnational processes changing Latino immigrants’ diets prior to migration. CONCLUSION Researchers should approach the study of dietary change among Latino immigrants in the US through a transnational perspective in order to avoid overlooking potential confounders such as current food insecurity, new socioeconomic positions as undocumented, low-income persons, and increased hours worked outside of the home. PMID:22731980

Cultural change after migration: Circumcision of girls in Western migrant communities.

PubMed

Johnsdotter, Sara; Essén, Birgitta

2016-04-01

This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the 'Pharaonic' type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using--in a cautious way--the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The effect of recent amblyopia research on current practice in the UK.

PubMed

Newsham, D

2010-10-01

Several studies have recently provided insights into how amblyopia may be most effectively managed. Despite the new evidence, a US study reported that a recent randomised controlled trial had made little influence on clinical practice. The aims of this research are to assess current practice of amblyopia management in the UK and to determine the comparability with the evidence-based recommendations. A questionnaire was constructed to assess current amblyopia management practice, particularly in relation to areas investigated by recent research and emailed to every head orthoptist within the UK. There was a great deal of variability in the amount of occlusion that was prescribed for moderate and severe amblyopia. Sixty per cent of clinicians indicated that the maximum they would prescribe was in excess of the 6 h recommended by research. Atropine was rarely recommended as a first-line treatment, with occlusion generally being considered to be more effective. Despite recommendations regarding education as a means of reducing non-compliance, only 39% of clinicians always gave written information, although various other methods of enhancing compliance were used. A period of refractive adaptation was allowed by most clinicians but often far less than recommended. The uptake of recent research evidence into clinical practice is sporadic and incomplete with one-third of respondents indicating that following the studies, they had made no changes whatsoever to their practice. This is similar to other areas of medicine; the reasons are likely to be varied, and is an area that would benefit from greater attention.

History of cardiopulmonary bypass (CPB).

PubMed

Hessel, Eugene A

2015-06-01

The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal. Copyright © 2015 Elsevier Ltd. All rights reserved.

Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review.

PubMed

Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley

2015-12-01

Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings. © 2015 Occupational Therapy Australia.

Modeling the influence of climate change on watershed systems: Adaptation through targeted practices

NASA Astrophysics Data System (ADS)

Dudula, John; Randhir, Timothy O.

2016-10-01

Climate change may influence hydrologic processes of watersheds (IPCC, 2013) and increased runoff may cause flooding, eroded stream banks, widening of stream channels, increased pollutant loading, and consequently impairment of aquatic life. The goal of this study was to quantify the potential impacts of climate change on watershed hydrologic processes and to evaluate scale and effectiveness of management practices for adaptation. We simulate baseline watershed conditions using the Hydrological Simulation Program Fortran (HSPF) simulation model to examine the possible effects of changing climate on watershed processes. We also simulate the effects of adaptation and mitigation through specific best management strategies for various climatic scenarios. With continuing low-flow conditions and vulnerability to climate change, the Ipswich watershed is the focus of this study. We quantify fluxes in runoff, evapotranspiration, infiltration, sediment load, and nutrient concentrations under baseline and climate change scenarios (near and far future). We model adaptation options for mitigating climate effects on watershed processes using bioretention/raingarden Best Management Practices (BMPs). It was observed that climate change has a significant impact on watershed runoff and carefully designed and maintained BMPs at subwatershed scale can be effective in mitigating some of the problems related to stormwater runoff. Policy options include implementation of BMPs through education and incentives for scale-dependent and site specific bioretention units/raingardens to increase the resilience of the watershed system to current and future climate change.

Soil water management practices (terraces) helped to mitigate the 2015 drought in Ethiopia.

PubMed

Kosmowski, Frédéric

2018-05-31

While the benefits of soil water management practices relative to soil erosion have been extensively documented, evidence regarding their effect on yields is inconclusive. Following a strong El-Niño, some regions of Ethiopia experienced major droughts during the 2015/16 agricultural season. Using the propensity scores method on a nationally representative survey in Ethiopia, this study investigates the effect of two widely adopted soil water management practices - terraces and contour bunds - on yields and assesses their potential to mitigate the effects of climate change. It is shown that at the national level, terraced plots have slightly lower yields than non-terraced plots. However, data support the hypothesis that terraced plots acted as a buffer against the 2015 Ethiopian drought, while contour bunds did not. This study provides evidence that terraces have the potential to help farmer deal with current climate risks. These results can inform the design of climate change adaptation policies and improve targeting of soil water management practices in Ethiopia.

CNS role evolution.

PubMed

Payne, J L; Baumgartner, R G

1996-01-01

THE CNS ROLE has been actualized in a variety of ways. Flexibility-inherent in the role-and the revolution in health care consciousness tend to place the CNS at risk for criticism regarding value to the organization. At Vanderbilt University Medical Center, a CNS task force evaluated the current reality of CNS practice and recommended role changes to include the financial analysis of patient care. After incorporating a financial perspective into our present practice, we have embarked on an interesting journey of post-Master's degree study, that of the tertiary care nurse practitioner. This practice option could elevated the clinical and financial aspects of providing cost-effective health care to a more autonomous role form; however, the transition has been challenging. Since 1990, the American Nurses Association has recommended that nursing school curricula change to meet the needs of the health care environment and provide increased career flexibility through creating one advanced degree incorporating both CNS and NP functions. Swiftly moving past differences and toward similarities will bridge the gap for advanced practice nurses in the future.

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

PubMed

Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

2017-09-01

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

PubMed

Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

2010-01-01

Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

Shame as a Cultural Artifact: A Call for Self-Awareness and Reflexivity in Personality Assessment.

PubMed

Aschieri, Filippo

2016-01-01

It has become common for assessors to face therapeutic impasses and dilemmas when practicing within the Therapeutic Assessment (TA) model. This is due to the explicit goal of producing therapeutic changes in clients. In this article the author discusses the importance of assessors being aware of how their clinical practices relate to their assessment outcomes. To enhance such awareness, the author reviews the characteristics of psychological assessment practices as derived from 3 paradigms developed almost 1.5 centuries ago in Europe by the forefathers of psychology as a scientific discipline. Current assessment practices are deeply ingrained in specific cultural, social, and political frameworks originating in these paradigms. Being aware of such a historical and cultural background might help the assessor avoid blindly reenacting the values, norms, and latent relational schemas implied by different assessment methods, and instead use assessment tools as potent aids in the service of clients' change. Finally, the author illustrates how the experience of clients' shame in psychological assessment might also be understood as a by-product of the specific cultural and historical background of certain common assessment practices.

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law.

PubMed

O'Brien, J W; Natarajan, M; Shaikh, I

2017-06-01

The UK Supreme Court recently ruled that when consenting patients for treatments or procedures, clinicians must also discuss any associated material risks. We surveyed medical staff at a large UK teaching hospital in order to ascertain knowledge of consent law and current understanding of this change. Email survey sent to medical staff in all specialities at Norfolk and Norwich University Hospital in February 2016. 245 responses (141 Consultants and 104 junior doctors, response rate 32%). 82% consent patients for procedures at least monthly and 23% daily. 31% were not familiar with the concept of material risk. 35% were familiar with the recent change in consent law, 41% were not. 18% were "very uncertain" and 64% "a little uncertain" that their consenting process meets current legal requirements. >92% think that landmark cases and changes in law should be discussed through professional bodies and circulated better locally. The majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

Current State of Overlapping, Concurrent, and Multiple-Room Surgery in Otolaryngology: A National Survey.

PubMed

Cognetti, David M; Nussenbaum, Brian; Brenner, Michael J; Chi, David H; McCormick, Michael E; Venkatraman, Giri; Zhan, Tingting; McKinlay, Alex J

2017-12-01

Objective Multiple-room surgery has gained attention due to reports in the lay press scrutinizing the activity, with hospitals and the government collecting data on current practice. We studied practices and attitudes toward multiple-room surgery in otolaryngology. Methods A survey was developed by members of the Patient Safety and Quality Improvement Committee of the American Academy of Otolaryngology-Head and Neck Surgery. The survey was distributed to members of the Academy and included questions on demographics, current practices, and opinions regarding multiple-room surgery. The survey was designed to capture the spectrum of multidisciplinary, overlapping, and simultaneous/concurrent surgery practices. Data were collected via SurveyMonkey. Results A total of 907 of 9520 members completed the survey. Of the respondents, 40.4% reported performing some form of multiple-room surgery. Multiple-room surgery is more common amongst subspecialists than general otolaryngologists. Most believed that regulations disallowing multiple-room surgery would result in an increase in late starts (73.5%), an increase in the time to schedule surgery (84.5%), a detriment to residency training (63.1%), and no improvement in patient safety (60%.) Discussion Multiple-room surgery is common among responding otolaryngologists. Most respondents consider the practice to serve a role in facilitating access, efficiency, and training. Implications for Practice Due to recent attention placed on multiple-room surgery, institutions are reviewing policies regarding the practice. This survey suggests that policy changes that restrict multiple-room surgery must consider a potential unintended negative impact on patient care and access.

Practices and risks associated with operation of tie-down lashings in the vehicle transport industry.

PubMed

Fraysse, François; Milanese, Steven; Thewlis, Dominic

2016-12-01

Load restraint systems in automobile transport utilise tie-down lashings placed over the car's tyres, which are tensioned manually by the operator using a ratchet assembly. This process has been identified as a significant manual handling injury risk. The aim of this study was to gain insight on the current practices associated with tie-down lashings operation, and identify the gaps between current and optimal practice. We approached this with qualitative and quantitative assessments and one numerical simulation to establish: (i) insight into the factors involved in ratcheting; (ii) the required tension to hold the car on the trailer; and (iii) the tension achieved by drivers in practice and associated joint loads. We identified that the method recommended to the drivers was not used in practice. Drivers instead tensioned the straps to the maximum of their capability, leading to over-tensioning and mechanical overload at the shoulder and elbow. We identified the postures and strategies that resulted in the lowest loads on the upper body during ratcheting (using both hands and performing the task with their full body). This research marks the first step towards the development of a training programme aiming at changing practice to reduce injury risks associated with the operation of tie-down lashings in the automobile transport industry. Practitioner Summary: The study investigated current practice associated with the operation of tie-down lashings through qualitative (interviews) and quantitative (biomechanical analysis) methods. Operators tended to systematically over-tension the lashings and consequently overexert, increasing injury risks.

Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

PubMed

Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

2017-08-10

Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (P<0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14-0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24-6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02-3.94). Conclusions Rural-urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value.

K-5 mentor teachers' journeys toward reform-oriented science within a professional development school context

NASA Astrophysics Data System (ADS)

Manno, Jacqueline L.

Reform-oriented science teaching with a specific focus on evidence and explanation provides a student-centered learning environment which encourages children to question, seek answers to those questions, experience phenomena, share ideas, and develop explanations of science concepts based on evidence. One of the ways schools have risen to meet the challenge of ever-increasing demands for success in science and all other curricular areas has been in the development of professional development schools (PDSs). Dedicated to the simultaneous renewal of schools and teacher education programs, the structure of a PDS plays a significant role in the change process. The purpose of this research study was to investigate the nature of change in mentor teachers' beliefs and pedagogical practices toward science teaching in the elementary school as conveyed through their own "stories of practice". The major research questions that guided the study were: (1) How do mentor teachers describe their science teaching practices and how have they changed as a result of participation in PDS? (a) In what ways do PDS mentor teachers' descriptions of practice reflect contemporary reform ideas and practices in science education? (b) To what extent do their stories emphasize technical aspects of teaching versus epistemological changes in their thinking and knowledge? (c) How is student learning in science reflected in teachers' stories of practice? (2) What is the relationship between the levels and types of involvement in PDS to change in thinking about and practices of teaching science? (3) What is the depth of commitment that mentors convey about changes in science teaching practices? Using case study design, the research explored the ways experienced teachers, working within the context of a PDS community, described changes in the ways they think about and teach science. The connection to the issue of change in teaching practices grew out of interest in understanding the relationship between mentor teachers' engagement in PDS activities and their thinking about classroom practice. The main focus of this research study was on change in science teaching within the context of a professional development school. PDS literature and current literature on the learning and teaching of science in grades K-8 provided a theoretical orientation to guide the research. Additionally, literature on the process of change in schools helped to narrow the focus of the study while using a lens of situated learning provided additional insight. Analysis of the interview data generated seven assertions that captured the nature of the change process of mentor teachers. Science-specific professional development as well as strong support and encouragement within an active community of learners played significant roles in the transformation of mentor teachers from traditional or activity-based science teachers into educators who use reform-oriented methods and a lens of evidence and explanation to guide their science teaching. Mentor teachers acknowledged an increase in student interest and excitement toward science as a result of these changes in science teaching practices. In addition, data revealed that mentor teachers remained committed to their changed practice after several years. By examining the change process of mentor teachers in a PDS environment, findings from this study are discussed based on implications regarding the factors that contribute to and affect change as reform-oriented practices are implemented in science, a curricular area that is often neglected by elementary teachers.

Strategies to translate knowledge related to common musculoskeletal conditions into physiotherapy practice: a systematic review.

PubMed

Bérubé, Marie-Ève; Poitras, Stéphane; Bastien, Marc; Laliberté, Lydie-Anne; Lacharité, Anyck; Gross, Douglas P

2018-03-01

Many physiotherapists underuse evidence-based practice guidelines or recommendations when treating patients with musculoskeletal disorders, yet synthesis of knowledge translation interventions used within the field of physiotherapy fails to offer clear conclusions to guide the implementation of clinical practice guidelines. To evaluate the effectiveness of various knowledge translation interventions used to implement changes in the practice of current physiotherapists treating common musculoskeletal issues. A computerized literature search of MEDLINE, CINHAL and ProQuest of systematic reviews (from inception until May 2016) and primary research studies (from January 2010 until June 2016). Eligibility criteria specified articles evaluating interventions for translating knowledge into physiotherapy practice. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Of a total of 13014 articles located and titles and abstracts screened, 34 studies met the inclusion criteria, including three overlapping publications, resulting in 31 individual studies. Knowledge translation interventions appear to have resulted in a positive change in physiotherapist beliefs, attitudes, skills and guideline awareness. However, no consistent improvement in clinical practice, patient and economic outcomes were observed. The studies included had small sample sizes and low methodological quality. The heterogeneity of the studies was not conducive to pooling the data. The intensity and type of knowledge translation intervention seem to have an effect on practice change. More research targeting financial, organizational and regulatory knowledge translation interventions is needed. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada

PubMed Central

2013-01-01

Background Balance impairment is common in multiple clinical populations, and comprehensive assessment is important for identifying impairments, planning individualized treatment programs, and evaluating change over time. However, little information is available regarding whether clinicians who treat balance are satisfied with existing assessment tools. In 2010 we conducted a cross-sectional survey of balance assessment practices among physiotherapists in Ontario, Canada, and reported on the use of standardized balance measures (Sibley et al. 2011 Physical Therapy; 91: 1583-91). The purpose of this study was to analyse additional survey data and i) evaluate satisfaction with current balance assessment practices and standardized measures among physiotherapists who treat adult or geriatric populations with balance impairment, and ii) identify factors associated with satisfaction. Methods The questionnaire was distributed to 1000 practicing physiotherapists. This analysis focuses on questions in which respondents were asked to rate their general perceptions about balance assessment, the perceived utility of individual standardized balance measures, whether they wanted to improve balance assessment practices, and why. Data were summarized with descriptive statistics and utility of individual measures was compared across clinical practice areas (orthopaedic, neurological, geriatric or general rehabilitation). Results The questionnaire was completed by 369 respondents, of which 43.4% of respondents agreed that existing standardized measures of balance meet their needs. In ratings of individual measures, the Single Leg Stance test and Berg Balance Scale were perceived as useful for clinical decision-making and evaluating change over time by over 70% of respondents, and the Timed Up-and-Go test was perceived as useful for decision-making by 56.9% of respondents and useful for evaluating change over time by 62.9% of respondents, but there were significant differences across practice groups. Seventy-nine percent of respondents wanted to improve their assessments, identifying individual, environmental and measure-specific barriers. The most common barriers were lack of time and knowledge. Conclusions This study offers new information on issues affecting the evaluation of balance in clinical settings from a broad sample of physiotherapists. Continued work to address barriers by specific practice area will be critical for the success of any intervention attempting to implement optimal balance assessment practices in the clinical setting. PMID:23510277

The Molecules of Life.

ERIC Educational Resources Information Center

Weinberg, Robert A.

1985-01-01

New advances in molecular biology have established a biotechnology industry and have changed ways people think about living things. In support of this theme, a discussion on historical development and current practice of gene cloning is presented. The role of nucleic acids, viruses, and therapeutic intervention is also considered. (DH)

Financial Reporting for Tennessee Public Colleges and Universities.

ERIC Educational Resources Information Center

Tennessee Higher Education Commission, Nashville.

This manual provides a framework for accounting practices, budgeting and reporting procedures for Tennessee public higher education institutions. Emphasis is placed on principles and procedures of accounting and financial reporting; the balance sheet; statement of changes in fund balances; statement of current funds revenues, expenditures, and…

Reinvention of the Public Library for the 21st Century.

ERIC Educational Resources Information Center

Whitesides, William L., Sr., Ed.

This book, written by graduate students at the Catholic University (District of Columbia) School of Library and Information Science, examines current priorities, policies, and practices of public libraries. Following an introduction, "Reinventing Libraries: Responding to the Forces of Change" (Lisa Crisman), chapters include: (1) "A…

Defining and Applying a Functionality Approach to Intellectual Disability

ERIC Educational Resources Information Center

Luckasson, R.; Schalock, R. L.

2013-01-01

Background: The current functional models of disability do not adequately incorporate significant changes of the last three decades in our understanding of human functioning, and how the human functioning construct can be applied to clinical functions, professional practices and outcomes evaluation. Methods: The authors synthesise current…

Soil quality impacts of current South American agricultural practices

USDA-ARS?s Scientific Manuscript database

Increasing global demand for oil seeds and cereals during the past 50 years has caused an expansion in the cultivated areas and resulted in major soil management and crop production changes throughout Bolivia, Paraguay, Uruguay, Argentina and southern Brazil. Unprecedented adoption of no-tillage as ...

History and Current Status of Divorce in the United States.

ERIC Educational Resources Information Center

Furstenberg, Frank F., Jr.

1994-01-01

Explores the remarkable shift in marriage and divorce practices that has occurred in the last third of this century in the United States. Information is presented on trends in this country and other industrialized nations, and some reasons for these changes are explored. (SLD)

A Streamlined Monitoring Framework for Sustainable and Low Impact Development Stormwater Management Practices - 2

EPA Science Inventory

The problems of urbanization and stormwater management, as they pertain to monitoring the condition of water and environmental resources, are grounded in issues of scale, connectivity, temporal and non-linear change. Given our current understanding of these issues, the challenge ...

Characterizing body temperature and activity changes at the onset of estrus in replacement gilts

USDA-ARS?s Scientific Manuscript database

Accurate estrus detection can improve sow conception rates and increase swine production efficiency. Unfortunately, current estrus detection practices based on individual animal behavior may be inefficient due to large sow populations at commercial farms and the associated labor required. Therefore,...

Mobilising Research Knowledge in Education

ERIC Educational Resources Information Center

Levin, Ben

2011-01-01

The field of knowledge mobilisation (KM) addresses the multiple ways in which stronger connections can be made between research, policy and practice. This paper reviews the current situation around knowledge mobilisation in education. It addresses changing understandings of KM, considers some of the main issues in conducting empirical research in…

Assessing Outcomes: Practical Methods and Evidence

ERIC Educational Resources Information Center

Moore, Jon; Owen, Jesse

2014-01-01

University counseling center clients' (N = 52) perceptions of precounseling functioning were highly correlated with their actual well-being scores at intake. The magnitude of change based on perceptions of precounseling functioning to current well-being was approximately double of what is found from the difference of actual precounseling…

Where the Money Is.

ERIC Educational Resources Information Center

Wharton, Clifton R., Jr.

1991-01-01

The chief executive officer of the Teachers' Insurance and Annuities Fund-College Retirement Equities Fund (TIAA-CREF) discusses the current widespread concern over retirement issues in general and the ending of mandatory retirement ages for college faculty. Changes in TIAA-CREF policies and practices affecting range and coverage of retirement…

Psychosocial Well-Being and the Relationship between Divorce and Children's Academic Achievement

ERIC Educational Resources Information Center

Potter, Daniel

2010-01-01

As an unprecedented number of children live in families experiencing divorce, researchers have developed increasingly complex explanations for the consequences associated with marital dissolution. Current accounts focus on changes to family finances, destabilized parenting practices, elevated parental conflict, and deterioration of the…

Changing Teacher Preparation in Art Education

ERIC Educational Resources Information Center

Henry, Carole; Lazzari, Mary

2007-01-01

Within art education, Day (1997) and others (for example; Beudert, 2006; Galbraith, 2001; Galbraith & Grauer, 2004; Hutchens, 1997; Sabol, 2004; Thurber, 2004; Zimmerman, 1997, 2004) have called for increased research into teacher preparation in order to understand current practice, to recognize what is working well, and to determine directions…

Education for the Information Age.

ERIC Educational Resources Information Center

Breivik, Patricia Senn

1992-01-01

To be effective in the current rapidly changing environment, individuals need more than a knowledge base. They also need information literacy which includes techniques for exploring new information, synthesizing it, and using it in practical ways. Undergraduate education should focus on such resource-based learning directed at problem solving.…

A depression training session with consumer educators to reduce stigmatizing views and improve pharmacists' depression care attitudes and practices.

PubMed

Liekens, Sophie; Smits, Tim; Laekeman, Gert; Foulon, Veerle

2013-08-12

To measure the impact of a depression training day for pharmacists that included a 75-minute session with a consumer educator. The training day included interactive lectures on depression; the effects and side effects of and indications for the use of antidepressants; adherence issues; non-drug treatment options for depression; and basic skills in communication. Pharmacists also participated in a session with a consumer educator and in counseling exercises that included role playing. The study used a randomized, clustered, comparative design to measure pharmacists' stigma, attitudes, and current practice related to the provision of pharmaceutical care to people with depression. Mean scores for depression-care practice after the training session were significantly higher in the intervention group than in the control group. Analysis of the changes between baseline and postintervention measures in both the control and intervention groups confirmed a significant difference in the change in both social distance and practice but no significant difference in the change in attitude between the 2 groups of pharmacists. A continuing-education depression training day for pharmacists that involve consumer educators may improve the care delivered in the community pharmacy to people with depression.

Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.

PubMed

McCluskey, Annie; Vratsistas-Curto, Angela; Schurr, Karl

2013-08-19

Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments while physiotherapists generally knew how to implement best-practice mobility rehabilitation (an enabler). Findings add to current knowledge about barriers to change and implementation of multiple guideline recommendations. Major challenges included sexuality education and depression screening. Limited knowledge and skills was a common barrier. Knowledge about specific interventions was needed before implementation could commence, and to maintain treatment fidelity. The provision of detailed online intervention protocols and manuals may help clinicians to overcome the knowledge barrier.

Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study

PubMed Central

2013-01-01

Background Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. Methods A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Results Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments while physiotherapists generally knew how to implement best-practice mobility rehabilitation (an enabler). Conclusions Findings add to current knowledge about barriers to change and implementation of multiple guideline recommendations. Major challenges included sexuality education and depression screening. Limited knowledge and skills was a common barrier. Knowledge about specific interventions was needed before implementation could commence, and to maintain treatment fidelity. The provision of detailed online intervention protocols and manuals may help clinicians to overcome the knowledge barrier. PMID:23958136

Activist engineering: changing engineering practice by deploying praxis.

PubMed

Karwat, Darshan M A; Eagle, Walter E; Wooldridge, Margaret S; Princen, Thomas E

2015-02-01

In this paper, we reflect on current notions of engineering practice by examining some of the motives for engineered solutions to the problem of climate change. We draw on fields such as science and technology studies, the philosophy of technology, and environmental ethics to highlight how dominant notions of apoliticism and ahistoricity are ingrained in contemporary engineering practice. We argue that a solely technological response to climate change does not question the social, political, and cultural tenet of infinite material growth, one of the root causes of climate change. In response to the contemporary engineering practice, we define an activist engineer as someone who not only can provide specific engineered solutions, but who also steps back from their work and tackles the question, What is the real problem and does this problem "require" an engineering intervention? Solving complex problems like climate change requires radical cultural change, and a significant obstacle is educating engineers about how to conceive of and create "authentic alternatives," that is, solutions that differ from the paradigm of "technologically improving" our way out of problems. As a means to realize radically new solutions, we investigate how engineers might (re)deploy the concept of praxis, which raises awareness in engineers of the inherent politics of technological design. Praxis empowers engineers with a more comprehensive understanding of problems, and thus transforms technologies, when appropriate, into more socially just and ecologically sensitive interventions. Most importantly, praxis also raises a radical alternative rarely considered-not "engineering a solution." Activist engineering offers a contrasting method to contemporary engineering practice and leads toward social justice and ecological protection through problem solving by asking not, How will we technologize our way out of the problems we face? but instead, What really needs to be done?

Educating change agents: a qualitative descriptive study of graduates of a Master's program in evidence-based practice.

PubMed

Hole, Grete Oline; Brenna, Sissel Johansson; Graverholt, Birgitte; Ciliska, Donna; Nortvedt, Monica Wammen

2016-02-25

Health care professionals are expected to build decisions upon evidence. This implies decisions based on the best available, current, valid and relevant evidence, informed by clinical expertise and patient values. A multi-professional master's program in evidence-based practice was developed and offered. The aims of this study were to explore how students in this program viewed their ability to apply evidence-based practice and their perceptions of what constitute necessary conditions to implement evidence-based practice in health care organizations, one year after graduation. A qualitative descriptive design was chosen to examine the graduates' experiences. All students in the first two cohorts of the program were invited to participate. Six focus-group interviews, with a total of 21 participants, and a telephone interview of one participant were conducted. The data was analyzed thematically, using the themes from the interview guide as the starting point. The graduates reported that an overall necessary condition for evidence-based practice to occur is the existence of a "readiness for change" both at an individual level and at the organizational level. They described that they gained personal knowledge and skills to be "change-agents" with "self-efficacy, "analytic competence" and "tools" to implement evidence based practice in clinical care. An organizational culture of a "learning organization" was also required, where leaders have an "awareness of evidence- based practice", and see the need for creating "evidence-based networks". One year after graduation the participants saw themselves as "change agents" prepared to improve clinical care within a learning organization. The results of this study provides useful information for facilitating the implementation of EBP both from educational and health care organizational perspectives.

Consideration of climate change impacts and adaptation in EIA practice — Perspectives of actors in Austria and Germany

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiricka, Alexandra, E-mail: alexandra.jiricka@boku.ac.at; Department of Landscape, Spatial and Infrastructure Sciences, Institute for Landscape Development, Recreation and Conservation Planning, Peter-Jordan-Straße 82, 1190 Vienna; Formayer, Herbert

Current political discussions and developments indicate the importance and urgency of incorporating climate change considerations into EIA processes. The recent revision of the EU Directive 2014/52/EU on Environmental Impact Assessment (EIA) requires changes in the EIA practice of the EU member states. This paper investigates the extent to which the Environmental Impact Assessment (EIA) can contribute to an early consideration of climate change consequences in planning processes. In particular the roles of different actors in order to incorporate climate change impacts and adaptation into project planning subject to EIA at the appropriate levels are a core topic. Semi-structured expert interviewsmore » were carried out with representatives of the main infrastructure companies and institutions responsible in these sectors in Austria, which have to carry out EIA regularly. In a second step expert interviews were conducted with EIA assessors and EIA authorities in Austria and Germany, in order to examine the extent to which climate-based changes are already considered in EIA processes. This paper aims to discuss the different perspectives in the current EIA practice with regard to integrating climate change impacts as well as barriers and solutions identified by the groups of actors involved, namely project developers, environmental competent authorities and consultants (EIA assessors/practitioners). The interviews show that different groups of actors consider the topic to different degrees. Downscaling of climate change scenarios is in this context both, a critical issue with regards to availability of data and costs. Furthermore, assistance for the interpretation of relevant impacts, to be deducted from climate change scenarios, on the specific environmental issues in the area is needed. The main barriers identified by the EIA experts therefore include a lack of data as well as general uncertainty as to how far climate change should be considered in the process without reliable data but in the presence of knowledge about possible consequences at an abstract level. A joint strategy on how to cope with uncertain prognoses about main impacts on environmental issues for areas without reliable data requires a discussion and cooperation between EIA consultants and environmental authorities. - Highlights: • The consideration of climate change impacts in EIA practice in Austria and Germany was analysed through expert interviews. • Barriers as well as possible solutions were indentified by the different groups of actors involved in EIA. • The main challenges regard the investigation of specific entry points. • Limits of feasibility need to be discussed amongst the different groups of actors.« less

Theoretical links supporting the use of problem-based learning in the education of the nurse practitioner.

PubMed

Chikotas, Noreen Elaine

2008-01-01

The need to evaluate current strategies in educating the advanced practice nurse, specifically the nurse practitioner, is becoming more and more imperative due to the ever-changing health care environment. This article addresses the role of problem-based learning (PBL) as an instructional strategy in educating and preparing the nurse practitioner for future practice.Two theoretical frameworks supporting PBL, andragogy and constructivism, are presented as important to the use of PBL in the education of the nurse practitioner.

Getting governance right for a sustainable regionalised business model.

PubMed

Laurence, Caroline O; Black, Linda E; Rowe, Mark; Pearce, Rod

2011-06-06

The 1998 Ministerial Review of General Practice Training identified several areas for improvement that led to major changes in the provision of general practice training, including the establishment of General Practice Education and Training (GPET) and the regionalisation of training. The regionalised training business model has been in place for nearly 10 years, and several key organisations have been involved in its evolution, including the Australian Government, speciality colleges, GPET and regionalised training providers. Both the college-focused and regionalised-focused models have had some successes. These include recognition and support of general practice as a vocational specialty, increased numbers of junior doctors undertaking placements in general practice, and increased numbers of registrars training in rural areas. This period has also seen changes in the governance and decision-making processes with creation of a new framework that is inclusive of all the key players in the new regionalised training system. The future holds challenges for the regionalised training business model as the general practice education and training landscape becomes more complex. The framework in the current model will provide a base to help meet these challenges and allow for further sustainable expansion.

Integrating Climate Change Adaptation into Disaster Risk Reduction in Urban Contexts: Perceptions and Practice

PubMed Central

Rivera, Claudia

2014-01-01

This paper analyses the perceptions of disaster risk reduction (DRR) practitioners concerning the on-going integration of climate change adaptation (CCA) into their practices in urban contexts in Nicaragua. Understanding their perceptions is important as this will provide information on how this integration can be improved. Exploring the perceptions of practitioners in Nicaragua is important as the country has a long history of disasters, and practitioners have been developing the current DRR planning framework for more than a decade. The analysis is based on semi-structured interviews designed to collect information about practitioners’ understanding of: (a) CCA, (b) the current level of integration of CCA into DRR and urban planning, (c) the opportunities and constraints of this integration, and (d) the potential to adapt cities to climate change. The results revealed that practitioners’ perception is that the integration of CCA into their practice is at an early stage, and that they need to improve their understanding of CCA in terms of a development issue. Three main constraints on improved integration were identified: (a) a recognized lack of understanding of CCA, (b) insufficient guidance on how to integrate it, and (c) the limited opportunities to integrate it into urban planning due to a lack of instruments and capacity in this field. Three opportunities were also identified: (a) practitioners’ awareness of the need to integrate CCA into their practices, (b) the robust structure of the DRR planning framework in the country, which provides a suitable channel for facilitating integration, and (c) the fact that CCA is receiving more attention and financial and technical support from the international community. PMID:24475365

ACOG Committee Opinion no. 597: Committee on Obstetric Practice: Labor induction or augmentation and autism.

PubMed

2014-05-01

Functional oxytocin deficiency and a faulty oxytocin signaling pathway have been observed in conjunction with autism spectrum disorder (ASD). Because exogenous synthetic oxytocin commonly is administered for labor induction and augmentation, some have hypothesized that synthetic oxytocin used for these purposes may alter fetal oxytocin receptors and predispose exposed offspring to ASD. However, current evidence does not identify a causal relationship between labor induction or augmentation in general, or oxytocin labor induction specifically, and autism or ASD. Recognizing the limitations of available study design, conflicting data, and the potential consequences of limiting labor induction and augmentation, the Committee on Obstetric Practice recommends against a change in current guidance regarding counseling and indications for and methods of labor induction and augmentation.

The trials and tribulations of a practitioner-researcher: challenges and lessons learned through testing a feminist-cognitive-relational social work model of practice.

PubMed

Dombo, Eileen A; Bass, Ami P

2014-01-01

In practice with adult women who survived childhood sexual abuse, the field of social work currently lacks an evidence-based intervention. The current interventions, from the 1990s, come primarily from psychologists. The hypothesis that the Feminist-Cognitive-Relational Social Work Model and Intervention will be more effective in decreasing cognitive distortions, and increasing intimacy and relational health when compared to the standard agency intervention was tested in a quasi-experimental study. The challenges in carrying out the study in small, non-profit organizations are explored to highlight the difficulties in developing evidence-based interventions. Changes to implementation that resulted from the research findings are discussed.

Clinical immunology review series: an approach to desensitization

PubMed Central

Krishna, M T; Huissoon, A P

2011-01-01

Allergen immunotherapy describes the treatment of allergic disease through administration of gradually increasing doses of allergen. This form of immune tolerance induction is now safer, more reliably efficacious and better understood than when it was first formally described in 1911. In this paper the authors aim to summarize the current state of the art in immunotherapy in the treatment of inhalant, venom and drug allergies, with specific reference to its practice in the United Kingdom. A practical approach has been taken, with reference to current evidence and guidelines, including illustrative protocols and vaccine schedules. A number of novel approaches and techniques are likely to change considerably the way in which we select and treat allergy patients in the coming decade, and these advances are previewed. PMID:21175592

Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania.

PubMed

Carthon, J Margo Brooks; Wiltse Nicely, Kelly; Altares Sarik, Danielle; Fairman, Julie

2016-05-01

Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes. © The Author(s) 2016.

Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania

PubMed Central

Carthon, J. Margo Brooks; Nicely, Kelly Wiltse; Sarik, Danielle Altares; Fairman, Julie

2017-01-01

Background Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. Purpose To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. Method We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Discussion Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. Conclusions The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes. PMID:27502393

Probable Maximum Precipitation in the U.S. Pacific Northwest in a Changing Climate

NASA Astrophysics Data System (ADS)

Chen, Xiaodong; Hossain, Faisal; Leung, L. Ruby

2017-11-01

The safety of large and aging water infrastructures is gaining attention in water management given the accelerated rate of change in landscape, climate, and society. In current engineering practice, such safety is ensured by the design of infrastructure for the Probable Maximum Precipitation (PMP). Recently, several numerical modeling approaches have been proposed to modernize the conventional and ad hoc PMP estimation approach. However, the underlying physics have not been fully investigated and thus differing PMP estimates are sometimes obtained without physics-based interpretations. In this study, we present a hybrid approach that takes advantage of both traditional engineering practice and modern climate science to estimate PMP for current and future climate conditions. The traditional PMP approach is modified and applied to five statistically downscaled CMIP5 model outputs, producing an ensemble of PMP estimates in the Pacific Northwest (PNW) during the historical (1970-2016) and future (2050-2099) time periods. The hybrid approach produced consistent historical PMP estimates as the traditional estimates. PMP in the PNW will increase by 50% ± 30% of the current design PMP by 2099 under the RCP8.5 scenario. Most of the increase is caused by warming, which mainly affects moisture availability through increased sea surface temperature, with minor contributions from changes in storm efficiency in the future. Moist track change tends to reduce the future PMP. Compared with extreme precipitation, PMP exhibits higher internal variability. Thus, long-time records of high-quality data in both precipitation and related meteorological fields (temperature, wind fields) are required to reduce uncertainties in the ensemble PMP estimates.

The safety of high-hazard water infrastructures in the U.S. Pacific Northwest in a changing climate

NASA Astrophysics Data System (ADS)

Chen, X.; Hossain, F.; Leung, L. R.

2017-12-01

The safety of large and aging water infrastructures is gaining attention in water management given the accelerated rate of change in landscape, climate and society. In current engineering practice, such safety is ensured by the design of infrastructure for the Probable Maximum Precipitation (PMP). Recently, several numerical modeling approaches have been proposed to modernize the conventional and ad hoc PMP estimation approach. However, the underlying physics have not been investigated and thus differing PMP estimates are obtained without clarity on their interpretation. In this study, we present a hybrid approach that takes advantage of both traditional engineering practice and modern climate science to estimate PMP for current and future climate conditions. The traditional PMP approach is improved and applied to five statistically downscaled CMIP5 model outputs, producing an ensemble of PMP estimates in the Pacific Northwest (PNW) during the historical (1970-2016) and future (2050-2099) time periods. The new historical PMP estimates are verified against the traditional estimates. PMP in the PNW will increase by 50%±30% of the current level by 2099 under the RCP8.5 scenario. Most of the increase is caused by warming, which mainly affects moisture availability through increased sea surface temperature, with minor contributions from changes in storm efficiency in the future. Moist track change tends to reduce the future PMP. Compared with extreme precipitation, PMP exhibits higher internal variability. Thus long-time records of high-quality data in both precipitation and related meteorological fields (temperature, wind fields) are required to reduce uncertainties in the ensemble PMP estimates.

Implementing Treat-to-Target Practices for Chronic Pain Through Shared Decision Making: Requisites, Prospects, and Challenges.

PubMed

Falzer, Paul R

2017-02-01

Treat-to-target (T2T) includes a target or goal, standard symptom assessment, and a treatment decision. In specialties that threat chronic pain, T2T is expected to be implemented collaboratively. The ability of patients to participate fully has been questioned, but these concerns have not been demonstrated empirically. The current study examined how patient self-assessed symptom measures and illness beliefs affect their willingness to change their current treatment. A total of 157 patients with rheumatoid arthritis completed a standard "disease activity" (DA) battery consisting of current joint pain, recent pain, daily functioning, and generality disability assessments, along with an illness belief questionnaire and a willingness to change measure. Data were collected at 2-month intervals over a 6-month period. Single and multiple influences on willingness to change were examined using linear mixed models. Willingness is strongly and directly associated with DA scores. Beliefs that were significant as single factors became nonsignificant once DA scores were introduced. The findings established a strong and consistent link between DA scores and willingness, and ruled out the prospect that illness beliefs mediate or moderate this relationship. It was also found that willingness to change is directly related to the number of significant self-reported symptoms. Concerns about the ability of patients to participate in a collaborative implementation of T2T were not substantiated. Future studies can examine the subtle interplay of goals, assessments, and treatment decisions and clarify outstanding issues about the practice of clinical decision making. © 2016 World Institute of Pain.

Nurse education regarding agitated patients and its effects on clinical practice.

PubMed

Ozdemir, Leyla; Karabulut, Erdem

This study identified the impact of an education program on nurses' practices for agitated patients and documented the changes in practice after completion of the training. Eighteen cardiac intensive care nurses were included to the study. Prior to nurses' participation in an education program, a pre-test indicating nurses' current practices for 40 agitated patients was evaluated with the 'Nurse Practice Form'. After the pre-test data collection period was completed, the 2-day training program on caring for agitated patients was conducted. The last step of the study was evaluation of post-test nurses' practices for 40 agitated patients using the 'Nurse Practice Form'. The findings indicated that instead of pre-test nurses' use of physical restraints for controlling agitated patients without a physician order, none of post-test nurses applied them. The training program provided nurses the knowledge and skills needed to evaluate and to manage the causes of agitation.

Should general practitioners have any role in maternity care in the future?

PubMed Central

Smith, L F

1996-01-01

Maternity services in England are currently being reorganized. The success of the changes will be judged against the recommendations of the Changing Childbirth report. This paper describes the nature of maternity care and of general practice. It is argued that maternity care provision by general practitioners is a central and essential part of British general practice. Specifically, it is shown how general practitioners can help to achieve the objectives of the report, and thus, have a future role. It is suggested that all general practitioners who wish maternity care to remain an essential part of general practice need to argue the case with providers and purchasers. If they do not, then it is quite likely that general practitioners will be increasingly excluded as the commissioning and contracting mechanisms become more effective with midwives providing low-risk care and consultant obstetricians high-risk care. PMID:8703528

Changing Provider Behavior in the Context of Chronic Disease Management: Focus on Clinical Inertia.

PubMed

Lavoie, Kim L; Rash, Joshua A; Campbell, Tavis S

2017-01-06

Widespread acceptance of evidence-based medicine has led to the proliferation of clinical practice guidelines as the primary mode of communicating current best practices across a range of chronic diseases. Despite overwhelming evidence supporting the benefits of their use, there is a long history of poor uptake by providers. Nonadherence to clinical practice guidelines is referred to as clinical inertia and represents provider failure to initiate or intensify treatment despite a clear indication to do so. Here we review evidence for the ubiquity of clinical inertia across a variety of chronic health conditions, as well as the organizational and system, patient, and provider factors that serve to maintain it. Limitations are highlighted in the emerging literature examining interventions to reduce clinical inertia. An evidence-based framework to address these limitations is proposed that uses behavior change theory and advocates for shared decision making and enhanced guideline development and dissemination.

Survey of the contamination of eyedrops of hospital inpatients and recommendations for the changing of current practice in eyedrop dispensing.

PubMed Central

Stevens, J D; Matheson, M M

1992-01-01

Topical ophthalmic medications used on the ward and from the outpatient area have been taken and cultured for potential bacterial contamination in the laboratory. We examined 143 bottles used by patients who had had routine cataract surgery and trabeculectomy. We also examined for bacterial contamination 216 bottles of eyedrops used in the outpatient area of the hospital. No contamination was found in the postoperative eyedrops, but five bottles were contaminated from the outpatient area (2.3%). The bacterial growth from outpatient drops was of the same order of magnitude as in previous studies. The practice in the UK for postoperative eyedrops to be discarded and fresh, separate bottles to take home is discussed. We recommend that this practice be changed so that the postoperative drops used for 72 hours or less are taken home. PMID:1739689

Has publication of the results of the ORACLE Children Study changed practice in the UK?

PubMed

Kenyon, S; Pike, K; Jones, D; Brocklehurst, P; Marlow, N; Salt, A; Taylor, D

2010-10-01

  To investigate whether publication of the results of the ORACLE Children's Study, a 7-year follow-up of the ORACLE trial, changed practice with regard to the routine prescription of antibiotics to women with preterm rupture of membranes or spontaneous preterm labour (intact membranes).   A comparative questionnaire survey of clinical practice in November 2007 (before publication) and March 2009 (after publication).   Lead obstetricians for labour wards of all maternity units in the UK.   Self-administered questionnaires requested information about the routine prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour (intact membranes).   Change in practice for prescription of antibiotics.   The response rate was 166/214 (78%) in 2007 and 158/209 (76%) in 2009. In total, 120 maternity units responded on both occasions. For women with preterm rupture of membranes, 162/214 (98%) in 2007 and 151/158 (96%) in 2009 maternity units reported that they prescribed antibiotics, with the majority using erythromycin (98%). For women with spontaneous preterm labour (intact membranes), 35/166 (21%) in 2007 and 25/158 (16%) in 2009 maternity units reported that they routinely prescribed antibiotics. The findings from units who responded on both occasions are similar.   There has been little change in the reported prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour following publication of the ORACLE Children's Study. This suggests that current practice may require updated guidance.

Change the management of patients with heart failure: Rationale and design of the CHAMP-HF registry.

PubMed

DeVore, Adam D; Thomas, Laine; Albert, Nancy M; Butler, Javed; Hernandez, Adrian F; Patterson, J Herbert; Spertus, John A; Williams, Fredonia B; Turner, Stuart J; Chan, Wing W; Duffy, Carol I; McCague, Kevin; Mi, Xiaojuan; Fonarow, Gregg C

2017-07-01

Heart failure (HF) with reduced ejection fraction (HFrEF) is a common and costly condition that diminishes patients' health status and confers a poor prognosis. Despite the availability of multiple guideline-recommended pharmacologic and cardiac device therapies for patients with chronic HFrEF, outcomes remain suboptimal. Currently, there is limited insight into the rationale underlying clinical decisions by health care providers and patient factors that guide the use and intensity of outpatient HF treatments. A better understanding of current practice patterns has the potential to improve patients' outcomes. The CHAnge the Management of Patients with Heart Failure (CHAMP-HF) registry will evaluate the care and outcomes of patients with chronic HFrEF by assessing real-world treatment patterns, as well as the reasons for and barriers to medication treatment changes. CHAMP-HF will enroll approximately 5,000 patients with chronic HFrEF (left ventricular ejection fraction ≤40%) at approximately 150 US sites, and patients will be followed for a maximum duration of 24 months. Participating sites will collect data from both providers (HF history, examination findings, results of diagnostic studies, pharmacotherapy treatment patterns, decision-making factors, and clinical outcomes) and patients (medication adherence and patient-reported outcomes). The CHAMP-HF registry will provide a unique opportunity to study practice patterns and the adoption of new HF therapies across a diverse mix of health care providers and outpatient practices in the United States that care for HFrEF patients. Copyright © 2017 Elsevier Inc. All rights reserved.

From Cat's Cradle to Beat the Reaper: Getting Evidence-Based Treatments into Practice In Spite of Ourselves

PubMed Central

Sorensen, James L.

2011-01-01

Kurt Vonnegut was one of the most influential novelists of the late 20th Century. His wry views of people and organizations are applicable to the today's efforts to use science to improve the effectiveness of substance use treatment programs. His 1963 book, Cat's Cradle pointed to the potentially disastrous consequences of the development of science for science's sake. Moving to more current viewpoints, in 2009 the young writer and medical doctor Josh Bazell published Beat the Reaper, a novel that discusses modern medical care and pharmaceutical treatments with sarcasm and wit. Currently we are witnessing many developments to incorporate evidence-based practices into addiction treatment, ranging from Institute of Medicine overviews to the organization the Substance Abuse and Mental Health Services Administration, fielding the National Registry of National Registry of Evidence-based Programs and Practices for preventing and treating substance abuse and mental health disorders, legislative initiatives, efforts to upgrade the treatment workforce and, most recently, health care reform. There are signs that these and other efforts are upgrading the effectiveness of treatments for addiction. Yet the checks and balances of every effort to create change make for a field that shows halting and peripatetic development. “Top-down” reforms are watered down by “bottom-up” approaches, and vice-versa. Several concrete steps can be taken to improve the magnitude and speed of change in the field. We cannot change human nature, but we can improve addiction treatment. PMID:21330063

[The fiscal position of medical specialists].

PubMed

Stevens, S; Moors, M

2013-01-01

Independent medical specialists in the Netherlands are treated as entrepreneurs for tax purposes and therefore enjoy tax benefits. A change in the legal relationship between medical specialists and hospitals is foreseen in 2015. Independent medical specialists will then no longer be considered to be entrepreneurs. This could negatively affect their tax position. The Dutch government has adopted a policy aimed at controlling expenses arising from medical specialists' fees. According to this policy, the formation of regional practices or mega-practices of specialists will be discouraged. In contrast, the current fiscal legislation encourages medical specialists to incorporate their practice into regional practices or mega-practices or to become shareholders of their hospitals. It has been proposed that fiscal benefits be linked to certain aspects of entrepreneurship, such as investing in medical equipment or employing medical personnel.

Nanoscale Structural Changes Upon Electrooxidation of Au(111) as Probed by Potentiodynamic Scanning Tunneling Microscopy

DTIC Science & Technology

1994-02-01

electrochemical formation and removal of oxide films is of broadbased practical as well as fundamental importance. Studies of noble metals, such as gold and...atomic level. At the current state of development of STM, monocrystalline gold electrodes provide efficacious choices of systems, partly in view of...several in-situ STM studies have focussed on the surface morphological changes attending oxidation and rereduction of single-crystal gold electrodes

Assessing the Impact of Psychotropic Medication Changes on Challenging Behavior of Individuals with Intellectual Disabilities

PubMed Central

Valdovinos, Maria G.; Henninger-McMahon, Meara; Schieber, Elizabeth; Beard, Lisa; Conley, Brenna; Haas, Annette

2016-01-01

Objective The use of psychotropic medication to address challenging behavior in individuals diagnosed with intellectual disabilities is common practice; however, very few studies have examined how multiple medication use (or combination treatment) impacts the behaviors these medications are prescribed to treat. Method The current study followed eight individuals over a two-year period as they experienced changes in their psychotropic medication regimens. During that time, data from functional analyses and indirect assessments of challenging behavior were collected. Results The results suggest that changes in psychotropic medication regimens can produce changes in functional assessment outcomes, suggesting a need for continued behavioral assessment to better inform medication practices and behavioral treatment. Of the eight participants in the study, five participants’ behaviors varied in rate of responding in FAs across all medication changes. Additionally, three participants’ FAs produced changes in outcomes; however, those changes were not consistent across all medication changes, that is, not every medication change yielded different outcomes from previous assessments. Conclusion This study demonstrates how the outcome of an FA can be used to monitor the effects of psychotropic medication changes, specifically when medications are combined, on challenging behavior in individuals with intellectual and developmental disabilities. PMID:27429750

United States Air and Space Power in the 21st Century: Strategic Appraisal

DTIC Science & Technology

2002-01-01

changes in current U.S. nuclear operational practice. It would require at the very least • suitable planning systems (e.g., near- real - time target...to increase real - time visibility into demands, inventories, and flows will likely be very valuable in this regard. Robust, well-stocked FSLs will...of the type of wholesale shift required. The current system is designed for heavy deployments with fairly long lead times . To sup- port Air

Genome-wide prediction models that incorporate de novo GWAS are a powerful new tool for tropical rice improvement

USDA-ARS?s Scientific Manuscript database

To address the multiple challenges to food security posed by global climate change, population growth and rising incomes, plant breeders are developing new crop varieties that can enhance both agricultural productivity and environmental sustainability. Current breeding practices, however, are unable...

Business Management for Independent Schools. Fourth Edition.

ERIC Educational Resources Information Center

National Association of Independent Schools, Boston, MA.

This fourth edition of a guide for independent school business managers has been produced in looseleaf format so that changes may be made promptly as decisions of regulatory bodies require modifications in current practice. Fourteen chapters are organized under three broad topic headings. Chapters in part 1, Accounting and Financial Reporting,…

Student Perception of Online Learning in ESL Bilingual Teacher Preparation

ERIC Educational Resources Information Center

Daniel, Mayra C.; Schumacher, Gail; Stelter, Nicole; Riley, Carolyn

2016-01-01

Current technologies are changing delivery options for post-graduate teacher education. Many practicing teachers who return to school to prepare to educate English learners choose distance learning. This article explores teachers' perceived satisfaction with the quality of online courses, with the collaborative tasks required in these, and the…

Discovering "Space" in the Elementary Classroom

ERIC Educational Resources Information Center

Weckbacher, Lisa Marie; Okamoto, Yukari

2015-01-01

Recent studies have shown that strengths in spatial skills are a key to success in STEM (science, technology, engineering, and mathematics) careers. However, these skills are undervalued in our educational system and thus seldom incorporated in classroom teaching. As a first step towards changing the current practices, we worked with a group of…

Prayer and Adolescence: Can Formal Instruction Make a Difference?

ERIC Educational Resources Information Center

Sigel, Deena

2016-01-01

This design experiment in prayer education for Jewish students was motivated by a current educational concern: educating for spirituality and religious practice. Educators are tasked with formally nurturing spirituality (Wright 2001). It is known that attitude to religious observance may change during adolescence (Hyde 1963), thus attitude to…

A Content Analysis of Aging Network Conference Proceedings

ERIC Educational Resources Information Center

Moone, Rajean P.; Cagle, John G.

2011-01-01

The Aging Network is a federally funded group of collaborating organizations which provides support and services to older adults and caregivers. Professionals within the network are charged with staying up-to-date on current best practices, pertinent changes in federal policies, and the latest developments in aging. To promote professional…

From "Piracy" to Payment: Audio-Visual Copyright and Teaching Practice.

ERIC Educational Resources Information Center

Anderson, Peter

1993-01-01

The changing circumstances in Australia governing the use of broadcast television and radio material in education are examined, from the uncertainty of the early 1980s to current management of copyrighted audiovisual material under the statutory licensing agreement between universities and an audiovisual copyright agency. (MSE)

Collaborative Practitioner Research: Opening a Third Space for Local Knowledge Production

ERIC Educational Resources Information Center

Skattebol, Jen; Arthur, Leonie Maree

2014-01-01

Early childhood education and care is currently experiencing unprecedented policy interest and expansion. This policy and practice landscape requires new forms of adaptive leadership, new spaces for production of the knowledge necessary for this changing context, and tools that can support the development of leadership qualities. This paper…

Language and Higher Education: Two Current Challenges

ERIC Educational Resources Information Center

Brumfit, Christopher

2004-01-01

For higher education, two recent changes in world language practices are crucial: the emergence of English as the default language of international communication, and the technology of the Internet. The first appears to have contributed to problems of motivation for English-speaking learners of foreign languages. Information is provided about…

Changing Managerial Imperatives. New Directions for Community Colleges, Number 84.

ERIC Educational Resources Information Center

Alfred, Richard L., Ed.; Carter, Patricia, Ed.

1993-01-01

Intended as a forum for the discussion of governance and management in community colleges, this book details current trends in management approaches at the institutions, provides a practical description of management roles and responsibilities for college faculty and staff, and examines critical issues facing leaders engaged in management…

A Survey of Internet-Mediated Intercultural Foreign Language Education in China

ERIC Educational Resources Information Center

Wang, Liang; Coleman, James A.

2009-01-01

In all educational contexts, technological developments and changes in pedagogical theory mean that any picture of current practice and attitudes must be dynamic. In many countries, the learning outcomes of foreign language courses now include intercultural communicative competence (ICC), although the precise model for teaching ICC varies even…

Social Learning Analytics: Navigating the Changing Settings of Higher Education

ERIC Educational Resources Information Center

de Laat, Maarten; Prinsen, Fleur R.

2014-01-01

Current trends and challenges in higher education (HE) require a reorientation towards openness, technology use and active student participation. In this article we will introduce Social Learning Analytics (SLA) as instrumental in formative assessment practices, aimed at supporting and strengthening students as active learners in increasingly open…

Mathematics Teachers "Telling It Like It Is"

ERIC Educational Resources Information Center

Espedido, Rosei; Du Toit, Wilhelmina

2017-01-01

The authors of this article strongly advocate for a change to the current Australian model of primary education in order to, among other things, establish the concrete practicalities of systematic mathematics thinking thereby limiting the "re-teaching" time required of secondary school mathematics teachers; bring a clear focus to the…

Picture This

ERIC Educational Resources Information Center

Dillon, Robert

2012-01-01

Images can be powerful tools for change, but without compelling images of the future of education, everyone will be forced to use the images of the past. The problem is that schools can't be built on old images: they must reflect current best practices that infuse technology, relationships, background knowledge, culturally responsive texts, and…

Instructional Design for the Future of Undergraduate Journalism Education

ERIC Educational Resources Information Center

Farmer, Christopher J.

2012-01-01

In the face of communication changes brought on by technology, journalism curriculum needs restructuring while staying true to its core values. Using an instructional design framework, and a case study, this paper proposes a journalism education based on Esser's spheres of influence. Current practices and principles are discussed. A literature…

The Geology and Sociology of Consumption: Team-Teaching Sustainability in an Interdisciplinary First-Year Seminar

ERIC Educational Resources Information Center

Walsh, Emily O.; Davis, Emily Calhoun

2017-01-01

The complex consequences of current consumption practices, such as climate change and ecosystem degradation, necessitate increased interdisciplinary exploration. In order to raise student awareness of these consumption-related issues, we designed a first-year team-taught seminar on sustainability. This innovative interdisciplinary course links…

Leadership Metaphors: School Principals' Sense-Making of a National Reform

ERIC Educational Resources Information Center

Schechter, Chen; Shaked, Haim; Ganon-Shilon, Sherry; Goldratt, Miri

2018-01-01

During reforms, principals often experience ambiguity, contradicting demands, and lack of information. As critical change agents and system players, principals interpret reform demands and translate them into school practices through a process of sense-making. The current qualitative research explored 59 elementary school principals' sense-making…

The Wisdom of Scientific Inquiry on Education

ERIC Educational Resources Information Center

Glass, Gene V.

1972-01-01

Under current conditions evaluative research based on curriculum products of master teachers using basic knowledge from the social and natural sciences is more likely to contribute to the improvement of educational practice than is an attempt to build theories of teaching based upon rapidly changing philosophy and technique. (AL)

Soil quality evaluation using Soil Management Assessment Framework (SMAF) in Brazilian oxisols with contrasting texture

USDA-ARS?s Scientific Manuscript database

To ensure current land use strategies and management practices are economically, environmentally, and socially sustainable, tools and techniques for assessing and quantifying changes in soil quality/health (SQ) need to be developed through rigorous research and potential use by consultants, and othe...

AN EVALUATION OF HYDROLOGIC RESPONSE TO 25 YEARS OF LANDSCAPE CHANGE IN A SEMI-ARID WATERSHED

EPA Science Inventory

The assessment of land use and land cover is an extremely important activity for contemporary land management. A large body of current literature suggests that human land-use practices are the most important factor influencing natural resource management at multiple scales. D...

Rainfall Intensity Effects on Runoff and Sediment Losses From a Colorado Alfisol

USDA-ARS?s Scientific Manuscript database

For the Front Range region of Colorado, quantifying rainfall partitioning under current and/or proposed farming practices and changing precipitation patterns is the first step to understanding how to efficiently conserve water and soil resources to meet crop water demands. We quantified the effects ...

An Initial Attempt at Operationalizing and Testing the Community Coalition Action Theory

ERIC Educational Resources Information Center

Kegler, Michelle C.; Swan, Deanne W.

2011-01-01

The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 "California Healthy Cities" and "Communities" coalitions to test relationships between…

New Goals and Changed Roles: Re-Visioning Teacher Education.

ERIC Educational Resources Information Center

Hawley, Willis D.

1993-01-01

It is argued that the current agenda for improving teacher education only seeks to improve the present system. A new, radically restructured approach would train teachers to learn from their experiences, communicate clearly, know their subject matter, integrate ideas into practice, apply learning theory and child development principles, and…

Discharge planning for heart failure patients in a tertiary hospital in Shanghai: a best practice implementation project.

PubMed

Chen, Yu; Zhu, Li; Xu, Fei; Chen, Jun

2016-02-01

Heart failure is a major public health concern which contributes significantly to rising healthcare costs. Comprehensive discharge planning can improve health outcomes and reduce readmission rates which, in turn, can lead to cost savings. The aim of this project was to promote best practice in the discharge planning of heart failure patients admitted in the coronary care unit of Zhongshan Hospital. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Five audit criteria that represent best practice recommendations for heart failure discharge planning were used. A baseline audit was conducted followed by the implementation of multiple strategies, and the project was finalized with a follow-up audit to determine change in practice. Improvements in practice were observed for all five criteria. The most significant improvements were in the following: completion of a discharge checklist (from 0% to 100% compliance), comprehensive (i.e. inclusion of six topics for self-care) discharge education for patients (from 7% to 100% compliance), and conducting a telephone follow-up (from 0% to 76% compliance). The compliance rates for the two remaining criteria, completion of a structured education for patients and scheduling an outpatient clinic visit, both increased from 93% to 100%.Strategies that were implemented to achieve change in practice included development of a local discharge planning checklist, provision of training for nurses, and development of resources. The project demonstrated positive changes in the discharge planning practices of nurses in the coronary care unit of Zhongshan Hospital. A formalized discharge planning is currently in place and plans for sustaining practice change are underway. A continuous cycle of audit and re-audit will need to be carried out in the future to determine the impact of this evidence implementation activity on heart failure patient outcomes.

The Future of Pork Production in the World: Towards Sustainable, Welfare-Positive Systems

PubMed Central

McGlone, John J.

2013-01-01

Simple Summary More pork is eaten in the world than any other meat. Making production systems and practices more sustainable will benefit the animals, the planet and people. A system is presented by which production practices are evaluated using a sustainability matrix. The matrix shows why some practices are more common in some countries and regions and the impediments to more sustainable systems. This method can be used to assess the sustainability of production practices in the future where objective, science-based information is presented alongside ethical and economic information to make the most informed decisions. Finally, this paper points to current pork production practices that are more and less sustainable. Abstract Among land animals, more pork is eaten in the world than any other meat. The earth holds about one billion pigs who deliver over 100 mmt of pork to people for consumption. Systems of pork production changed from a forest-based to pasture-based to dirt lots and finally into specially-designed buildings. The world pork industry is variable and complex not just in production methods but in economics and cultural value. A systematic analysis of pork industry sustainability was performed. Sustainable production methods are considered at three levels using three examples in this paper: production system, penning system and for a production practice. A sustainability matrix was provided for each example. In a comparison of indoor vs. outdoor systems, the food safety/zoonoses concerns make current outdoor systems unsustainable. The choice of keeping pregnant sows in group pens or individual crates is complex in that the outcome of a sustainability assessment leads to the conclusion that group penning is more sustainable in the EU and certain USA states, but the individual crate is currently more sustainable in other USA states, Asia and Latin America. A comparison of conventional physical castration with immunological castration shows that the less-common immunological castration method is more sustainable (for a number of reasons). This paper provides a method to assess the sustainability of production systems and practices that take into account the best available science, human perception and culture, animal welfare, the environment, food safety, worker health and safety, and economics (including the cost of production and solving world hunger). This tool can be used in countries and regions where the table values of a sustainability matrix change based on local conditions. The sustainability matrix can be used to assess current systems and predict improved systems of the future. PMID:26487410

A 2015 Survey of Clinical Practice Patterns in the Management of Thyroid Nodules.

PubMed

Burch, Henry B; Burman, Kenneth D; Cooper, David S; Hennessey, James V; Vietor, Nicole O

2016-07-01

The management of thyroid nodules has changed dramatically over the past two decades. In the interim, technological advances including high-resolution ultrasound and molecular testing of thyroid nodules have been introduced. We sought to document current practices in the management thyroid nodules and assess the extent to which technological advances have been incorporated into current practice. We further sought to compare current practice to recommendations made in a recently updated American Thyroid Association (ATA) clinical practice guideline (CPG) and examine differences in thyroid nodule management among international members of U.S.-based endocrine societies. Members of The Endocrine Society, ATA, and American Association of Clinical Endocrinologists were invited to participate in a Web-based survey dealing with testing, treatment preference, and modulating factors in patients with thyroid nodules. A total of 897 respondents participated in the survey, including 661 members of The Endocrine Society, 454 American Association of Clinical Endocrinologists members, and 365 ATA members. Thyroid fine-needle aspiration (FNA) in 2015 is generally performed by endocrinologists (56.6%) and radiologists (31.9%), most frequently using ultrasound guidance (83.3%). Respondents in general have a lower threshold for FNA of thyroid nodules than that recommended in the updated ATA CPG. Management depends on the FNA result, with follicular lesion of undetermined significance/atypia of undetermined significance resulting in molecular testing (38.8% of respondents), repeat FNA cytology (31.5%), or immediate referral for thyroid surgery (24.4%). Nodules showing follicular neoplasm by FNA are referred for thyroid surgery by 61.2% of respondents (46.6 % lobectomy, 14.6 % total thyroidectomy) or molecular testing (29.0 %). Nodules found suspicious but not conclusive for malignancy (Bethesda category V), are referred for thyroid surgery (86.0%) and rarely undergo molecular testing (9.5%). During pregnancy, only 47.6% of respondents would perform FNA in the absence of nodular growth, with most respondents deferring FNA until after pregnancy. Endocrinologists are 64.2% less likely to perform FNA in an octogenarian than a younger patient with a comparable thyroid nodule. Striking international differences were identified in the routine measurement of calcitonin and in the use of molecular testing of thyroid nodules. In summary, our survey of clinical endocrinologists on the management of thyroid nodules documents current practice patterns and demonstrates both concordance and focal discordance with recently updated CPGs. Both international differences and a change in practice patterns during the past two decades are demonstrated.

Land management strategies for improving water quality in biomass production under changing climate

NASA Astrophysics Data System (ADS)

Ha, Miae; Wu, May

2017-03-01

The Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. The watershed is covered primarily with annual crops (corn and soybeans). With cropland conversion to switchgrass, stover harvest, and implementation of best management practices (BMPs) (such as establishing riparian buffers and applying cover crops), significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under a historical climate scenario, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compared with current land use when a portion of the cropland is converted to switchgrass and a cover crop is in place. Climate change could cause increases of 9.7% in SS, 4.1% in N, and 7.2% in P compared to current land use. Under future climate scenarios, nutrients including SS, N, and P were reduced through land management and practices and BMPs by up to 54.0% (SS), 30.4% (N), and 7.1% (P). Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management by using long-term monitoring data from field to watershed is necessary to verify the findings and move toward watershed-specific regional programs for climate adaptation.

Psychotherapy, psychopathology, research and practice: pathways of connections and integration.

PubMed

Castonguay, Louis G

2011-03-01

This paper describes three pathways of connections between different communities of knowledge seekers: integration of psychotherapeutic approaches, integration of psychotherapy and psychopathology, and integration of science and practice. Some of the issues discussed involve the delineation and investigation of common factors (e.g., principles of change), improvement of major forms of psychotherapy, clinical implications of psychopathology research, as well as current and future directions related to practice-research networks. The aim of this paper is to suggest that building bridges across theoretical orientations, scientific fields, professional experiences, and epistemological views may be a fruitful strategy to improve our understanding and the impact of psychotherapy.

Clinical trial design in the neurocritical care unit.

PubMed

Hall, C E; Mirski, M; Palesch, Y Y; Diringer, M N; Qureshi, A I; Robertson, C S; Geocadin, R; Wijman, C A C; Le Roux, P D; Suarez, Jose I

2012-02-01

Clinical trials provide a robust mechanism to advance science and change clinical practice across the widest possible spectrum. Fundamental in the Neurocritical Care Society's mission is to promote Quality Patient Care by identifying and implementing best medical practices for acute neurological disorders that are consistent with the current scientific knowledge. The next logical step will be to foster rapid growth of our scientific body of evidence, to establish and disseminate these best practices. In this manuscript, five invited experts were impaneled to address questions, identified by the conference organizing committee as fundamental issues for the design of clinical trials in the neurological intensive care unit setting.

Shining trinkets and unkempt gardens: on the materiality of care.

PubMed

van Hout, Annemarie; Pols, Jeannette; Willems, Dick

2015-11-01

The increasing use of telecare will profoundly change nursing care. How to understand these changes is, however, far from clear. This is because (i) studies on telecare seldom consider the situation it replaces, and (ii) current concepts and methods used to study the impact of telecare may not allow us to fully grasp these changes. We suggest that an analysis of the changing materiality of care practices is a suitable way to articulate and reflect on possible concerns. It allows us to compare care practices in the same terms before and after telecare has been introduced. To demonstrate this, we study the materiality of the classical care setting, the nursing house call, to map the situation before telecare is introduced. Building on science and technology studies, we apply four categories as heuristics to analyse materiality in care: signs, dis/enablers (or scripted things), tools and practical arrangements. We leave open the question of how material arrangements could or should be matters of concern in nursing care, and instead argue for studies that give insights into the everyday tinkering with the materiality of care that both nurses and patients need to engage in. © 2015 Foundation for the Sociology of Health & Illness.

One hertz repetitive transcranial magnetic stimulation over dorsal premotor cortex enhances offline motor memory consolidation for sequence-specific implicit learning.

PubMed

Meehan, S K; Zabukovec, J R; Dao, E; Cheung, K L; Linsdell, M A; Boyd, L A

2013-10-01

Consolidation of motor memories associated with skilled practice can occur both online, concurrent with practice, and offline, after practice has ended. The current study investigated the role of dorsal premotor cortex (PMd) in early offline motor memory consolidation of implicit sequence-specific learning. Thirty-three participants were assigned to one of three groups of repetitive transcranial magnetic stimulation (rTMS) over left PMd (5 Hz, 1 Hz or control) immediately following practice of a novel continuous tracking task. There was no additional practice following rTMS. This procedure was repeated for 4 days. The continuous tracking task contained a repeated sequence that could be learned implicitly and random sequences that could not. On a separate fifth day, a retention test was performed to assess implicit sequence-specific motor learning of the task. Tracking error was decreased for the group who received 1 Hz rTMS over the PMd during the early consolidation period immediately following practice compared with control or 5 Hz rTMS. Enhanced sequence-specific learning with 1 Hz rTMS following practice was due to greater offline consolidation, not differences in online learning between the groups within practice days. A follow-up experiment revealed that stimulation of PMd following practice did not differentially change motor cortical excitability, suggesting that changes in offline consolidation can be largely attributed to stimulation-induced changes in PMd. These findings support a differential role for the PMd in support of online and offline sequence-specific learning of a visuomotor task and offer converging evidence for competing memory systems. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Strategies for Achieving Whole-Practice Engagement and Buy-in to the Patient-Centered Medical Home

PubMed Central

Bleser, William K.; Miller-Day, Michelle; Naughton, Dana; Bricker, Patricia L.; Cronholm, Peter F.; Gabbay, Robert A.

2014-01-01

PURPOSE The current model of primary care in the United States limits physicians’ ability to offer high-quality care. The patient-centered medical home (PCMH) shows promise in addressing provision of high-quality care, but achieving a PCMH practice model often requires comprehensive organizational change. Guided by Solberg’s conceptual framework for practice improvement, which argues for shared prioritization of improvement and change, we describe strategies for obtaining organizational buy-in to and whole-staff engagement of PCMH transformation and practice improvement. METHODS Semistructured interviews with 136 individuals and 7 focus groups involving 48 individuals were conducted in 20 small- to mid-sized medical practices in Pennsylvania during the first regional rollout of a statewide PCMH initiative. For this study, we analyzed interview transcripts, monthly narrative reports, and observer notes from site visits to identify discourse pertaining to organizational buy-in and strategies for securing buy-in from personnel. Using a consensual qualitative research approach, data were reduced, synthesized, and managed using qualitative data management and analysis software. RESULTS We identified 13 distinct strategies used to obtain practice buy-in, reflecting 3 overarching lessons that facilitate practice buy-in: (1) effective communication and internal PCMH campaigns, (2) effective resource utilization, and (3) creation of a team environment. CONCLUSION Our study provides a list of strategies useful for facilitating PCMH transformation in primary care. These strategies can be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers. Our study findings also extend Solberg’s conceptual framework for practice improvement to include buy-in as a necessary condition across all elements of the change process. PMID:24445102

Inefficiencies and high-value improvements in U.S. cervical cancer screening practice: A cost-effectiveness analysis

PubMed Central

Kim, Jane J.; Campos, Nicole G.; Sy, Stephen; Burger, Emily A.; Cuzick, Jack; Castle, Philip E.; Hunt, William C.; Waxman, Alan; Wheeler, Cosette M.

2016-01-01

Background Studies suggest that cervical cancer screening practice in the United States is inefficient. The cost and health implications of non-compliance in the screening process compared to recommended guidelines are uncertain. Objective To estimate the benefits, costs, and cost-effectiveness of current cervical cancer screening practice and assess the value of screening improvements. Design Model-based cost-effectiveness analysis. Data Sources New Mexico HPV Pap Registry; medical literature. Target Population Cohort of women eligible for routine screening. Time Horizon Lifetime. Perspective Societal. Interventions Current cervical cancer screening practice; improved compliance to guidelines-based screening interval, triage testing, diagnostic referrals, and precancer treatment referrals. Outcome Measures Reductions in lifetime cervical cancer risk, quality-adjusted life-years (QALYs), lifetime costs, incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs Results of Base-Case Analysis Current screening practice was associated with lower health benefit and was not cost-effective relative to guidelines-based strategies. Improvements in the screening process were associated with higher QALYs and small changes in costs. Perfect c4mpliance to a 3-yearly screening interval and to colposcopy/biopsy referrals were associated with the highest INMBs ($759 and $741, respectively, at a willingness-to-pay threshold of $100,000 per QALY gained); together, the INMB increased to $1,645. Results of Sensitivity Analysis Current screening practice was inefficient in 100% of simulations. The rank ordering of screening improvements according to INMBs was stable over a range of screening inputs and willingness-to-pay thresholds. Limitations The impact of HPV vaccination was not considered. Conclusions The added health benefit of improving compliance to guidelines, especially the 3-yearly interval for cytology screening and diagnostic follow-up, may justify additional investments in interventions to improve U.S. cervical cancer screening practice. Funding Source U.S. National Cancer Institute. PMID:26414147

Barriers faced by expanded practice dental hygienists in Oregon.

PubMed

Coplen, Amy E; Bell, Kathryn P

2015-04-01

Oregon allows dental hygienists to provide services without the supervision of a dentist if they hold an expanded practice permit (EPP). This study surveyed practicing and non-practicing EPP holders with the purpose of assessing perceived barriers to practicing independently and better educating students to begin independent practice upon graduation. A survey was developed, approved by the institutional review board and pilot tested with current Expanded Practice Dental Hygienists (EPDHs). A list of EPDHs was obtained from the Oregon State Dental Board, and 181 surveys were mailed in November 2011. The response rate was 39% (n=71). Data from this study indicate a large number of new EPP holders, with 62% (n=41) holding their permit for 3 years or less, but only 41% (n=29) of respondents are actually providing care in a setting requiring an EPP. Responding practicing EPDHs reported barriers including: challenges with insurance reimbursement, lack of knowledge/acceptance, equipment cost/maintenance, difficulty obtaining a collaborative agreement/cooperating facility, advertising and inability to make a living wage. Responding non-practicing EPDHs reported barriers including: currently working in another setting, lack of business knowledge, time, start-up cost, inability to make a living wage, lack of opportunity, reimbursement difficulties and lack of experience. Perceived barriers to practicing independently differ between those practicing utilizing their EPP and those not practicing. Ways to eliminate barriers for both practicing and non-practicing EPDHs should be explored. There is potential to reduce the barriers to independent practice through curricular changes, public health partnerships among EPDHs, and new health care systems that specifically address barriers found through this study. Copyright © 2015 The American Dental Hygienists’ Association.

Climate change: Evolving technologies, U.S. business, and the world economy in the 21. century

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harter, J.J.

1996-12-31

The International Climate Change Partnership presents this report as one of its efforts to present current information on climate change to the public. One often hears about the expenses entailed in protecting the environment. Unfortunately, one hears less about the economic benefits that may be associated with prudent actions to counter environmental threats. This conference is particularly useful because it focuses attention on profitable business opportunities in the United States and elsewhere that arise from practical efforts to mitigate the risks of climate change. The report contains a brief synopsis of each speaker`s address on climate change.

Minimal improvement of nurses' motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial.

PubMed

Jansink, Renate; Braspenning, Jozé; Laurant, Miranda; Keizer, Ellen; Elwyn, Glyn; Weijden, Trudy van der; Grol, Richard

2013-03-28

The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients' readiness to change lifestyle, and quality of life. Fifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients' readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses. At one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, "inviting the patient to talk about behaviour change" (mean difference=0.39, p=0.009), and "assessing patient's confidence in changing their lifestyle" (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients' readiness to change health behaviour was associated positively with applying MI skills. The maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change. Current Controlled Trials ISRCTN68707773.

Effectiveness of past and current critical incident analysis on reflective learning and practice change.

PubMed

Vachon, Brigitte; LeBlanc, Jeannette

2011-09-01

Critical incident analysis (CIA) is one of the strategies frequently used to facilitate reflective learning. It involves the thorough description and analysis of an authentic and experienced event within its specific context. However, CIA has also been described as having the potential to expose vulnerabilities, threaten learners' coping mechanisms and increase rather than reduce their anxiety levels. The aim of this study was to compare the analysis of current critical incidents with that of past critical incidents, and to further explore why and how the former is more conducive to reflective learning and practice change than the latter. A collaborative research study was conducted. Eight occupational therapists were recruited to participate in a reflective learning group that convened for 12 meetings held over a 15-month period. The group facilitator planned and adapted the learning strategies to be used to promote reflective learning and guided the group process. Critical incident analysis represented the main activity carried out in the group discussions. The data collected were analysed using the grounded theory method. Three phenomena were found to differentiate between the learning contexts created by the analysis of, respectively, past and current critical incidents: attitudinal disposition; legitimacy of purpose, and the availability of opportunities for experimentation. Analysis of current clinical events was found to improve participants' motivation to self-evaluate, to increase their self-efficacy, and to help them transfer learning into action and to progressively self-regulate. The results of this collaborative research study suggest that the analysis of current clinical events in order to promote reflection offers a safer and more constructive learning environment than does the analysis of incidents that have occurred in the past. This learning strategy is directly grounded in health professional practice. The remaining challenge for continuing education providers is that of creating conditions conducive to its use. © Blackwell Publishing Ltd 2011.

Changing dietary behaviour: the role and development of practitioner communication.

PubMed

Whitehead, Kirsten

2015-05-01

The need to support people to change diet-related behaviour is widely advocated and how to do this effectively in practice is an expanding area of research. Important factors to consider are how healthcare practitioners communicate with their patients and how that communication may affect diet-related behaviour change and subsequent outcomes. The aim of the present paper is to discuss communication skills for behaviour change (CSBC), focusing predominantly on registered dietitians who are required to communicate effectively and have an important role in supporting patients to change diet-related behaviour. The views of dietitians in relation to CSBC have been investigated and respondents have consistently reported that they perceive these skills to be of vital importance in practice. Patient views have reiterated the importance of good CSBC in one-to-one consultations. However, pre-qualification training of dietitians is thought to deliver practitioners who are competent at a minimum level. The need for ongoing continuous professional development (CPD) in relation to CSBC has been recognised but currently most CPD focuses on updating knowledge rather than improving these essential skills. Measuring CSBC in a consistent and objective manner is difficult and an assessment tool, DIET-COMMS, has been developed and validated for this purpose. DIET-COMMS can be used to support CSBC development, but concerns about logistical challenges and acceptability of implementing this in practice have been raised. Although a suitable assessment tool now exists there is a need to develop ways to facilitate assessment of CSBC in practice.

Reducing inequalities in access to health care: developing a toolkit through action research.

PubMed

Goyder, E C; Blank, L; Ellis, E; Furber, A; Peters, J; Sartain, K; Massey, C

2005-10-01

Healthcare organisations are expected both to monitor inequalities in access to health services and also to act to improve access and increase equity in service provision. Locally developed action research projects with an explicit objective of reducing inequalities in access. Eight different health care services in the Yorkshire and Humber region, including community based palliative care, general practice asthma care, hospital based cardiology clinics, and termination of pregnancy services. Changes in service provision, increasing attendance rates in targeted groups. Local teams identified the population concerned and appropriate interventions using both published and grey literature. Where change to service provision was achieved, local data were collected to monitor the impact of service change. A number of evidence based changes to service provision were proposed and implemented with variable success. Service uptake increased in some of the targeted populations. Interventions to improve access must be sensitive to local settings and need both practical and managerial support to succeed. It is particularly difficult to improve access effectively if services are already struggling to meet current demand. Key elements for successful interventions included effective local leadership, identification of an intervention which is both evidence based and locally practicable, and identification of additional resources to support increased activity. A "toolkit" has been developed to support the identification and implementation of appropriate changes.

Two challenges for U.S. irrigation due to climate change: increasing irrigated area in wet states and increasing irrigation rates in dry states.

PubMed

McDonald, Robert I; Girvetz, Evan H

2013-01-01

Agricultural irrigation practices will likely be affected by climate change. In this paper, we use a statistical model relating observed water use by U.S. producers to the moisture deficit, and then use this statistical model to project climate changes impact on both the fraction of agricultural land irrigated and the irrigation rate (m³ ha⁻¹). Data on water withdrawals for US states (1985-2005) show that both quantities are highly positively correlated with moisture deficit (precipitation--PET). If current trends hold, climate change would increase agricultural demand for irrigation in 2090 by 4.5-21.9 million ha (B1 scenario demand: 4.5-8.7 million ha, A2 scenario demand: 9.1-21.9 million ha). Much of this new irrigated area would occur in states that currently have a wet climate and a small fraction of their agricultural land currently irrigated, posing a challenge to policymakers in states with less experience with strict regulation of agriculture water use. Moreover, most of this expansion will occur in states where current agricultural production has relatively low market value per hectare, which may make installation of irrigation uneconomical without significant changes in crops or practices by producers. Without significant increases in irrigation efficiency, climate change would also increase the average irrigation rate from 7,963 to 8,400-10,415 m³ ha⁻¹ (B1 rate: 8,400-9,145 m³ ha⁻¹, A2 rate: 9,380-10,415 m³ ha⁻¹). The irrigation rate will increase the most in states that already have dry climates and large irrigation rates, posing a challenge for water supply systems in these states. Accounting for both the increase in irrigated area and irrigation rate, total withdrawals might increase by 47.7-283.4 billion m³ (B1 withdrawal: 47.7-106.0 billion m³, A2 withdrawal: 117.4-283.4 billion m³). Increases in irrigation water-use efficiency, particularly by reducing the prevalence of surface irrigation, could eliminate the increase in total irrigation withdrawals in many states.

Unification: An international aerospace information issue

NASA Technical Reports Server (NTRS)

Cotter, Gladys A.; Lahr, Thomas F.

1991-01-01

Science and technology projects are becoming more and more international and interdisciplinary. Other parts of the world, notably Europe, are increasingly powerful players in the aerospace business. This change has led to the development of various aerospace information initiatives in other countries. With scarce resources in all areas of government and industry, the NASA STI Program is reviewing its current acquisition and exchange practices and policies to factor in the changing requirements and new opportunities within the international community. Current NASA goals and activities are reviewed with a view toward developing a scenario for establishing an international aerospace data base, maintaining compatibility among national aerospace information systems, eliminating duplication of effort, and sharing resources through international cooperation wherever possible.

Unification - An international aerospace information opportunity

NASA Technical Reports Server (NTRS)

Cotter, Gladys A.; Lahr, Thomas F.

1992-01-01

Science and technology projects are becoming more and more international and interdisciplinary. Other parts of the world, notably Europe, are increasingly powerful players in the aerospace industry. This change has led to the development of various aerospace information initiatives in other countries. With scarce resources in all areas of government and industry, the NASA STI Program is reviewing its current acquisition and exchange practices and policies to factor in the changing requirements and new opportunities within the international community. Current NASA goals and activities are reviewed with a new view toward developing a scenario for establishing an international aerospace database, maintaining compatibility among national aerospace information systems, eliminating duplication of effort, and sharing resources through international cooperation wherever possible.

Unification: An international aerospace information opportunity

NASA Technical Reports Server (NTRS)

Cotter, Gladys A.; Lahr, Thomas F.; Carroll, Bonnie C.

1992-01-01

Science and technology projects are becoming more and more international and interdisciplinary. Other parts of the world, notably Europe, are increasingly powerful players in the aerospace industry. This change has led to the development of various aerospace information initiatives in other countries. With scarce resources in all areas of government and industry, the NASA STI Program is reviewing its current acquisition and exchange practices and policies to factor in the changing requirements and new opportunities within the international community. Current NASA goals and activities are reviewed with a new view toward developing a scenario for establishing an international aerospace database, maintaining compatibility among national aerospace information systems, eliminating duplication of effort, and sharing resources through international cooperation wherever possible.

The path to impact of operational research on tuberculosis control policies and practices in Indonesia

PubMed Central

Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U.; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W.; Alisjahbana, Bachti

2016-01-01

Background Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. Objective We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Design Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Results Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Conclusions Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored. PMID:26928217

The path to impact of operational research on tuberculosis control policies and practices in Indonesia.

PubMed

Probandari, Ari; Widjanarko, Bagoes; Mahendradhata, Yodi; Sanjoto, Hary; Cerisha, Ancila; Nungky, Saverina; Riono, Pandu; Simon, Sumanto; Farid, Muhammad Noor; Giriputra, Sardikin; Putra, Artawan Eka; Burhan, Erlina; Wahyuni, Chatarina U; Mustikawati, Dyah; Widianingrum, Christina; Tiemersma, Edine W; Alisjahbana, Bachti

2016-01-01

Operational research is currently one of the pillars of the global strategy to control tuberculosis. Indonesia initiated capacity building for operational research on tuberculosis over the last decade. Although publication of the research in peer-reviewed journals is an important indicator for measuring the success of this endeavor, the influence of operational research on policy and practices is considered even more important. However, little is known about the process by which operational research influences tuberculosis control policy and practices. We aimed to investigate the influence of operational research on tuberculosis control policy and practice in Indonesia between 2004 and 2014. Using a qualitative study design, we conducted in-depth interviews of 50 researchers and 30 policy makers/program managers and performed document reviews. Transcripts of these interviews were evaluated while applying content analysis. Operational research contributed to tuberculosis control policy and practice improvements, including development of new policies, introduction of new practices, and reinforcement of current program policies and practices. However, most of these developments had limited sustainability. The path from the dissemination of research results and recommendations to policy and practice changes was long and complex. The skills, interests, and political power of researchers and policy makers, as well as health system response, could influence the process. Operational research contributed to improving tuberculosis control policy and practices. A systematic approach to improve the sustainability of the impact of operational research should be explored.

[Centennial retrospective on the evolution and development of the nursing practice environment in Taiwan].

PubMed

Lin, Shou-Ju; Huang, Lain-Hua

2014-08-01

The practice environment for nurses has seen tremendous change over the past century due to the dedication and trailblazing work of nursing pioneers. This article describes how the nursing practice environment in Taiwan has evolved over this period. References used include nursing narratives, hospital accreditation standards, standard operating procedures, workplace safety standards, and worksite-related values and expectations. The efforts of the professional nursing community to realize a positive practice environment are further discussed. Over this century of change, the only thing that has remained unchanged is the commitment of nurses to "treat patients as one's own family". In the current as well as the previous periods of manpower shortages in nursing, the nursing community has managed to turn crisis into opportunity by using the situation to enhance pay and benefits. Nursing professionalism is widely respected and recognized throughout Taiwan society. The rapidly changing needs of the 21st century in aspects such as the advancement of high technology, the rapid growth of the elderly population, and the fast rate of social change seriously impact the development of the nursing profession. How to effectively apply high technology, simplify workflows, provide high quality and humanistic nursing care, build safe and quality workplaces, attract bright nursing students, and provide healthcare for the entire population will remain the responsibilities of nursing for generations to come.

Clinical update for the diagnosis and treatment of Clostridium difficile infection

PubMed Central

IV, Edward C Oldfield; III, Edward C Oldfield; Johnson, David A

2014-01-01

Clostridium difficile infection (CDI) presents a rapidly evolving challenge in the battle against hospital-acquired infections. Recent advances in CDI diagnosis and management include rapid changes in diagnostic approach with the introduction of newer tests, such as detection of glutamate dehydrogenase in stool and polymerase chain reaction to detect the gene for toxin production, which will soon revolutionize the diagnostic approach to CDI. New medications and multiple medical society guidelines have introduced changing concepts in the definitions of severity of CDI and the choice of therapeutic agents, while rapid expansion of data on the efficacy of fecal microbiota transplantation heralds a revolutionary change in the management of patients suffering multiple relapses of CDI. Through a comprehensive review of current medical literature, this article aims to offer an intensive review of the current state of CDI diagnosis, discuss the strengths and limitations of available laboratory tests, compare both current and future treatments options and offer recommendations for best practice strategies. PMID:24729930

Fluid therapy and the hypovolemic microcirculation.

PubMed

Gruartmoner, G; Mesquida, J; Ince, Can

2015-08-01

In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Macrocirculatory changes induced by volume expansion are not always coupled to proportional changes in microcirculatory perfusion. Loss of hemodynamic coherence limits the value of guiding fluid therapy according to macrohemodynamics, and highlights the importance of evaluating the ultimate target of volume administration, the microcirculation. Current approach to intravascular volume optimization is made from a macrohemodynamic perspective. However, several situations wherein macrocirculatory and microcirculatory coherence is lost have been described. Future clinical trials should explore the usefulness of integrating the microcirculatory evaluation in fluid optimization.

Capturing reimbursement for advanced practice nurse services in acute and critical care: legal and business considerations.

PubMed

Buppert, Carolyn

2005-01-01

Advanced practice nurses (APNs) have been affected positively and negatively by recent changes in the way hospitals are financed. Among these changes are the shift from cost-based reimbursement to a prospective payment system and increased opportunities for billing APN services under the physician payment system. Positive effects include the need for hospitals to decrease the length of stay of hospitalized patients, leading to jobs for APNs who make the hospital course and discharge more efficient. Negative effects include budget shortfalls that lead to layoffs. This article explains the current financial landscape, including phenomena that are impeding the billing of APN services, and recommends adjustments so that the APN role will be on firm financial footing.

Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology.

PubMed

Mendoza, Walter; Miranda, J Jaime

2017-02-01

One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades. Copyright © 2016 Elsevier Inc. All rights reserved.

Contemporary analysis of practicing otolaryngologists.

PubMed

Harrill, Willard C; Melon, David E; Seshul, Merritt J; Katz, Marc S; Zanation, Adam M

2018-05-04

To investigate contemporary issues facing practicing otolaryngologists including workforce dynamics, ancillary service modeling, otolaryngic allergy integration, ambulatory surgery center utilization, and relevant certificate of need legislation. A cross-sectional survey analysis of academic and private practicing otolaryngologists in North and South Carolina in 2016. A cross-sectional survey was e-mailed to 510 practicing otolaryngologists in North and South Carolina. A 21.3% survey response rate was achieved. Otolaryngology workforce was defined by horizontal aggregation of otolaryngologists into larger group models, with fewer solo practitioners being replaced by younger otolaryngologists or employing otolaryngology extenders. Excluding academic practice, few otolaryngologists have chosen direct hospital employment as a career option, although otolaryngologists with fewer years of practice are pursuing that option with greater frequency. Ancillary services showed audiology and hearing aid services being the most common, followed by otolaryngic allergy, point-of-service computed tomography, and ultrasound. Although otolaryngologists tend to avoid vertical integration, ambulatory surgery center (ASC) ownership trends favor a joint venture model with a hospital system partner. Most otolaryngologists favor changes to certificate of need legislation to improve patient access to these lower-cost facilities, regardless of whether they currently utilize or have access to an ASC. Otolaryngology is uniquely positioned to adapt and respond to current paradigm shifts within ambulatory medicine. Further analysis is needed to prepare current and future otolaryngologists for the demands and opportunities these challenges pose as patient-centered care models and consumer dynamics shape future patient expectations and utilization of healthcare. 5. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Reliable change indices and standardized regression-based change score norms for evaluating neuropsychological change in children with epilepsy.

PubMed

Busch, Robyn M; Lineweaver, Tara T; Ferguson, Lisa; Haut, Jennifer S

2015-06-01

Reliable change indices (RCIs) and standardized regression-based (SRB) change score norms permit evaluation of meaningful changes in test scores following treatment interventions, like epilepsy surgery, while accounting for test-retest reliability, practice effects, score fluctuations due to error, and relevant clinical and demographic factors. Although these methods are frequently used to assess cognitive change after epilepsy surgery in adults, they have not been widely applied to examine cognitive change in children with epilepsy. The goal of the current study was to develop RCIs and SRB change score norms for use in children with epilepsy. Sixty-three children with epilepsy (age range: 6-16; M=10.19, SD=2.58) underwent comprehensive neuropsychological evaluations at two time points an average of 12 months apart. Practice effect-adjusted RCIs and SRB change score norms were calculated for all cognitive measures in the battery. Practice effects were quite variable across the neuropsychological measures, with the greatest differences observed among older children, particularly on the Children's Memory Scale and Wisconsin Card Sorting Test. There was also notable variability in test-retest reliabilities across measures in the battery, with coefficients ranging from 0.14 to 0.92. Reliable change indices and SRB change score norms for use in assessing meaningful cognitive change in children following epilepsy surgery are provided for measures with reliability coefficients above 0.50. This is the first study to provide RCIs and SRB change score norms for a comprehensive neuropsychological battery based on a large sample of children with epilepsy. Tables to aid in evaluating cognitive changes in children who have undergone epilepsy surgery are provided for clinical use. An Excel sheet to perform all relevant calculations is also available to interested clinicians or researchers. Copyright © 2015 Elsevier Inc. All rights reserved.

A profile of Australian nuclear medicine technologist practice.

PubMed

Adams, Edwina J; Cox, Jennifer M; Adamson, Barbara J; Schofield, Deborah J

2008-01-01

Nuclear medicine in Australia has encountered significant change over the past 30 years, with a move to privately owned practices, technological advances and the transfer of education of the nuclear medicine technologist (NMT) from technical college apprenticeships to university degrees. Currently, shortages of nuclear medicine technologists are reported in some states of Australia. It is not known whether changes in NMT practice or the type of centre in which an NMT works have an influence on retention of staff. The primary objective of this survey was to establish a profile of NMT practice in Australia, with the aim of producing baseline data that could be used in further research to establish levels of retention and job satisfaction. Chief technologists in three states of Australia were invited to respond to a written questionnaire. The questionnaire included data about staffing levels, imaging modalities, procedures performed, and movement of staff. Findings presented will relate to the profile of practice data only. Forty-eight (54%) chief technologists responded to the questionnaire with 73% working in privately owned practices. The majority of centres employ up to two full-time equivalent nuclear medicine technologists and have two gamma cameras and one full-time equivalent nuclear medicine physician. Most centres perform a limited range of studies with bone scans predominating. More than half the centres make some use of a centralized radiopharmacy service. Further research is required to determine how these changes may impact on workplace satisfaction and in turn, on retention.

National climate assessment technical report on the impacts of climate and land use and land cover change

USGS Publications Warehouse

Loveland, Thomas; Mahmood, Rezaul; Patel-Weynand, Toral; Karstensen, Krista; Beckendorf, Kari; Bliss, Norman; Carleton, Andrew

2012-01-01

This technical report responds to the recognition by the U.S. Global Change Research Program (USGCRP) and the National Climate Assessment (NCA) of the importance of understanding how land use and land cover (LULC) affects weather and climate variability and change and how that variability and change affects LULC. Current published, peer-reviewed, scientific literature and supporting data from both existing and original sources forms the basis for this report's assessment of the current state of knowledge regarding land change and climate interactions. The synthesis presented herein documents how current and future land change may alter environment processes and in turn, how those conditions may affect both land cover and land use by specifically investigating, * The primary contemporary trends in land use and land cover, * The land-use and land-cover sectors and regions which are most affected by weather and climate variability,* How land-use practices are adapting to climate change, * How land-use and land-cover patterns and conditions are affecting weather and climate, and * The key elements of an ongoing Land Resources assessment. These findings present information that can be used to better assess land change and climate interactions in order to better assess land management and adaptation strategies for future environmental change and to assist in the development of a framework for an ongoing national assessment.

"Why not bathe the baby today?": A qualitative study of thermal care beliefs and practices in four African sites.

PubMed

Adejuyigbe, Ebunoluwa Aderonke; Bee, Margaret Helen; Amare, Yared; Omotara, Babatunji Abayomi; Iganus, Ruth Buus; Manzi, Fatuma; Shamba, Donat Dominic; Skordis-Worrall, Jolene; Odebiyi, Adetanwa; Hill, Zelee Elizabeth

2015-10-14

Recommendations for care in the first week of a newborn's life include thermal care practices such as drying and wrapping, skin to skin contact, immediate breastfeeding and delayed bathing. This paper examines beliefs and practices related to neonatal thermal care in three African countries. Data were collected in the same way in each site and included 16-20 narrative interviews with recent mothers, eight observations of neonatal bathing, and in-depth interviews with 12-16 mothers, 9-12 grandmothers, eight health workers and 0-12 birth attendants in each site. We found similarities across sites in relation to understanding the importance of warmth, a lack of opportunities for skin to skin care, beliefs about the importance of several baths per day and beliefs that the Vernix caseosa was related to poor maternal behaviours. There was variation between sites in beliefs and practices around wrapping and drying after delivery, and the timing of the first bath with recent behavior change in some sites. There was near universal early bathing of babies in both Nigerian sites. This was linked to a deep-rooted belief about body odour. When asked about keeping the baby warm, respondents across the sites rarely mentioned recommended thermal care practices, suggesting that these are not perceived as salient. More effort is needed to promote appropriate thermal care practices both in facilities and at home. Programmers should be aware that changing deep rooted practices, such as early bathing in Nigeria, may take time and should utilize the current beliefs in the importance of neonatal warmth to facilitate behaviour change.

Village midwives and their changing roles in Brunei Darussalam: A qualitative study.

PubMed

Abdul-Mumin, Khadizah Haji

2016-10-01

There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain

PubMed Central

2014-01-01

Background Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. Methods We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Results Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Conclusions Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process. PMID:24428945

Development of a theory- and evidence-based intervention to enhance implementation of physical therapy guidelines for the management of low back pain.

PubMed

Rutten, Geert M; Harting, Janneke; Bartholomew, Leona K; Braspenning, Jozé C; van Dolder, Rob; Heijmans, Marcel Fgj; Hendriks, Erik Jm; Kremers, Stef Pj; van Peppen, Roland Ps; Rutten, Steven Tj; Schlief, Angelique; de Vries, Nanne K; Oostendorp, Rob Ab

2014-01-15

Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process.

Reasoning, evidence, and clinical decision-making: The great debate moves forward.

PubMed

Loughlin, Michael; Bluhm, Robyn; Buetow, Stephen; Borgerson, Kirstin; Fuller, Jonathan

2017-10-01

When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical import, is currently the preoccupation of some of the most influential and insightful contributors to the on-going evidence-based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life. © 2017 John Wiley & Sons, Ltd.

Traditional and emerging forms of dental practice. Cost, accessibility, and quality factors.

PubMed Central

Rovin, S; Nash, J

1982-01-01

The traditional and predominant manner of delivering dental care is through a fee-for-service, private practice system. A number of alternative dental care delivery systems have emerged and are being tested, and others are just emerging. These systems include department store practices, hospital dental services, health maintenance organizations, the independent practice of dental hygiene, and denturism. Although it is too soon to draw final conclusions about the efficacy and effectiveness of these systems, we examine them for their potential to compete with and change the way dental care is currently delivered. Using the parameters of cost, accessibility, and quality, we compare these systems to traditional dental practice. Some of these emerging forms clearly have the potential to complete favorably with traditional practice. Other seem less likely to alter the existing system substantially. The system which can best control costs, increase accessibility, and enhance quality will gain the competitive edge. PMID:7091453

Significance chasing in research practice: causes, consequences and possible solutions.

PubMed

Ware, Jennifer J; Munafò, Marcus R

2015-01-01

The low reproducibility of findings within the scientific literature is a growing concern. This may be due to many findings being false positives which, in turn, can misdirect research effort and waste money. We review factors that may contribute to poor study reproducibility and an excess of 'significant' findings within the published literature. Specifically, we consider the influence of current incentive structures and the impact of these on research practices. The prevalence of false positives within the literature may be attributable to a number of questionable research practices, ranging from the relatively innocent and minor (e.g. unplanned post-hoc tests) to the calculated and serious (e.g. fabrication of data). These practices may be driven by current incentive structures (e.g. pressure to publish), alongside the preferential emphasis placed by journals on novelty over veracity. There are a number of potential solutions to poor reproducibility, such as new publishing formats that emphasize the research question and study design, rather than the results obtained. This has the potential to minimize significance chasing and non-publication of null findings. Significance chasing, questionable research practices and poor study reproducibility are the unfortunate consequence of a 'publish or perish' culture and a preference among journals for novel findings. It is likely that top-down change implemented by those with the ability to modify current incentive structure (e.g. funders and journals) will be required to address problems of poor reproducibility. © 2014 Society for the Study of Addiction.

Significance chasing in research practice: Causes, consequences, and possible solutions

PubMed Central

Ware, Jennifer J.; Munafò, Marcus R.

2016-01-01

Background and Aims The low reproducibility of findings within the scientific literature is a growing concern. This may be due to many findings being false positives, which in turn can misdirect research effort and waste money. Methods We review factors that may contribute to poor study reproducibility and an excess of ‘significant’ findings within the published literature. Specifically, we consider the influence of current incentive structures, and the impact of these on research practices. Results The prevalence of false positives within the literature may be attributable to a number of questionable research practices, ranging from the relatively innocent and minor (e.g., unplanned post hoc tests), to the calculated and serious (e.g., fabrication of data). These practices may be driven by current incentive structures (e.g. pressure to publish), alongside the preferential emphasis placed by journals on novelty over veracity. There are a number of potential solutions to poor reproducibility, such as new publishing formats that emphasise the research question and study design, rather than the results obtained. This has the potential to minimise significance chasing and non-publication of null findings. Conclusions Significance chasing, questionable research practices, and poor study reproducibility are the unfortunate consequence of a “publish or perish” culture and a preference among journals for novel findings. It is likely that top-down change implemented by those with the ability to modify current incentive structure (e.g., funders and journals) will be required to address problems of poor reproducibility. PMID:25040652

A systematic review of neurobiological and clinical features of mindfulness meditations.

PubMed

Chiesa, A; Serretti, A

2010-08-01

Mindfulness meditation (MM) practices constitute an important group of meditative practices that have received growing attention. The aim of the present paper was to systematically review current evidence on the neurobiological changes and clinical benefits related to MM practice in psychiatric disorders, in physical illnesses and in healthy subjects. A literature search was undertaken using Medline, ISI Web of Knowledge, the Cochrane collaboration database and references of retrieved articles. Controlled and cross-sectional studies with controls published in English up to November 2008 were included. Electroencephalographic (EEG) studies have revealed a significant increase in alpha and theta activity during meditation. Neuroimaging studies showed that MM practice activates the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC) and that long-term meditation practice is associated with an enhancement of cerebral areas related to attention. From a clinical viewpoint, Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for many psychiatric and physical conditions and also for healthy subjects, Mindfulness-Based Cognitive Therapy (MBCT) is mainly efficacious in reducing relapses of depression in patients with three or more episodes, Zen meditation significantly reduces blood pressure and Vipassana meditation shows efficacy in reducing alcohol and substance abuse in prisoners. However, given the low-quality designs of current studies it is difficult to establish whether clinical outcomes are due to specific or non-specific effects of MM. Despite encouraging findings, several limitations affect current studies. Suggestions are given for future research based on better designed methodology and for future directions of investigation.

Land management strategies for improving water quality in biomass production under changing climate

DOE PAGES

Ha, Miae; Wu, May

2017-03-07

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

Land management strategies for improving water quality in biomass production under changing climate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ha, Miae; Wu, May

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

COMMERCIAL SURROGACY: WHAT ROLE FOR LAW IN AUSTRALIA?

PubMed

Sifris, Ronli; Ludlow, Karinne; Sifris, Adiva

2015-12-01

This editorial begins by illuminating current conversations regarding the regulation of commercial surrogacy in Australia. It defines "commercial surrogacy" and explains the interaction between changes in social attitudes and changes to the law before setting out the current Australian law and practice in this area. An examination of current domestic law and practice reveals that surrogacy legislation in Australia is mired in inconsistencies and a lack of uniformity but that the one key common element is the prohibition of commercial surrogacy. The inability of couples to access commercial surrogacy within Australia has led to offshore reproductive tourism and unpredictable, contradictory decision-making as the Family Court attempts to apply legislation which was never intended to apply in this context. The editorial then turns to consider the international arena, discussing the approach of the Hague Conference on Private International Law before delving into a human rights analysis of commercial surrogacy arrangements. The adoption of a rights-based approach requires an analysis of this vexed issue from the perspective of the child, surrogate and intending parents. While questions surrounding the human rights implications of legalising commercial surrogacy continue to be the subject of passionate debate, the authors believe that the human rights of all parties are best protected through appropriate regulation rather than absolute prohibition.

A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan.

PubMed

Hashmi, Furqan K; Hassali, Mohamed Azmi; Khalid, Adnan; Saleem, Fahad; Aljadhey, Hisham; Babar, Zaheer Ud Din; Bashaar, Mohammad

2017-07-19

In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan.

Engaging and empowering patients to manage their type 2 diabetes, Part I: a knowledge, attitude, and practice gap?

PubMed

Serrano-Gil, Manuel; Jacob, Stephan

2010-06-01

For over 20 years, the World Health Assembly has recognized diabetes (type 1 and type 2) as a serious threat to national health and economic development and called for action regarding its prevention and control. However, the prevalence of type 2 diabetes continues to rise despite a significant percentage of cases being preventable. Furthermore, data suggest that in many patients diagnosed with type 2 diabetes, glycated hemoglobin (HbA(1c)) levels remain above the agreed international and national target levels, despite the availability of numerous antihyperglycemic agents, the best intentions of both patient and physician, and the support of the wider healthcare team. Part I of this two-part review considers evidence that seems to suggest there is a knowledge, attitude, and practice (KAP) gap in type 2 diabetes, and that although theoretical knowledge of how type 2 diabetes should be managed exists, the attitude of patients and healthcare professionals may influence the practicalities of implementing life-enhancing changes for patients living day-to-day with the condition. Here, we consider why there may be a KAP gap, how type 2 diabetes is currently being assessed and managed, and whether these current management approaches remain valid in the light of recent studies evaluating the impact of lowering current target HbA(1c) levels. This article also explores how encouraging patients to self-manage their disease, as well as engaging all stakeholders in the necessary behavioral changes, can positively influence the long-term treatment outcomes of patients with type 2 diabetes.

Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice.

PubMed

Rostami-Nejad, Mohammad; Villanacci, Vincenzo; Hogg-Kollars, Sabine; Volta, Umberto; Manenti, Stefania; Reza-Zali, Mohammad; Caio, Giacomo; Giovenali, Paolo; Barakauskiene, Ausrine; Kazenaite, Edita; Becheanu, Gabriel; Diculescu, Mircea; Pellegrino, Salvatore; Magazzù, Giuseppe; Casella, Giovanni; Di-Bella, Camillo; Decarli, Nicola; Biancalani, Mauro; Bassotti, Gabrio; Rostami, Kamran

2013-07-01

the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.

[Introduction of translational research in omics science to clinical anesthesia].

PubMed

Sugino, Shigekazu; Hayase, Tomo; Yamakage, Michiaki

2013-03-01

Much progress has been made in omics research following completion of the Human Genome Project. This comprehensive analysis produced a new discipline (i.e., bioinformatics), and its findings contributed to the clinical practice of anesthesiology. Genomes of patients show genetic variations and may predict the sensitivity to anesthetics and analgesics, incidence of adverse effects, and intensity of postsurgical pain. Changes in the transcriptomes of patients may also reflect anesthesia-related expression profiles of various types of neurons in the brain, and information on such changes may contribute to molecular targeted therapy in anesthetized patients. In addition, novel epigenome research may explain why environments change the phenotypes of clinical anesthesia. We currently hypothesize that female gender is associated with DNA methylation in pain-related and vomiting-related gene promoter regions at the genome-wide level and that epigenetic mechanisms are involved in gender differences in anesthesia practice.

Metabolic and Homeostatic Changes in Seizures and Acquired Epilepsy—Mitochondria, Calcium Dynamics and Reactive Oxygen Species

PubMed Central

Kovac, Stjepana; Dinkova Kostova, Albena T.; Melzer, Nico; Meuth, Sven G.; Gorji, Ali

2017-01-01

Acquired epilepsies can arise as a consequence of brain injury and result in unprovoked seizures that emerge after a latent period of epileptogenesis. These epilepsies pose a major challenge to clinicians as they are present in the majority of patients seen in a common outpatient epilepsy clinic and are prone to pharmacoresistance, highlighting an unmet need for new treatment strategies. Metabolic and homeostatic changes are closely linked to seizures and epilepsy, although, surprisingly, no potential treatment targets to date have been translated into clinical practice. We summarize here the current knowledge about metabolic and homeostatic changes in seizures and acquired epilepsy, maintaining a particular focus on mitochondria, calcium dynamics, reactive oxygen species and key regulators of cellular metabolism such as the Nrf2 pathway. Finally, we highlight research gaps that will need to be addressed in the future which may help to translate these findings into clinical practice. PMID:28885567

Perceived Changes to Obstetric Care and the Integration of Personal and Professional Life as a Pregnant Prenatal Genetic Counselor.

PubMed

Rietzler, Jennifer L; Birkeland, Laura E; Petty, Elizabeth M

2018-02-08

The impact of practicing as a prenatal genetic counselor while pregnant is unclear given the limited amount of published literature on this issue. To address this gap in knowledge, a total of 215 current and past prenatal genetic counselors provided insights regarding this personal yet professional juncture through completion of an online survey that allowed for both close-ended and open-ended responses. While participants agreed that experiencing pregnancy affected their perspectives and counseling in several ways, this paper focuses on one particular finding-that of the changes in their own obstetric care perceived by genetic counselors while working within the prenatal setting and being pregnant themselves. As a result of these changes, considerations about when to disclose a pregnancy to colleagues along with how to integrate personal and professional needs as a pregnant prenatal genetic counselor surfaced. Additional findings, practice implications, and research recommendations are discussed.

A practical method of determining water current velocities and diffusion coefficients in coastal waters by remote sensing techniques

NASA Technical Reports Server (NTRS)

James, W. P.

1971-01-01

A simplified procedure is presented for determining water current velocities and diffusion coefficients. Dye drops which form dye patches in the receiving water are made from an aircraft. The changes in position and size of the patches are recorded from two flights over the area. The simplified data processing procedure requires only that the ground coordinates about the dye patches be determined at the time of each flight. With an automatic recording coordinatograph for measuring coordinates and a computer for processing the data, this technique provides a practical method of determining circulation patterns and mixing characteristics of large aquatic systems. This information is useful in assessing the environmental impact of waste water discharges and for industrial plant siting.

The Impact of Therapeutic Antibodies on the Management of Digestive Diseases: History, Current Practice, and Future Directions.

PubMed

Sofia, M Anthony; Rubin, David T

2017-04-01

The development of therapeutic antibodies represents a revolutionary change in medical therapy for digestive diseases. Beginning with the initial studies that confirmed the pathogenicity of cytokines in inflammatory bowel disease, the development and application of therapeutic antibodies brought challenges and insights into their potential and optimal use. Infliximab was the first biological drug approved for use in Crohn's disease and ulcerative colitis. The lessons learned from infliximab include the importance of immunogenicity and the influence of pharmacokinetics on disease response and outcomes. Building on this foundation, other therapeutic antibodies achieved approval for inflammatory bowel disease and many more are in development for several digestive diseases. In this review, we reflect on the history of therapeutic antibodies and discuss current practice and future directions for the field.

Microsurgery Training for the Twenty-First Century

PubMed Central

Myers, Simon Richard; Froschauer, Stefan; Akelina, Yelena; Tos, Pierluigi; Kim, Jeong Tae

2013-01-01

Current educational interventions and training courses in microsurgery are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess current training tools in microsurgery education and devise alternative methods that would enhance training. Simulation is an increasingly important tool for educators because, whilst facilitating improved technical proficiency, it provides a way to reduce risks to both trainees and patients. The International Microsurgery Simulation Society has been founded in 2012 in order to consolidate the global effort in promoting excellence in microsurgical training. The society's aim to achieve standarisation of microsurgical training worldwide could be realised through the development of evidence based educational interventions and sharing best practices. PMID:23898422

Circumcision: what should be done?

PubMed

Ben-Yami, Hanoch

2013-07-01

I explain why I think that considerations regarding the opposing rights involved in the practice of circumcision-rights of the individual to bodily integrity and rights of the community to practice its religion-would not help us decide on the desirable policy towards this controversial practice. I then suggest a few measures that are not in conflict with either religious or community rights but that can both reduce the harm that circumcision as currently practiced involves and bring about a change in attitude towards the practice, thus further reducing its frequency. These measures are the compulsory administration of anaesthetics; the banning of the metzitzah b'peh; and having an upper age limit of a few months on non-therapeutic circumcision of minors. I conclude with general considerations on why the steps taken towards the reform of circumcision should be moderate.

The National Practice Benchmark for Oncology: 2015 Report for 2014 Data

PubMed Central

Balch, Carla; Ogle, John D.

2016-01-01

The National Practice Benchmark (NPB) is a unique tool used to measure oncology practices against others across the country in a meaningful way despite variations in practice demographics, size, and setting. In today’s challenging economic environment, each practice positions service offerings and competitive advantages to attract patients. Although the data in the NPB report are primarily reported by community oncology practices, the business structure and arrangements with regional health care systems are also reflected in the benchmark report. The ability to produce detailed metrics is an accomplishment of excellence in business and clinical management. With these metrics, a practice should be able to measure and analyze its current business practices and make appropriate changes, if necessary. In this report, we build on the foundation initially established by Oncology Metrics (acquired by Flatiron Health in 2014) over years of data collection and refine definitions to deliver the NPB, which is uniquely meaningful in the oncology market. PMID:27006357

The influence of retrieval practice on metacognition: The contribution of analytic and non-analytic processes.

PubMed

Miller, Tyler M; Geraci, Lisa

2016-05-01

People may change their memory predictions after retrieval practice using naïve theories of memory and/or by using subjective experience - analytic and non-analytic processes respectively. The current studies disentangled contributions of each process. In one condition, learners studied paired-associates, made a memory prediction, completed a short-run of retrieval practice and made a second prediction. In another condition, judges read about a yoked learners' retrieval practice performance but did not participate in retrieval practice and therefore, could not use non-analytic processes for the second prediction. In Study 1, learners reduced their predictions following moderately difficult retrieval practice whereas judges increased their predictions. In Study 2, learners made lower adjusted predictions than judges following both easy and difficult retrieval practice. In Study 3, judge-like participants used analytic processes to report adjusted predictions. Overall, the results suggested non-analytic processes play a key role for participants to reduce their predictions after retrieval practice. Copyright © 2016 Elsevier Inc. All rights reserved.

Determining Competencies for Frontline Sales Managers in For-Profit Organizations

ERIC Educational Resources Information Center

Busch, Tina Killough

2012-01-01

Practice in the sales profession and current competency research indicate salesperson competence is key to organizational competitive advantage. With models of selling evolving to respond to the marketplace, there are changes in the competency requirements and roles people must play for future success, resulting in the emergence of new kinds of…

Humanity, U.S. Immigration and Refugee Policy and the Select Commission.

ERIC Educational Resources Information Center

Butler, Broadus N.

1981-01-01

Examines United States policy and practices in regard to immigrants and refugees. Observes that recent changes in refugee and immigration legislation may have provided the catalyst for less racial and ethnic discrimination in American domestic and foreign policy. Suggests that current trends point to the possibility of unity in cultural pluralism.…

A Design for a Model College Financial Aid Office. Revised 1980.

ERIC Educational Resources Information Center

Van Dusen, William D.; O'Hearne, John J.

The third edition of a guide for the college financial aid office substantially modifies previously presented material because of the changes that have been occurring in college student financial aid. Topics are as follows: development of student financial aid programs; current forms of college student financial aid; principles and practices of…

Changing Teaching and Learning in the Primary School

ERIC Educational Resources Information Center

Webb, Rosemary, Ed.

2006-01-01

In this topical book, leading academics in primary education evaluate New Labour's Education policy. They draw on the findings of the latest research to discuss the impact of policies on primary school practice and on the views and experiences of primary school teachers and pupils. Current issues and initiatives are analyzed to identify the extent…

Campus Ecology: A Guide to Assessing Environmental Quality and Creating Strategies for Change.

ERIC Educational Resources Information Center

Smith, April A.; And Others

This book is designed to take the environmental issues and principles currently being studied in the classroom and move them outside the classroom doors into the campus community and the larger world. By making environmental knowledge part and parcel of campus environmental practice, students, faculty, and administrators have an extraordinary…

Field Guide to Academic Leadership: A Publication of the National Academy for Academic Leadership.

ERIC Educational Resources Information Center

Diamond, Robert M., Ed.

This "Field Guide" is designed to help academic leaders in the current climate of change. It provides information and suggestions for action and administrative practice around a range of issues. The first section, "Basis," contains these chapters: (1) "Pressures for Fundamental Reform: Creating a Viable Academic…

Strategies for Change: A Case Study of Innovative Practices at the Coast Community College District.

ERIC Educational Resources Information Center

Brightman, Richard W.

This paper examines current professional literature and assesses: (1) the degree to which community colleges have (or are developing) administrative programs that actively foster instructional innovation; and (2) how education programs in general, and innovative programs in particular are evaluated in terms of relative effectiveness and costs…

General Education Today. A Critical Analysis of Controversies, Practices, and Reforms.

ERIC Educational Resources Information Center

Gaff, Jerry G.

The range of controversies and changes emerging from the current revival of general education are examined, and many ideas, examples, and recommendations for achieving realistic and successful curricular reform are offered. Instead of either offering an apology for general education or advocating any particular approach, the book draws on solid…

78 FR 579 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-03

... by the PCGFMP. II. Major Provisions This final rule contains two types of major provisions. The first... fishing sector because different fishing sectors require different types of management to control catch... existing management measures and do not represent a change from current management practices. These types...

Leading Innovation and Change: Knowledge Creation by Schools for Schools

ERIC Educational Resources Information Center

Harris, Alma

2008-01-01

This article explores the process and practice of knowledge creation within development and research (D and R) networks. It focuses upon D and R networks in England that are currently engaged in collaboration and innovation. Early evaluative evidence suggests that D and R school networks offer "spaces" for collaborative working, mutual…