The Role of Permissive and Induced Hypotension in Current Neuroanesthesia Practice.

PubMed

Soghomonyan, Suren; Stoicea, Nicoleta; Sandhu, Gurneet S; Pasternak, Jeffrey J; Bergese, Sergio D

2017-01-01

Induced hypotension (IH) had been used for decades in neurosurgery to reduce the risk for intraoperative blood loss and decrease blood replacement. More recently, this method fell out of favor because of concerns for cerebral and other end-organ ischemia and worse treatment outcomes. Other contributing factors to the decline in its popularity include improvements in microsurgical technique, widespread use of endovascular procedures, and advances in blood conservation and transfusion protocols. Permissive hypotension (PH) is still being used occasionally in neurosurgery; however, its role in current anesthesia practice remains unclear. Our objective was to describe contemporary utilization of IH and PH (collectively called PH) in clinical practice among members of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC). A questionnaire was developed and distributed among SNACC members that addressed practice patterns related to the use of PH. The responses were analyzed based on the number of individuals who responded to each specific question. Of 72 respondents, 67.6% reported over 10 years of clinical experience, while 15.5% reported 5-10 years of post-training experience. The respondents admitted to providing anesthesia for 300 (median) neurosurgical cases per year. PH was applied most commonly during open interventions on cerebral aneurysms (50.8%) and arteriovenous malformations (46%). Seventy-three percent of respondents were not aware of any complications in their practice attributable to PH. PH is still being used in neuroanesthesia practice by some providers. Further research is justified to clarify the risks and benefits of PH in modern neuroanesthesia practice.

Is dosimetry still a necessity in current dental practice?

PubMed

Reddy, S S; Rakesh, N; Chauhan, Pallavi; Clint, Joseph Ben; Sharma, Shivani

2015-12-01

Today, dentists have a wide range of imaging modalities to choose from, the film based techniques, digital techniques, and the recent introduction of 3D volumetric or cone beam computed tomography (CBCT). The inherent design features of the new generation dental x-ray equipment has significantly improved over the years with no evidence of substandard x-ray units in operation. In dental facilities radiological workload is comparatively low, newer radiation equipments and accessories follow safety guidelines and employ better radiation protection measures for the patient and the operator. Dentists' knowledge and expertise in radiation protection measures is good, enabling them to carry out riskfree radiation procedures in their practice. Therefore, the present study is aimed at assessing the need for dosimeters in current dental scenario. 'Is there currently a significant risk from dental radiography to merit the use of personal dosimetery in dental practice. 'Dental health professionals (Oral radiologists) and radiographic assistants of fourteen dental colleges in Karnataka state participated in this questionnaire study. The questionnaire consisted of the following questions--the make, type, year of manufacture of radiographic machines used in their setup, number of radiographs made per day in the institution, type of receptors used, number of personnel at risk for radiation exposure, radiation protection measures used, regular monitoring by personal dosimeters, equivalent dosage readings for the past 12 months and whether the reading of thermoluminescent dosimeters (TLD) for any personnel had exceeded the recommended exposure value in the last 3 years. Dosimetry records of the radiology staff in the last three years shows doses no more than 1.50 mSv per year. The various institutions' dose (person mSv) was in the range of 3.70 mSv-3.90 mSv. Personal monitoring for Dentists can be omitted in the dental colleges since the estimated dose of oral radiologists

21 CFR 210.1 - Status of current good manufacturing practice regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Status of current good manufacturing practice... SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL § 210.1 Status of current good manufacturing practice regulations...

Cost analysis of laparoscopic gastric bypass practice using current Medicare reimbursement and practice costs.

PubMed

Madan, Atul K; Powelson, Jill E; Tichansky, David S

2008-01-01

We performed a formal cost analysis of a hypothetical bariatric practice consisting of a surgeon, dietitian, clinical coordinator/office manager, receptionist, and certified medical assistant to determine whether a bariatric practice would have a difficult time surviving financially with the current Medicare reimbursement. The number of possible cases was calculated for the 2005 calendar year. Most of the costs and assumptions were taken from an actual bariatric practice. The malpractice insurance premium (but not physician salary and benefits) was calculated into the practice cost. With a total of 231 days available for clinical work in 2005, 300 scheduled laparoscopic gastric bypasses could have been performed to allow for appropriate clinic time for new patient visits, postoperative visits, and annual visits. The total reimbursement from Medicare would have been $516,158, with most of the reimbursement coming from procedure fees ($407,063). The total practice cost would have been $444,592. Most of the costs were clinic staff salary and benefits ($207,065) and the malpractice premium ($55,150). The net difference of $71,566 was left to pay the salary and benefits of the bariatric surgeon. The low reimbursement of Medicare for laparoscopic gastric bypass threatens the financial viability of a bariatric surgery practice. With the increasing cost of malpractice and the threatened decrease in Medicare physician reimbursement, Medicare recipients could see a decrease in the number of bariatric surgeons offering them service.

Current practice and usual care of major cervical disorders in Korea

PubMed Central

Choi, A Ryeon; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Oh, Min-seok; Lee, Eun-Jung; Kim, Sungchul; Kim, Mia; Ha, In-Hyuk

2017-01-01

Abstract Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea. Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia). Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%–34%) and physical therapy (14%–16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics. This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current

Current challenges in European oncology pharmacy practice.

PubMed

Hoppe-Tichy, Torsten

2010-03-01

The demand for pharmacy cancer services is expected to at least double over the next 10 years, as the population ages and new treatments are introduced. Safe and efficient handling of cytotoxic products minimises risks to staff and reduces medication errors. To identify and describe strategies for coping safely and effectively with heavier workloads in the hospital oncology pharmacy, currently and in the future. The PubMed database was searched for literature on approaches to safe handling of antineoplastic agents and to decreasing medication errors in the hospital pharmacy. Articles that were judged to be of prime importance to the hospital oncologist were reviewed. These safety concepts are put into the context of contemporary hospital oncology pharmacy practice through discussion of key issues, including increased demand, the role of the pharmacist in determining the hospital formulary, and growth in patient preferences for oral chemotherapy. Recommendations on best practices are also provided, based on relevant literature and author experience. Efficient, safe hospital pharmacy operations can be aided by capacity planning, dose banding, and knowledge of novel products and procedures that can reduce risks to health while increasing the number of patients who are safely treated. Consideration may also be given to the economic role of oncology pharmacists in formulary development.

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.

Emergency room management of ureteral calculi: current practices.

PubMed

Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

2009-06-01

To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

Current Practices in Resident Assistant Training

ERIC Educational Resources Information Center

Koch, Virginia Albaneso

2016-01-01

Developing resident assistant (RA) training is a challenge for most housing and residence life staff. Grounded in the author's doctoral research on the curricular design of RA training programs, this study summarizes current practices in three types of RA training programs--preservice training, in-service training, and academic courses--and…

Pectus carinatum treatment in Canada: current practices.

PubMed

Emil, Sherif; Laberge, Jean-Martin; Sigalet, David; Baird, Robert

2012-05-01

Multiple treatment options currently exist for the correction of pectus carinatum (PC). We performed a survey of Canadian pediatric surgeons to define current practices. All active members of Canadian Association of Paediatric Surgeons were surveyed online during winter 2011 through the Canadian Association of Paediatric Surgeons Web site. The survey assessed multiple facets of PC evaluation and treatment, with particular emphasis on the practice of bracing. Forty-five active members (85%) responded, of whom 32 (71%) currently treat PC. Fifty-three percent of practices are low volume (<5 patients annually). In terms of preferred or most used treatment modality, 69% of surgeons used bracing, 25% performed Ravitch repairs, 3% performed open minimal cartilage resections, and 3% performed reverse Nuss procedures. Of 23 surgeons (72%) who used bracing, 83% used it for most or the patients. Fifty-seven percent judged their bracing results as good or excellent, and 74% felt that most or all patients braced were satisfied; 80% and 88% agreed or strongly agreed that bracing was generally preferable to surgical repair and that bracing should be first line treatment, respectively. Bracing is the preferred treatment for PC by most Canadian pediatric surgeons, despite lack of prospective outcome data. This presents an opportunity for a multicenter prospective study. Copyright © 2012 Elsevier Inc. All rights reserved.

Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

PubMed

Arnold, Lesley M; Clauw, Daniel J

2017-09-01

The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

Quality management of clinical-practical instruction for Practical Year medical students in Germany - proposal for a catalogue of criteria from the German Society of Medical Education.

PubMed

Raes, Patricia; Angstwurm, Matthias; Berberat, Pascal; Kadmon, Martina; Rotgans, Jerome; Streitlein-Böhme, Irmgard; Burckhardt, Gerhard; Fischer, Martin R

2014-01-01

Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities. In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany. The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed. The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

A critical review of current nursing faculty practice.

PubMed

Sawyer, M J; Alexander, I M; Gordon, L; Juszczak, L J; Gilliss, C

2000-12-01

To critically examine the current literature on nursing faculty practice, using the National Organization of Nurse Practitioner Faculties (NONPF) Guidelines for Evaluation of Faculty Practice, and to examine faculty practice models' strengths, weaknesses, and barriers. Thirty-five articles describing models of faculty practice were identified through an exhaustive search on CINAHL and Medline. Two NONPF monographs on nursing faculty practice were used as guidelines for the critical review. Faculty practice has become an integral component of faculty-role expectations at many schools of nursing. Workload, especially without adequate compensation, remains a hindrance to practice. The value of faculty practice time and expertise has not been sufficiently demonstrated. Integration of practitioner, educator and researcher roles remains extremely difficult and sometimes elusive. Faculty practice offers many advantages to schools of nursing, including educational and research opportunities for faculty and students, as well as practice sites and affordable community healthcare. Providing health care in the community presents an opportunity for independent and collaborative practice. To fully utilize the great research opportunities provided by faculty practice, more emphasis must be placed on gathering and analyzing descriptive data.

Transition of Care in Adolescents With Cerebral Palsy: A Survey of Current Practices.

PubMed

Bolger, Ashlee; Vargus-Adams, Jilda; McMahon, Mary

2017-03-01

Transition of care from pediatric to adult health care providers for youth with special needs (including cerebral palsy [CP]) is of current interest because these individuals are now living well into adulthood. Studies have attempted to identify barriers to transition, ideal timing for transition of care, and key elements for successful transition programs. These studies often encompass a wide range of diagnoses, and results cannot be fully applied to those with CP. To identify and describe current transition-of-care (TOC) practices and beliefs among physician providers of adolescents with CP in multidisciplinary CP clinics. Descriptive survey. Multidisciplinary CP clinics in the United States. Physician leaders in the aforementioned CP clinics. Respondents completed an electronic survey. Responses were deidentified and reported in aggregate by the use of descriptive statistics. Electronic survey addressing 3 domains: demographics of clinics, current opinions/practices related to TOC processes, and perceived barriers to successful TOC. Fifteen surveys were sent with 11 returned (response rate = 73%). TOC practices varied among clinics surveyed. Fifty-five percent of clinics had a structured transition program, but only one transitioned 100% of their patients to adult providers by 22 years of age. Only one clinic had an absolute upper age limit for seeing patients, and 36% of clinics accepted new patients older than 21 years. No respondent was "completely satisfied" with their transition process, and only one respondent was "moderately satisfied." The majority of respondents felt the ideal care setting for adults with CP was a comprehensive, multidisciplinary adult-focused clinic in an adult hospital/clinic with primarily adult providers. They noted the top 3 perceived barriers to successful TOC were limited adult providers willing to accept CP patients, concern about the level of care in the adult health care system, and lack of financial resources. Current TOC

CURRENT PRACTICES IN QSAR DEVELOPMENT AND APPLICATIONS

EPA Science Inventory

Current Practices in QSAR Development and Applications

Although it is commonly assumed that the structure and properties of a single chemical determines its activity in a particular biological system, it is only through study of how biological activity varies with changes...

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION TOMOGRAPHY DRUGS (Eff. 12-12-2011) General Provisions § 212.2 What is current good manufacturing practice for...

21 CFR 210.2 - Applicability of current good manufacturing practice regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Applicability of current good manufacturing practice regulations. 210.2 Section 210.2 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING...

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

Maternal self-efficacy and feeding practices in children aged 3-6 years

PubMed Central

Doaei, Saeid; Gholamalizadeh, Maryam; Entezari, Mohammad Hassan

2015-01-01

Objective: Nutrition in childhood has an important role in current and adulthood health. Recent studies have shown that the mother’s lifestyle has an important role in the methods used by mother to feed child. This paper aimed to investigate the association between mother’s weight efficacy lifestyle with feeding practices in children aged 3- 6 years. Materials and Methods: In this cross-sectional study which was carried out in 30 primary schools of Rasht (Iran) in 2012, 165 mothers with children aged 3-6 years were participated. Mothers reported their own and their child’s demographics. Aspects of mother’s weight efficacy lifestyle and mother’s control practices were assessed using Weight Efficacy Lifestyle (WEL) questionnaire and Comprehensive Feeding Practices questionnaire (CFPQ) respectively. Height and weight of mothers participated in the study were measured. The role of mother’s weight efficacy in predicting child’s feeding practices was assessed using linear regression. Results: Results showed that mother’s weight efficacy was related to child feeding practices. The mothers with similar weight efficacy lifestyle applied similar methods in child nutrition. Mothers with better weight efficacy used more encourage balance and variety, environmental control, child involvement and less emotion regulation using foods. Conclusion: ‎ ‏ ‏‎ The result of the ‎study showed that maternal ‎lifestyle was associated with ‎child feeding practices.‎ PMID:27006673

Teaching Math Online: Current Practices in Turkey

ERIC Educational Resources Information Center

Akdemir, Omur

2011-01-01

Changing nature of student population, developments in technology, and insufficient number of traditional universities have made online courses popular around the globe. This study was designed to investigate the current practices of teaching mathematics online in Turkish Universities through a qualitative inquiry. The snowball sampling method was…

Current practices for evaluation of resonance disorders in North America.

PubMed

Stelck, Elizabeth Huebert; Boliek, Carol A; Hagler, Paul H; Rieger, Jana M

2011-02-01

Improving treatment outcomes for people with resonance problems (due to velopharyngeal disorders) is a priority for many speech-language pathologists (SLPs), but there exists a limited understanding of the practices SLPs are using to assess and monitor therapeutic effects in this population. The current study was designed to answer the following questions: (1) What are current clinical practices versus best practices for assessing resonance disorders, tracking therapeutic effects, and determining discharge criteria? (2) What assessment practices would SLPs prefer to use with clients who have resonance disorders? (3) What are barriers to SLPs' use of best practices? and (4) What effects do SLP demographics have on clinical practices? Thirty-eight SLPs, specializing in the treatment of resonance disorders, participated in the study. Responses were compared with best practice recommendations derived from the literature. Most clinicians were using low-tech assessment tools, often because they lacked access to high-tech tools. Demographics and training did not affect clinical assessment practices. There is a need to increase the availability of high-tech assessment tools to SLPs practicing in the area of resonance disorders, as consistent use of sophisticated assessment devices would exemplify contemporary thinking about the transfer of knowledge to practice in this area. © Thieme Medical Publishers.

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 practice of radioiodine treatment in the management of differentiated thyroid cancer in Germany.

PubMed

Hoelzer, S; Steiner, D; Bauer, R; Reiners, C; Farahati, J; Hundahl, S A; Dudeck, J

2000-10-01

This prospective, observational study of a cohort of thyroid cancer patients in Germany focusses on the "real-world" practice in the management of thyroid cancer patients. This report includes data from 2376 patients with primary differentiated thyroid carcinoma first diagnosed in the year 1996. The study reveals considerable differences in actual practice concerning surgery and radioiodine treatment. The results indicate that consensus is lacking with respect to the multimodality treatment approach for differentiated thyroid carcinoma. Our analysis represents the most current and comprehensive national assessment of presenting patient characteristics, diagnostic tests, treatment and complications for thyroid cancer.

Gender trends in dental practice patterns. A review of current U.S. literature.

PubMed

Dolan, T A

1991-01-01

This paper reviews three recent reports of national gender trends in dental practice patterns. Although the three independent cross-sectional studies were conducted at different points in time, used different sampling strategies, and used similar but independent survey instruments, findings were consistent across studies. In summary: Women dentists are less likely to be married and have fewer children. Women are more likely to assume child rearing and household responsibilities. Women are less likely to be practice owners. Women worked slightly fewer hours per week and weeks per year, and were more likely to take a leave of absence for illness or child rearing. However, women dentists demonstrate a far greater professional work commitment than was previously reported in the literature. Women earn significantly less income from the practice of dentistry, even after controlling for age, practice ownership, hours worked per week, and other personal characteristics. The most current "Gender Wage Gap" estimates range from 57.7% for specialists to 75.4% for general practitioners (8). delta.

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act... the methods used in, or the facilities or controls used for, its manufacture, processing, packing, or...

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act... the methods used in, or the facilities or controls used for, its manufacture, processing, packing, or...

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act... the methods used in, or the facilities or controls used for, its manufacture, processing, packing, or...

21 CFR 225.1 - Current good manufacturing practice.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act... the methods used in, or the facilities or controls used for, its manufacture, processing, packing, or...

Current practice in continuous renal replacement therapy: An epidemiological multicenter study.

PubMed

Tomasa Irriguible, T M; Sabater Riera, J; Poch López de Briñas, E; Fort Ros, J; Lloret Cora, M J; Roca Antònio, J; Navas Pérez, A; Ortiz Ballujera, P; Servià Goixart, L; González de Molina Ortiz, F J; Rovira Anglès, C; Rodríguez López, M; Roglan Piqueras, A

2017-05-01

The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

How Advertising History Helps Explain Current Practices.

ERIC Educational Resources Information Center

Lanfranco, Leonard W.

Students majoring in advertising can benefit from a study of that field in its historical context because such study helps them to understand current practices and to foresee future developments. One model of teaching advertising history within a required course about advertising and society begins with some basic definitions of the advertising…

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.

Cost-Effectiveness Analysis of Universal Vaccination of Adults Aged 60 Years with 23-Valent Pneumococcal Polysaccharide Vaccine versus Current Practice in Brazil.

PubMed

de Soárez, Patrícia Coelho; Sartori, Ana Marli Christovam; Freitas, Angela Carvalho; Nishikawa, Álvaro Mitsunori; Novaes, Hillegonda Maria Dutilh

2015-01-01

To evaluate the cost-effectiveness of introducing universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine (PPV23) into the National Immunization Program (NIP) in Brazil. Economic evaluation using a Markov model to compare two strategies: (1) universal vaccination of adults aged 60 years with one dose of PPV23 and 2) current practice (vaccination of institutionalized elderly and elderly with underlying diseases). The perspective was from the health system and society. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Clinical syndromes of interest were invasive pneumococcal disease (IPD) including meningitis, sepsis and others and pneumonia. Vaccine efficacy against IPD was obtained from a meta-analysis of randomized control trials and randomized studies, whereas vaccine effectiveness against pneumonia was obtained from cohort studies. Resource utilization and costs were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS). Univariate and multivariate sensitivity analysis were performed. The universal vaccination strategy avoided 7,810 hospitalizations and 514 deaths, saving 3,787 years of life and costing a total of USD$31,507,012 and USD$44,548,180, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$1,297 per LYS, from the perspective of the health system, and USD$904 per LYS, from the societal perspective. The results suggest that universal vaccination of adults aged 60 years with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is a very cost-effective intervention for preventing hospitalization and deaths for IPD and pneumonia is this age group in Brazil.

Inclusion Classrooms and Teachers: A Survey of Current Practices

ERIC Educational Resources Information Center

Kilanowski-Press, Lisa; Foote, Chandra J.; Rinaldo, Vince J.

2010-01-01

This study investigates the current state of inclusion practices in general education classrooms via survey of 71 inclusion teachers currently serving as special educators across the state of New York. Specifically, small group instruction, co-teaching, one-to-one instruction, and planning support are explored in relationship to class size, number…

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.

Bimodal Programming: A Survey of Current Clinical Practice.

PubMed

Siburt, Hannah W; Holmes, Alice E

2015-06-01

The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

Analyzing Matrices of Meta-Analytic Correlations: Current Practices and Recommendations

ERIC Educational Resources Information Center

Sheng, Zitong; Kong, Wenmo; Cortina, Jose M.; Hou, Shuofei

2016-01-01

Researchers have become increasingly interested in conducting analyses on meta-analytic correlation matrices. Methodologists have provided guidance and recommended practices for the application of this technique. The purpose of this article is to review current practices regarding analyzing meta-analytic correlation matrices, to identify the gaps…

Carotid Endarterectomy: Current Concepts and Practice Patterns

PubMed Central

Saha, Sibu P.; Saha, Subhajit; Vyas, Krishna S.

2015-01-01

Background Stroke is the number one cause of disability and third leading cause of death among adults in the United States. A major cause of stroke is carotid artery stenosis (CAS) caused by atherosclerotic plaques. Randomized trials have varying results regarding the equivalence and perioperative complication rates of stents versus carotid endarterectomy (CEA) in the management of CAS. Objectives We review the evidence for the current management of CAS and describe the current concepts and practice patterns of CEA. Methods A literature search was conducted using PubMed to identify relevant studies regarding CEA and stenting for the management of CAS. Results The introduction of CAS has led to a decrease in the percentage of CEA and an increase in the number of CAS procedures performed in the context of all revascularization procedures. However, the efficacy of stents in patients with symptomatic CAS remains unclear because of varying results among randomized trials, but the perioperative complication rates exceed those found after CEA. Conclusions Vascular surgeons are uniquely positioned to treat carotid artery disease through medical therapy, CEA, and stenting. Although data from randomized trials differ, it is important for surgeons to make clinical decisions based on the patient. We believe that CAS can be adopted with low complication rate in a selected subgroup of patients, but CEA should remain the standard of care. This current evidence should be incorporated into practice of the modern vascular surgeon. PMID:26417192

ICU nurses' oral-care practices and the current best evidence.

PubMed

DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all

Thirty-five year review of a mercury monitoring service for Scottish dental practices.

PubMed

Duncan, A; O'Reilly, D Stj; McDonald, E B; Watkins, T R; Taylor, M

2011-02-12

To review a long-standing mercury monitoring service offered to staff in dental practices in Scotland. During the first 20 years of the service, dentists and their staff were contacted by letter and invited to participate. Respondents were asked to collect samples of head hair, pubic hair, fingernail and toenail for analysis of mercury. After 1995, head hair samples were collected initially and further samples were only measured if head hair mercury was elevated. At the start of this scheme many staff, including administrative staff, had systemic exposure to mercury (defined as increased mercury in all four samples). Incidents of exposure have decreased over the 35 years and are now very rare. Male staff were found to have higher mercury concentrations than female staff and dentists tended to have higher concentrations than other staff. Staff working in dental practices more than five years old had small but discernable increases in head hair mercury concentration. In recent years the use of reusable capsules such as Dentomats has been associated with a slight but statistically significant increase in head hair mercury concentrations when compared to the use of encapsulated amalgam systems. Staff wearing open-toed footwear had significantly higher toenail mercury concentrations compared to those who wore shoes. Exposure of staff to mercury in Scottish dental practices is currently now very low. This is probably as a result of increased awareness to the toxicity of mercury and improved methods of preparing amalgam. It may be possible to reduce exposure further, although probably only slightly, by upgrading practices and using encapsulated mercury amalgam.

Current Practices in the Delivery of Undergraduate Exercise Physiology Content

ERIC Educational Resources Information Center

Fisher, Michele M.

2013-01-01

The purpose of this study was to identify current practices for the delivery of exercise physiology content at the undergraduate level. An anonymous 22-item survey was sent to instructors of exercise physiology to collect information concerning the structure of course offerings and instructional practices. One hundred ten instructors responded to…

21 CFR 210.2 - Applicability of current good manufacturing practice regulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Applicability of current good manufacturing... AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PROCESSING, PACKING, OR HOLDING OF DRUGS; GENERAL § 210.2 Applicability of current good manufacturing...

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Current good manufacturing practice. 113.5 Section 113.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED...

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Current good manufacturing practice. 113.5 Section 113.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED...

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Current good manufacturing practice. 113.5 Section 113.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED...

21 CFR 113.5 - Current good manufacturing practice.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Current good manufacturing practice. 113.5 Section 113.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION THERMALLY PROCESSED LOW-ACID FOODS PACKAGED IN HERMETICALLY SEALED...

Autism Spectrum Disorders: Neurobiology and Current Assessment Practices

ERIC Educational Resources Information Center

Allen, Ryan A.; Robins, Diana L.; Decker, Scott L.

2008-01-01

This study reviews recent research related to the neurobiology of Autism Spectrum Disorders (ASDs) an provides an empirical analysis of current assessment practices. Data were collected through a survey of 117 school psychologists. The Childhood Autism Rating Scale (CARS), Gilliam Autism Rating Scale (GARS), and Gilliam Asperger's Disorder Scale…

21 CFR 120.5 - Current good manufacturing practice.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 120.5 Section 120.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

21 CFR 120.5 - Current good manufacturing practice.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Current good manufacturing practice. 120.5 Section 120.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

21 CFR 120.5 - Current good manufacturing practice.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Current good manufacturing practice. 120.5 Section 120.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

21 CFR 120.5 - Current good manufacturing practice.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Current good manufacturing practice. 120.5 Section 120.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

21 CFR 120.5 - Current good manufacturing practice.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Current good manufacturing practice. 120.5 Section 120.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) SYSTEMS General...

Serving Wounded Warriors: Current Practices in Postsecondary Education

ERIC Educational Resources Information Center

Vance, Mary Lee; Miller, Wayne K., II

2009-01-01

From September to October 2009 the Association on Higher Education and Disabilities (AHEAD) invited anonymous voluntary responses from 2,500 members and affiliates to complete a 29-question online survey on current practices in postsecondary education for serving veterans with disabilities (wounded warriors). Two hundred and thirty seven complete…

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.

A survey of current clinical practice in permanent and temporary prostate brachytherapy: 2010 update.

PubMed

Buyyounouski, Mark K; Davis, Brian J; Prestidge, Bradley R; Shanahan, Thomas G; Stock, Richard G; Grimm, Peter D; Demanes, D Jeffrey; Zaider, Marco; Horwitz, Eric M

2012-01-01

To help establish patterns of care and standards of care of interstitial permanent low-dose-rate (LDR) and temporary high-dose-rate brachytherapy for prostate cancer and to compare the results with a similar 1998 American Brachytherapy Society (ABS) survey. A comprehensive questionnaire intended to survey specific details of current clinical brachytherapy practice was provided to the participants of the seventh ABS Prostate Brachytherapy School. Responses were tabulated and descriptive statistics are reported. Sixty-five brachytherapy practitioners responded to the survey. Eighty-nine percent (89%) of respondents performed LDR and 49% perform high-dose-rate brachytherapy. The median number of years of experience for LDR brachytherapists increased from 5 to 10 years over the course of the 12 years since the preceding survey. Compared with the first ABS, a smaller proportion of respondents received formal brachytherapy residency training (43% vs. 56%) or formal "hands-on" brachytherapy training (15% vs. 63%). There has been a marked decline in the utilization of the Mick applicator (Mick Radio-Nuclear Instruments, Inc., Mount Vernon, NY, USA) (60% vs. 28%) and an increase in the use of stranded seeds (40% vs. 11%). Compliance with postimplant dosimetry was higher in the 2010 survey. This survey does suggest an evolution in the practice of LDR brachytherapy since 1998 and aids in identifying aspects that require further progress or investigation. ABS guidelines and other practice recommendations appear to impact the practice of brachytherapy. Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Deployment guidelines for diplomats: current policy and practice.

PubMed

Dunn, R; Kemp, V; Patel, D; Williams, R; Greenberg, N

2015-10-01

Diplomatic organizations routinely send staff to high-threat postings (HTPs) and consequentially have moral and legal obligations to protect their health as far as is reasonably practicable. To carry out an international survey of diplomatic organizations that send personnel to HTPs to establish how they deal practically with their obligations to protect the mental health of their staff. An online anonymous survey about their organizations' policies relating to HTPs completed by international diplomatic organizations. Fourteen of 30 organizations approached completed the questionnaire, with a response rate of 47%. Deployment length varied: no minimum (15%), a minimum of 2 years (39%) and a maximum of 2 (31%), 3 (15%) or 4 years (31%); one organization did not state any maximum. HTP and low-threat postings had the same policies in 46% of organizations. Additional care and support (66%), additional preparation (50%), enhanced leave (33%) and additional physical and mental health assessments were informally adopted to address psychosocial risks of deployment to HTPs. There was little consensus on policies and practice for HTP deployment. We suggest that formal, consistently written guidelines, based on available quality evidence, and associated training and quality assurance should be formulated to make international practice more consistent and equitable. © Crown copyright 2015.

[DOPPS estimate of patient life years attributable to modifiable hemodialysis practices in France].

PubMed

Canaud, Bernard; Combe, Christian; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Friedrich K

2008-07-01

In this study, we used a prevalent cross-sectional sample of French hemodialysis patients from Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 (2002-2004) to determine the percentage of patients whose values failed to meet targets in six different areas of hemodialysis practice (dialysis dose, anemia, serum phosphorus (PO(4)), serum calcium (Ca), serum albumin and catheter use for vascular access). Cox survival models, with adjustments for patient characteristics, were used for these analyses to estimate mortality hazard ratios (HR). Based on the mortality HR, the fraction of patients outside each target and the total HD population in France, we estimated the number of patient life years that could potentially be gained if every chronic, in-center hemodialysis patient in France who is currently outside of the specified target was able to achieve it. The proportion of patients failing to meet one of the six practice targets in France varied from 15% (dialysis dose) to 75% (albumin) while the percentage of patients complying with all six targets was restricted to 1.2%. The relative risk of mortality (RR) associated with being outside these targets varied from 1.12 to 1.46. Based on these two measures the life-years survival was estimated. The projected number of patients and life years potentially gained from adherence to the six targets was estimated close to 10,600 years-patient. In conclusion, this study suggests large opportunities to improve hemodialysis patient care in France still exist. Compliance with two major practice targets, such as albumin and restriction of catheter use will save highly significant life years of hemodialysis patient. Implementing and strict adherence to national and international guidelines should serve as a basic inspiration for continual improvement of hemodialysis patient care.

Bariatric surgery and the changing current scope of general surgery practice: implications for general surgery residency training.

PubMed

Mostaedi, Rouzbeh; Ali, Mohamed R; Pierce, Jonathan L; Scherer, Lynette A; Galante, Joseph M

2015-02-01

The scope of general surgery practice has evolved tremendously in the last 20 years. However, clinical experience in general surgery residency training has undergone relatively little change. To evaluate the current scope of academic general surgery and its implications on surgical residency. The University HealthSystem Consortium and Association of American Medical Colleges established the Faculty Practice Solution Center (FPSC) to characterize physician productivity. The FPSC is a benchmarking tool for academic medical centers created from revenue data collected from more than 90,000 physicians who practice at 95 institutions across the United States. The FPSC database was queried to evaluate the annual mean procedure frequency per surgeon (PFS) in each calendar year from 2006 through 2011. The associated work relative value units (wRVUs) were also examined to measure physician effort and skill. During the 6-year period, 146 distinct Current Procedural Terminology codes were among the top 100 procedures, and 16 of these procedures ranked in the top 10 procedures in at least 1 year. The top 10 procedures accounted for more than half (range, 52.5%-57.2%) of the total 100 PFS evaluated for each year. Laparoscopic Roux-en-Y gastric bypass was consistently among the top 10 procedures in each year (PFS, 18.2-24.6). The other most frequently performed procedures included laparoscopic cholecystectomy (PFS, 30.3-43.5), upper gastrointestinal tract endoscopy (PFS, 26.5-34.3), mastectomy (PFS, 16.5-35.0), inguinal hernia repair (PFS, 15.5-22.1), and abdominal wall hernia repair (PFS, 21.6-26.1). In all years, laparoscopic Roux-en-Y gastric bypass generated the highest number of wRVUs (wRVUs, 491.0-618.2), and laparoscopic cholecystectomy was regularly the next highest (wRVUs, 335.8-498.7). A significant proportion of academic general surgery is composed of bariatric surgery, yet surgical training does not sufficiently emphasize the necessary exposure to technical expertise

International online survey to assess current practice in equine anaesthesia.

PubMed

Wohlfender, F D; Doherr, M G; Driessen, B; Hartnack, S; Johnston, G M; Bettschart-Wolfensberger, R

2015-01-01

Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. Online questionnaire survey. An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 4 2011-04-01 2011-04-01 false What is current good manufacturing practice for PET drugs? 212.2 Section 212.2 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION...

Crystallization screening: the influence of history on current practice.

PubMed

Luft, Joseph R; Newman, Janet; Snell, Edward H

2014-07-01

While crystallization historically predates crystallography, it is a critical step for the crystallographic process. The rich history of crystallization and how that history influences current practices is described. The tremendous impact of crystallization screens on the field is discussed.

Values and principles evident in current health promotion practice.

PubMed

Gregg, Jane; O'Hara, Lily

2007-04-01

Modern health promotion practice needs to respond to complex health issues that have multiple interrelated determinants. This requires an understanding of the values and principles of health promotion. A literature review was undertaken to explore the values and principles evident in current health promotion theory and practice. A broad range of values and principles are espoused as being integral to modern health promotion theory and practice. Although there are some commonalities across these lists, there is no recognised, authoritative set of values and principles accepted as fundamental and applicable to modern health promotion. There is a continuum of values and principles evident in health promotion practice from those associated with holistic, ecological, salutogenic health promotion to those more in keeping with conventional health promotion. There is a need for a system of values and principles consistent with modern health promotion that enables practitioners to purposefully integrate these values and principles into their understanding of health, as well as their needs assessment, planning, implementation and evaluation practice.

Specialization and the Current Practices of General Surgeons

PubMed Central

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

Specialization and the current practices of general surgeons.

PubMed

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2013 CFR

2013-04-01

... PET drugs? 212.2 Section 212.2 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... TOMOGRAPHY DRUGS General Provisions § 212.2 What is current good manufacturing practice for PET drugs? Current good manufacturing practice for PET drugs is the minimum requirements for the methods to be used...

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2014 CFR

2014-04-01

... PET drugs? 212.2 Section 212.2 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... TOMOGRAPHY DRUGS General Provisions § 212.2 What is current good manufacturing practice for PET drugs? Current good manufacturing practice for PET drugs is the minimum requirements for the methods to be used...

21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

Code of Federal Regulations, 2012 CFR

2012-04-01

... PET drugs? 212.2 Section 212.2 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... TOMOGRAPHY DRUGS General Provisions § 212.2 What is current good manufacturing practice for PET drugs? Current good manufacturing practice for PET drugs is the minimum requirements for the methods to be used...

Crystallization screening: the influence of history on current practice

PubMed Central

Luft, Joseph R.; Newman, Janet; Snell, Edward H.

2014-01-01

While crystallization historically predates crystallography, it is a critical step for the crystallographic process. The rich history of crystallization and how that history influences current practices is described. The tremendous impact of crystallization screens on the field is discussed. PMID:25005076

A 30-Year Follow-Up Study of Actual Applied Music Practice Versus Estimated Practice

ERIC Educational Resources Information Center

Madsen, Clifford K.

2004-01-01

This study was designed to determine if adults are able to remember how much time they actually spent practicing during a past time period of their lives where detailed daily records were kept of actual number of minutes practiced. It also addressed how past practice time relates to their highest level of musical performance across the 30 years on…

Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients.

PubMed

Campbell, Denise J; Brown, Fiona G; Craig, Jonathan C; Gallagher, Martin P; Johnson, David W; Kirkland, Geoffrey S; Kumar, Subramanian K; Lim, Wai H; Ranganathan, Dwarakanathan; Saweirs, Walaa; Sud, Kamal; Toussaint, Nigel D; Walker, Rowan G; Williams, Lesley A; Yehia, Maha; Mudge, David W

2016-04-01

Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice. This is a multicentre network study involving eight PD units in Australia and New Zealand, with a focus on adherence to guideline recommendations on antimicrobial prophylaxis in PD patients. Current practice was established by asking the PD unit heads to respond to a short survey about practice/protocols/policies and a 'process map' was constructed following a face-to-face interview with the primary PD nurse at each unit. The perceived barriers/enablers to adherence to the relevant guideline recommendations were obtained from the completion of 'cause and effect' diagrams by the nephrologist and PD nurse at each unit. Data on PD-related infections were obtained for the period 1 January 2011 to 31 December 2011. Perceived barriers that may result in reduced adherence to guideline recommendations included lack of knowledge, procedural lapses, lack of a centralized patient database, patients with non-English speaking background, professional concern about antibiotic resistance, medication cost and the inability of nephrologists and infectious diseases staff to reach consensus on unit protocols. The definitions of PD-related infections used by some units varied from those recommended by the International Society for Peritoneal Dialysis, particularly with exit-site infection (ESI). Wide variations were observed in the

Adolescents' physical activity is associated with previous and current physical activity practice by their parents.

PubMed

Christofaro, Diego Giulliano Destro; Andersen, Lars Bo; Andrade, Selma Maffei de; Barros, Mauro Virgílio Gomes de; Saraiva, Bruna Thamyres Ciccotti; Fernandes, Rômulo Araújo; Ritti-Dias, Raphael Mendes

The purpose of this study was to determine whether parents' current and previous physical activity practice is associated with adolescents' physical activity. The sample was composed of 1231 adolescents (14-17 years), and 1202 mothers and 871 fathers were interviewed. Weight and height of the adolescents were measured. Self-reported parents' weight and height were obtained. The current and previous physical activity levels (Baecke's questionnaire) of parents (during childhood and adolescence) and adolescents' physical activity levels were obtained using a questionnaire. The magnitude of the associations between parent and adolescent physical activity levels was determined by binary logistic regression (adjusted by sex, age, and socioeconomic level of adolescents and education level of parents). The current physical activity practice by parents was associated with adolescents' physical activity (p<0.001). The physical activities reported by parents in their childhood and adolescence were also associated with higher physical activity levels among adolescents. Adolescents whose parents were both physically active in the past and present were six times (OR=6.67 [CI=1.94-22.79]) more likely to be physically active compared to adolescents with no parents who were physically active in the past. The current and previous physical activities of parents were associated with higher levels of physical activity in adolescents, even after controlling for confounding factors. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

An Exploratory Study Examining Current Assessment Supervisory Practices in Professional Psychology.

PubMed

Iwanicki, Sierra; Peterson, Catherine

2017-01-01

The extant literature reveals a considerable amount of research examining course work or technical training in psychological assessment, but a dearth of empirical research on assessment supervision. This study examined perspectives on current assessment supervisory practices in professional psychology through an online survey. Descriptive and qualitative data were collected from 125 survey respondents who were members of assessment-focused professional organizations and who had at least 1 year of supervision experience. Responses indicated a general recognition of the need for formal training in assessment supervision, ongoing training opportunities, and adherence to supervision competencies. Responses indicated more common use of developmental and skill-based models, although most did not regard any one model of assessment supervision as superior. Despite the recommended use of a supervision contract, only 65.6% (n = 80) of respondents use one. Discussion, directed readings, modeling, role-play, and case presentations were the most common supervisory interventions. Although conclusions are constrained by low survey response rate, results yielded rich data that might guide future examination of multiple perspectives on assessment supervision and ultimately contribute to curriculum advances and the development of supervision "best practices."

76 FR 38399 - Assessing the Current Research, Policy, and Practice Environment in Public Health Genomics

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... CDC-2011-0008] Assessing the Current Research, Policy, and Practice Environment in Public Health... information helpful to assess the current research, policy, and practice environment in public health genomics. HHS/CDC is currently leading a process to assess the most important steps for public health genomics...

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

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

....150 Section 1271.150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150... implemented for reproductive HCT/Ps described in § 1271.10 and regulated solely under section 361 of the...

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

....150 Section 1271.150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150... implemented for reproductive HCT/Ps described in § 1271.10 and regulated solely under section 361 of the...

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

....150 Section 1271.150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150... implemented for reproductive HCT/Ps described in § 1271.10 and regulated solely under section 361 of the...

21 CFR 1271.150 - Current good tissue practice requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

....150 Section 1271.150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150... implemented for reproductive HCT/Ps described in § 1271.10 and regulated solely under section 361 of the...

State Blood Alcohol Concentration (BAC) Testing and Reporting for Drivers Involved in Fatal Crashes : Current Practices, Results, and Strategies, 1997-2009

DOT National Transportation Integrated Search

2012-08-01

This report documents current State blood alcohol concentration (BAC) testing and reporting practices and results for drivers involved in fatal crashes. It summarizes known BAC results by State for the years 1997 to 2009 for both fatally injured and ...

Birth Control in Clinical Trials: Industry Survey of Current Use Practices, Governance, and Monitoring.

PubMed

Stewart, J; Breslin, W J; Beyer, B K; Chadwick, K; De Schaepdrijver, L; Desai, M; Enright, B; Foster, W; Hui, J Y; Moffat, G J; Tornesi, B; Van Malderen, K; Wiesner, L; Chen, C L

2016-03-01

The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives.

76 FR 47593 - Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

...] Guidance for Small Business Entities on Current Good Manufacturing Practice for Positron Emission... entitled ``PET Drugs--Current Good Manufacturing Practice (CGMP); Small Entity Compliance Guide.'' FDA has... consistent with FDA's good guidance practices regulation (21 CFR 10.115). The guidance represents the Agency...

Short-range transit planning : current practice and a proposed framework

DOT National Transportation Integrated Search

1984-06-01

The research described in this report explored the service and operations : planning process in the transit industry in a two-phase approach. In the first : phase a detailed assessment of current short range transit planning practice was : undertaken...

Current practice in airway management: A descriptive evaluation.

PubMed

Kjonegaard, Rebecca; Fields, Willa; King, Major L

2010-03-01

Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

29 CFR 548.306 - Average earnings for year or quarter year preceding the current quarter.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PAY Interpretations Authorized Basic Rates § 548.306 Average earnings for year or quarter year... regular rates of pay during the current quarter year, and (ii) such average hourly remuneration during the... 29 Labor 3 2011-07-01 2011-07-01 false Average earnings for year or quarter year preceding the...

Current obstetrical practice and umbilical cord prolapse.

PubMed

Usta, I M; Mercer, B M; Sibai, B M

1999-01-01

The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

Assessment of current cybersecurity practices in the public domain : cyber indications and warnings domain.

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

Hamlet, Jason R.; Keliiaa, Curtis M.

This report assesses current public domain cyber security practices with respect to cyber indications and warnings. It describes cybersecurity industry and government activities, including cybersecurity tools, methods, practices, and international and government-wide initiatives known to be impacting current practice. Of particular note are the U.S. Government's Trusted Internet Connection (TIC) and 'Einstein' programs, which are serving to consolidate the Government's internet access points and to provide some capability to monitor and mitigate cyber attacks. Next, this report catalogs activities undertaken by various industry and government entities. In addition, it assesses the benchmarks of HPC capability and other HPC attributes thatmore » may lend themselves to assist in the solution of this problem. This report draws few conclusions, as it is intended to assess current practice in preparation for future work, however, no explicit references to HPC usage for the purpose of analyzing cyber infrastructure in near-real-time were found in the current practice. This report and a related SAND2010-4766 National Cyber Defense High Performance Computing and Analysis: Concepts, Planning and Roadmap report are intended to provoke discussion throughout a broad audience about developing a cohesive HPC centric solution to wide-area cybersecurity problems.« less

Plastics processing: statistics, current practices, and evaluation.

PubMed

Cooke, F

1993-11-01

The health care industry uses a huge quantity of plastic materials each year. Much of the machinery currently used, or supplied, for plastics processing is unsuitable for use in a clean environment. In this article, the author outlines the reasons for the current situation and urges companies to re-examine their plastic-processing methods, whether performed in-house or subcontracted out. Some of the factors that should be considered when evaluating plastics-processing equipment are outlined to assist companies in remaining competitive and complying with impending EC regulations on clean room standards for manufacturing areas.

Knowledge, attitudes and practice of final-year student pharmacists in public health in Namibia, Zambia and Zimbabwe: an exploratory survey.

PubMed

Law, Miranda G; Maposa, Prosper; Chambula, Elias; Steeb, David R; Eckel, Stephen F; Duncan, Gregory

2018-05-06

To explore the knowledge, attitudes and practice of final-year student pharmacists about public health. Knowledge, attitudes and practice of all final-year student pharmacists (N = 158) in Namibia, Zambia and Zimbabwe were assessed through a quantitative 12-item survey. The survey assessed personal interest and attitude towards public health activities, self-assessed ability to perform basic public health activities, perspectives towards current pharmacist practices within public health activities in their country, and student involvement in public health activities during pharmacy school. Eighty-two per cent of students responded to the survey (n = 129). The majority (95%) of all final-year student pharmacists are interested in contributing to public health activities in both health promotion and disease prevention and feel, as pharmacists, they have the responsibility to do so. Additionally, the majority of students would like more education during pharmacy school on health promotion (93%) and disease prevention (89%). Despite their interest, low numbers of student pharmacists feel that pharmacists are currently utilised in disease prevention (35%) and health promotion (42%). Final-year student pharmacists in Namibia, Zambia and Zimbabwe express strong interest in public health education and involvement in public health activities. This interest and enthusiasm can serve as evidence for advancing public health education in the pharmacy curricula and for developing pharmacist opportunities in public health efforts that match the needs of the country. © 2018 Royal Pharmaceutical Society.

Analysis of the current rib support practices and techniques in U.S. coal mines

PubMed Central

Mohamed, Khaled M.; Murphy, Michael M.; Lawson, Heather E.; Klemetti, Ted

2016-01-01

Design of rib support systems in U.S. coal mines is based primarily on local practices and experience. A better understanding of current rib support practices in U.S. coal mines is crucial for developing a sound engineering rib support design tool. The objective of this paper is to analyze the current practices of rib control in U.S. coal mines. Twenty underground coal mines were studied representing various coal basins, coal seams, geology, loading conditions, and rib control strategies. The key findings are: (1) any rib design guideline or tool should take into account external rib support as well as internal bolting; (2) rib bolts on their own cannot contain rib spall, especially in soft ribs subjected to significant load—external rib control devices such as mesh are required in such cases to contain rib sloughing; (3) the majority of the studied mines follow the overburden depth and entry height thresholds recommended by the Program Information Bulletin 11-29 issued by the Mine Safety and Health Administration; (4) potential rib instability occurred when certain geological features prevailed—these include draw slate and/or bone coal near the rib/roof line, claystone partings, and soft coal bench overlain by rock strata; (5) 47% of the studied rib spall was classified as blocky—this could indicate a high potential of rib hazards; and (6) rib injury rates of the studied mines for the last three years emphasize the need for more rib control management for mines operating at overburden depths between 152.4 m and 304.8 m. PMID:27648341

The first two years of practice: a longitudinal perspective on the learning and professional development of promising novice physical therapists.

PubMed

Hayward, Lorna M; Black, Lisa L; Mostrom, Elizabeth; Jensen, Gail M; Ritzline, Pamela D; Perkins, Jan

2013-03-01

Physical therapists work in complex health care systems requiring professional competence in clinical reasoning and confidence in decision-making skills. For novice physical therapists, the initial practice years are a time for developing professional identity and practical knowledge. The study purpose was to extend previous research describing the experiences, learning, and professional development of 11 promising novice therapists during their first year of practice. The present study examined the continued development of the same therapists during their second year of clinical practice. Seven researchers from 4 physical therapist educational programs in the eastern and midwestern United States used a longitudinal, qualitative, multiple case study approach. Eleven physical therapist graduates identified as "promising novices" were recruited using purposive sampling. Participants ranged in age from 24 to 29 years and entered varied practice settings. Data were collected for 2 years using semistructured interviews, reflective journals, and participant observation. A conceptual model describing the participants' ongoing development during the second year of practice emerged. The 3 themes were formal and informal learning, increasing confidence and expansion of skills, and engagement in an environment characterized by collaborative exchange and opportunities for teaching. The second year represented consolidation and elaboration of practice-based learning and skills. The expansion of confidence, skills, and responsibilities and the externalization of learning the participants experienced promoted professional role formation. Learning previously directed inward and self-focused turned outward, fueled by growing self-confidence. Research illuminating the professional role formation experienced during early clinical practice is not widely available. The current study and further research into the learning and development of novice practitioners may assist educators in

Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice.

PubMed

Römkens, Tessa E H; Gijsbers, Kim; Kievit, Wietske; Hoentjen, Frank; Drenth, Joost P H

2016-12-01

Recently, treatment goals in inflammatory bowel disease (IBD) in clinical trials have shifted from mainly symptom-based to more mucosa-driven. Real world data on treatment priorities are lacking. We aimed to investigate the current practice and most commonly used definitions of IBD treatment targets among Dutch gastroenterologists. Dutch gastroenterologists were asked to participate in a computer-based nation-wide survey. We asked questions on demographics, opinion and current practice regarding IBD treatment targets. Twenty-four percent (134/556) of the respondents completed the survey. For both Crohn's disease (CD) (47.3%, 61/129) and ulcerative colitis (UC)(45%, 58/129) the main treatment goal was to achieve and maintain deep remission, defined as clinical, biochemical and endoscopic remission. Seventy-six percent of the participants use mucosal healing (MH) as a potential treatment target for IBD, whereas 22.6% use histological remission. There is no single definition for MH in IBD. The majority use Mayo score ≤ 1 in UC (52%) and 'macroscopic normal mucosa' in CD (66%). More stringent and mucosa-driven treatment targets as 'deep remission' and 'mucosal healing' have found traction in clinical practice. The most commonly used definition for MH in routine practice is endoscopic MAYO score

Texas entry-year agriculture teachers' perceptions, practices, and preparation regarding safety and health in agricultural education.

PubMed

Hubert, D J; Ullrich, D R; Murphy, T H; Lindner, J R

2001-08-01

The purpose of this study was to gather benchmark data for the assessment of the knowledge, attitudes, and perceptions regarding agricultural safety issues and curricula held by Texas agricultural teachers with less than two full years of teaching experience (entry-year teachers). Seventy-four of 118 well-distributed teachers responded to this survey. Researchers concluded that more females were entering a traditionally male-dominated field. Overall, teachers addressed safety within units of instruction rather than as separate units. The most useful forms of new teaching resources that this group of teachers would like to see produced were safety videos and study guides, and class demonstration/simulation activities. There was a significant difference in rankings between teachers less than 26 years old and teachers more than 26 years old regarding the usefulness of transparencies as a new teaching resource (F = 5.00, p = 0.0268). Few teachers were currently CPR and first aid certified, even though most had received training and completed a general safety and/or health related course while in college. Teachers generally agreed philosophically with most practices and exhibited personal beliefs consistent with proper safety preparedness and practice in agricultural settings. However, many of these teachers failed to practice what was expected of safe tractor operators, such as wearing safety belts and allowing younger drivers to operate the equipment.

Large-Eddy Simulation: Current Capabilities, Recommended Practices, and Future Research

NASA Technical Reports Server (NTRS)

Georgiadis, Nicholas J.; Rizzetta, Donald P.; Fureby, Christer

2009-01-01

This paper presents the results of an activity by the Large Eddy Simulation (LES) Working Group of the AIAA Fluid Dynamics Technical Committee to (1) address the current capabilities of LES, (2) outline recommended practices and key considerations for using LES, and (3) identify future research needs to advance the capabilities and reliability of LES for analysis of turbulent flows. To address the current capabilities and future needs, a survey comprised of eleven questions was posed to LES Working Group members to assemble a broad range of perspectives on important topics related to LES. The responses to these survey questions are summarized with the intent not to be a comprehensive dictate on LES, but rather the perspective of one group on some important issues. A list of recommended practices is also provided, which does not treat all aspects of a LES, but provides guidance on some of the key areas that should be considered.

Plastic and reconstructive robotic microsurgery--a review of current practices.

PubMed

Saleh, D B; Syed, M; Kulendren, D; Ramakrishnan, V; Liverneaux, P A

2015-08-01

We sought to review the current state of robotics in this specialty. A Pubmed and Medline search was performed using key search terms for a comprehensive review of the whole cross-section of plastic and reconstructive practice. Overall, 28 publications specific to robotic plastic and reconstructive procedures were suitable for appraisal. The current evidence suggests robotics is comparable to standard methods despite its infancy. The possible applications are wide and could translate into superior patient outcomes. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Current Practice and Infrastructures for Campus Centers of Community Engagement

ERIC Educational Resources Information Center

Welch, Marshall; Saltmarsh, John

2013-01-01

This article provides an overview of current practice and essential infrastructure of campus community engagement centers in their efforts to establish and advance community engagement as part of the college experience. The authors identified key characteristics and the prevalence of activities of community engagement centers at engaged campuses…

Management of tinnitus in English NHS audiology departments: an evaluation of current practice

PubMed Central

Hoare, Derek J; Gander, Phillip E; Collins, Luke; Smith, Sandra; Hall, Deborah A

2012-01-01

Rationale, aim and objective In 2009, the UK Department of Health formalized recommended National Health Service practices for the management of tinnitus from primary care onwards. It is timely therefore to evaluate the perceived practicality, utility and impact of those guidelines in the context of current practice. Methods We surveyed current practice by posting a 36-item questionnaire to all audiology and hearing therapy staff that we were able to identify as being involved in tinnitus patient care in England. Results In total, 138 out of 351 clinicians responded (39% response rate). The findings indicate a consensus opinion that management should be tailored to individual symptom profiles but that there is little standardization of assessment procedures or tools in use. Conclusions While the lack of standardized practice might provide flexibility to meet local demand, it has drawbacks. It makes it difficult to ascertain key standards of best practice, it complicates the process of clinical audit, it implies unequal patient access to care, and it limits the implementation of translational research outcomes. We recommend that core elements of practice should be standardized, including use of a validated tinnitus questionnaires and an agreed pathway for decision making to better understand the rationale for management strategies offered. PMID:21087449

Currents in STSE Education: Mapping a Complex Field, 40 Years on

ERIC Educational Resources Information Center

Pedretti, Erminia; Nazir, Joanne

2011-01-01

It has been 40 years since science, technology, society, and environment (STSE) education first appeared in science education research and practice. Although supported among many educators worldwide, there is much confusion surrounding the STSE slogan. Widely differing discourses on STSE education and diverse ways of practicing, have led to an…

Aphasia: Current Concepts in Theory and Practice

PubMed Central

Tippett, Donna C.; Niparko, John K.; Hillis, Argye E.

2014-01-01

Recent advances in neuroimaging contribute to a new insights regarding brain-behavior relationships and expand understanding of the functional neuroanatomy of language. Modern concepts of the functional neuroanatomy of language invoke rich and complex models of language comprehension and expression, such as dual stream networks. Increasingly, aphasia is seen as a disruption of cognitive processes underlying language. Rehabilitation of aphasia incorporates evidence based and person-centered approaches. Novel techniques, such as methods of delivering cortical brain stimulation to modulate cortical excitability, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, are just beginning to be explored. In this review, we discuss the historical context of the foundations of neuroscientific approaches to language. We sample the emergent theoretical models of the neural substrates of language and cognitive processes underlying aphasia that contribute to more refined and nuanced concepts of language. Current concepts of aphasia rehabilitation are reviewed, including the promising role of cortical stimulation as an adjunct to behavioral therapy and changes in therapeutic approaches based on principles of neuroplasticity and evidence-based/person-centered practice to optimize functional outcomes. PMID:24904925

Human resource management in general practice: survey of current practice.

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters

Assessing and Treating Pain in Hospices: Current State of Evidence-Based Practices

PubMed Central

Herr, Keela; Titler, Marita; Fine, Perry; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen

2010-01-01

The aim of this article is to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index (CPPI), a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of the those key evidence-based practices (EBPs) that were applicable to their situation. When examining individual practices, the majority of patients had their pain assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps including: additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the Pain Treatment Plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by pain medication increases (15.8%); monitoring of analgesic- induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both non-pharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices. PMID:20471542

Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations.

PubMed

Assefa, Yibeltal; Van Damme, Wim; Hermann, Katharina

2010-01-01

PURPOSE OF VIEW: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention.

Narrative, Poststructuralism, and Social Justice: Current Practices in Narrative Therapy

ERIC Educational Resources Information Center

Combs, Gene; Freedman, Jill

2012-01-01

This paper is a review of current practice in narrative therapy with a focus on how it is attractive and useful for therapists who wish to work for social justice. The authors describe narrative therapy's roots in poststructuralist philosophy and social science. They illustrate its major theoretical constructs, including the "narrative metaphor,"…

Patients' evaluations of European general practice--revisited after 11 years.

PubMed

Petek, Davorina; Künzi, Beat; Kersnik, Janko; Szecsenyi, Joachim; Wensing, Michel

2011-12-01

In the last decade many things have changed in healthcare systems, primary care practices and populations. To describe evaluations of general practice care by patients with a chronic illness in 2009 and compare these with a previous study done in 1998. A descriptive analysis of patients' evaluations, using data from the European practice assessment Cardio study on cardiovascular patients in eight European countries in 2009. We compared these evaluations with a subgroup of patients with self-defined chronic illness from the study in 1998, using a linear regression model. Patients' evaluation of general practice using the EUROPEP questionnaire. The EUROPEP is a 23-item validated measure of patient evaluations of general practice care. In 2009, 7472 patients from 251 practices participated in the study with an overall response rate of 49.6%. The percentage of patients with positive evaluations (good/excellent) was 80% or higher for all items, except for the waiting time. More positive evaluations were found in older patients, patients with a longer attachment to the practice, patients with a higher self-evaluation of their health, patients with fewer mental health problems and less pain/discomfort. The comparison between 1998 and 2009 showed no overall trends for all countries combined. Whereas English patients became fairly more positive about general practice in 2009, German patients became slightly less positive, although still more positive than English patients. Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time.

The role of community pharmacy-based vaccination in the USA: current practice and future directions

PubMed Central

Bach, Albert T; Goad, Jeffery A

2015-01-01

Community pharmacy-based provision of immunizations in the USA has become commonplace in the last few decades, with success in increasing rates of immunizations. Community pharmacy-based vaccination services are provided by pharmacists educated in the practice of immunization delivery and provide a convenient and accessible option for receiving immunizations. The pharmacist’s role in immunization practice has been described as serving in the roles of educator, facilitator, and immunizer. With a majority of pharmacist-provided vaccinations occurring in the community pharmacy setting, there are many examples of community pharmacists serving in these immunization roles with successful outcomes. Different community pharmacies employ a number of different models and workflow practices that usually consist of a year-round in-house service staffed by their own immunizing pharmacist. Challenges that currently exist in this setting are variability in scopes of immunization practice for pharmacists across states, inconsistent reimbursement mechanisms, and barriers in technology. Many of these challenges can be alleviated by continual education; working with legislators, state boards of pharmacy, stakeholders, and payers to standardize laws; and reimbursement design. Other challenges that may need to be addressed are improvements in communication and continuity of care between community pharmacists and the patient centered medical home. PMID:29354521

Health technology reassessment of non-drug technologies: current practices.

PubMed

Leggett, Laura; Noseworthy, Tom W; Zarrabi, Mahmood; Lorenzetti, Diane; Sutherland, Lloyd R; Clement, Fiona M

2012-07-01

Obsolescence is a natural phase of the lifecycle of health technologies. Given increasing cost of health expenditures worldwide, health organizations have little choice but to engage in health technology reassessment (HTR); a structured, evidence-based assessment of the medical, social, ethical, and economic effects of a technology, currently used within the healthcare system, to inform optimal use of that technology in comparison to its alternatives. This research was completed to identify and summarize international HTR initiatives for non-drug technologies. A systematic review was performed using the terms disinvestment, obsolescence, obsolete technology, ineffective, reassessment, reinvestment, reallocation, program budgeting, and marginal analysis to search PubMED, MEDLINE, EMBASE, and CINAHL until November 2011. Websites of organizations listed as members of INAHTA and HTAi were hand-searched for gray literature. Documents were excluded if they were unavailable in English, if the title/abstract was irrelevant to HTR, and/or if the document made no mention of current practices. All citations were screened in duplicate with disagreements resolved by consensus. Sixty full-text documents were reviewed and forty were included. One model for reassessment was identified; however, it has never been put into practice. Eight countries have some evidence of past or current work related to reassessment; seven have shown evidence of continued work in HTR. There is negligible focus on monitoring and implementation. HTR is in its infancy. Although health technology reassessments are being conducted, there is no standardized approach. Future work should focus on developing and piloting a comprehensive methodology for completing HTR.

Test result communication in primary care: a survey of current practice.

PubMed

Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

2015-11-01

The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the

Test result communication in primary care: a survey of current practice

PubMed Central

Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

2015-01-01

Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for

Baby walkers--health visitors' current practice, attitudes and knowledge.

PubMed

Kendrick, Denise; Illingworth, Rachel; Hapgood, Rhydian; Woods, Amanda J; Collier, Jacqueline

2003-09-01

Baby walkers are a commonly used item of nursery equipment. Between 12% and 50% of parents whose infant uses a walker report that their child has suffered a walker-related injury. Health visitors' knowledge, attitudes and practice with regard to walkers and related health education has not been explored so far. The aim of the study was to describe health visitors' knowledge of walkers and walker-related injuries, their attitudes towards walkers and current practice with regard to walker health education, and to examine the relationship between knowledge and attitudes and knowledge and practice. A survey was carried out with 64 health visitors prior to participation in a randomized controlled trial assessing the effectiveness of an educational package in reducing baby walker use. The response rate was 95%. Half of the health visitors always discussed walkers postnatally, most frequently at the 6-9 month check. Most did not usually discuss the frequency of walker-related injuries. Most had negative attitudes towards walkers, but believed that parents hold positive attitudes to them and that it is hard to persuade parents not to use them. Health visitors had a limited knowledge of walker use and walker-related injuries. Those giving advice on walkers most often had higher knowledge scores than those giving advice less often (P = 0.03). Those with higher knowledge scores held more negative attitudes towards walkers (rs = 0.29, P = 0.023) and believed parents to have more positive attitudes towards walkers (rs = -0.49, P < 0.001). Few health visitors had resources to discuss walkers. Health visitor advice regarding walkers needs to be given earlier in the postnatal period than is currently common practice, and they need more knowledge about walker use and related injuries. Education about baby walkers needs to be incorporated into undergraduate and in-service education, which may need to include the development of skills in exploring reasons why parents use walkers and

Screening mammography among nursing home residents in the United States: Current guidelines and practice.

PubMed

Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L

2018-06-04

United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.

High-Impact Practices and the First-Year Student

ERIC Educational Resources Information Center

Tukibayeva, Malika; Gonyea, Robert M.

2014-01-01

High-impact practices, programs, and activities where students commit considerable time and effort in different settings can help to define the first-year college experience and are likely to increase success in areas like persistence, deep learning, and self-reported gains.

Congruence of the current practices in Hymenoptera venom allergic patients in Poland with EAACI guidelines

PubMed Central

Cichocka-Jarosz, Ewa; Diwakar, Lavanya; Brzyski, Piotr; Tobiasz-Adamczyk, Beata; Lis, Grzegorz; Pietrzyk, Jacek J.

2011-01-01

Introduction Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance. Material and methods A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines. Results Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders. Conclusions There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries. PMID:22291828

[Diagnosis and venom specific immunotherapy (VIT) in allergic children in Poland--how much the current practice follows the international guidelines?].

PubMed

Cichocka-Jarosz, Ewa; Brzyski, Piotr; Lis, Grzegorz; Jedynak-Wasowicz, Urszula; Pietrzyk, Jacek Józef; Lange, Joanna; Małaczyńska, Teresa; Kraluk, Barbara; Swiebocka, Ewa; Breborowicz, Anna; Kycler, Zdzisława; Pietraszek-Mamcarz, Jolanta; Poszwiński, Adam; Gaszczyk, Grzegorz

2010-01-01

Insect venom allergy requires a high level approach adequate to allergy intensity. In case of severe IgE-mediated sting reactions, in children older than five years, venom immunotherapy is a treatment of choice. Identification of current practices applied to venom allergic children in Poland and their adherence to the international guidelines. Questionnaire survey concerning diagnostic and treatment rules was carried out in 8 centres of pediatric allergology, based on a similar audit conducted in the United Kingdom [Diwakar L. et al. Clin Exp Allergy 2008, 38: 1651]. In 5 centres both RAST and SPT tests were used as the first line of investigation. Subsequently 6 centres performed IDT. In three centres baseline serum tryptase levels were estimated. In case of sensitization to both bee and wasp venom in a child with the history of severe systemic reaction, but uncertain culprit insect, specific venom immunotherapy with both venoms was practised by 2 centres. In systemic reaction and not-detectable IgE in 6 centres child was followed-up in 6-12 months. Antihistamine premedication concerned all children in 7 centres. Six-week interval between booster doses was applied in half of centres. A target dose equal 100 mcg was used in 7 centres. Similarly all centres practiced 3-5 five year period of VIT. In Poland current practice with venom allergic children was conducted in congruence with most of the recommendations.

Biomedical waste management in Ayurveda hospitals - current practices & future prospectives.

PubMed

Rajan, Renju; Robin, Delvin T; M, Vandanarani

2018-03-16

Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

The Practice of School Psychology in Quebec English Schools: Current Challenges and Opportunities

ERIC Educational Resources Information Center

Finn, Cindy A.

2016-01-01

In Quebec, school psychology is alive and well. This article outlines current challenges and opportunities related to the practice of psychology in Quebec English schools. Changes to the practice of psychology in Quebec over the last decade have had an impact on the delivery of psychological services in schools. Modifications of the admission…

Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

ERIC Educational Resources Information Center

Beckley, Firle; Best, Wendy; Beeke, Suzanne

2017-01-01

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

Liver resections in over-75-year-old patients: surgical hazard or current practice?

PubMed

Aldrighetti, Luca; Arru, Marcella; Catena, Marco; Finazzi, Renato; Ferla, Gianfranco

2006-03-01

To assess the safety of hepatic resections in the very old patient by comparing the outcome in patients younger and older than 75 years. Thirty-two resections in 31 patients > or =75 years (Over-75 Group) were compared with 164 resections in 162 patients <75 years (Control Group). Indications for resection, concomitant diseases, previous abdominal surgery, type of resection, associated surgical procedures, use/length of portal clamping, intra-operative blood losses and transfusions, and length of operation were preliminarily compared. The outcome was evaluated in terms of post-operative mortality, morbidity, transfusions, and postoperative hospitalization. Mean age was 76.0 +/- 2.3 years (range 75-83) in the Over-75 Group and 58.4 +/- 10.7 years (range 23-74) in the Control Group. The over-75 group included more hepatomas (43.8% vs. 26.8%, P = 0.09), chronic liver disease (31.3% vs. 28.7%, P = 0.03) and concomitant diseases (62.5% vs. 32.9%, P = 0.002). The two groups were comparable (P = n.s.) when evaluated for all other variables. The 30-day mortality rate was 3.6% in the Control Group and none in the Over-75 Group. Postoperative surgical complications occurred in 37 patients (22.6%) in the Control Group and 1 patient (3.1%) in the Over-75 Group, with statistically significant differences (P = 0.01), and incidence of medical complications was 13.4% in the Control Group and 3.1% in the Over-75 Group. Median postoperative hospitalization and transfusions were not statistically different. Hepatic resections in over-75-year-old patients are not a surgical hazard and may be carried out relatively safely as long as an accurate selection of the patient is performed.

Practice patterns of family physicians with 2-year residency v. 1-year internship training: do both roads lead to Rome?

PubMed Central

Sheps, S B; Schechter, M T; Grantham, P; Finlayson, N; Sizto, R

1989-01-01

Are there differences in patterns of practice between actively practising physicians who have been certified after a 2-year family practice residency and matched physicians without certification who have completed the standard 1-year internship? With the use of billing files prepared by the British Columbia Medical Association a group of 65 family practice certificants in active practice in British Columbia was compared with a control group of 130 internship trainees matched by year and school of graduation, category of billing (i.e., solo or group) and region. A wide range of practice features was assessed for the fiscal years 1984-85, 1985-86 and 1986-87. No differences were detected between the groups in 1986-87 for the following practice variables: number of patients (1888 and 1842 respectively), number of personal services billed for (7265 and 7173), number of personal services per patient (3.9), amount of funding for personal services ($140,192 and $140,100) and amount per patient for personal services ($77 and $79). Age-adjusted costs for male and female patients were similar in the two groups. Of six services thought to be influenced by type of training, only maternity care generated a significantly higher number of billings in the study group (341 v. 249). These results suggest that there is no demonstrable effect of training on patterns of practice. However, the question of the effect of training on quality of care and whether the 2-year residency may have a longer effect on practice patterns should be the focus of future research. PMID:2702528

Meaningful Peer Review in Radiology: A Review of Current Practices and Potential Future Directions.

PubMed

Moriarity, Andrew K; Hawkins, C Matthew; Geis, J Raymond; Dreyer, Keith J; Kamer, Aaron P; Khandheria, Paras; Morey, Jose; Whitfill, James; Wiggins, Richard H; Itri, Jason N

2016-12-01

The current practice of peer review within radiology is well developed and widely implemented compared with other medical specialties. However, there are many factors that limit current peer review practices from reducing diagnostic errors and improving patient care. The development of "meaningful peer review" requires a transition away from compliance toward quality improvement, whereby the information and insights gained facilitate education and drive systematic improvements that reduce the frequency and impact of diagnostic error. The next generation of peer review requires significant improvements in IT functionality and integration, enabling features such as anonymization, adjudication by multiple specialists, categorization and analysis of errors, tracking, feedback, and easy export into teaching files and other media that require strong partnerships with vendors. In this article, the authors assess various peer review practices, with focused discussion on current limitations and future needs for meaningful peer review in radiology. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Implications of current resident work-hour guidelines on the future practice of surgery in Canada.

PubMed

Maruscak, Adam A; VanderBeek, Laura; Ott, Michael C; Kelly, Stephen; Forbes, Thomas L

2012-01-01

Work-hour restrictions have had a profound impact on surgical training. However, little is known of how work-hour restrictions may affect the future practice patterns of current surgical residents. The purpose of this study is to compare the anticipated career practice patterns of surgical residents who are training within an environment of work-hour restrictions with the current practice of faculty surgeons. An electronic survey was sent to all surgery residents and faculty at 2 Canadian university-affiliated medical centers. The survey consisted of questions regarding expected (residents) or current (faculty) practice patterns. A total of 149 residents and 125 faculty members completed the survey (50.3% and 52.3% response rates, respectively). A greater proportion of males were in the faculty cohort than in the resident group (77.6% vs 62.4%, p = 0.0003). More faculty than residents believed that work-hour restrictions have a negative impact on both residency education (40.8% vs 20.8%, p = 0.008) and preparation for a surgical career (56.8% vs 19.5%, p < 0.0001). Compared with current faculty, residents plan to take less call (p < 0.0003), work fewer days of the week (p < 0.0001), are more likely to limit their duty hours on postcall days (p = 0.009), and take parental leave (p = 0.02) once in practice. Male and female residents differed somewhat in their responses in that more female residents plan to limit their postcall duty hours (55.4% vs 36.5%, p = 0.009) and to take a parental leave (51.8% vs 16.1%, p < 0.0001) compared with their male resident colleagues. Current surgical residents expect to adopt components of resident work-hour guidelines into their surgical practices after completing their residency. These practice patterns will have surgical workforce implications and might require larger surgical groups and reconsideration of resource allocation. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

Articulating current service development practices: a qualitative analysis of eleven mental health projects

PubMed Central

2014-01-01

Background The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Methods Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Results Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. Conclusions This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial. PMID:24438471

Articulating current service development practices: a qualitative analysis of eleven mental health projects.

PubMed

Jun, Gyuchan Thomas; Morrison, Cecily; Clarkson, P John

2014-01-17

The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

National Geomagnetism Program: Current Status & Five-Year Plan, 2006-2010

USGS Publications Warehouse

Love, Jeffrey J.

2006-01-01

Executive Summary: The U.S. Geological Survey's Geomagnetism Program serves the scientific community and the broader public by collecting and distributing magnetometer data from an array of ground-based observatories and by conducting scientific analysis on those data. Preliminary, variational time-series can be collected and distributed in near-real time, while fully calibrated, absolute time-series are distributed after processing. The data are used by the civilian and military parts of the Federal Government, by private industry, and by academia, for a wide variety of purposes of both immediately practical importance and long-term scientific interest, including space-weather diagnosis and related hazard mitigation, mapping of the magnetic field and measurement of its activity, and research on the nature of the Earth's interior and the near-Earth space environment. This document reviews the current status of the Program, in terms of its situation within the Government and within the scientific community; summarizes the Program's operations, its staffing situation, and its facilities; describes the diversity of uses of Program magnetometer data; and presents a plan for the next 5 years for enhancing the Program's data-based services, developing products, and conducting scientific research.

Managing Appalachian hardwood stands using four regeneration practices--34 year results

Treesearch

H. Clay Smith; Gary W. Miller

1987-01-01

Adjacent Appalachian hardwood stands in West Virginia established on excellent growing sites were managed for a 34-year period using four regeneration practices. These practices included a commercial clearcut, 15.5-in diameter-limit, and two single-tree selection practices. An uncut area was maintained as a control. Stand development, growth response, and some stumpage...

Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

PubMed

Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

2016-05-13

Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

How well do final year undergraduate medical students master practical clinical skills?

PubMed Central

Störmann, Sylvère; Stankiewicz, Melanie; Raes, Patricia; Berchtold, Christina; Kosanke, Yvonne; Illes, Gabrielle; Loose, Peter; Angstwurm, Matthias W.

2016-01-01

Introduction: The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills. Methods: We conducted a formative 4-station objective structured clinical examination (OSCE) focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray). Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance. Results: 214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n=20) scored insufficiently (<60%). We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%), whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively. Discussion: Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year. PMID:27579358

Current practice of methylprednisolone administration for acute spinal cord injury in Germany: a national survey.

PubMed

Druschel, Claudia; Schaser, Klaus-Dieter; Schwab, Jan M

2013-05-15

Written mail-out survey. To determine current practice in high-dose methylprednisolone succinate (MPSS) administration for treatment of acute spinal cord injury (SCI) in Germany. Reanalysis of the National Acute Spinal Cord Injury Studies (NASCIS) resulted in criticism of the use of high-dose MPSS for treatment of acute SCI. Subsequently, SCI treatment guidelines were revised leading to a reduction in MPSS use across North America. The impact of these revisions on SCI treatment in Germany is not known. A questionnaire was sent to all trauma, orthopedic and neurosurgical departments of German university centers, affiliated teaching hospitals, and specialized SCI care centers. Survey included 6 questions about the administration of MPSS after acute SCI. Three hundred seventy-two respondents completed the survey (response rate: 51% overall, 76% university hospitals, 85% specialized SCI care centers). Overall, 55% of departments that treat SCI prescribe MPSS. Among them, 73% are "frequent" users administering MPSS to more than 50% of their patients. Ten percent prescribe according to NASCIS I, 43% NASCIS II, 33% NASCIS III, and 13% "generic protocols." As justification for MPSS treatment, "effectiveness" ranked before "common practice" and "medicolegal reasons." "Specialized" SCI care centers differ in that (1) MPSS is administered less frequently, (2) NASCIS I doses are not used, and (3) during the past several years, practice patterns are more likely to have shifted away from the treatment of SCI with MPSS. About one-half of the institutions continue to prescribe MPSS in the setting of acute SCI. A need for further education in almost one-fourth of German departments treating acute SCI is demonstrated through responses indicating use of the outdated NASCIS I protocol, a "legal need" or "unchanged MPSS application during the last years." "Specialized" SCI centers are more likely to change their practice in accordance with evolving literature. 3.

Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

PubMed

Naik, Ronak J; Patel, Neil R; Wang, Ming; Shah, Nishant C

2016-08-01

In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

Early sport practice is related to lower prevalence of cardiovascular and metabolic outcomes in adults independently of overweight and current physical activity.

PubMed

Fernandes, Rômulo Araújo; Zanesco, Angelina

2015-01-01

Early sport practice prevents development of diseases in children/adolescents, but still unclear its effect over health in adulthood. Therefore, the purpose of this study was to analyze the association between sport practice in early life and chronic diseases in adulthood. A retrospective population-based survey carried out in eight Brazilian cities with adults of both genders. Throughout a multistage random process 2720 adults (1096 male and 1624 female) were selected and interviewed. Type 2 diabetes mellitus and arterial hypertension were assessed in a face-to-face interview through a self-report, which was necessarily based on previous medical diagnosis. Early sport practice was assessed in childhood (7-10 years old) and adolescence (11-17 years old). Current physical activity and body mass index were assessed in adulthood throughout a face-to-face interview. Type 2 diabetes mellitus and arterial hypertension were identified in 8.1% (95% CI, 7.1-9.2) and 23.5% (95% CI, 21.9-25.1) of the sample, respectively. Early sport practice during childhood and adolescence was associated with lower occurrence of arterial hypertension (OR, 0.49; 95% CI, 0.33-0.73) and type 2 diabetes (OR, 0.46; 95% CI, 0.24-0.88) in adulthood. Independently of obesity and current physical activity, early sport practice in early life was positively associated with lower occurrence of chronic diseases in adulthood. Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

TESOL: Current Problems and Classroom Practices.

ERIC Educational Resources Information Center

Wardhaugh, Ronald

This paper attempts to "bridge the gap between the practical orientation of teachers and the theoretical concerns that should underlie practice," Discussed in turn are language, psychology, and pedagogical philosophy. An adequate knowledge of these areas is essential to good classroom practices; every bad practice is evidence of some weakness in…

Current Practices and Future Trends in Neuropathology Assessment for Developmental Neurotoxicity Testing

EPA Science Inventory

The continuing education course on "Developmental Neurotoxicity Testing" (DNT) was designed to communicate current practices for DNT neuropathology, describe promising innovations in quantitative analysis and non-invasive imaging, and facilitate a discussion among experienced neu...

Current practice of microsurgery by members of the American Society for Surgery of the Hand.

PubMed

Payatakes, Alexander H; Zagoreos, Nikolaos P; Fedorcik, Gregory G; Ruch, David S; Levin, L Scott

2007-04-01

First, to determine the percentage of members of the American Society for Surgery of the Hand (ASSH) that use microsurgical techniques as part of their surgery practice, and second, to identify factors limiting their use of these techniques. A 34-item, anonymous, Web-based survey was sent to all active ASSH members. Twelve items concerned demographics and 22 items addressed prior microsurgical training, current use of these techniques, factors currently limiting their use of these techniques, and potential methods to address these limiting factors. Responses were received from 561 of 1,238 of the ASSH members contacted (45% response rate). Most had residency training in orthopedics (N=460, 82%) or plastic surgery (N=79, 14%), followed by a hand fellowship in an orthopedic (N=363, 62%) or combined program (N=170, 30%). More than 54% (N=304) practiced privately, 33% (N=184) practiced in tertiary institutions, and the remainder practiced at regional centers. Of those responding, 505 (90%) stated that hand surgery constituted more than 50% of their practice, whereas for 527 (94%) respondents microsurgery comprised less than 25%. Most members (N=398, 71%) accepted emergency patients, of which 223 (56%) at a referral center. Three hundred sixteen respondents (56%) performed replantations, of whom 196 (62%) performed fewer than 5 per year. Four hundred fifteen respondents (74%) observed a decrease in replantation attempts over the past decade. This was attributed to refinement of indications (N=17, 83%), fewer patients with amputations (N=116, 28%), and declining reimbursement (N=344, 4%). Reasons for not personally performing replantations included busy elective schedules (N=125, 51%), inadequate confidence in performing replantations (N=96, 39%), and disappointment in results (N=56, 23%). Thirty percent (N=74) stated they would reconsider performing replantations if reimbursement was greater. Practice rates of examined microsurgical procedures ranged from 22% to 57

The current status of 3D imaging in dental practice.

PubMed

McNamara, Clare; House, Kate; Davies, Rebecca; Barker, Chris S; Chawla, Ourvinder; Sandy, Jonathan R; Ireland, Anthony J

2011-12-01

This article aims to describe the current status of 3-dimensional (3D) imaging in dental practice. Advances in this field have made 3D imaging far more accessible in all dental fields. This paper describes methods of imaging dental hard and soft tissues and their clinical uses. In addition, the potential advantages and disadvantages of various systems are discussed, as well as expected future developments.

Online Preparation Resources Help First Year Students to Benefit from Practical Classes

ERIC Educational Resources Information Center

Whittle, Sue R.; Bickerdike, Sue R.

2015-01-01

Practical skills are important for the employability of biosciences graduates; however, first year science undergraduates often struggle to adapt to university practical classes, affecting skills development and decreasing their enthusiasm for laboratory work. This study describes the effects of introducing online multimedia practical support…

Fifty years of longitudinal continuity in general practice: a retrospective observational study.

PubMed

White, Eleanor S; Pereira Gray, Denis; Langley, Peter; Evans, Philip H

2016-04-01

Continuity of care has been defined as relational continuity between patient and doctor and longitudinal continuity describing the duration of the relationship. Measurement of longitudinal continuity alone is associated with outcomes including patient satisfaction, medical costs, hospital admissions and mortality. In one UK general practice, records were searched for patients with continuous registration for 50 or more years. Characteristics of these patients were analysed for age, gender, social deprivation, partner registration and length of registration. Trends in numbers and proportions of this group over the previous 14 years were determined. A comparison group of patients, aged 50 or more, and registered in the same practice within the last 2-4 years, was identified. Patients registered for 50 years or more with a median registration of 56.2 years numbered 190 out of a population of 8420 (2.3%). These patients increased in number by 35.3% (1.7-2.3%) over 14 consecutive years. There were no differences between groups for GP consultation rate, number of repeat medications and hospital use, despite the significantly higher prevalence of multi-morbidity, depression and diabetes in patients with high continuity. This is the first report of 50-year continuity in general practice. Numbers of such patients and proportions are increasing. Longitudinal continuity is easily measured in general practice and associated with important clinical outcomes. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

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.

Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

PubMed

Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

2008-07-01

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

Communication skills assessment in the final postgraduate years to established practice: a systematic review.

PubMed

Gillis, Amy E; Morris, Marie C; Ridgway, Paul F

2015-01-01

Communication breakdown is a factor in the majority of all instances of medical error. Despite the importance, a relative paucity of time is invested in communication skills in postgraduate curricula. Our objective is to systematically review the literature to identify the current tools used to assess communication skills in postgraduate trainees in the latter 2 years of training and in established practice. Two reviewers independently reviewed the literature identifying communication skill assessment tools, for postgraduate trainees in the latter 2 years of training and in established practice following Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, and inclusion/exclusion criteria from January 1990 to 15 August 2014. PubMed/CINAHL/ERIC/EMBASE/PsycInfo/Psyc Articles/Cochrane. 222 articles were identified; after review, 34 articles fulfilled criteria for complete evaluation; the majority (26) had a high level of evidence scoring 3 or greater on the Best Evidence Medical Education guide. 22 articles used objective structured clinical examination/standardised patient (SP)-based formats in an assessment or training capacity. Evaluation tools included author-developed questionnaires and validated tools. Nineteen articles demonstrated an educational initiative. The reviewed literature is heterogeneous for objectives and measurement techniques for communication. Observed interactions, with patients or SPs, is the current favoured method of evaluation using author-developed questionnaires. The role of self-evaluation of skill level is questioned. The need for a validated assessment tool for communication skills is highlighted. 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.

Transitional care for rheumatic conditions in Europe: current clinical practice and available resources.

PubMed

Clemente, Daniel; Leon, Leticia; Foster, Helen; Carmona, Loreto; Minden, Kirsten

2017-06-09

To assess European pediatric rheumatology providers' current clinical practices and resources used in the transition from child-centered to adult-oriented care. European pediatric rheumatologists were invited to complete a 17-item anonymized e-survey assessing current transition practices, transition policy awareness, and needs in advance of the publication of EULAR/PReS recommendations on transition. The response rate was 121/276 (44%), including responses from 115 centers in 22 European Union countries. Although 32/121 (26%) responded that their centers did not offer transition services, the majority (99%) agreed that a formalized process in transitioning patients to adult care is necessary. A minority (<30%) of respondents stated that they have a written transition policy although 46% have an informal transition process. Designated staff to support transitional care were available in a minority of centers: nurse (35%), physiotherapist (15%), psychologist (15%), social worker (8%), and occupational therapist (2%). The existence of a designated team member to coordinate transition was acknowledged in many centers (64% of respondents) although just 36% use a checklist for young people as part of individualized transitional care. This survey of European pediatric rheumatology providers regarding transitional care practices demonstrates agreement that transitional care is important, and wide variation in current provision of transition services exists.

Guidance on How to Move from Current Practice to Recommended Practice in Life Cycle Impact Assessment (UNEP/SETAC Life Cycle Initiative Publication)

EPA Science Inventory

The report provides guidance on how to move from current practice to recommended practice in Life Cycle Impact Assessment. It is composed of three complementary parts elaborated in the first task force (TFI) of the LCIA programme, with contribution of the other three task forces:

Surgical handover in an era of reduced working hours: an audit of current practice.

PubMed

Shafiq-ur-Rehman; Mehmood, Sajid; Ahmed, Jamil; Razzaq, Muhammad Haroon; Khan, Shakeeb; Perry, Eugene Phillip

2012-06-01

To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.

Do gender disparities persist in gastroenterology after 10 years of practice?

PubMed

Singh, Aparajita; Burke, Carol A; Larive, Brett; Sastri, Suriya V

2008-07-01

Cross-sectional studies confirm gender disparity in many aspects of the practice of medicine and surgery. Some data suggest the disparities diminish after 10 yr of practice. This study aims to examine gender discrepancies in income, social, and professional status of gastroenterologists after 10 yr of practice. Prospective, observational, cohort study of gastroenterologists incepted upon graduation from a U.S. GI fellowship program in 1993 and 1995. A 36-item questionnaire was sent to the cohort at 3, 5, and 10 yr after graduation from GI fellowship training. The following are the results of the final, 10th year survey. A total of 168 men and 25 women (mean age 45.5 yr) responded. Men and women were equally likely to be board certified and married, however, women had fewer children. Men earned a mean annual gross income of $375,000 versus$245,000 for women (P= 0.001). After adjusting for practice setting, work hours, practice-ownership, free endoscopy center practice, and vacation time, female gastroenterologists earned $82,000 (22%) less per year than their male colleagues (95% CI $34,000-130,000, P= 0.001). Women were more frequently in academic practice (38%vs 17%), but were less likely to hold the most advanced academic positions. After 10 yr of practice, significant economic, professional, and social disparities persist between male and female gastroenterologists in this cohort. Women were more likely to practice in a setting with flexible work hours, a family leave provision, and in a practice with other women. Initiatives to equalize pay and ensure opportunities for professional advancement for women may diminish the significant practice disparities incurred by women in gastroenterology.

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.

Current practices of construction waste reduction through 3R practice among contractors in malaysia: Case study in penang

NASA Astrophysics Data System (ADS)

Ng, L. S.; Tan, L. W.; Seow, T. W.

2017-11-01

The effectiveness of the implementation of construction waste reduction through 3R reflects the sustainability in construction waste management. Weak implementation of construction waste reduction through 3R among contractors will lead to unsustainable construction waste management. Increase in construction waste on landfills is critical especially on islands where land is very limited for solid waste disposal. This aim of this paper is to investigate current practice of construction waste reduction through 3R practice among contractors in Penang, Malaysia. The findings reported herein is based on feedbacks from 143 construction contractors of grade CIDB G7, G6 and G5 in Penang and experts from Penang Local Authority, CIDB in Penang and its Headquarters, National Solid Waste Management Department, and Headquarters of Solid Waste and Public Cleansing Management Corporation. Interviews and questionnaire surveys have been found that 3R practice is not mandatory in construction waste management in Penang. Only 39.8% construction contractors practiced 3R in managing their waste. Therefore, 3R practices should be emphasized in construction industry. Reducing wastes through 3R practices in construction industry is a way forward towards sustainable construction waste management especially in expanding the lifetime of landfill.

Transforming nursing education: a review of current curricular practices in relation to Benner's latest work.

PubMed

Handwerker, Sarah M

2012-09-12

Current societal and healthcare system trends highlight the need to transform nursing education to prepare nurses capable of outstanding practice in the 21st century. Patricia Benner and colleagues urged nurse educators to transform their practice in the 2010 publication Educating Nurses, A Call to Radical Transformation. Frequently utilized pedagogical frameworks in nursing education include behaviorism and constructivism. Much of the structure and basis for instruction and evaluation can be found rooted in these philosophies. By first exploring both behaviorism and constructivism and then relating their use in nursing education to the call to transform, educators can be encourage to examine current practice and possibly modify aspects to include more rich experiential learning.

Critical Ethical Issues in Online Counseling: Assessing Current Practices with an Ethical Intent Checklist

ERIC Educational Resources Information Center

Shaw, Holly E.; Shaw, Sarah F.

2006-01-01

The authors used a 16-item Ethical Intent Checklist, developed from the American Counseling Association's (1999) Ethical Standards for Internet Online Counseling, to assess the current practices of 88 online counseling Web sites. Results showed fewer than half of online counselors were following the accepted practice on 8 of the 16 items. Online…

Family presence during management of acute deterioration: Clinician attitudes, beliefs and perceptions of current practices.

PubMed

Youngson, Megan J; Currey, Judy; Considine, Julie

2016-08-01

The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration. To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients. Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience. Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

The accelerated residency program: the Marshall University family practice 9-year experience.

PubMed

Petrany, Stephen M; Crespo, Richard

2002-10-01

In 1989, the American Board of Family Practice (ABFP) approved the first of 12 accelerated residency programs in family practice. These experimental programs provide a 1-year experience for select medical students that combines the requirements of the fourth year of medical school with those of the first year of residency, reducing the total training time by 1 year. This paper reports on the achievements and limitations of the Marshall University accelerated residency program over a 9-year period that began in 1992. Several parameters have been monitored since the inception of the accelerated program and provide the basis for comparison of accelerated and traditional residents. These include initial resident characteristics, performance outcomes, and practice choices. A total of 16 students were accepted into the accelerated track from 1992 through 1998. During the same time period, 44 residents entered the traditional residency program. Accelerated resident tended to be older and had more career experience than their traditional counterparts. As a group, the accelerated residents scored an average of 30 points higher on the final in-training exams provided by the ABFP. All residents in both groups remained at Marshall to complete the full residency training experience, and all those who have taken the ABFP certifying exam have passed. Accelerated residents were more likely to practice in West Virginia, consistent with one of the initial goals for the program. In addition, accelerated residents were more likely to be elected chief resident and choose an academic career than those in the traditional group. Both groups opted for small town or rural practice equally. The Marshall University family practice 9-year experience with the accelerated residency track demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential

Assessment of current practices in management of childhood TB among frontline clinicians in Southern Nigeria.

PubMed

Chukwu, Joseph N; Ukwaja, Kingsley N; Ekeke, Ngozi; Nwafor, Charles C; Meka, Anthony O; Madichie, Nelson O; Anyim, Moses C; Ogbudebe, Chidubem; Adegbesan, Julie; Ikebudu, Joy; Oshi, Daniel C

2016-07-01

Poor competence of clinicians may be a critical factor responsible for the under-diagnosis of childhood TB in high-burden settings. Our objective was to assess the current practices of management of childhood TB among clinicians in Nigeria. A cross-sectional survey was conducted among clinicians recruited through a three-stage sampling technique from 76 health facilities in Southern Nigeria. A semi-structured questionnaire was administered to all participants. Of 106 clinicians who completed the survey, 73 (68.9%) were <40 years and 67 (63.2%) were males. Also, 14 (13.2%) were paediatricians, 22 (20.8%) were paediatric specialist trainees and 70 (66%) were medical officers in primary and secondary care health facilities. About 94% of the respondents perceived diagnosis of childhood TB a challenge in Nigeria. The overall mean (SD) knowledge score was 3.8±0.9 (maximum 5), and 68 (64.2%) had good knowledge of childhood TB. The mean (SD) appropriate practice score was 4.0±1.7 (maximum 10) and, only 8 (7.5%) of them were considered to have adopted appropriate practices regarding childhood TB care. There are gaps in practices adopted by frontline clinicians in the management of childhood TB in Nigeria. Focused training of health workers on childhood TB care is urgently recommended. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Physiotherapy in upper abdominal surgery - what is current practice in Australia?

PubMed

Patman, Shane; Bartley, Alice; Ferraz, Allex; Bunting, Cath

2017-01-01

Upper abdominal surgery (UAS) has the potential to cause post-operative pulmonary complications (PPCs). In the absence of high-quality research regarding post-operative physiotherapy management, consensus-based best practice guidelines formulated by Hanekom et al. (2012) are available to clinicians providing recommendations for post-UAS treatment. Such best practice guidelines have recommended that physiotherapists should be using early mobilisation and respiratory intervention to minimise risk of PPCs. However, recent evidence supports the implementation of mobilisation as a standalone treatment in PPC prevention, though the diversity in literature poses questions regarding ideal current practice. This project aimed to document and report the assessment measures and interventions physiotherapists are utilising following UAS, establishing whether current management is reflective of best practice guidelines and recent evidence. An online survey was completed by 57 experienced Australian physiotherapists working with patients following UAS (35% survey response rate, 63% completion rate). On day one following UAS, when a patient's condition is not medically limited, most physiotherapists routinely mobilise. Additionally, routine chest treatment continues to be implemented, with only 23% ( n  = 11/47) of physiotherapists mobilising patients without accompanying specific respiratory intervention. Variability of screening tools used to identify post-operative patients at high risk of PPC development was evident. Patient-dependent factors such as 'fatigue' and 'non-compliance' were among those identified as barriers to treatment, all influencing the commencement of treatment. Physiotherapists indicated that early mobilisation away from the bedside was the preferred post-operative treatment within the UAS patient population. Many continue to perform routine respiratory interventions despite recent literature suggesting it may provide no additional benefit to preventing

Current CFD Practices in Launch Vehicle Applications

NASA Technical Reports Server (NTRS)

Kwak, Dochan; Kiris, Cetin

2012-01-01

The quest for sustained space exploration will require the development of advanced launch vehicles, and efficient and reliable operating systems. Development of launch vehicles via test-fail-fix approach is very expensive and time consuming. For decision making, modeling and simulation (M&S) has played increasingly important roles in many aspects of launch vehicle development. It is therefore essential to develop and maintain most advanced M&S capability. More specifically computational fluid dynamics (CFD) has been providing critical data for developing launch vehicles complementing expensive testing. During the past three decades CFD capability has increased remarkably along with advances in computer hardware and computing technology. However, most of the fundamental CFD capability in launch vehicle applications is derived from the past advances. Specific gaps in the solution procedures are being filled primarily through "piggy backed" efforts.on various projects while solving today's problems. Therefore, some of the advanced capabilities are not readily available for various new tasks, and mission-support problems are often analyzed using ad hoc approaches. The current report is intended to present our view on state-of-the-art (SOA) in CFD and its shortcomings in support of space transport vehicle development. Best practices in solving current issues will be discussed using examples from ascending launch vehicles. Some of the pacing will be discussed in conjunction with these examples.

Leadership of Learning in Early Years Practice: A Professional Learning Resource [Includes DVD

ERIC Educational Resources Information Center

Hallet, Elaine

2014-01-01

This book focuses upon effective pedagogical leadership and practice in the leadership of learning within early years settings and children's centres. The book and accompanying DVD, containing real-life examples of early years leaders, provides a framework for reflective thinking and learning for those leading practice and working with children,…

Autopsy in Islam and current practice in Arab Muslim countries.

PubMed

Mohammed, Madadin; Kharoshah, Magdy A

2014-03-01

Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A decade of individual participant data meta-analyses: A review of current practice.

PubMed

Simmonds, Mark; Stewart, Gavin; Stewart, Lesley

2015-11-01

Individual participant data (IPD) systematic reviews and meta-analyses are often considered to be the gold standard for meta-analysis. In the ten years since the first review into the methodology and reporting practice of IPD reviews was published much has changed in the field. This paper investigates current reporting and statistical practice in IPD systematic reviews. A systematic review was performed to identify systematic reviews that collected and analysed IPD. Data were extracted from each included publication on a variety of issues related to the reporting of IPD review process, and the statistical methods used. There has been considerable growth in the use of "one-stage" methods to perform IPD meta-analyses. The majority of reviews consider at least one covariate other than the primary intervention, either using subgroup analysis or including covariates in one-stage regression models. Random-effects analyses, however, are not often used. Reporting of review methods was often limited, with few reviews presenting a risk-of-bias assessment. Details on issues specific to the use of IPD were little reported, including how IPD were obtained; how data was managed and checked for consistency and errors; and for how many studies and participants IPD were sought and obtained. While the last ten years have seen substantial changes in how IPD meta-analyses are performed there remains considerable scope for improving the quality of reporting for both the process of IPD systematic reviews, and the statistical methods employed in them. It is to be hoped that the publication of the PRISMA-IPD guidelines specific to IPD reviews will improve reporting in this area. Copyright © 2015 Elsevier Inc. All rights reserved.

Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?

PubMed

Gardner, Tania; Refshauge, Kathryn; McAuley, James; Hübscher, Markus; Goodall, Stephen; Smith, Lorraine

2018-01-18

Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician's attitudes and beliefs and goal setting practice. A cross-sectional observational survey. The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.

National survey of fluid therapy in acute pancreatitis: current practice lacks a sound evidence base.

PubMed

Haydock, Matthew D; Mittal, Anubhav; van den Heever, Marc; Rossaak, Jeremy I; Connor, Saxon; Rodgers, Michael; Petrov, Maxim S; Windsor, John A

2013-10-01

Fluid therapy (FT) is a critical intervention in managing acute pancreatitis (AP). There is a paucity of evidence to guide FT and virtually no data on current prescribing practice. This survey aims to characterize current practice and opinion with regard to FT in AP throughout New Zealand. Information was collected on fluid selection, administration, and goal-directed FT. The survey was distributed online and in print to all doctors employed in General Surgery Departments in New Zealand on 1 May 2012. Monthly email reminders were sent for 6 months. The overall response rate was 47 % (n = 190/408). Crystalloids were the preferred initial fluid for all categories of severity; however, colloid use increased with severity (p < 0.001). Fluid volume also increased with severity (p = 0.001), with 74 % of respondents prescribing >4 L for AP with organ failure (OF). Clinicians treating 26-50 patients per year with AP were less likely to prescribe colloid for AP with OF (8 vs 43 %) (p = 0.001). Rate of fluid administration in AP with OF varied according to physicians' seniority (p = 0.004); consultants prescribed >4 L more than other groups (83 vs 68 %). Only 17 % of respondents reported the use of guidelines. This survey reveals significant variation in prescription of FT for AP, and aggressive FT is commonly prescribed for AP with OF. There is little adherence to published guidelines or best available evidence.

Current Evaluation Practices of Diversity Trainers in German-Speaking Countries

ERIC Educational Resources Information Center

Rohmann, Anette; Froncek, Benjamin; Mazziotta, Agostino; Piper, Verena

2017-01-01

Diversity training has been greatly expanded in recent years in order to help people deal with the challenges of increased social diversity. However, little is known about the systematic evaluation of diversity training. The present research surveyed 172 diversity trainers concerning their evaluation practices with regard to diversity training.…

Twenty years of multidisciplinary research and practice: the Journal of Occupational Rehabilitation then and now.

PubMed

Shaw, William S; Findley, Patricia A; Feuerstein, Michael

2011-12-01

Early research of work disability in the 1980s showed a complexity of factors influencing pain and health-related functional limitation at work; hence, multidisciplinary perspectives were necessary to understand the complex interplay between biomechanical, organizational, social, and psychological factors impacting work disability. To address this need, the Journal of Occupational Rehabilitation was founded in 1991 with the goal of providing a scientific, yet practical forum for presenting multidisciplinary research and practice in work disability. Now, the 20-year collection of articles in the Journal reflects important trends and directions in the field of occupational rehabilitation. We conducted a retrospective summary of the past 20 years of the Journal of Occupational Rehabilitation, including its inaugural goals and intent, rates of submission and acceptance, trends in the types of articles published, study topics, global distribution of authors, and future directions. The original goal of providing a multidisciplinary scientific and practical forum has been met, but current trends reflect a maturing scientific evidence base, with less representation of employer-based case studies and practical innovations. There has been a dramatic increase in the international representation of studies, authors, and peer reviewers outside of the US. Also, published studies now address work disability for a larger number of health concerns. Contributions to the Journal continue to reflect a multidisciplinary perspective, but the Journal has seen significant changes with respect to international representation, the expanding study of non-musculoskeletal sources of work disability, and the maturing scientific evidence base in the field of occupational rehabilitation. Future volumes of the Journal will likely reflect continuing changes in the global economy, workforce fitness, and job demands.

A survey of current practice of vascular surgeons in venous disease management.

PubMed

Bush, Ruth L; Gloviczki, Peter

2013-01-01

Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

Working through the Practice Architectures of First Year University Mathematics Teaching

ERIC Educational Resources Information Center

Balatti, Jo; Belward, Shaun

2012-01-01

This paper describes how a group of university lecturers are adopting an action research approach to improve the learning experience of students in first year mathematics. Using the three categories of saying/thinking, doing, and relating (Kemmis, 2009) to explore practice, it describes the new practices of the action research team, the…

Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in Saudi Arabia.

PubMed

Ibrahim, Nadia O; Sukkarieh, Hatouf H; Bustami, Rami T; Alshammari, Elaf A; Alasmari, Lama Y; Al-Kadri, Hanan M

2017-01-01

In Saudi Arabia, as in many countries, there is usually no clear definition of the timing of umbilical cord clamping (UCC) in the policies and procedures used by hospitals. The World Health Organization (WHO) recommends delayed cord clamping (DCC) ( > 1 minute after birth) as it can significantly improve hemodynamics and long-term neurodevelopment. To investigate current practices of healthcare professionals on the timing of UCC in Saudi Arabia. Cross-sectional survey. Five tertiary hospitals in Riyadh, Saudi Arabia, during May to October 2016. Obstetricians and midwives completed a widely-used questionnaire on UCC practices. Current UCC practices and attitudes of obstetricians and midwives toward DCC. Eighty-two obstetricians and 75 midwives completed the questionnaire for a response rate of 80%. The majority of respondents were aged 30 years or older (81%) and 84% were females. Most respondents were non-Saudi (66%) and had an educational level of bachelor's degree or higher (72%). Only 42% of respondents reported the existence of UCC guidelines in their practice; 38% reported the existence of a set time for UCC when the neonate was term and healthy, and only 32% had a set time for UCC in preterm neonates. While lower levels of agreement were reported among obstetricians and midwives on the benefits of DCC for babies requiring positive pressure ventilation, the majority of respondents (69-71%) thought that DCC was generally good for both term and preterm babies and that its benefits extend beyond the neonatal period. While the majority of obstetricians and midwives that participated in this study had a positive perception toward DCC, this did not translate to their daily practice as most of these professionals reported a lack of existing UCC guidelines in their institutions. Further studies are warranted to confirm these findings. Participant selection by convenience sampling.

Current UK dental sedation practice and the 'National Institute for Health and Care Excellence' (NICE) guideline 112: sedation in children and young people.

PubMed

Coulthard, P; Craig, D; Holden, C; Robb, N D; Sury, M; Chopra, S; Holroyd, I

2015-04-24

Describe current dental sedation practice for under 19-year-olds in the UK and compare it with the recommendations of NICE guidance 112. Members of the Society for the Advancement of Anaesthesia in Dentistry and members of the Dental Sedation Teachers Group were invited to participate in an online survey. Two hundred and sixty-six dentists and doctors completed the survey. Eighty-two percent were operator and sedationist (operator-sedationist). Ninety-five percent provided written information and 94% obtained written consent. Eighty-four percent kept a written or electronic sedation record. Eighty-six percent complied with life support training expectations. Eighty-six percent had immediate access to resuscitation equipment. Sixty-seven percent of sedationists reported that treatment could not be completed under sedation for <10% of cases during the previous year. When sedation was unsuccessful, 61% said they would schedule general anaesthesia and 54.5% would schedule advanced sedation care. Forty-nine percent believed that a dentist was an appropriate person to provide advanced sedation for 12-18 years. Only 24% thought a dentist should provide advanced sedation for children<12 years, with 75% preferring an anaesthetist. The appropriate setting for advanced sedation was thought to be primary care by 33% and secondary care by 68%. We found good agreement between the current practice of sedation and the recommendations of the NICE guidance 112.

Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

PubMed Central

Prins, Henrieke A.B.; Mugo, Peter; Wahome, Elizabeth; Mwashigadi, Grace; Thiong'o, Alexander; Smith, Adrian; Sanders, Eduard J.; Graham, Susan M.

2014-01-01

Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis. PMID:24842982

Analysis of current thyroid function test ordering practices.

PubMed

Kluesner, Joseph K; Beckman, Darrick J; Tate, Joshua M; Beauvais, Alexis A; Kravchenko, Maria I; Wardian, Jana L; Graybill, Sky D; Colburn, Jeffrey A; Folaron, Irene; True, Mark W

2018-04-01

Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. To evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing. A record of all TFTs obtained in the San Antonio Military Health System during a 3-month period was extracted from the electronic medical record. The TFTs of interest were TSH, FT4, thyroid panel (TSH + FT4), FT3, total thyroxine (T4), and total triiodothyronine (T3). These were categorized based on the presence or absence of hypothyroidism. Between August 1 and October 31, 2016, there were 38 214 individual TFTs ordered via 28 597 total laboratory requests; 11 486 of these requests were in patients with a history of hypothyroidism. The number (percent) of laboratory requests fell into these patterns: TSH alone 14 919 (52.14%), TSH + FT4 7641 (26.72%), FT3 alone 3039 (10.63%), FT4 alone 1219 (4.26%), TSH + FT4 + FT3 783 (2.74%), and others 996 (3.48%); 36.0% of TFTs ordered were free thyroid hormones. Projected out to a year, using Department of Defense laboratory costs, $317 429 worth of TFTs would be ordered, with free thyroid hormone testing accounting for $107 720. Inappropriate ordering of free thyroid hormone tests is common. In an era of rising healthcare costs, inappropriate thyroid function testing is an ideal target for efforts to reduce laboratory overutilization, which in our system, could save up to $120 000 per year. Further evaluation is needed to determine strategies that can reduce excessive thyroid hormone testing. Published 2017. This article is a U.S. Government work and is in the

The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience.

PubMed

Falase, Bode; Sanusi, Michael; Animasahun, Adeola; Mgbajah, Ogadinma; Majekodunmi, Adetinuwe; Nzewi, Onyekwelu; Nwiloh, Jonathan; Oke, David

2016-10-01

Although the specialty of cardiothoracic surgery has been practiced in Nigeria for many years, open heart surgery (OHS) has only in the last decade become relatively more frequent, mainly through visiting foreign cardiac surgical teams. At this early phase of development it is faced with multiple challenges, especially financing and local skilled manpower for which solutions have to be identified in order to ensure sustainability and future growth. This study is aimed at highlighting these obstacles to growth of cardiothoracic surgery based on our own institutional experience at Lagos State University Teaching Hospital (LASUTH) and the current status of OHS activity in other cardiothoracic centers in Nigeria. Prospectively acquired data from our center from March 2004 to December 2015 was reviewed. A telephone survey was also conducted with all other institutions in Nigeria performing cardiac surgery. During the study period 1,520 patients underwent various procedures with a mean age of 37±22.4 years and 813 (53.5%) were males. There were 450 major procedures (29.6%), 889 minor procedures (58.5%) and 181 endoscopic procedures (11.9%). The top ten clinical diagnoses were empyema thoracis (17.5%), malignant pleural effusion (14.7%), chest trauma (12%), hemodialysis access (6.1%), bradyarrhythmia (5.3%), aerodigestive foreign bodies (4.1%), vascular injury (3.9%), pericardial disease (3.8%), lung cancer (3.6%) and congenital heart disease (3.4%). The range of procedures was chest tube insertion (41.6%), endoscopy (11.9%), lung procedures (7%), arterio-venous fistula (6.1%), pacemaker implantation (5.3%), vascular repair (4.4%), OHS (3.4%), esophageal procedures (2.6%), chest wall surgery (2%), video assisted thoracic surgery (2%), closed heart surgery (1.6%), diaphragmatic procedures (1.6%) and thymectomy (1%). Survey of 15 centers in Nigeria with cardiac surgery activity showed a total of 496 OHS cases between 1974 and 2016, with 330 cases (66.5%) done between 2012

Psychopharmacological and Other Treatments in Preschool Children with Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice

PubMed Central

Arnold, L. Eugene; Anthony, Bruno J.

2008-01-01

Abstract Objective This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. Data Sources We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. Study Selection Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. Data Extraction Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. Conclusions The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet. PMID:18844482

The Current Landscape of Transitions of Care Practice Models: A Scoping Review.

PubMed

Rochester-Eyeguokan, Charmaine D; Pincus, Kathleen J; Patel, Roshni S; Reitz, Shirley J

2016-01-01

Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all

Bottle-feeding practices during early infancy and eating behaviors at 6 years of age.

PubMed

Li, Ruowei; Scanlon, Kelley S; May, Ashleigh; Rose, Chelsea; Birch, Leann

2014-09-01

Evidence suggests an association of breastfeeding with a maternal feeding style (MFS) that is less controlling than formula feeding, which, in turn, may improve a child's self-regulation of eating. This study examines associations of bottle-feeding practices during infancy with MFS and children's eating behavior (CEB) at 6 years old. We linked data from the Infant Feeding Practices Study II to the Year 6 Follow-Up, which include 8 MFS and CEB measures adapted from previous validated instruments. Bottle-feeding practices during the first 6 months estimated by using the Infant Feeding Practices Study II were bottle-feeding intensity (BFI), mother's encouragement of infant to finish milk in the bottle, and infant finishing all milk in the bottle. Adjusted odds ratios (aORs) for associations of bottle-feeding practices with MFS and CEB at 6 years old were calculated by using multivariable logistic regressions controlling for sociodemographic characteristics and other feeding practices (N = 1117). Frequent bottle emptying encouraged by mothers during infancy increased odds of mothers encouraging their child to eat all the food on their plate (aOR: 2.37; 95% confidence interval [CI]: 1.65-3.41] and making sure their child eats enough (aOR: 1.62; 95% CI: 1.14-2.31) and of children eating all the food on their plate at 6 years old (aOR: 2.01; 95% CI: 1.05-3.83). High BFI during early infancy also increased the odds of mothers being especially careful to ensure their 6-year-old eats enough. Bottle-feeding practices during infancy may have long-term effects on MFS and CEB. Frequent bottle emptying encouraged by mothers and/or high BFI during early infancy increased the likelihood of mothers pressuring their 6-year-old child to eat and children's low satiety responsiveness. Copyright © 2014 by the American Academy of Pediatrics.

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.

Current trends of balloon laryngoplasty in Thailand.

PubMed

Moungthong, Greetha; Bunbanjerdsuk, Sacarin; Wright, Nida; Sathavornmanee, Thanakrit; Setabutr, Dhave

2017-06-01

To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

Examining Current Beliefs, Practices and Barriers about Technology Integration: A Case Study

ERIC Educational Resources Information Center

Hsu, Pi-Sui

2016-01-01

The purpose of this mixed-methods study was to examine the current beliefs, practices and barriers concerning technology integration of Kindergarten through Grade Six teachers in the midwestern United States. The three data collection methods were online surveys with 152 teachers as well as interviews and observations with 8 teachers. The findings…

Current practice and views of neurologists on the transition from pediatric to adult care.

PubMed

Oskoui, Maryam; Wolfson, Christina

2012-12-01

To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

Current State of Environmental Education in Mexico: A Study on Practices, Audiences, Settings, and Topics

ERIC Educational Resources Information Center

Marcos-Iga, Jose; Shaw, William

2011-01-01

Environmental education in Mexico takes many forms and plays a wide variety of roles. Through an online survey, we addressed the need to present a wider picture on the current state of environmental education practices in Mexico: Who is engaging in environmental education practices, how important is it for their organization, who are they…

Dyslexia in the Early Years: A Handbook for Practice

ERIC Educational Resources Information Center

Reid, Gavin

2017-01-01

Research has shown that early identification and intervention is crucial and can in fact minimise, and may even prevent, the challenges of dyslexia from becoming too detrimental at later stages of education. This book offers both research insights and practical guidance for teachers working in Early Years settings on how to create resource…

Venting during prophylactic nailing for femoral metastases: current orthopedic practice.

PubMed

Dalgorf, Dustin; Borkhoff, Cornelia M; Stephen, David J G; Finkelstein, Joel; Kreder, Hans J

2003-12-01

Reamed intramedullary nailing, recommended for impending fracture of a femur weakened by bone metastases, causes a rise in intramedullary pressure and increases the risk of a fat embolism syndrome. The pressure can be equalized by the technique of venting--drilling a hole into the distal cortex of the femur. Our objective was to study the current practice of orthopedic surgeons in Ontario with respect to venting during prophylactic intramedullary nailing for an impending femoral fracture due to bone metastases. We mailed a questionnaire to all orthopedic surgeons from the Province of Ontario listed in the 1999 Canadian Medical Directory or on the Canadian Orthopaedic Association membership list, asking if they vent when prophylactically nailing an impending pathologic femoral fracture. The responses were modelled as a function of surgeon volume and year of graduation. Of the 415 surveys mailed, 223 (54%) surgeons responded. Of these, 81% reported having prophylactically treated a femoral metastatic lesion during the previous year; 67% treated 1 to 3 metastatic lesions and 14% treated more than 3; 19% did not treat a metastatic femoral lesion prophylactically. Over two-thirds of surgeons had never considered venting, whereas one-third always or sometimes vented the femoral canal. More recent graduates were 3 times more likely to vent than earlier (before 1980) graduates (odds ratio [OR] = 3.2, 95% confidence interval [CI] 1.6-6.5) as were those who treat a greater number of impending fractures (OR = 1.4, 95% CI 1.1-1.7). Although there is a theoretical rationale for routine venting, there is disagreement among Ontario orthopedic surgeons regarding the use of this technique during prophylactic nailing for femoral metastatic lesions. Prospective evidence will be required to warrant a change in the standard of care.

Extensive Reading in EFL Classroom at Secondary Schools in Bangladesh: Current Practices and Future Possibilities

ERIC Educational Resources Information Center

Haider, Md. Zulfeqar; Akhter, Elina

2012-01-01

Extensive reading is being practiced in many EFL and ESL classrooms as an effective means for developing learners' reading as well as other related skills. This paper is based on a small-scale study that explores the current practices and future possibilities of using extensive reading in the EFL classrooms at the junior secondary schools in…

Overuse Injuries in Professional Ballet: Influence of Age and Years of Professional Practice.

PubMed

Sobrino, Francisco José; Guillén, Pedro

2017-06-01

In spite of the high rate of overuse injuries in ballet dancers, no studies have investigated the prevalence of overuse injuries in professional dancers by providing specific diagnoses and details on the differences in the injuries sustained as a function of age and/or years of professional practice. Overuse injuries are the most prevalent injuries in ballet dancers. Professional ballet dancers suffer different types of injuries depending on their age and years of professional practice. Descriptive epidemiology study. This descriptive epidemiological study was carried out between January 1, 2005, and October 10, 2010, regarding injuries sustained by professional dancers belonging to the major Spanish ballet companies practicing classical, neoclassical, contemporary, and Spanish dance. The sample was distributed into 3 different groups according to age and years of professional practice. Data were obtained from the specialized medical care the dancers received from the Trauma and Orthopaedic Surgery Service at Fremap in Madrid. The dependent variable was the study of the injury. A total of 486 injuries were identified over the study period, with overuse injuries being the most common etiology ( P < .0001); these injuries were especially prevalent in junior professional dancers practicing classical ballet and veteran dancers practicing contemporary ballet ( P = .01). Specifically, among other findings, stress fractures of the base of the second metatarsal ( P = .03), patellofemoral syndrome, and os trigonum syndrome were more prevalent among junior professionals ( P = .04); chondral injury of the knee in senior professionals ( P = .04); and cervical disc disease in dancers of intermediate age and level of experience. Overall, overuse injuries were more prevalent in younger professionals, especially in women. This finding was especially true for the more technical ballet disciplines. On the other hand, in the athletic ballet disciplines, overuse lesions occurred

An examination of current stroke rehabilitation practice in Peru: Implications for interprofessional education.

PubMed

McDonald, Cody L; Fuhs, Amy K; Kartin, Deborah

2018-05-01

This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and

Antidepressants during pregnancy: Guideline adherence and current practice amongst Dutch gynaecologists and midwives.

PubMed

Molenaar, Nina M; Brouwer, Marlies E; Duvekot, Johannes J; Burger, Huibert; Knijff, Esther M; Hoogendijk, Witte J; Bockting, Claudi L H; de Wolf, G S; Lambregtse-van den Berg, Mijke P

2018-06-01

prescription rates of antidepressants during pregnancy range from 2-3% in The Netherlands to 6.2% in the USA. Inconclusive evidence about harms and benefits of antidepressants during pregnancy leads to variation in advice given by gynaecologists and midwives. The objective was to investigate familiarity with, and adherence to the Dutch multidisciplinary guideline on Selective Serotonin Reuptake Inhibitor (SSRI) use during pregnancy by gynaecologists and midwives in the Netherlands. an online survey was developed and send to Dutch gynaecologists and midwives. The survey consisted mainly of multiple-choice questions addressing guideline familiarity and current practice of the respondent. Also, caregiver characteristics associated with guideline adherence were investigated. a total of 178 gynaecologists and 139 midwives responded. Overall familiarity with the Dutch guideline was 92.7%. However, current practice and advice given to patients by caregivers differed substantially, both between gynaecologists and midwives as well as within both professions. Overall guideline adherence was 13.9%. Multivariable logistic regression showed that solely caregiver profession was associated with guideline adherence, with gynaecologists having a higher adherence rate (OR 2.10, 95%CI 1.02-4.33) than midwives. although reported familiarity with the guideline is high, adherence to the guideline is low, possibly resulting in advice to patients that is inconsistent with guidelines and unwanted variation in current practice. further implementation of the recommendations as given in the guideline should be stimulated. Additional research is needed to examine how gynaecologists and midwives can be facilitated to follow the recommendations of the clinical guideline on SSRI use during pregnancy. Copyright © 2018 Elsevier Ltd. All rights reserved.

The "millennials": first year in practice.

PubMed

Olson, Marianne E

2009-01-01

Each year, thousands of novice nurses join the workforce. The overwhelming majority begin their careers in an acute care facility. Most of what we know about novice nurses comes from studies conducted over the last several decades. These studies have focused heavily on issues such as novice/expert differences on the performance of tasks. While they illuminate differences in judgment and decision-making skills, they provide little information on the reality of the novices' clinical practice. What is missing in the literature is an insider's look from the perspective of the millennial-born (1980-1999) novice nurse. Millennial novice nurses have both educators and experienced nurses searching for communication and learning strategies to engage the newest members of the nursing profession, yet the perceptions of millennial novice nurses have not yet been identified. This is a qualitative interpretive longitudinal study that utilized phenomenology as the philosophical and context method to illuminate the perceptions of millennial novice nurses. Audio-taped interviews were conducted at 3 months, 6 months, and 1 year. Findings have implications for both nurse educators and nurses in acute care facilities, especially those orienting the newest generation of novice nurses.

Vascular access cannulation in hemodialysis patients - a survey of current practice and its relation to dialysis dose.

PubMed

Gauly, Adelheid; Parisotto, Maria Teresa; Skinder, Aleksandra; Schoder, Volker; Furlan, Andreja; Schuh, Erika; Marcelli, Daniele

2011-01-01

The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose. This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD®. In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0±3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V = 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter. This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.

Carbohydrate levels in current-year shoots of sugar maple

Treesearch

John R. Donnelly

1976-01-01

Diurnal changes in carbohydrate concentrations in leaves and current-year stems of a mature sugar maple tree were studied in June and September. In leaves, alcohol-soluble sugar concentration was highest in the morning and lowest in late afternoon or early evening; diurnal changes in starch lagged about 5 hours behind changes in sugar. Carbohydrate concentrations in...

Current Faculty Development Practices for Alternative Delivery Systems in Christian Higher Education Institutions: A Qualitative Study

ERIC Educational Resources Information Center

Yates, Steven Lowell

2009-01-01

This research study was an investigation of current faculty development practices for alternative delivery systems. Attention was given to faculty development in general as well as specific facets of faculty development for alternative delivery systems. Future or intended faculty development practices were pursued, along with factors that…

Graphical Presentation of Patient-Treatment Interaction Elucidated by Continuous Biomarkers. Current Practice and Scope for Improvement.

PubMed

Shen, Yu-Ming; Le, Lien D; Wilson, Rory; Mansmann, Ulrich

2017-01-09

Biomarkers providing evidence for patient-treatment interaction are key in the development and practice of personalized medicine. Knowledge that a patient with a specific feature - as demonstrated through a biomarker - would have an advantage under a given treatment vs. a competing treatment can aid immensely in medical decision-making. Statistical strategies to establish evidence of continuous biomarkers are complex and their formal results are thus not easy to communicate. Good graphical representations would help to translate such findings for use in the clinical community. Although general guidelines on how to present figures in clinical reports are available, there remains little guidance for figures elucidating the role of continuous biomarkers in patient-treatment interaction (CBPTI). To combat the current lack of comprehensive reviews or adequate guides on graphical presentation within this topic, our study proposes presentation principles for CBPTI plots. In order to understand current practice, we review the development of CBPTI methodology and how CBPTI plots are currently used in clinical research. The quality of a CBPTI plot is determined by how well the presentation provides key information for clinical decision-making. Several criteria for a good CBPTI plot are proposed, including general principles of visual display, use of units presenting absolute outcome measures, appropriate quantification of statistical uncertainty, correct display of benchmarks, and informative content for answering clinical questions especially on the quantitative advantage for an individual patient with regard to a specific treatment. We examined the development of CBPTI methodology from the years 2000 - 2014, and reviewed how CBPTI plots were currently used in clinical research in six major clinical journals from 2013 - 2014 using the principle of theoretical saturation. Each CBPTI plot found was assessed for appropriateness of its presentation and clinical utility

Toward a more materialistic medicine: the value of authentic materialism within current and future medical practice.

PubMed

Leder, Drew; Krucoff, Mitchell W

2011-09-01

Modern medicine is often accused by diverse critics of being "too materialistic" and therefore insufficiently holistic and effective. Yet, this critique can be misleading, dependent upon the ambiguous meanings of "materialism." The term can refer to the prevalence of financial concerns in driving medical practice. Alternatively, it can refer to "mechanistic materialism," the patient viewed as a body-machine. In each case, this article shows that this represents not authentic "materialism" at play, but a focus upon high-level abstractions. "Bottom-line" financial or diagnostic numbers can distract practitioners from the embodied needs of sick patients. In this sense, medical practice is not materialist enough. Through a series of clinical examples, this article explores how an authentic materialism would look in current and future practice. The article examines the use of prayer/comfort shawls at the bedside; hospitals and nursing homes redesigned as enriched healing environments; and a paradigmatic medical device--the implantable cardioverter defibrillator--as it might be presented to patients, in contrast to current practice.

The challenge of risk characterization: current practice and future directions.

PubMed Central

Gray, G M; Cohen, J T; Graham, J D

1993-01-01

Risk characterization is perhaps the most important part of risk assessment. As currently practiced, risk characterizations do not convey the degree of uncertainty in a risk estimate to risk managers, Congress, the press, and the public. Here, we use a framework put forth by an ad hoc study group of industry and government scientists and academics to critique the risk characterizations contained in two risks assessments of gasoline vapor. After discussing the strengths and weaknesses of each assessment's risk characterization, we detail an alternative approach that conveys estimates in the form of a probability distribution. The distributional approach can make use of all relevant scientific data and knowledge, including alternative data sets and all plausible mechanistic theories of carcinogenesis. As a result, this approach facilitates better public health decisions than current risk characterization procedures. We discuss methodological issues, as well as strengths and weaknesses of the distributional approach. PMID:8020444

Current trends in nursing theories.

PubMed

Im, Eun-Ok; Chang, Sun Ju

2012-06-01

To explore current trends in nursing theories through an integrated literature review. The literature related to nursing theories during the past 10 years was searched through multiple databases and reviewed to determine themes reflecting current trends in nursing theories. The trends can be categorized into six themes: (a) foci on specifics; (b) coexistence of various types of theories; (c) close links to research; (d) international collaborative works; (e) integration to practice; and (f) selective evolution. We need to make our continuous efforts to link research and practice to theories, to identify specifics of our theories, to develop diverse types of theories, and to conduct international collaborative works. Our paper gives implications for future theoretical development in diverse clinical areas of nursing research and practice. © 2012 Sigma Theta Tau International.

Current best practice in the management of Turner syndrome

PubMed Central

Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

2017-01-01

Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

Current Australasian practice for diagnosis and management of idiopathic pulmonary fibrosis: Where are we now?

PubMed

Troy, Lauren K; Chapman, Sally A; Lake, Fiona; Wilsher, Margaret L; Honeysett, Liarna B; Macansh, Sacha; Corte, Tamera J

2015-05-01

Recent international consensus statements have refined evidence-based guidelines for the diagnosis and management of idiopathic pulmonary fibrosis (IPF). This study sought to investigate how closely these guidelines are adhered to and to compare current practices with those of a similar cohort 15 years ago. A questionnaire on IPF diagnosis and management was distributed to respiratory physicians practising in Australia and New Zealand, in 2012-2013, and results were compared with a similar survey conducted in 1999. A total of 172 and 144 questionnaires were completed in 1999 and 2012-2013, respectively. The most important investigations in both survey populations were high-resolution computed tomography scans, spirometry, diffusing capacity for carbon monoxide, chest X-ray, static lung volumes and autoimmune serology. In 1999, physicians were more likely to perform arterial blood gases, bronchoalveolar lavage and transbronchial lung biopsy. In the 2012-2013 cohort, 6-min walk tests and pulse oximetry were more widely utilized. Treatment choices differed considerably between the two survey populations. In 1999, the majority would offer a steroid-based regimen, whereas most would not use any specific treatment or would refer for trial participation in 2012-2013. Approach to IPF diagnosis and management is not uniform and has changed over 15 years. Surveyed respiratory physicians were generally practising in accordance with clinical guidelines, although significant variation in practice was identified in both cohorts. This study identifies the need to standardize care of IPF patients across Australia and New Zealand. © 2015 Asian Pacific Society of Respirology.

Reliability, Validity, and Factor Structure of the Current Assessment Practice Evaluation-Revised (CAPER) in a National Sample.

PubMed

Lyon, Aaron R; Pullmann, Michael D; Dorsey, Shannon; Martin, Prerna; Grigore, Alexandra A; Becker, Emily M; Jensen-Doss, Amanda

2018-05-11

Measurement-based care (MBC) is an increasingly popular, evidence-based practice, but there are no tools with established psychometrics to evaluate clinician use of MBC practices in mental health service delivery. The current study evaluated the reliability, validity, and factor structure of scores generated from a brief, standardized tool to measure MBC practices, the Current Assessment Practice Evaluation-Revised (CAPER). Survey data from a national sample of 479 mental health clinicians were used to conduct exploratory and confirmatory factor analyses, as well as reliability and validity analyses (e.g., relationships between CAPER subscales and clinician MBC attitudes). Analyses revealed competing two- and three-factor models. Regardless of the model used, scores from CAPER subscales demonstrated good reliability and convergent and divergent validity with MBC attitudes in the expected directions. The CAPER appears to be a psychometrically sound tool for assessing clinician MBC practices. Future directions for development and application of the tool are discussed.

Influences on final year medical students' attitudes to general practice as a career.

PubMed

Parker, Johanna E; Hudson, Ben; Wilkinson, Tim J

2014-03-01

General practice is under-represented in student career choices. This study aimed to identify and explore factors that influence the attitudes of final year medical students to general practice as a career. This qualitative study used semi-structured interviews of focus groups of final year undergraduate medical students at the University of Otago, Christchurch, New Zealand. Thematic analysis and grounded theory were used to interpret the data. General practitioners (GPs) play a key role in influencing medical students' attitudes to general practice as a career. Students identified their general practice placement during medical school training and personal contact with their own GP as principal factors. The media portrayal of general practice and the attitudes of friends and family were also influential. Students were positively influenced when they were made to feel part of the team, involved with consultations, allowed to carry out practical procedures under supervision, and witnessed what they perceived as good medical practice during clinical placements. Positive experiences often occurred later in training, when students felt more confident of their clinical abilities. While students reported occasional negative comments about general practice by some hospital doctors, these had a lesser role in influencing their perceptions of general practice compared with their own experiences, both as students and patients. GPs have a strong influence, positively and negatively, on the attitudes of medical students to general practice as a career. Effective influences include being made to feel welcome, involved, valued, and given legitimate roles during clinical placements.

Current Status and Future Agenda for the Theory, Research, and Practice of Childhood Career Development

ERIC Educational Resources Information Center

Schultheiss, Donna E. Palladino

2008-01-01

This article reviews the current status and a future agenda for childhood career development theory, research, and practice. The fragmented nature of the current state of the literature is noted, and a call is made for a reexamination and reconsideration of the childhood developmental pathways of life's work. It is suggested that the study of…

Feeding practices of low-income mothers: how do they compare to current recommendations?

PubMed

Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

2015-03-07

Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Eighty low-income mothers and their preschool children were videotaped at dinner in their homes. Mothers were chosen from a larger study to create a 2 X 2 X 2 design: maternal ethnicity (African American vs. Latina) by child gender by child weight status (healthy weight vs. overweight/obese). Observers coded videotapes for a range of maternal feeding strategies and other behaviors. Many mothers spent considerable time encouraging eating--often in spite of the child's insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Latina mothers showed higher levels of teaching eating skills and encouraging their children to eat; African American mothers showed higher levels of enforcing table manners and getting children to clear their plates. Mothers of boys used more unelaborated commands and less questions/suggestions than mothers of girls. Finally, compared to mothers of overweight/obese children, mothers of healthy weight children showed higher levels of encouraging eating and lower levels of discouraging eating. Most of the mothers in this study did not engage in feeding practices that are consistent with current recommendations. They did this, despite the fact that they knew they were being observed. These results should be used to inform future research about the motivations behind mothers' feeding practices and the development of interventions by helping identify areas in greatest need of change.

Clinical exome sequencing reports: current informatics practice and future opportunities.

PubMed

Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

2017-11-01

The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

PubMed

Collins, Sarah A; Rozenblum, Ronen; Leung, Wai Yin; Morrison, Constance Rc; Stade, Diana L; McNally, Kelly; Bourie, Patricia Q; Massaro, Anthony; Bokser, Seth; Dwyer, Cindy; Greysen, Ryan S; Agarwal, Priyanka; Thornton, Kevin; Dalal, Anuj K

2017-04-01

To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Current practices in treatment of female genital fistula: a cross sectional study.

PubMed

Arrowsmith, Steven D; Ruminjo, Joseph; Landry, Evelyn G

2010-11-10

Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for

Current practice in assessment and treatment of bronchial asthma in young males in Italy.

PubMed

Ferrante, E; Pantaleo, C; Quatela, M; Fuso, L; Basso, S; Pistelli, R

2000-10-01

The aim of the study was to evaluate, in a sample of young asthmatics in Italy, the current practice in assessment and treatment of asthma after the publication of guidelines. Young soldiers who declared bronchial asthma at the beginning of the compulsory military service were evaluated. One-hundred and thirty-eight subjects with confirmed asthma were selected. Sixty-seven subjects (48.5%) had had at last one spirometry, and only one subject had underwent peak flow monitoring at home; most of the subjects (96.8%) had had prick tests. More of the 50% of the subjects with bronchial obstruction or with severe bronchial hyperresponsiveness, with clinical moderate or severe asthma, had used only bronchodilators or no therapy at all in the preceding year. In this sample of young asthmatics, the lung function tests were still underutilized for the diagnosis and follow-up of bronchial asthma; moreover, the inhaled anti-inflammatory drugs were still underutilized.

Overuse Injuries in Professional Ballet: Influence of Age and Years of Professional Practice

PubMed Central

Sobrino, Francisco José; Guillén, Pedro

2017-01-01

Background: In spite of the high rate of overuse injuries in ballet dancers, no studies have investigated the prevalence of overuse injuries in professional dancers by providing specific diagnoses and details on the differences in the injuries sustained as a function of age and/or years of professional practice. Hypothesis: Overuse injuries are the most prevalent injuries in ballet dancers. Professional ballet dancers suffer different types of injuries depending on their age and years of professional practice. Study Design: Descriptive epidemiology study. Methods: This descriptive epidemiological study was carried out between January 1, 2005, and October 10, 2010, regarding injuries sustained by professional dancers belonging to the major Spanish ballet companies practicing classical, neoclassical, contemporary, and Spanish dance. The sample was distributed into 3 different groups according to age and years of professional practice. Data were obtained from the specialized medical care the dancers received from the Trauma and Orthopaedic Surgery Service at Fremap in Madrid. The dependent variable was the study of the injury. Results: A total of 486 injuries were identified over the study period, with overuse injuries being the most common etiology (P < .0001); these injuries were especially prevalent in junior professional dancers practicing classical ballet and veteran dancers practicing contemporary ballet (P = .01). Specifically, among other findings, stress fractures of the base of the second metatarsal (P = .03), patellofemoral syndrome, and os trigonum syndrome were more prevalent among junior professionals (P = .04); chondral injury of the knee in senior professionals (P = .04); and cervical disc disease in dancers of intermediate age and level of experience. Conclusion: Overall, overuse injuries were more prevalent in younger professionals, especially in women. This finding was especially true for the more technical ballet disciplines. On the other hand, in

Footwear in rock climbing: Current practice.

PubMed

McHenry, R D; Arnold, G P; Wang, W; Abboud, R J

2015-09-01

Many rock climbers wear ill-fitting and excessively tight footwear during activity. However, there is insufficient evidence of the extent or harms of this practice. To investigate footwear use in rock climbers with a focus on issues surrounding fit. A cross-sectional study with active rock climbers of over one year of experience completing a survey on their activity and footwear. Additionally, the authors quantified foot and shoe lengths and sizes alongside demographic data. Ill-fitting and excessively tight footwear was found in 55 out of 56 rock climbers. Foot pain during activity was also commonplace in 91% of the climbers. A mean size reduction of almost 4 UK shoe sizes was found between the climbers' street shoe size and that of their climbing footwear using a calibrated foot/shoe ruler. There is an unfortunate association of climbers of higher abilities seeking a tighter shoe fit (p<0.001). With the elucidation of footwear use amongst rock climbers, further investigation may aim to quantify its impact and seek a solution balancing climbing performance while mitigating foot injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

Current practice patterns in conservative thumb CMC joint care: survey results.

PubMed

O'Brien, Virginia H; McGaha, Jamie L

2014-01-01

Cross-sectional descriptive survey Best practice for conservative clinical care pathways is not well outlined in the literature for patients with thumb carpometacarpal joint (CMCJ) pain. This self-report survey investigated the current practice patterns of assessments and conservative interventions for the painful thumb CMCJ among hand therapists. An online survey was distributed to members of the American Society of Hand Therapists (ASHT). Questions were included about evaluation measures and intervention techniques used for this population. A descriptive analysis was completed of the results. A total of 23.5% of the ASHT membership responded to the survey. Results were categorized using the International Classification of Functioning and Disability domains as a framework. The survey results report varying use of evaluation measures, therapeutic interventions, including orthotic fabrication, joint protection and patient education all therapeutic interventional techniques, and modalities. Therapists use a comprehensive array of evaluation measures and interventions for body functions and structures in the care of thumb CMC pain. In contrast, more consistent use is needed of psychometrically-sound functional outcome measures that show change in activities and participation. This survey highlights areas to employ current evidence, as well as, future research should address environmental factors and personal factors for this population Not applicable. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Re/creating entrepreneurs of the self: discourses of worker and employee 'value' and current vocational rehabilitation practices.

PubMed

Fadyl, Joanna; McPherson, Kathryn; Nicholls, David

2015-05-01

Vocational rehabilitation for people experiencing work disability is a social practice often situated within health services, but the social and political drivers and effects of this practice are rarely critically analysed in health research or policy. In this study we used a Foucauldian theoretical perspective to analyse the ways in which current vocational rehabilitation practices in New Zealand re/produce notions of worker and employee 'value', and how different approaches to vocational rehabilitation deploy current discourses about value. We also consider the subject positions produced through these different approaches and the identities and actions they make possible for people experiencing work disability. The analysis showed that notions about the importance of worker and employee value in a job market are pervasive in vocational rehabilitation, and reflect wider societal discourses. However, the deployment of those discourses in different approaches to vocational rehabilitation practice are diverse, producing different opportunities and constraints for people experiencing disability. We argue that an examination of these various opportunities and constraints at the level of practice approaches is important, as considerable time and resources are allocated to developing solutions to help those who do not thrive in the current systems, yet we rarely critique the premises on which the systems are based. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Time transfer techniques: Historical overview, current practices and future capabilities

NASA Technical Reports Server (NTRS)

Klepczynski, W. J.

1984-01-01

A brief historical review of time transfer techniques used during the last twenty years is presented. Methods currently used are discussed in terms of cost effectiveness as a function of accuracy achievable. Future trends are also discussed in terms of projected timekeeping capabilities.

Embedding Evidence-based Practice Education into a Post-graduate Physiotherapy Program: Eight Years of pre-Post Course Evaluations.

PubMed

Perraton, L; Machotka, Z; Grimmer, K; Gibbs, C; Mahar, C; Kennedy, K

2017-04-01

Little has been published about the effectiveness of training postgraduate physiotherapy coursework students in research methods and evidence-based practice (EBP) theory. Graduate qualities in most universities include lifelong learning. Inclusion of EBP in post-graduate coursework students' training is one way for students to develop the knowledge and skills needed to implement current best evidence in their clinical practice after graduation, thereby facilitating lifelong learning. This paper reports on change in confidence and anxiety in knowledge of statistical terminology and concepts related to research design and EBP in eight consecutive years of post-graduate physiotherapy students at one Australian university. Pre-survey/post-survey instruments were administered to students in an intensive 3-week post-graduate course, which taught health research methods, biostatistics and EBP. This course was embedded into a post-graduate physiotherapy programme from 2007 to 2014. The organization and delivery of the course was based on best pedagogical evidence for effectively teaching adult physiotherapists. The course was first delivered each year in the programme, and no other course was delivered concurrently. There were significant improvements in confidence, significantly decreased anxiety and improvements in knowledge of statistical terminology and concepts related to research design and EBP, at course completion. Age, gender and country of origin were not confounders on learning outcomes, although there was a (non-significant) trend that years of practice negatively impacted on learning outcomes (p = 0.09). There was a greater improvement in confidence in statistical terminology than in concepts related to research design and EBP. An intensive teaching programme in health research methods and biostatistics and EBP, based on best practice adult physiotherapy learning principles, is effective immediately post-course, in decreasing anxiety and increasing

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life.

PubMed

Feldens, C A; Kramer, P F; Sequeira, M C; Rodrigues, P H; Vitolo, M R

2012-04-01

To identify risk factors for cariogenic feeding practices in the first year of life. Cohort study. 500 children born within the public health care system in São Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. Adjusted relative risks for the outcome were estimated using robust Poisson regression models. A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26-3.82) and was 70% higher in children from mothers with 5-8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

A review of current surgical practice in the operative treatment of proximal humeral fractures

PubMed Central

Jones, L. D.; Palmer, A. J. R.; Macnair, R. D.; Brewer, P. E.; Jayadev, C.; Wheelton, A. N.; Ball, D. E. J.; Nandra, R. S.; Aujla, R. S.; Sykes, A. E.; Carr, A. J.

2016-01-01

Objectives The PROximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial has recently demonstrated that surgery is non-superior to non-operative treatment in the management of displaced proximal humeral fractures. The objective of this study was to assess current surgical practice in the context of the PROFHER trial in terms of patient demographics, injury characteristics and the nature of the surgical treatment. Methods A total of ten consecutive patients undergoing surgery for the treatment of a proximal humeral fracture from each of 11 United Kingdom hospitals were retrospectively identified over a 15 month period between January 2014 and March 2015. Data gathered for the 110 patients included patient demographics, injury characteristics, mode of surgical fixation, the grade of operating surgeon and the cost of the surgical implants. Results A majority of the patients were female (66%, 73 of 110). The mean patient age was 62 years (range 18 to 89). A majority of patients met the inclusion criteria for the PROFHER trial (75%, 83 of 110). Plate fixation was the most common mode of surgery (68%, 75 patients), followed by intramedullary fixation (12%, 13 patients), reverse shoulder arthroplasty (10%, 11 patients) and hemiarthroplasty (7%, eight patients). The consultant was either the primary operating surgeon or supervising the operating surgeon in a large majority of cases (91%, 100 patients). Implant costs for plate fixation were significantly less than both hemiarthroplasty (p < 0.05) and reverse shoulder arthroplasty (p < 0.0001). Implant costs for intramedullary fixation were significantly less than plate fixation (p < 0.01), hemiarthroplasty (p < 0.0001) and reverse shoulder arthroplasty (p < 0.0001). Conclusions Our study has shown that the majority of a representative sample of patients currently undergoing surgical treatment for a proximal humeral fracture in these United Kingdom centres met the inclusion criteria for the PROFHER trial

Rural domestic waste management in Zhejiang Province, China: Characteristics, current practices, and an improved strategy.

PubMed

Guan, Yidong; Zhang, Yuan; Zhao, Dongye; Huang, Xiaofeng; Li, Haini

2015-06-01

Lack of access to adequate sanitation facilities has serious health implications for rural dwellers and can degrade the ecosystems. This study offers a systemantic and quantitative overview of historical data on rural domestic waste (RDW) production and past and current management practices in a prototype region in China, where rural areas are undergoing rapid urbanization and are confronted with great environmental challenges associated with poor RDW management practices. The results indicate that RDW is characterized with a large fraction of kitchen waste (42.9%) and high water content (53.4%). The RDW generation (RDWG) per capita between 2012 and 2020 is estimated to increase from 0.68 to 1.01 kg/d-cap. The Hill 1 model is able to adequately simulate/project the population growth in a rural area from 1993 to 2020. The annual RDWG in the region is estimated to double from 6,033,000 tons/year in 2008 to 12,030,000 tons/year by 2020. By comparing three RDW management scenarios based on the life-cycle inventory approach and cost-benefit analysis, it is strongly recommended that the present Scenario 2 (sanitary landfill treatment) be upgraded to Scenario 3 (source separation followed by composting and landfill of RDW) to significantly reduce the ecological footprint and to improve the cost-effectiveness and long-term sustainability. Rural domestic waste (RDW) is affecting 720 million people in China and more than 3221 million people worldwide. Consequently, handling and disposal of RDW have serious health implications to rural dwellers and the ecosystems. This study offers a systemantic and quantitative overview and analysis of historical data on RDW production and management practices in a prototype region in China, which is confronted with great environmental challenges associated with RDW. Then we predict future production of RDW and propose a sustainable RDW management strategy, which holds the promise of greatly mitigating the mounting environmental pressure

Cervical Screening for Women with Learning Disability: Current Practice and Attitudes within Primary Care in Edinburgh

ERIC Educational Resources Information Center

Wood, Rachael; Douglas, Margaret

2007-01-01

This study aimed to evaluate current practice in, and to explore primary care professionals' views about, providing cervical screening to women with learning disability, in two areas of Edinburgh. A postal questionnaire was sent to all 24 GP practices in the project area: 20 responded. Seven respondents were invited to participate in follow up…

A 5-Year Analysis of Peer-Reviewed Journal Article Publications of Pharmacy Practice Faculty Members

PubMed Central

Spivey, Christina; Martin, Jennifer R.; Wyles, Christina; Ehrman, Clara; Schlesselman, Lauren S.

2012-01-01

Objectives. To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates. Methods. Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH). Results. Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006). Conclusion. Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications. PMID:23049099

Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs.

PubMed

Mihalopoulos, Cathrine; Magnus, Anne; Lal, Anita; Dell, Lisa; Forbes, David; Phelps, Andrea

2015-04-01

To assess, from a health sector perspective, the incremental cost-effectiveness of three treatment recommendations in the most recent Australian Clinical Practice Guidelines for posttraumatic stress disorder (PTSD). The interventions assessed are trauma-focused cognitive behavioural therapy (TF-CBT) and selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD in adults and TF-CBT in children, compared to current practice in Australia. Economic modelling, using existing databases and published information, was used to assess cost-effectiveness. A cost-utility framework using both quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted was used. Costs were tracked for the duration of the respective interventions and applied to the estimated 12 months prevalent cases of PTSD in the Australian population of 2012. Simulation modelling was used to provide 95% uncertainty around the incremental cost-effectiveness ratios. Consideration was also given to factors not considered in the quantitative analysis but could determine the likely uptake of the proposed intervention guidelines. TF-CBT is highly cost-effective compared to current practice at $19,000/QALY, $16,000/DALY in adults and $8900/QALY, $8000/DALY in children. In adults, 100% of uncertainty iterations fell beneath the $50,000/QALY or DALY value-for-money threshold. Using SSRIs in people already on medications is cost-effective at $200/QALY, but has considerable uncertainty around the costs and benefits. While there is a 13% chance of health loss there is a 27% chance of the intervention dominating current practice by both saving dollars and improving health in adults. The three Guideline recommended interventions evaluated in this study are likely to have a positive impact on the economic efficiency of the treatment of PTSD if adopted in full. While there are gaps in the evidence base, policy-makers can have considerable confidence that the recommendations

Public Elementary and Secondary School Revenues and Current Expenditures for Fiscal Year 1987 (School Year 1986-87): Preliminary Tabulations. E.D. TABS.

ERIC Educational Resources Information Center

National Center for Education Statistics (ED), Washington, DC.

This document reports preliminary tabulations of public elementary and secondary school revenues and current expenditures for Fiscal Year 1987 (School Year 1986-87). Data shows revenues by local, state, intermediate, and federal sources, and current expenditures by categories of instruction, support services, noninstructional services, and fixed…

Practical Knowledge and Teacher Reflection from a Practice-Based Literacy Teacher Education Program in the First Years: A Longitudinal Study

ERIC Educational Resources Information Center

Wetzel, Melissa Mosley; Hoffman, James V.; Roach, Audra K.; Russell, Katie

2018-01-01

This longitudinal study explores how one university's practice-based teacher preparation program prepared literacy teachers to develop practical knowledge for teaching and how that knowledge was tested and adapted in the first years of teaching. To understand change, we identified and analyzed points of tension, challenge, or dissonance in the…

A 4-year intervention to increase adoption of safer dairy farming work practices.

PubMed

Chapman, Larry J; Brunette, Christopher M; Karsh, Ben-Tzion; Taveira, Alvaro D; Josefsson, K Gunnar

2011-03-01

Traumatic and musculoskeletal injury rates have been high in dairy farming compared to other industries. Previous work has shown that social marketing efforts can persuade farm managers to adopt practices that reduce injury hazards compared to traditional practices if the new practices maintain profits. The intervention disseminated information to 4,300 Northeast Wisconsin dairy farm managers about three safer and more profitable production practices (barn lights, silage bags, and calf feed mixing sites) using information channels that these managers were known to rely on. We evaluated rolling, independent, community-based samples, at baseline and then again after each of four intervention years. We also evaluated samples from Maryland's 1,200 dairy farms after the second through the fourth year of the intervention. Maryland dairy managers read many of the same nationally distributed print mass media that we used in the intervention and so were a "partially exposed" comparison group. The intervention to disseminate information about the innovations was successful. In comparisons before and after the intervention, Wisconsin managers reported getting more information about calf sites from public events and equipment dealers, about silage bags from other farmers and equipment dealers, and about barn lights from public events, other farmers, equipment dealers, consultants, and electrical suppliers. Wisconsin managers also reported getting more information than Maryland managers from public events for barn lights and silage bags. During years three and four, the intervention managed to sustain, but not improve, earlier increases in adoption and awareness from the first 2 years. After adjusting for farm manager and operation variables, intervention years was associated with increased Wisconsin manager adoption of two of three practices in comparisons between the baseline and the fourth intervention year: barn lights (odds ratio = 5.58, 95% confidence interval = 3

Group Therapy for School-Aged Children Who Stutter: A Survey of Current Practices

ERIC Educational Resources Information Center

Liddle, Hilary; James, Sarah; Hardman, Margaret

2011-01-01

Although group therapy is recommended for school-aged children who stutter (CWS), it is not widely researched. This study aimed to explore this provision, using a postal survey which investigated the current practices of Speech & Language Therapists (SLTs) in the UK. Seventy percent of SLT services provided some group therapy, but the level of…

Small Business and Defense Acquisitions: A Review of Policies and Current Practices

DTIC Science & Technology

2011-01-01

Office of Management and Budget xviii Small Business and Defense Acquisitions: A Review of Policies and Current Practices PSC Product and Service Code...themselves as minority-owned, women-owned, veteran- owned, or small disadvantaged businesses . The resulting database gives sourcing managers a tool for...REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Small Business and Defense Acquisitions: A

Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

PubMed

Abbott, Lisa M; Magnusson, Roger S; Gibbs, Emma; Smith, Saxon D

2018-05-01

Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession. © 2017 The Australasian College of Dermatologists.

Figures in clinical trial reports: current practice & scope for improvement

PubMed Central

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-01-01

Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used. PMID:18021449

Figures in clinical trial reports: current practice & scope for improvement.

PubMed

Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

2007-11-19

Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

Interpersonal Relationships, Motivation, Engagement, and Achievement: Yields for Theory, Current Issues, and Educational Practice

ERIC Educational Resources Information Center

Martin, Andrew J.; Dowson, Martin

2009-01-01

In this review, we scope the role of interpersonal relationships in students' academic motivation, engagement, and achievement. We argue that achievement motivation theory, current issues, and educational practice can be conceptualized in relational terms. Influential theorizing, including attribution theory, expectancy-value theory, goal theory,…

Research Reproducibility in Geosciences: Current Landscape, Practices and Perspectives

NASA Astrophysics Data System (ADS)

Yan, An

2016-04-01

Reproducibility of research can gauge the validity of its findings. Yet currently we lack understanding of how much of a problem research reproducibility is in geosciences. We developed an online survey on faculty and graduate students in geosciences, and received 136 responses from research institutions and universities in Americas, Asia, Europe and other parts of the world. This survey examined (1) the current state of research reproducibility in geosciences by asking researchers' experiences with unsuccessful replication work, and what obstacles that lead to their replication failures; (2) the current reproducibility practices in community by asking what efforts researchers made to try to reproduce other's work and make their own work reproducible, and what the underlying factors that contribute to irreproducibility are; (3) the perspectives on reproducibility by collecting researcher's thoughts and opinions on this issue. The survey result indicated that nearly 80% of respondents who had ever reproduced a published study had failed at least one time in reproducing. Only one third of the respondents received helpful feedbacks when they contacted the authors of a published study for data, code, or other information. The primary factors that lead to unsuccessful replication attempts are insufficient details of instructions in published literature, and inaccessibility of data, code and tools needed in the study. Our findings suggest a remarkable lack of research reproducibility in geoscience. Changing the incentive mechanism in academia, as well as developing policies and tools that facilitate open data and code sharing are the promising ways for geosciences community to alleviate this reproducibility problem.

Current practices of Asia-Pacific cardiologists in the utilization of bioresorbable scaffolds.

PubMed

Chanana, B B; Chandra, Praveen; Cheng, Jack Jun; Dick, Ron; Gwon, Hyeon-Cheol; Hiremath, M S; Huan, Do Quang; Jeamanukoolkit, Anuruck; Jiang, Tiemin; Kwok, On-Hing; Lim, Michael C L; Low, Adrian F; Mathew, Rony; Mathew, Samuel K; McClean, Dougal; Nakamura, Sunao; Nguyen, Michael; Qiao, Shubin; Santoso, Teguh; Saxena, Sudheer; Schultz, Carl; Sengottuvelu, G; Seth, Ashok; Simonton, Charles A; Soo, Chee Siong; Sudhir, Krishnankutty; Tsai, Cheng-Ting; Wasan, Udayachalerm; Whelan, Alan; Wong, Chris; Yap, Yee Guan

2016-11-01

Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists ('Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS ('Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

PubMed

Bergstraesser, Eva; Zimmermann, Karin; Eskola, Katri; Luck, Patricia; Ramelet, Anne-Sylvie; Cignacco, Eva

2015-08-01

To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. ClinicalTrials.gov Identifier: NCT01983852. © 2015 John Wiley & Sons Ltd.

Current optometric practices and attitudes in keratoconus patient management.

PubMed

Ortiz-Toquero, Sara; Martin, Raul

2017-08-01

To compare the current optometric practices and attitudes in the management of keratoconus patients in the UK and Spain. An online survey (adapted to optometric practices) was distributed via a newsletter emailed by various professional organizations in the UK and Spain. Four hundred and sixty-four practitioners (126 in the UK; 338 in Spain) who prescribed gas permeable GP contact lenses (CLs) more than once per month (54.8% of UK practitioners and 28.1% of practitioners in Spain; p<0.01) responded to the questionnaire. A combination of multiple factors is considered necessary in the keratoconus detection (79.4% in the UK, 75% in Spain; p=0.68), and the use of classification criteria is considered relevant (67.5% in the UK, 70.7% in Spain; p=0.49). There is a high consensus on the consideration that GP CL fitting is more difficult in keratoconus (79.4% in the UK, 80.5% in Spain; p=0.79) requiring more diagnostic lenses (3.2±1.4 and 3.4±1.2 in the UK and Spain, respectively; p=0.72) than are necessary for healthy eyes. Using corneal topography is uncommon from both countries (38.1% in the UK, 59.8% in Spain; p<0.01), with a similar ophthalmologist referral pattern (at initial diagnosis, 50% in both the UK and Spain; p=1.00). Few cases of co-management with ophthalmologists were noted (no co-management reported by 60.3% in the UK and 72.8% in Spain, p=0.01). This study provides initial observations and evidence regarding keratoconus management by optometrists in the UK and Spain and shows similarity in the professional practices and attitudes of practitioners in these two countries. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Management of Symptomatic Floaters: Current Attitudes, Beliefs, and Practices Among Vitreoretinal Surgeons.

PubMed

Cohen, Michael N; Rahimy, Ehsan; Ho, Allen C; Garg, Sunir J

2015-09-01

To assess the current attitudes, beliefs, and practice patterns among vitreoretinal surgeons when dealing with symptomatic floaters in patients with otherwise healthy eyes. A cross-sectional, Internet-based anonymous survey of 10 questions was distributed via email to vitreoretinal specialists practicing in the United States. The survey response rate was 6.1% (159 of 2,600). Forty of 159 respondents (25%) reported they would perform pars plana vitrectomy (PPV) to reduce symptomatic floaters, and 110 of 159 (69%) had previously performed PPV for this indication. When compared to those unlikely to intervene for symptomatic floaters, 33 of 40 (83%) of those likely to intervene performed more than 100 vitrectomy surgical cases annually (P<.05). Between those that had and had not performed PPV for symptomatic floaters in the past, statistically significant differences were observed regarding the likelihood to perform PPV for symptomatic floaters in the future (35% vs. 4%; P<.0001) and tendency to elect a procedure if the surgeon's own vision were impacted by symptomatic floaters (55% vs. 8%; P<.001). When compared to those likely to perform surgery for symptomatic floaters, those unlikely to intervene identified three statistically significant barriers: the surgical risks involved with PPV (28% vs. 86%; P<.001), unrealistic patient expectations (25% vs 58%; P<.001), and the possibility of ridicule from the local retina community (10% vs. 32%; P<.01). Vitreoretinal specialists are more likely to intervene for symptomatic floaters if they have previously done so and if they perform more than 100 surgical cases per year. The major barriers preventing physicians from performing an intervention for floaters are standard risks associated with PPV, the fear of unreasonable patient expectations, and the possibility of ridicule within the local retina community. Copyright 2015, SLACK Incorporated.

Becoming Warm Demanders: Perspectives and Practices of First Year Teachers

ERIC Educational Resources Information Center

Bondy, Elizabeth; Ross, Dorene D.; Hambacher, Elyse; Acosta, Melanie

2013-01-01

In the literature on culturally responsive pedagogy "warm demanders" are teachers who embrace values and enact practices that are central to their students' success. Few scholars have examined the experience of novice teachers who attempt to enact this stance. In this study of two first-year, female, European American teachers who attempted to be…

Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

DTIC Science & Technology

2012-08-01

to trauma, surgery or blood diseases such as anemia, hemophilia or sickle- cell disease. But transfusions carry risks. Current practices are often...Blood Management Topic 4: Diagnosis of Red cell disorders and oxygen carrying capacity Topic 5: Diagnosis of Disorders in homeostasis Topic 6...the Clinical Transfusion Medicine Committee of the AABB. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med

Lung Cancer Risk and Demographic Characteristics of Current 20-29 Pack-year Smokers: Implications for Screening.

PubMed

Pinsky, Paul F; Kramer, Barnett S

2015-11-01

Based on current recommendations, 30+ pack-years of smoking are required for eligibility for low-dose CT (LDCT) lung cancer screening; former smokers must have quit within 15 years. We investigated whether current smokers with 20 to 29 pack-years have similar lung cancer risks as eligible former smokers and also whether they have a different demographic profile. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) was a randomly assigned screening trial of subjects age 55 to 74 years with chest radiographs (CXR) used for lung cancer. Subjects completed a baseline questionnaire containing smoking history questions. Cox proportional hazards models, adjusted for age and sex, were utilized to estimate hazard ratios (HRs) for various smoking history groups. Next, we utilized the National Health Interview Survey (NHIS), which inquired about smoking history and race/ethnicity, to analyze the demographic profiles of various high-risk smoking history categories. All statistical tests were two-sided. The PLCO cohort included 18 114 former and 12 243 current LDCT-eligible smokers, plus 2283 20- to 29-pack-year current smokers. The hazard ratio for 20- to 29-pack-year current smokers compared with eligible (30+ pack-year) former smokers was 1.07 (95% confidence interval [CI] = 0.75 to 1.5). Based on the NHIS, 10 million persons in the United States are currently LDCT eligible; an additional 1.6 million (16%, 95% CI = 13.6% to 19.0%) are 20- to 29-pack-year current smokers. The percentage increase in eligibles if 20- to 29-pack-year current smokers were included was substantially greater for women than men (22.2%, 95% CI = 17.9% to 26.7%; vs 12.2%, 95% CI = 9.3% to 15.3%, P < .001) and for minorities than non-Hispanic whites (30.0%, 95% CI = 24.2% to 36.0%; vs 14.1%, 95% CI = 11.1% to 17.0%, P < .001). The potential benefits and harms of recommending LDCT screening for 20 to 29-pack-year current smokers should be assessed. Published by Oxford University

Current Operating Costs of Two-Year Colleges in the South.

ERIC Educational Resources Information Center

Scales, Eldridge E.

This analysis of current expenditures of 127 accredited public and private 2-year colleges in 11 southern states is intended to provide data for comparison of expenditures by private and public colleges, to show administrators where spending differs among the colleges, and to provide objective data for them to judge the efficiency of their own…

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

Pediatric Neurocritical Care: A Short Survey of Current Perceptions and Practices.

PubMed

Murphy, Sarah A; Bell, Michael J; Clark, Maureen E; Whalen, Michael J; Noviski, Natan

2015-10-01

Although attention to neurologic injuries and illnesses in pediatric critical care is not new, a sub-specialized field of pediatric neurocritical care has only recently been recognized. Pediatric neurocritical care is an emerging area of clinical and investigative focus. Little is known about the prevalence of specialized pediatric neurocritical care services nor about perceptions regarding how it is impacting medical practice. This survey sought to capture perceptions about an emerging area of specialized pediatric neurocritical care among practitioners in intersecting disciplines, including pediatric intensivists, pediatric neurologits and pediatric neurosurgeons. A web-based survey was distributed via email to members of relevant professional societies and groups. Survey responses were analyzed using descriptive statistics. Differences in responses between groups of respondents were analyzed using Chi-squared analysis where appropriate. Specialized clinical PNCC programs were not uncommon among the survey respondents with 20% currently having a PNCC service at their institution. Despite familiarity with this area of sub-specialization among the survey respondents, the survey did not find consensus regarding its value. Overall, 46% of respondents believed that a specialized clinical PNCC service improves the quality of care of critically ill children. Support for PNCC sub-specialization was more common among pediatric neurologists and pediatric neurosurgeons than pediatric intensivists. This survey found support across specialties for creating PNCC training pathways for both pediatric intensivists and pediatric neurologists with an interest in this specialized field. PNCC programs are not uncommon; however, there is not clear agreement on the optimal role or benefit of this area of practice sub-specialization. A broader dialog should be undertaken regarding the emerging practice of pediatric neurocritical care, the potential benefits and drawbacks of this

Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

PubMed

Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

2012-11-01

Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

European cardiac nurses' current practice and knowledge on anticoagulation therapy.

PubMed

Oterhals, Kjersti; Deaton, Christi; De Geest, Sabina; Jaarsma, Tiny; Lenzen, Mattie; Moons, Philip; Mårtensson, Jan; Smith, Karen; Stewart, Simon; Strömberg, Anna; Thompson, David R; Norekvål, Tone M

2014-06-01

Successful management of warfarin, new anti-thrombotic agents and self-monitoring devices requires that health care professionals effectively counsel and educate patients. Previous studies indicate that health care professionals do not always have the knowledge to provide patients with the correct information. The purpose of this study was to investigate European cardiovascular nurses' knowledge on the overall management of anticoagulation therapy and examine if this knowledge was influenced by level of education and years in clinical practice. A questionnaire including 47 items on practice patterns and knowledge on warfarin, new anticoagulants, warfarin-drug and warfarin-food interactions, and self-management of International Normalized Ratio (INR) was distributed to the attendants at a European conference in 2012. The response rate was 32% (n=206), of whom 84% reported having direct patient contact. Warfarin was the most common used oral anticoagulation in daily practice. One third offered their patients both patient self-testing and patient self-management of INR. The mean total score on the knowledge questions was 28±6 (maximum possible score 53). Nurses in direct patient care had a higher mean score (p=0.011). Knowledge on warfarin and medication-interactions were low, but knowledge on warfarin-diet interactions and how to advise patients on warfarin as somewhat better. European cardiac nurses need to improve their knowledge and practice patterns on oral anticoagulation therapy. This area of knowledge is important in order to deliver optimal care to cardiac patients and to minimise adverse effects of the treatment.

Circumcision of preschool boys in Baghdad, Iraq: prevalence, current practice and complications.

PubMed

Naji, Hussein; Mustafa, Rajaa

2013-03-01

Circumcision is probably one of the most ancient surgical operations and has been performed more than any other operation. The aim of this study is to assess the prevalence of circumcision in preschool boys and to present an overview of the current practices and complications in Baghdad, Iraq. A statistical survey was conducted at the Central Teaching Hospital for Children in Baghdad, Iraq during the period April 2003 to October 2004. The survey consisted of structured interviews with the accompanying parents while waiting for their children's routine appointments. A total of 4000 boys were included. 2443 (61%) were circumcised and the prevalence of circumcision increased from 18% at 6 months of age to reach 92% at 6 years. Only 180 (7.4%) boys had a medical reason while the rest were circumcised for religious reasons. Parents were the only determinant in deciding the time and place of religious circumcision. Circumcision was performed by a doctor in 732 (30%) boys, by a nurse in 1276 (52%) and by a traditional circumciser in 435 (18%). Post-operative complications were encountered in 209 (8.5%) boys. Circumcision is an important surgical procedure that should be performed by trained medical staff in medical institutions. Circumcision performed by medical professionals caused significantly less complications.

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

Current practices in library/informatics instruction in academic libraries serving medical schools in the Western United States: a three-phase action research study.

PubMed

Eldredge, Jonathan D; Heskett, Karen M; Henner, Terry; Tan, Josephine P

2013-09-04

To conduct a systematic assessment of library and informatics training at accredited Western U.S. medical schools. To provide a structured description of core practices, detect trends through comparisons across institutions, and to identify innovative training approaches at the medical schools. Action research study pursued through three phases. The first phase used inductive analysis on reported library and informatics skills training via publicly-facing websites at accredited medical schools and the academic health sciences libraries serving those medical schools. Phase Two consisted of a survey of the librarians who provide this training to undergraduate medical education students at the Western U.S. medical schools. The survey revealed gaps in forming a complete picture of current practices, thereby generating additional questions that were answered through the Phase Three in-depth interviews. Publicly-facing websites reviewed in Phase One offered uneven information about library and informatics training at Western U.S. medical schools. The Phase Two survey resulted in a 77% response rate. The survey produced a clearer picture of current practices of library and informatics training. The survey also determined the readiness of medical students to pass certain aspects of the United States Medical Licensure Exam. Most librarians interacted with medical school curricular leaders through either curricula committees or through individual contacts. Librarians averaged three (3) interventions for training within the four-year curricula with greatest emphasis upon the first and third years. Library/informatics training was integrated fully into the respective curricula in almost all cases. Most training involved active learning approaches, specifically within Problem-Based Learning or Evidence-Based Medicine contexts. The Phase Three interviews revealed that librarians are engaged with the medical schools' curricular leaders, they are respected for their knowledge and

Current practices in library/informatics instruction in academic libraries serving medical schools in the western United States: a three-phase action research study

PubMed Central

2013-01-01

Background To conduct a systematic assessment of library and informatics training at accredited Western U.S. medical schools. To provide a structured description of core practices, detect trends through comparisons across institutions, and to identify innovative training approaches at the medical schools. Methods Action research study pursued through three phases. The first phase used inductive analysis on reported library and informatics skills training via publicly-facing websites at accredited medical schools and the academic health sciences libraries serving those medical schools. Phase Two consisted of a survey of the librarians who provide this training to undergraduate medical education students at the Western U.S. medical schools. The survey revealed gaps in forming a complete picture of current practices, thereby generating additional questions that were answered through the Phase Three in-depth interviews. Results Publicly-facing websites reviewed in Phase One offered uneven information about library and informatics training at Western U.S. medical schools. The Phase Two survey resulted in a 77% response rate. The survey produced a clearer picture of current practices of library and informatics training. The survey also determined the readiness of medical students to pass certain aspects of the United States Medical Licensure Exam. Most librarians interacted with medical school curricular leaders through either curricula committees or through individual contacts. Librarians averaged three (3) interventions for training within the four-year curricula with greatest emphasis upon the first and third years. Library/informatics training was integrated fully into the respective curricula in almost all cases. Most training involved active learning approaches, specifically within Problem-Based Learning or Evidence-Based Medicine contexts. The Phase Three interviews revealed that librarians are engaged with the medical schools' curricular leaders, they are

Vitamin D status of dairy cattle: Outcomes of current practices in the dairy industry

USDA-ARS?s Scientific Manuscript database

The need for vitamin D supplementation of dairy cattle has been known for the better part of the last century and is well-appreciated by dairy producers and nutritionists. Whether current recommendations and practices for supplemental vitamin D are meeting the needs of dairy cattle, however, is not...

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

PubMed

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current

From distress guidelines to developing models of psychosocial care: current best practices.

PubMed

Clark, Paul G; Bolte, Sage; Buzaglo, Joanne; Golant, Mitch; Daratsos, Louisa; Loscalzo, Matthew

2012-01-01

Psychological distress has been recognized as having a significant effect upon cognitive and emotional functioning, quality of life, and in some populations increased costs of care. Screening for distress and provision of psychosocial care in oncology treatment settings has been identified as a future accreditation standard by the American College of Surgeons Commission on Cancer (CoC). Because there are few available models of programs of distress screening and referral to inform oncology social workers and other members of the psychosocial support team with planning their own programs, this article seeks to provide exemplars of best practices that are currently in place in four different settings where psychosocial support is provided to people living with cancer and their families. Each program will provide an overview of how it was successfully established and its contribution toward evolving evidence-informed best practices.

Current clinical practices of the Rhinoplasty Society members.

PubMed

Lee, Michael; Unger, Jacob G; Gryskiewicz, Joe; Rohrich, Rod J

2013-11-01

As rhinoplasty remains among the most challenging and controversial operations in plastic surgery, we sought to elucidate present-day practice characteristics. Members of The Rhinoplasty Society were polled in preparation for the national meeting held in Boston, Mass, on May 2011. The goal was to provide information regarding surgical approaches used as well as technique and practice patterns used. Two electronic surveys were distributed to members of The Rhinoplasty Society in preparation for the annual meeting. All 76 members received the surveys as well as instructions for completion. The initial survey included 10 questions discussing the preferred approach for rhinoplasty and practice details. The second survey dealt with specific techniques used during rhinoplasty. Data were collected and reviewed. The primary survey yielded a 61.8% response rate, whereas the secondary survey 48.7%. Of all surgeons, 72% reported doing the open approach for primary rhinoplasty more than 50% of the time, whereas the remaining 28% use the closed approach. For secondary rhinoplasty, 76% reported using the open approach in more than half of cases for which they were not the primary surgeons. In contrast, 53% used the closed approach in more than half the cases of secondary surgery if they were the initial surgeons. Revision rates for primary and secondary rhinoplasties were 9.1% and 7.8%, respectively. The difference was not statistically significant. On average, members performed 101 nasal surgeries per year. Previous patient recommendation was the most common reason for referral. Of the members, 54% reported using spreader grafts in more than half of the cases of aesthetic rhinoplasty and 75.7% when pertaining to functional rhinoplasty. Finally, 37.8% of responding members reported using tip grafts more than half the time when performing aesthetic rhinoplasty. Of the responding members of The Rhinoplasty Society, the open approach is the preferred choice for both primary and

Current Practices in the Construction of State Courses of Study. Bulletin, 1931, No. 4

ERIC Educational Resources Information Center

Langvick, Mina M.

1931-01-01

The purpose of this study is to analyze current practices in the construction of State courses of study. Available State courses of study, reports of survey commissions and educational officials, and other State educational publications have been examined to discover the problems considered significant by State educational officials and the…

Tobacco Cessation and Prevention Practices Reported by Second and Fourth Year Students at US Medical Schools

PubMed Central

Brooks, Daniel R.; Powers, Catherine A.; Brooks, Katie R.; Rigotti, Nancy A.; Bognar, Bryan; McIntosh, Scott; Zapka, Jane

2008-01-01

Background Tobacco dependence counseling is recommended to be included as core curriculum for US medical students. To date, there has been little information on students’ self-reported skills and practice opportunities to provide 5A’s (Ask, Advise, Assess, Assist, and Arrange) counseling for tobacco cessation. Methods We conducted anonymous surveys of second year and fourth year students at multiple US medical schools between February 2004 and March 2005 (overall response rate 70%). We report on the tobacco control practices of the 860 second year and 827 fourth year students completing the survey. Measurements and Main Results Fourth year students reported multiple opportunities to learn tobacco counseling in case-based discussions, simulated patient encounters, and clinical skills courses. They reported more instruction in family medicine (79%) and Internal Medicine (70%) than Pediatrics (54%), Obstetrics/Gynecology (41%), and Surgery clerkships (16%). Compared with asking patients about smoking, advising smokers to quit, and assessing patient willingness to quit, fourth year students were less likely to have multiple practice opportunities to assist the patient with a quit plan and arrange follow-up contact. More than half of second year students reported multiple opportunities for asking patients about smoking but far fewer opportunities for practicing the other 4 As. Conclusions By the beginning of their fourth year, most students in this group of medical schools reported multiple opportunities for training and practicing basic 5A counseling, although clear deficits for assisting patients with a quit plan and arranging follow-up care exist. Addressing these deficits and integrating tobacco teaching through tailored specific instruction across all clerkships, particularly in Surgery, Pediatrics, and Obstetrics/Gynecology is a challenge for medical school education. PMID:18612747

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations

PubMed Central

Dakkuri, Adnan; Abrons, Jeanine P.; Williams, Dennis; Ombengi, David N.; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O’Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-01-01

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education. PMID:27170809

Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

PubMed

Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

2016-04-25

International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

[Current practice in MR imaging of the liver].

PubMed

Kanematsu, M; Kondo, H; Matsuo, M; Hoshi, H

2001-12-01

MR imaging, which is able to evaluate T1- and T2-relaxation time, fat, hemorrhage, metal deposition, blood flow, perfusion, diffusion, and so on, has offered more information for the diagnosis of diffuse and focal hepatic diseases than CT. The spoiled-GRE sequence with high contrast resolution and ease of the aimed contrast capture derived from the k-space property, with the use of a phased-array multicoil, have remarkably increased the value of gadolinium-enhanced dynamic MR diagnosis of the liver. In recent years, the clinical use of ferumoxide has begun, and issues concerning the superiority or inferiority and combination of contrast media are being debated. This paper describes the value, role, and clinical practice of unenhanced, gadolinium-enhanced, and ferumoxide-enhanced MR imaging of the liver based on knowledge obtained in our institution, with some reference to the literature.

The slippery difficulty of ever containing drug resistance with current practices.

PubMed

Fullybright, R

2017-04-01

It has previously been shown that the rate of drug resistance emergence in medicine is exponential, while we have been producing drugs at a much lower rate. Our ability to successfully contain resistance at any one time is function of how many drugs we have at our disposal to counter new resistances from pathogens. Here, we assess our level of preparedness through a mathematical comparison of the drug manufacture rate by the pharmaceutical industry with the resistance emergence rate in pathogens. To that effect, changes in the rates of growth of the drugs production and resistance emergence processes are computed over multiple time segments and compared. It is found that new resistance emergence rate in infectious diseases medicine remains mathematically and permanently ahead of the drugs production rate by the pharmaceutical industry. Consequently, we are not in a position to ever contain current or future strengths of resistance from pathogens. A review of current practices is called for.

Laboratory Practices of Beginning Secondary Science Teachers: A Five-Year Study

ERIC Educational Resources Information Center

Wong, Sissy S.; Firestone, Jonah B.; Luft, Julie A.; Weeks, Charles B.

2013-01-01

During the beginning years of teaching, science teachers develop the knowledge and skills needed to design and implement science laboratories. In this regard, this quantitative study focused on the reported laboratory practices of 61 beginning secondary science teachers who participated in four different induction programs. The results…

Survey of Current Academic Practices for Full-Time Postlicensure Nursing Faculty Who Teach Online

ERIC Educational Resources Information Center

Hanford, Karen J.

2010-01-01

Purpose: The purpose of this study was to determine current academic practices of compensation, workload, rewards, and tenure and promotion for nursing faculty who teach graduate and postlicensure programs that are delivered 50% to 100% online. Deans and directors who are members of the American Association of Colleges of Nursing (AACN) were the…

Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

PubMed Central

Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.

2016-01-01

Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the “ladder-pipe system” for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

Religious slaughter: evaluation of current practices in selected countries.

PubMed

Velarde, A; Rodriguez, P; Dalmau, A; Fuentes, C; Llonch, P; von Holleben, K V; Anil, M H; Lambooij, J B; Pleiter, H; Yesildere, T; Cenci-Goga, B T

2014-01-01

As part of the project "Religious slaughter (DIALREL): improving knowledge and expertise through dialogue and debate on issues of welfare, legislation and socio-economic aspects", this paper discusses an evaluation of current practices during Halal and Shechita slaughter in cattle, sheep, goats and poultry. During religious slaughter, animals are killed with and without stunning by a transverse incision across the neck that is cutting the skin, muscles (brachiocephalic, sternocephalic, sternohyoid, and sternothyroid), trachea, esophagus, carotid arteries, jugular veins and the major, superficial and deep nerves of the cervical plexus. In this report, the restraint methods, stunning, neck cutting, exsanguination, slaughter techniques and postcut handling in the abattoir were assessed for religious slaughter. Information about the procedures used during religious slaughter in Belgium, Germany, Italy, the Netherlands, Spain, the UK, Turkey and Australia was collected by means of spot visits to abattoirs. To standardize the information gathered during the spot visits three guidelines were designed, one for each species, and translated into the national languages of the countries involved. The document included questions on the handling and restraint methods (stunning, neck cutting/exsanguination/slaughter techniques and postcut handling performed under religious practices) and for pain and distress of the animal during the restraint, neck cutting and induction to death in each abattoir. Results showed differences in the time from restraining to stun and to cut in the neck cutting procedures and in the time from cut to death. © 2013.

[Current status of practice of providing dietary advice to pregnant women by members of the Japanese Midwives' Association. Knowledge and utilization of the "Dietary Guidelines for Pregnant and Lactating Women"].

PubMed

Takimoto, Hidemi; Yonezawa, Junko; Shimada, Marie; Kato, Noriko; Yokoyama, Tetsuji

2013-01-01

Midwives are actively involved in providing dietary advice to pregnant women. In order to describe the current status of prenatal dietary advice provided by midwives, we conducted a questionnaire survey inquiring about their knowledge and usage of the "Dietary Guidelines for Pregnant and Lactating Women" (Guidelines) issued by the Ministry of Health, Labour, and Welfare in 2006. In total, 2000 members of the Japanese Midwives' Association were randomly selected for administration of the questionnaire. The recovery rate was 42.1%, and 785 responses were eligible for analyses. The questionnaire collected information on the respondent's age, years of work experience, current involvement in delivery practice, number of deliveries per year in the current affiliation, provision of dietary advice to pregnant women, and knowledge and usage of the Guidelines. The proportion of respondents in their 20 s was low (1.8%). About half of the respondents were practicing delivery. Further, 66.1% (519 midwives) reported they had knowledge of the Guidelines. Among those who had knowledge of the Guidelines and were currently providing dietary advice (426 midwives), 88.0% were using the Guidelines. The most frequently used item in the Guidelines was "Diet for preventing anemia" (75.8%). The least used item was "Shoku-iku (diet and nutrition education) for pregnant and lactating women" (58.5%). Midwives who were practicing delivery showed a significantly lower usage of the Guidelines than those who were not (84.9% vs. 92.6%, P = 0.02). Among midwives practicing delivery, the most common reason for not using the Guidelines was "using original educational material produced by oneself or the facility." Providing dietary advice to pregnant women constituted a large fraction of midwives' duties as well as delivery practice. About 90% of the midwives, who had knowledge of the Guidelines and provided dietary advice, were using the Guidelines. In order to increase the usage of individual items

Current thinking in qualitative research: evidence-based practice, moral philosophies, and political struggle.

PubMed

Papadimitriou, Christina; Magasi, Susan; Frank, Gelya

2012-01-01

In this introduction to the special issue on current thinking in qualitative research and occupational therapy and science, the authors focus on the importance of rigorous qualitative research to inform occupational therapy practice. The authors chosen for this special issue reflect a "second generation of qualitative researchers" who are critical, theoretically sophisticated, methodologically productive, and politically relevant to show that working with disabled clients is political work. Three themes emerged across the articles included in this special issue: (1) recognizing and addressing social justice issues; (2) learning from clients' experiences; and (3) critically reframing occupational therapy's role. These themes can inform occupational therapy practice, research, and education to reflect a more client-centered and politically engaging approach. Copyright 2012, SLACK Incorporated.

"We All Share a Common Vision and Passion": Early Years Professionals Reflect upon Their Leadership of Practice Role

ERIC Educational Resources Information Center

Hallet, Elaine

2013-01-01

Early Years Professionals are graduate leaders working with children below 5 years of age, their families and practitioners in early years settings in the private, voluntary and independent sectors and children's centres in England. Their leadership of practice role is central to raising the quality of early years provision and practice. In this…

Defensive Practice as ‘Fear-Based’ Practice: Social Work's Open Secret?

PubMed Central

Whittaker, Andrew; Havard, Tirion

2016-01-01

Defensive practice has received attention through the Munro review of child protection, which has identified that current organisational cultures increase the likelihood of defensive practice. Whilst the wider socio-political climate that gives rise to defensive practice has been explored within the literature, little attention has been paid to the everyday realities of defensive practice. This paper reports the findings of a study into final year social work students' attitudes towards defensive practice within social work. Three focus groups were completed with a total of ninety final-year students that collected qualitative and quantitative data using interactive software. This paper examines how participants perceived defensive practice, both in general and when faced with real-life vignettes. Participants distinguished between pro-active behaviour (sins of commission) and passive behaviour (sins of omission), generally regarding the latter as less serious because it was less tangible and easier to attribute to more positive motives. Whilst the literature identifies defensive practice as deliberate behaviour, the focus group discussions suggest that it is a subtler and less conscious process. Whilst there was there was a general consensus about the nature of defensive practice, there was considerable disagreement about specific vignettes and several competing explanations are explored. PMID:27559220

Revalidation and electronic cataract surgery audit: a Scottish survey on current practice and opinion.

PubMed

Megaw, R; Rane-Malcolm, T; Brannan, S; Smith, R; Sanders, R

2011-11-01

To determine current knowledge and opinion on revalidation, and methods of cataract surgery audit in Scotland and to outline the current and future possibilities for electronic cataract surgery audit. In 2010 we conducted a prospective, cross-sectional, Scottish-wide survey on revalidation knowledge and opinion, and cataract audit practice among all senior NHS ophthalmologists. Results were anonymised and recorded manually for analysis. In all, 61% of the ophthalmologists surveyed took part. Only 33% felt ready to take part in revalidation, whereas 76% felt they did not have adequate information about the process. Also, 71% did not feel revalidation would improve patient care, but 85% agreed that cataract surgery audit is essential for ophthalmic practice. In addition, 91% audit their cataract outcomes; 52% do so continuously. Further, 63% audit their subspecialist surgical results. Only 25% audit their cataract surgery practice electronically, and only 12% collect clinical data using a hospital PAS system. Funding and system incompatibility were the main reasons cited for the lack of electronic audit setup. Currently, eight separate hospital IT patient administration systems are used across 14 health boards in Scotland. Revalidation is set to commence in 2012. The Royal College of Ophthalmologists will use cataract outcome audit as a tool to ensure surgical competency for the process. Retrospective manual auditing of cataract outcome is time consuming, and can be avoided with an electronic system. Scottish ophthalmologists view revalidation with scepticism and appear to have inadequate knowledge of the process. However, they strongly agree with the concept of cataract surgery audit. The existing and future electronic applications that may support surgical audit are commercial electronic records, web-based applications, centrally funded software applications, and robust NHS connections between community and hospital.

Biodiversity in environmental assessment-current practice and tools for prediction

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

Gontier, Mikael; Balfors, Berit; Moertberg, Ulla

Habitat loss and fragmentation are major threats to biodiversity. Environmental impact assessment and strategic environmental assessment are essential instruments used in physical planning to address such problems. Yet there are no well-developed methods for quantifying and predicting impacts of fragmentation on biodiversity. In this study, a literature review was conducted on GIS-based ecological models that have potential as prediction tools for biodiversity assessment. Further, a review of environmental impact statements for road and railway projects from four European countries was performed, to study how impact prediction concerning biodiversity issues was addressed. The results of the study showed the existing gapmore » between research in GIS-based ecological modelling and current practice in biodiversity assessment within environmental assessment.« less

Current practice and access to prostate MR imaging in France.

PubMed

Renard-Penna, R; Rouvière, O; Puech, P; Borgogno, C; Abbas, L; Roy, C; Claudon, M; Correas, J-M; Cormier, L; Ploussard, G; Mejean, A; Tezenas-du-Montcel, S; Rozet, F

2016-11-01

To obtain an overview of the degree of discrepancy between current clinical practice of prostate magnetic resonance imaging (MRI) in France and recommendations. A brief survey was sent to 1229 members of the French society of urology in order to identify their indications of prostate MRI and its impact on patient management. The urologists were asked to answer several questions regarding age, practice modality, prostate MRI examinations (technique, indication before first biopsy, second biopsy, cancer staging, active surveillance, recurrence, focal therapy) and quality of reports. A total of 445 responses were received (participation rate of 36%). The mean delay for obtaining an appointment for prostate MRI ranged between 15-30 days in 54%. Fifty-four percent of MRI reports contained a PIRADS score and 23% a Likert score. The indications of multiparametric-MRI were tumor detection/location prior to repeat biopsy (90%), cancer staging (85%), management of patients under active surveillance (85%), selection of candidates to focal therapy (63%), tumor detection/location in biopsy naïve patients (53%), detection of local recurrence after radical (51%). Only 119 urologists (28.6%) had access to image fusion (MRI and transrectal ultrasound) and 351 (85.4%) used cognitive fusion. Mostly, targeted biopsies are done by urologists alone (nearly 80%), a very few are done by radiologists (8%) or by the two of them in collaboration (12%). The majority of urologists consider that prostate MRI is essential for the management of patients with prostate cancer. Practices are ahead of recommendations particularly before the first biopsy and in active surveillance. Copyright © 2016 Editions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Current best practice for the health surveillance of enzyme workers in the soap and detergent industry.

PubMed

Nicholson, P J; Newman Taylor, A J; Oliver, P; Cathcart, M

2001-03-01

This study defines current best practice for the health surveillance of workers who are potentially exposed to enzymes in the manufacture of enzymatic detergent products. It is recommended that health surveillance is performed 6-monthly for the first 2 years and annually thereafter. The health surveillance programme should include a respiratory questionnaire to detect symptoms, assessment of lung function to detect pre-symptomatic changes and an immunological test to detect specific immunoglobulin E (IgE) to enzymes. The International Union Against Tuberculosis and Lung Disease respiratory questionnaire should be used since it has been validated extensively for detecting asthma. Operators should observe the American Thoracic Society performance criteria for spirometers and standardized procedures for conducting spirometry. Since current airborne monitoring techniques for enzymes do not detect short-duration peak exposures, the incidence of employee sensitizations remains the most reliable measure of the integrity of environmental control. The Pepys skin prick test has been validated as a sensitive, specific and practical test for detecting specific IgE to many inhalant allergens including enzymes. For newly sensitized workers, a multi-cause investigation should be conducted to identify potential sources of exposure. Group results of immunological test results assist in the evaluation of workplace control measures, and should be used to monitor the effectiveness of hygiene and engineering programmes and to help prioritize areas for improvement. Positive responses to a questionnaire or abnormal spirometry should be assessed further. Occupational asthma should be excluded in any case of adult-onset asthma that starts or deteriorates during working life. This is particularly important because an accurate diagnosis of occupational asthma with early avoidance of exposure to its cause can result in remission of symptoms and restoration of lung function.

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…

Training Needs of Nurses in Public Hospitals in Australia: Review of Current Practices and Future Research Agenda

ERIC Educational Resources Information Center

Carlisle, Joanna; Bhanugopan, Ramudu; Fish, Alan

2011-01-01

Purpose: This paper seeks to provide an overview of the concept of training needs analysis (TNA), current practice, models and the impact that training needs analysis currently has on nurses in public hospitals in Australia. Thus, the paper should aid future research in the area of TNA of nurses through helping researchers to clarify the…

Survey of current practice in clinical transvaginal ultrasound scanning in the UK

PubMed Central

Shaw, Adam; Lees, Christoph

2015-01-01

During transvaginal ultrasound scanning, the fetus and other sensitive tissues are placed close to the transducer. Heating of these tissues occurs by direct conduction from the transducer and by absorption of ultrasound in the tissue. The extent of any heating will depend on the equipment and settings used, the duration of the scan, imaging modes and other aspects of scanning practice. To ensure that scans are performed with minimum risk, staff should have an appropriate knowledge of safety and follow guidelines issued by professional bodies. An online survey aiming to document current practice in transvaginal ultrasound in the UK was created and distributed to individuals performing this type of scanning. The survey posed questions about the respondents, the departments where scans were performed, the equipment used, knowledge of ultrasound safety, scanning practice and the frequency, duration and mode of transvaginal ultrasound scans for gynaecology, obstetrics and fertility applications. In all, 294 responses were obtained, mostly from sonographers (94%). From the analysis of the responses, it was clear that there was a good understanding of the general meaning of thermal and mechanical index and high awareness of guidelines issued by professional bodies. However, 40% of respondents stated that they rarely or never monitor Thermal or Mechanical indices during scanning. Scanning practice was consistent in terms of the duration of scans, scan protocols followed and use of imaging modes. The results highlight the importance of continued ultrasound safety training and promotion of safety guidelines to users. PMID:27433250

Review of Manganese Processing for Production of TRIP/TWIP Steels, Part 1: Current Practice and Processing Fundamentals

NASA Astrophysics Data System (ADS)

Elliott, R.; Coley, K.; Mostaghel, S.; Barati, M.

2018-02-01

The increasing demand for high-performance steel alloys has led to development of transformation-induced plasticity (TRIP) and twinning-induced plasticity (TWIP) alloys over the past three decades. These alloys offer exceptional combinations of high tensile strength and ductility. Thus, the mechanical behavior of these alloys has been a subject of significant work in recent years. However, the challenge of economically providing Mn in the quantity and purity required by these alloys has received considerably less attention. To enable commercial implementation of ultrahigh-Mn alloys, it is desirable to lower the high material costs associated with their production. Therefore, the present work reviews Mn processing routes in the context of the chemical requirements of these alloys. The aim of this review is to assess the current state of the art regarding reduction of manganese ores and provide a comprehensive reference for researchers working to mitigate material processing costs associated with Mn production. The review is presented in two parts: Part 1 introduces TRIP and TWIP alloys, current industrial practice, and pertinent thermodynamic fundamentals; Part 2 addresses available literature regarding reduction of Mn ores and oxides, and seeks to identify opportunities for future process development.

The relevance of the early history of probability theory to current risk assessment practices in mental health care.

PubMed

Large, Matthew

2013-12-01

Probability theory is at the base of modern concepts of risk assessment in mental health. The aim of the current paper is to review the key developments in the early history of probability theory in order to enrich our understanding of current risk assessment practices.

Current status of information literacy instruction practices in medical libraries of Pakistan

PubMed Central

Ullah, Midrar; Ameen, Kanwal

2014-01-01

Objectives: The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan. Methods: A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff. Results: The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used. Conclusion: IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction. Implications: Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum. PMID:25349546

Current status of information literacy instruction practices in medical libraries of Pakistan.

PubMed

Ullah, Midrar; Ameen, Kanwal

2014-10-01

The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan. A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff. The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used. IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction. Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum.

Understanding the (inter)disciplinary and institutional diversity of citizen science: A survey of current practice in Germany and Austria.

PubMed

Pettibone, Lisa; Vohland, Katrin; Ziegler, David

2017-01-01

Citizen science has become more popular in recent years, quickly taking on a variety of potentially conflicting characteristics: a way to collect massive data sets at relatively low cost, a way to break science out of the ivory tower and better engage the public, an approach to educate lay people in scientific methods. But the extent of current citizen science practice-the types of actors and scientific disciplines who take part-is still poorly understood. This article builds on recent surveys of citizen science in PLOS One by analyzing citizen science practice in Germany and Austria through the projects on two online platforms. We find evidence supporting previous findings that citizen science is a phenomenon strongest in biodiversity and environmental monitoring research, but at home in a number of scientific fields, such as history and geography. In addition, our survey method yields new insights into citizen science projects initiated by non-scientific actors. We close by discussing additional methodological considerations in attempting to present a cross-disciplinary overview of citizen science.

Deep-vein thrombosis prophylaxis in foot and ankle surgery: what is the current state of practice?

PubMed

Shah, Kalpesh; Thevendran, Gowreeson; Younger, Alastair; Pinney, Stephen J

2015-04-01

When contemplating thromboprophylaxis for patients undergoing elective foot and ankle surgery the potential for complications secondary to venous thromboembolism (VTE) must be balanced against the cost, risk, and effectiveness of prophylactic treatment. The incidence of pulmonary embolism (PE) following foot and ankle surgery is considerably lower than after hip or knee surgery. The purpose of this study was to assess current trends in practice regarding VTE prophylaxis among expert orthopaedic foot and ankle surgeons. An e-mail-based survey of active AOFAS (American Orthopaedic Foot and Ankle Society) committee members was conducted (n = 100). Surgeons were questioned as to their use, type, and duration of thromboprophylaxis following elective ankle fusion surgery. Scenarios included the following: (1) A 50-year-old woman with no risk factors; (2) a 50-year-old woman with a history of PE; and (3) a 35-year-old woman actively using birth control pills (BCPs). The response rate for the survey was 80% (80/100). Replies regarding the use of thromboprophylaxis were as follows: (1) in the absence of risk factors, 57% of respondents (45/80) answered, "No prophylaxis required"; (2) for the scenario in which the patient had experienced a previous PE, 97.5% of respondents (78/80) answered, "Yes" to prophylaxis use; (3) for the scenario in which the patient was on BCP, 61.3% of respondents (49/80) stated that they would give some type of thromboprophylaxis. The most commonly recommended methods of prophylaxis were aspirin, 49% (24/49), and low-molecular-weight heparin, 47% (23/49). The recommended length of time for thromboprophylaxis varied widely, from 1 day to more than 6 weeks. . There remains wide variation in the practice of deep-vein thrombosis thromboprophylaxis within the foot and ankle community. Because risks for foot and ankle patients differ from those in the well-studied areas of hip and knee, specific guidelines are needed for foot and ankle surgery. Level V

Globalization of Gerontology Education: Current Practices and Perceptions for Graduate Gerontology Education in the United States

PubMed Central

MWANGI, SAMUEL M.; YAMASHITA, TAKASHI; EWEN, HEIDI H.; MANNING, LYDIA K.; KUNKEL, SUZANNE R.

2013-01-01

The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education. PMID:22490075

Globalization of gerontology education: current practices and perceptions for graduate gerontology education in the United States.

PubMed

Mwangi, Samuel M; Yamashita, Takashi; Ewen, Heidi H; Manning, Lydia K; Kunkel, Suzanne R

2012-01-01

The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education.

Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones.

PubMed

Manzo, B O; Bertacchi, M; Lozada, E; Rasguido, A; Aleman, E; Cabrera, M; Rodríguez, A; Manzo, G; Sánchez, H; Blasco, J

2016-05-01

The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed >100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones >2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring >2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones <2cm; a small percentage of these urologists perform >100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Physicians' Current Practices and Opportunities for DNA Banking of Dying Patients With Cancer

PubMed Central

Quillin, John M.; Bodurtha, Joann N.; Siminoff, Laura A.; Smith, Thomas J.

2011-01-01

Purpose: The availability of genetic tests for cancer susceptibility is increasing. Current tests, however, have limited clinical sensitivity. Even when clinically valid tests are available, the genetic counseling and informed consent process might not be feasible for dying patients with cancer. DNA banking preserves the opportunity for future research or clinical testing and may provide critical opportunities for surviving relatives. This study explored the current practices and potential for DNA banking for cancer susceptibility among oncologists specializing in palliative care. Methods: Palliative care oncologists actively providing clinical care for dying patients with cancer were recruited for an online survey. Descriptive statistics for DNA banking practices, perceived qualification to recommend banking, and potential predictors were assessed. Results: Data were collected from 49 physicians (37% recruitment rate). Eighty percent reported assessing at least some patients for genetic cancer susceptibility in the past 12 months. No participants reported banking DNA for patients in the past 12 months. Only 5% reported feeling at least somewhat qualified to order DNA banking. A Web-based risk assessment tool and genetic counselor on staff were perceived as the most helpful potential resources. Conclusion: Despite its potential, DNA banking is not being used by palliative care oncologists. PMID:21886501

Socio-Spatial Practices in a Finnish Daycare Group for One- to Three-Year-Olds

ERIC Educational Resources Information Center

Rutanen, Niina

2012-01-01

This qualitative case study approaches early childhood education and care practices from a socio-spatial point of view. One Finnish daycare group for one- to three-year-olds participated in the study. The ethnographic observations from the practices are analyzed together with the ECE practitioners' audio-recorded team meetings and video-elicited…

Hands as Companions of the Mind: Essential Practical Life for the 5-Year-Old

ERIC Educational Resources Information Center

Gilder, Sharon Allen

2012-01-01

Numerous observations in Montessori classrooms led veteran Montessorians Pamela W. Trumble and Eleni Bokas to the conclusion that a universal need exists to bring integrity back to Practical Life, especially for 5-year-olds. Maria Montessori's observations over a century ago revealed the importance of Practical Life and its relationship to the…

[Current practices of oocyte donation in France and Europe].

PubMed

Letur, H

2007-12-01

This review aims to evaluate, in France, oocyte donation, an assisted reproductive technique (ART), for which 25 years of experience have shown its efficacy for the palliative treatment of infertility caused by ovarian exocrine failure. Its indications have since been expanded to cover certain genetic diseases and document failures of other ART attempts. Oocyte donation is performed within the framework of French legislation - bioethics laws 94-653 and 94-654 of 29 July 1994, and the revised bioethics law 2004-800 of 6 August 2004. Its main fundamental principles are: voluntary, free, anonymous donation, for which regulated confidentiality is assured and now - judicial decree 2004-606 of 24 June 2004 - and the synchronization of donor-recipient cycles with fresh embryo transfer in accordance with established safety procedures. According to the 2004 results of the French Group for the Study of Oocyte Donation (GEDO) for French centers actively involved in ART, the chance of pregnancy was increased to 43.4% for synchronized cycles with fresh embryo transfers versus 18.7% for deferred cycles with frozen-thawed embryos (P<0.01). In addition, follow-up studies reported the excellent family relationships and physical and psychological development of these children. The major difficulties encountered in the daily practice of oocyte donation concern the recruitment and management of donors, but also, and above all, the lack of optimal means to exercise this medical specialty, due to the lack of recognition of the organizational duties incurred, which are the cornerstone of the character-specific functioning of this type of ART. In comparison, we foresee that the discrepancies of this ART practice in Europe, with it differential facets, will lead to medical nomadism for those couples financially able to do so, when national conditions of access fail because of prohibitions but also as a consequence of insufficient means to perform the inherent tasks. Today, it seems

Ten years since the discovery of iPS cells: The current state of their clinical application.

PubMed

Aznar, J; Tudela, J

On the 10-year anniversary of the discovery of induced pluripotent stem cells, we review the main results from their various fields of application, the obstacles encountered during experimentation and the potential applications in clinical practice. The efficacy of induced pluripotent cells in clinical experimentation can be equated to that of human embryonic stem cells; however, unlike stem cells, induced pluripotent cells do not involve the severe ethical difficulties entailed by the need to destroy human embryos to obtain them. The finding of these cells, which was in its day a true scientific milestone worthy of a Nobel Prize in Medicine, is currently enveloped by light and shadow: high hopes for regenerative medicine versus the, as of yet, poorly controlled risks of unpredictable reactions, both in the processes of dedifferentiation and subsequent differentiation to the cell strains employed for therapeutic or experimentation goals. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Current practices and experience of transition of young people on long term home parenteral nutrition (PN) to adult services - A perspective from specialist centres.

PubMed

Kyrana, E; Beath, S V; Gabe, S; Small, M; Hill, S

2016-08-01

There has been an estimated fivefold increase in the number of children receiving parenteral nutrition (PN) at home in the past 10 years with some children approaching the age when they should be referred to adult services whilst still on treatment. Models of care for moving young people onto adult providers of PN at home are not yet well developed, and transition is a potentially dangerous time for young people with complex health needs. A questionnaire to ascertain current experience and practices of transition in the context of home PN services was dispatched to 170 consultant gastroenterologists who were members of the British Association of Parenteral and Enteral Nutrition (BAPEN) and also to all 40 members of the Nutrition and IF working group of the British Society of Paediatric Gastroenterology and Nutrition (BSPGHAN). Anonymised returns were received from 12 adult and 18 paediatric centres. We estimate about 50% paediatric IF centres, and the three largest adult IF centres responded to the survey. We identified 14 young adults already transitioned and 43 currently in transition. The practices and processes of transition reported were highly variable. Time taken to achieve transition ranged from under 6 months up to 2 years. The most frequent concerns to be identified were confusion around care routines and psychological problems at the time of transition (in one third of respondents). We conclude that a transition pathway and service standards for adolescents on home PN should be developed, consideration should be given to checklists for practical aspects (e.g. pumps), key worker and psychology input to enhance emotional resilience of the young people and carers. Copyright © 2016. Published by Elsevier Ltd.

Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

PubMed

Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

2018-06-01

The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

NanoSIMS for biological applications: Current practices and analyses

DOE PAGES

Nunez, Jamie R.; Renslow, Ryan S.; Cliff, III, John B.; ...

2017-09-27

Secondary ion mass spectrometry (SIMS) has become an increasingly utilized tool in biologically-relevant studies. Of these, high lateral resolution methodologies using the NanoSIMS 50/50L have been especially powerful within many biological fields over the past decade. Here, we provide a review of this technology, sample preparation and analysis considerations, examples of recent biological studies, data analysis, and current outlooks. Specifically, we offer an overview of SIMS and development of the NanoSIMS. We describe the major experimental factors that should be considered prior to NanoSIMS analysis and then provide information on best practices for data analysis and image generation, which includesmore » an in-depth discussion of appropriate colormaps. Additionally, we provide an open-source method for data representation that allows simultaneous visualization of secondary electron and ion information within a single image. Lastly, we present a perspective on the future of this technology and where we think it will have the greatest impact in near future.« less

NanoSIMS for biological applications: Current practices and analyses

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

Nunez, Jamie R.; Renslow, Ryan S.; Cliff, III, John B.

Secondary ion mass spectrometry (SIMS) has become an increasingly utilized tool in biologically-relevant studies. Of these, high lateral resolution methodologies using the NanoSIMS 50/50L have been especially powerful within many biological fields over the past decade. Here, we provide a review of this technology, sample preparation and analysis considerations, examples of recent biological studies, data analysis, and current outlooks. Specifically, we offer an overview of SIMS and development of the NanoSIMS. We describe the major experimental factors that should be considered prior to NanoSIMS analysis and then provide information on best practices for data analysis and image generation, which includesmore » an in-depth discussion of appropriate colormaps. Additionally, we provide an open-source method for data representation that allows simultaneous visualization of secondary electron and ion information within a single image. Lastly, we present a perspective on the future of this technology and where we think it will have the greatest impact in near future.« less

Still Subversive after All These Years: The Relevance of Feminist Therapy in the Age of Evidence-Based Practice

ERIC Educational Resources Information Center

Brown, Laura S.

2006-01-01

In this article, based on my Carolyn Wood Sherif Memorial Award Address, I address questions of the viability of feminist practice in the current zeitgeist. Using the framework of responding to questions raised by doctoral students about feminist therapy, I address how feminist practice aligns with the evidence-based practice movement,…

Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

PubMed

Guttmann-Bauman, I; Thornton, P; Adhikari, S; Reifschneider, K; Wood, M A; Hamby, T; Rubin, K

2018-03-26

The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

PubMed

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Understanding the Current 30-Year Shipbuilding Plan Through Three Models

DTIC Science & Technology

2014-12-01

to what the Navy can ultimately build in ten years and beyond due to the fact that this plan is revised annually. In a political game this...the game and each one hoping for a different outcome. Though not currently possible with the FY2015 Long Range Plan it is possible to analyze the...to make a choice while the bounded rationality theory acknowledges the limits of human capabilities, knowledge, and capacity. Therefore, bounded

Current beliefs and practice patterns among urologists regarding prostate magnetic resonance imaging and magnetic resonance-targeted biopsy.

PubMed

Muthigi, Akhil; Sidana, Abhinav; George, Arvin K; Kongnyuy, Michael; Maruf, Mahir; Valayil, Subin; Wood, Bradford J; Pinto, Peter A

2017-01-01

Multiparametric magnetic resonance imaging (MRI) and magnetic resonance (MR) -targeted biopsy have a growing role in the screening and evaluation of prostate cancer. We aim to evaluate the current knowledge, attitude, and practice patterns of urologists regarding this new technique. An anonymous online questionnaire was designed to collect information on urologists' beliefs and use of prostate multiparametric MRI and MR-targeted biopsy. The survey was sent to members of the Society of Urologic Oncology, the Endourological Society, and European Association of Urology. Multivariate logistic regression analysis was performed to determine predictors for use of prostate MRI and MR-targeted biopsy. A total of 302 responses were received (Endourological Society: 175, European Association of Urology: 23, and Society of Urologic Oncology: 104). Most respondents (83.6%) believe MR-targeted biopsy to be moderately to extremely beneficial in the evaluation of prostate cancer. Overall, 85.7% of responders use prostate MRI in their practice, and 63.0% use MR-targeted biopsy. The 2 most common settings for use of MR-targeted biopsy include patients with history of prior negative biopsy result (96.3%) and monitoring patients on active surveillance (72.5%). In those who do not use MR-targeted biopsy, the principal reasons were lack of necessary infrastructure (64.1%) and prohibitive costs (48.1%). On multivariate logistic regression analysis, practice in an academic setting (1.86 [1.02-3.40], P = 0.043) and performing greater than 25 radical prostatectomies per year (2.32 [1.18-4.56], P = 0.015) remained independent predictors for using MR-targeted biopsy. Most respondents of our survey look favorably on use of prostate MRI and MR-targeted biopsy in clinical practice. Over time, reduction in fixed costs and easier access to equipment may lead to further dissemination of this novel and potentially transformative technology. Published by Elsevier Inc.

Who will be the Radiologists of Tomorrow? A survey of radiology during the "Practical Year" in Germany.

PubMed

Dettmer, Sabine; Fischer, Volkhard; Paeßens, Carolin; Meyer, Simone; Wacker, Frank K; Rodt, Thomas

2017-10-01

Purpose  Aim of our study was to evaluate the motivation of medical students in their final year of medical school to choose radiology for further specialization by means of a Germany-wide survey. Materials and Methods  The survey was performed during the 2015/16 semester among German medical students in their four months radiology elective during the final year. Invitations for the study were distributed by the Student Secretariats of each university. The survey was web-based with EvaSys 7.0 software. Questions on radiology contents during medical studies and "practical year" were part of the survey. Plans for residency and possible advantages and disadvantages of radiology as medical specialty were inquired. Descriptive statistics and group comparisons were used as analysis methods. Results  89 students participated in the survey at the beginning and 60 students at the end of the practical year. Of these 39 students could be identified who answered both questionnaires. Most students were satisfied with their final year radiology elective (mean 1.8 on a range from 1 to 5). Nevertheless, they criticized mentoring during routine work (mean 2.1) and a lack of educational courses (mean 2.1). Most students (83 %) were uncertain about their residency choice at the beginning of their "practical year" and about one fifth changed their plans. From the students' point of view main advantages of radiology included contact with many other clinical disciplines (87 %) and the working conditions (68 %). The reduced patient contact (42 %), the large amount of work at a computer (43 %), and the dependency on referring physicians (42 %) were regarded as the main disadvantages. The students regarded the way radiology is taught during the studies as not practical enough. With regard to radiology the majority of students (63 %) felt poorly prepared for their future work. Conclusion  The "practical year" is important regarding the choice of future specialization

The Profile of Patients and Current Practice of Treatment of Upper Limb Muscle Spasticity with Botulinum Toxin Type A: An International Survey

ERIC Educational Resources Information Center

Bakheit, Abdel Magid

2010-01-01

To document the current practice in relation with the treatment of patients with upper limb spasticity with botulinum toxin type A to inform future research in this area. We designed an international, cross-sectional, noninterventional survey of current practice. Nine hundred and seventy-four patients from 122 investigational centres in 31…

Collection development and outsourcing in academic health sciences libraries: a survey of current practices.

PubMed Central

Blecic, D D; Hollander, S; Lanier, D

1999-01-01

Academic health sciences libraries in the United States and Canada were surveyed regarding collection development trends, including their effect on approval plan and blanket order use, and use of outsourcing over the past four years. Results of the survey indicate that serials market forces, budgetary constraints, and growth in electronic resources purchasing have resulted in a decline in the acquisition of print items. As a result, approval plan use is being curtailed in many academic health sciences libraries. Although use of blanket orders is more stable, fewer than one-third of academic health sciences libraries report using them currently. The decline of print collections suggests that libraries should explore cooperative collection development of print materials to ensure access and preservation. The decline of approval plan use and the need for cooperative collection development may require additional effort for sound collection development. Libraries were also surveyed about their use of outsourcing. Some libraries reported outsourcing cataloging and shelf preparation of books, but none reported using outsourcing for resource selection. The reason given most often for outsourcing was that it resulted in cost savings. As expected, economic factors are driving both collection development and outsourcing practices. PMID:10219477

Managing Appalachian hardwood stands using four management practices: 60-year results

Treesearch

Thomas M. Schuler; Melissa Thomas-Van Gundy; John P. Brown; Jan Wiedenbeck

2017-01-01

A long-term forest management case study on the Fernow Experimental Forest in West Virginia referred to as the Cutting Practice Level study is evaluated after 60 years. Treatments include a commercial clearcut (one time application), a 39 cm diameter-limit (applied 4 times), uneven-aged management using two variations of single-tree selection (applied 7 and 8 times,...

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990-2020.

PubMed

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-03

To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. In 2000-2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50-70% in 2000-2008 compared with 1990-1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38-113) future cancers. Current practices would lead to about 300 (90% UI: 230-680) future cancers induced by scans performed in 2016-2020. Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers.

Teachers' Nature of Science Implementation Practices 2-5 Years after Having Completed an Intensive Science Education Program

ERIC Educational Resources Information Center

Herman, Benjamin C.; Clough, Michael P.; Olson, Joanne K.

2013-01-01

Few, if any, studies have examined the impact of nature of science (NOS) instruction on science teachers' practices 2 or more years after completing a science teacher education program. Extant studies on preservice and first-year teachers' NOS teaching practices have had disappointing results, with few teachers valuing NOS as a cognitive objective…

Voice rest after vocal fold surgery: current practice and evidence.

PubMed

Coombs, A C; Carswell, A J; Tierney, P A

2013-08-01

Voice rest is commonly recommended after vocal fold surgery, but there is a lack of evidence base and no standard protocol. The aim of this study was to establish common practice regarding voice rest following vocal fold surgery. An online survey was circulated via e-mail invitation to members of the ENT UK Expert Panel between October and November 2011. The survey revealed that 86.5 per cent of respondents agreed that 'complete voice rest' means no sound production at all, but there was variability in how 'relative voice rest' was defined. There was no dominant type of voice rest routinely recommended after surgery for laryngeal papillomatosis or intermediate pathologies. There was considerable variability in the duration of voice rest recommended, with no statistically significant, most popular response (except for malignant lesions). Surgeons with less than 10 years of experience were more likely to recommend fewer days of voice rest. There is a lack of consistency in advice given to patients after vocal fold surgery, in terms of both type and length of voice rest. This may arise from an absence of robust evidence on which to base practice.

Using vital signs to assess children with acute infections: a survey of current practice.

PubMed

Thompson, Matthew; Mayon-White, Richard; Harnden, Anthony; Perera, Rafael; McLeod, Diane; Mant, David

2008-04-01

GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known. To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections. Questionnaire survey. All 210 GP principals working within a 10 mile radius of Oxford, UK. Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness. One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness. Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently.

Current developments in bovine mastitis treatment and control.

PubMed

Wager, L A; Linquist, W E; Hayes, G L; Britten, A M; Whitehead, R G; Webster, D E; Barnes, F D

1978-01-01

Mastitis in its complexity has managed to forestall all efforts of eradication in spite of years of research, antibiotics and practical control measures. This minisymposium will touch on seven topics current to treatment and control of this economically important disease.

The Semiotic Landscape and 3-Year-Olds' Emerging Understanding of Multimodal Communication Practices

ERIC Educational Resources Information Center

Yamada-Rice, Dylan

2014-01-01

This article considers the impact of the increasing use of the visual mode in texts found in urban landscapes on two 3-year-olds' understanding of communication practices. The data discussed are taken from a study into a group of 3- to 6-year-olds' interaction with and emerging comprehension of the visual mode and its connection to writing in…

Shifting currents: Progress, setbacks, and shifts in policy and practice

USGS Publications Warehouse

,; Dunning, Charles; Robertson, Dale M.

2016-01-01

The Wisconsin Academy’s initial Waters of Wisconsin project (WOW I) facilitated a statewide conversation between 2000 and 2003 around one main question: How can we ensure healthy aquatic ecosystems and clean, abundant water supplies for tomorrow’s Wisconsin? Robust participation in this conversation underscored the important role citizens have in the stewardship of our waters, and we found enthusiastic support for farsighted policies—based on sound science—to manage our water legacy. Overall, we found that Wisconsinites cherish water and see our waters as essential to our way of life in Wisconsin. Nationally, our state ranks 25th in land area but has the fourth-highest area covered by water. Wisconsin is 20th in population but is second only to Florida in the number of fishing licenses sold each year. Clean water supports billions of dollars’ worth of economic activity through tourism, agriculture, and industry. From the Northwoods cabin to the Port of Milwaukee to the Wisconsin Dells, water shapes our state’s identity. Our tradition of safeguarding Wisconsin’s waters is grounded in values such as responsibility to family and future generations, respect for land and wildlife, protecting public health and safety, and caring for water as a common good, as articulated in the state’s Public Trust Doctrine (see page 9). These deeply held values have also shaped a conservation ethic, and its legacy has served many generations who depend upon and enjoy the waters of the state. Through WOW I, we identified the need to overcome the institutional and disciplinary separation of science, policy, and management protocols through a more integrated approach to water management. WOW also affirmed that the Wisconsin Department of Natural Resources (DNR) and other public agencies play a critical role in sound scientific application, citizen participation, and the practical implementation of policy while balancing public and private interests toward the goal of a

Identifying g: A Review of Current Factor Analytic Practices in the Science of Mental Abilities

ERIC Educational Resources Information Center

Reeve, Charlie L.; Blacksmith, Nikki

2009-01-01

Factor analysis is arguably one of the most important tools in the science of mental abilities. While many studies have been conducted to make recommendations regarding "best practices" concerning its use, it is unknown the degree to which contemporary ability researchers abide by those standards. The current study sought to evaluate the typical…

Discounting in cost-utility analysis of healthcare interventions: reassessing current practice.

PubMed

Cohen, Brian J

2003-01-01

Cost-utility analysis (CUA) is a technique that can potentially be used as a guide to allocating healthcare resources so as to obtain the maximum health benefits possible under a given budget constraint. However, it is not clear that current practice captures societal preferences regarding health benefits. In analyses of healthcare interventions providing survival benefits, the market rate of interest is the sole empirical variable that reflects societal preferences. This approach is based on the assumptions that: (i) healthcare interventions should be ranked using cost-effectiveness (CE) ratios; (ii) the discount rate for costs in CUA should be equal to that used in cost-benefit analysis (CBA); (iii) the discount rate in CBA should be the market rate of interest on long-term government bonds; and (iv) the Keeler-Cretin paradox is applicable to CUA of healthcare interventions, so that the discount rate for benefits in CUA should be set equal to the discount rate for costs. This approach ignores a fundamental difference between CBA and CUA, namely that CUA assumes that a budget constraint has been specified prior to the analysis. It starts with the assumption that a given amount of funds have been withdrawn from the economy to fund healthcare, so there is no opportunity cost to consider. For that reason, the principles on which the choice of discount rate rests differ in the two techniques. Furthermore, use of CE ratios to rank interventions assumes that the budget constraint can be expressed as a single constraint. But healthcare budgets are multiyear budgets that are roughly constant from year to year. A more realistic model would involve multiple constraints and would require linear programming for solution. This can be reduced to a series of single constraints, thereby allowing use of the simpler CE ratio approach, if we assume that the budget being allocated is intended for one cohort at a time, i.e. all people for whom a new funding decision must be made in a

Priority setting for health technology assessments: a systematic review of current practical approaches.

PubMed

Noorani, Hussein Z; Husereau, Donald R; Boudreau, Rhonda; Skidmore, Becky

2007-01-01

This study sought to identify and compare various practical and current approaches of health technology assessment (HTA) priority setting. A literature search was performed across PubMed, MEDLINE, EMBASE, BIOSIS, and Cochrane. Given an earlier review conducted by European agencies (EUR-ASSESS project), the search was limited to literature indexed from 1996 onward. We also searched Web sites of HTA agencies as well as HTAi and ISTAHC conference abstracts. Agency representatives were contacted for information about their priority-setting processes. Reports on practical approaches selected through these sources were identified independently by two reviewers. A total of twelve current priority-setting frameworks from eleven agencies were identified. Ten countries were represented: Canada, Denmark, England, Hungary, Israel, Scotland, Spain, Sweden, The Netherlands, and United States. Fifty-nine unique HTA priority-setting criteria were divided into eleven categories (alternatives; budget impact; clinical impact; controversial nature of proposed technology; disease burden; economic impact; ethical, legal, or psychosocial implications; evidence; interest; timeliness of review; variation in rates of use). Differences across HTA agencies were found regarding procedures for categorizing, scoring, and weighing of policy criteria. Variability exists in the methods for priority setting of health technology assessment across HTA agencies. Quantitative rating methods and consideration of cost benefit for priority setting were seldom used. These study results will assist HTA agencies that are re-visiting or developing their prioritization methods.

Fish quarantine: current practices in public zoos and aquaria.

PubMed

Hadfield, Catherine A; Clayton, Leigh A

2011-12-01

The primary goal of quarantine is to reduce the risk of introducing infectious diseases into established collections. Fish quarantine is inherently complex because of the variety of species, environmental requirements, and facilities. To examine current practices, questionnaires were submitted to 60 public zoos and aquaria, predominantly in North America. Questions reviewed system type (closed, flow-through), quarantine length, diagnostics, treatments, and cleaning and disinfection. Forty-two of the 60 institutions responded. Most institutions had separate quarantine protocols for freshwater teleosts, marine teleosts, and elasmobranchs. Ninety-five percent of institutions had a minimum quarantine period of 30 days or more. Sixty-four percent of institutions used isolated areas for some or all of their fish quarantine. Twenty-five percent had designated fish quarantine staff. All institutions used regular visual examinations to assess animal health. Fifty-four percent of the institutions carried out routine hands-on diagnostics on some fish; this was more common for elasmobranchs than teleosts. All institutions carried out necropsies on mortalities. Fifteen percent of institutions performed histopathology on almost all fresh mortalities; 54% percent performed histopathology on less than 10% of mortalities. Prophylactic treatments were common in closed systems, in particular, formalin immersion for teleosts, freshwater dips and copper sulfate immersion for marine teleosts, and praziquantel immersion for marine teleosts and elasmobranchs. Institutions using dips generally did so at the start or end of quarantine. Fenbendazole- and praziquantel-medicated foods were used commonly in teleosts, but dosages varied greatly. Cleaning and disinfection of systems and equipment increased in response to known pathogens. These results can be used to compare and discuss fish quarantine practices at display facilities in order to improve quarantine success.

Current Warm-Up Practices and Contemporary Issues Faced by Elite Swimming Coaches.

PubMed

McGowan, Courtney J; Pyne, David B; Raglin, John S; Thompson, Kevin G; Rattray, Ben

2016-12-01

McGowan, CJ, Pyne, DB, Raglin, JS, Thompson, KG, and Rattray, B. Current warm-up practices and contemporary issues faced by elite swimming coaches. J Strength Cond Res 30(12): 3471-3480, 2016-A better understanding of current swimming warm-up strategies is needed to improve their effectiveness. The purpose of this study was to describe current precompetition warm-up practices and identify contemporary issues faced by elite swimming coaches during competition. Forty-six state-international level swimming coaches provided information through a questionnaire on their prescription of volume, intensity, and recovery within their pool and dryland-based competition warm-ups, and challenges faced during the final stages of event preparation. Coaches identified four key objectives of the precompetition warm-up: physiological (elevate body temperature and increase muscle activation), kinesthetic (tactile preparation, increase "feel" of the water), tactical (race-pace rehearsal), and mental (improve focus, reduce anxiety). Pool warm-up volume ranged from ∼1300 to 2100 m, beginning with 400-1000 m of continuous, low-intensity (∼50-70% of perceived maximal exertion) swimming, followed by 200-600 m of stroke drills and 1-2 sets (100-400 m in length) of increasing intensity (∼60-90%) swimming, concluding with 3-4 race or near race-pace efforts (25-100 m; ∼90-100%) and 100-400 m easy swimming. Dryland-based warm-up exercises, involving stretch cords and skipping, were also commonly prescribed. Coaches preferred swimmers complete their warm-up 20-30 minutes before race start. Lengthy marshalling periods (15-20+ minutes) and the time required to don racing suits (>10 minutes) were identified as complicating issues. Coaches believed that the pool warm-up affords athletes the opportunity to gain a tactile feel for the water and surrounding pool environment. The combination of dryland-based activation exercises followed by pool-based warm-up routines seems to be the preferred

FY 1987 current fiscal year work plan

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

Not Available

This Current Year Work Plan presents a detailed description of the activities to be performed by the Joint Integration Office during FY87. It breaks down the activities into two major work areas: Program Management and Program Analysis. Program Management is performed by the JIO by providing technical planning and guidance for the development of advanced TRU waste management capabilities. This includes equipment/facility design, engineering, construction, and operations. These functions are integrated to allow transition from interim storage to final disposition. JIO tasks include program requirements identification, long-range technical planning, budget development, program planning document preparation, task guidance, task monitoring, informationmore » gathering and task reporting to DOE, interfacing with other agencies and DOE lead programs, integrating public involvement with program efforts, and preparation of program status reports for DOE. Program Analysis is performed by the JIO to support identification and assessment of alternatives, and development of long-term TRU waste program capabilities. This work plan includes: system analyses, requirements analyses, interim and procedure development, legislative and regulatory analyses, dispatch and traffic analyses, and data bases.« less

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

PubMed Central

Ariel, Amnon; Altraja, Alan; Belevskiy, Andrey; Boros, Piotr W; Danila, Edvardas; Fležar, Matjaz; Koblizek, Vladimir; Fridlender, Zvi G; Kostov, Kosta; Krams, Alvils; Milenkovic, Branislava; Somfay, Attila; Tkacova, Ruzena; Tudoric, Neven; Ulmeanu, Ruxandra; Valipour, Arschang

2018-01-01

COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups. PMID:29317810

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

One-on-one tutorials in private practices and clinics: four years of experience in Basel, Switzerland.

PubMed

Tschudi, Peter; Bally, Klaus; Isler, Ruedi

2003-09-01

The one-on-one tutorial is a new form of learning that is practice oriented. It is based on a teacher-student relationship continuing over two years. Since 1997, third- and fourth-year students have worked for one half day per week under the supervision of their tutor, be it in a private practice or in a hospital. This programme facilitates direct patient contact at an early stage of medical school. In addition, it allows students to apply their knowledge in everyday life. The interactive form of learning is of paramount importance in this module. The ARIVA learning model was developed specially for third-year students and the logbook for fourth-year students. After each tutorial third-year students completed the ARI VA worksheet and fourth-year students completed the logbook. They were handed in together with the structured learning report. Between 85 and 109 students per year participated in these tutorials, totalling 733 students. Each student was taught an average of 3.1 patients in the presence of the tutor. In addition students examined an average of 2.4 patients independently and fulfilled an average of 1.2 practical tasks. For the fourth-year students the number of contacts with patients and the spectrum of diseases examined are impressive. All learning goals were fulfilled The one-on-one tutorial is a practice-oriented, interactive learning method. It uses a variety of didactic methods based on the principals of problem-oriented learning. In a relatively early stage of their medical education one-on-one tutorials give students the opportunity to learn independently how to interview and examine patients. They also give students the possibility to acquaint themselves with a multitude of diseases with the aid of instructions and demonstrations. They are conducive to work with patients above all because students learn how to perform certain techniques.

Investigation of the current requirements engineering practices among software developers at the Universiti Utara Malaysia Information Technology (UUMIT) centre

NASA Astrophysics Data System (ADS)

Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Abdullah, Inam

2016-08-01

Requirements Engineering (RE) is a systemic and integrated process of eliciting, elaborating, negotiating, validating and managing of the requirements of a system in a software development project. UUM has been supported by various systems developed and maintained by the UUM Information Technology (UUMIT) Centre. The aim of this study was to assess the current requirements engineering practices at UUMIT. The main problem that prompted this research is the lack of studies that support software development activities at the UUMIT. The study is geared at helping UUMIT produce quality but time and cost saving software products by implementing cutting edge and state of the art requirements engineering practices. Also, the study contributes to UUM by identifying the activities needed for software development so that the management will be able to allocate budget to provide adequate and precise training for the software developers. Three variables were investigated: Requirement Description, Requirements Development (comprising: Requirements Elicitation, Requirements Analysis and Negotiation, Requirements Validation), and Requirement Management. The results from the study showed that the current practice of requirement engineering in UUMIT is encouraging, but still need further development and improvement because a few RE practices were seldom practiced.

Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data.

PubMed

Choi, A Ryeon; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Oh, Min-Seok; Lee, Eun-Jung; Kim, Sungchul; Kim, Mia; Ha, In-Hyuk

2017-11-01

Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.

Deterrence and the United States Coast Guard: Enhancing Current Practice with Performance Measures

DTIC Science & Technology

2012-03-01

Talley,  Jin , Kite Powell,  The US Coast Guard Vessel Inspection Programme (2005)  Deterrence and the United States Coast Guard: Enhancing Current...practical problem-solving, not from theory or strategy. As a result, the activities are fractured and may not even be recognized as related to...of Sun Tzu’s admonition: “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” The US

Structured assessment of current mental state in clinical practice: an international study of the reliability and validity of the Current Psychiatric State interview, CPS-50.

PubMed

Falloon, I R H; Mizuno, M; Murakami, M; Roncone, R; Unoka, Z; Harangozo, J; Pullman, J; Gedye, R; Held, T; Hager, B; Erickson, D; Burnett, K

2005-01-01

To develop a reliable standardized assessment of psychiatric symptoms for use in clinical practice. A 50-item interview, the Current Psychiatric State 50 (CPS-50), was used to assess 237 patients with a range of psychiatric diagnoses. Ratings were made by interviewers after a 2-day training. Comparisons of inter-rater reliability on each item and on eight clinical subscales were made across four international centres and between psychiatrists and non-psychiatrists. A principal components analysis was used to validate these clinical scales. Acceptable inter-rater reliability (intra-class coefficient > 0.80) was found for 46 of the 50 items, and for all eight subscales. There was no difference between centres or between psychiatrists and non-psychiatrists. The principal components analysis factors were similar to the clinical scales. The CPS-50 is a reliable standardized assessment of current mental status that can be used in clinical practice by all mental health professionals after brief training. Blackwell Munksgaard 2004

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

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.

Enhancing Teachers' Technological Knowledge and Assessment Practices to Enhance Student Learning in Technology: A Two-year Classroom Study

NASA Astrophysics Data System (ADS)

Moreland, Judy; Jones, Alister; Northover, Ann

2001-02-01

This paper reports on a two-year classroom investigation of primary school (Years 1-8) technology education. The first year of the project explored emerging classroom practices in technology. In the second year intervention strategies were developed to enhance teaching, learning and assessment practices. Findings from the first year revealed that assessment was often seen in terms of social and managerial aspects, such as teamwork, turn taking and co-operative skills, rather than procedural and conceptual technological aspects. Existing formative interactions with students distorted the learning away from the procedural and conceptual aspects of the subject. The second year explored the development of teachers' technological knowledge in order to enhance formative assessment practices in technology, to inform classroom practice in technology, and to enhance student learning. Intervention strategies were designed to enhance the development of procedural, conceptual, societal and technical aspects of technology for teachers and students. The results from this intervention were very positive. This paper highlights the importance of developing teacher expertise pertaining to broad concepts of technology, detailed concepts in different technological areas and general pedagogical knowledge. The findings from this research therefore have implications for thinking about teaching, learning and assessment in technology.

First year physics practicals in distance education in South Africa

NASA Astrophysics Data System (ADS)

Cilliers, Johanna Albertha

Although the merits of practical work in physics is often questioned, it remains part of physics curricula word- wide. In distance education the incorporation of practical work into the curriculum is considerably complicated by the unique logistics of the setting and the high cost involved. The research reported in this thesis emanated from the need to improve the practical work module for first year physics at the University of South Africa, one of the largest distance education universities in the world. Specifically, the home-based component which, up to the commencement of the research had been entirely text-based, needed to be addressed. To this end it was necessary to identify a valid and attainable set of objectives and to determine the characteristics, abilities and needs of the students in the target group. A survey polling the viewpoints of South African physics lecturers and students about the objectives of practical work was conducted and an extensive student profile comprising a biographic, cognitive and affective component was compiled. Biographically, the target group is unique in the sense that it consists mainly of adult learners, a large percentage of whom study in a second language. The cognitive component of the profile covered aptitude, proficiency in English, mathematics and the integrated science process skills and level of cognitive development, all of which were investigated for possible influence on performance in practical work. On an affective level, students displayed a very positive attitude towards practical work, seated mainly in their need for concrete exploration of the theory. A practical work module structured around an experiential learning cycle adapted to the distance education environment was subsequently designed. The study material developed for the module comprised an interactive study guide on data processing and experimental procedure, a home experiment kit with accompanying workbook and a laboratory manual. From the

Current Continuing Professional Education Practice among Malaysian Nurses

PubMed Central

Chong, Mei Chan; Francis, Karen; Cooper, Simon; Abdullah, Khatijah Lim

2014-01-01

Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562) of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6%) and tertiary education was the most unpopular activity (10, 1.3%). The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE) is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses' (RNs) needs and not simply organizational requirements. PMID:24523961

Eight years of quality control in Bulgaria: impact on mammography practice.

PubMed

Avramova-Cholakova, S; Lilkov, G; Kaneva, M; Terziev, K; Nakov, I; Mutkurov, N; Kovacheva, D; Ivanova, M; Vasilev, D

2015-07-01

The requirements for quality control (QC) in diagnostic radiology were introduced in Bulgarian legislation in 2005. Hospital medical physicists and several private medical physics groups provide QC services to radiology departments. The aim of this study was to analyse data from QC tests in mammography and to investigate the impact of QC introduction on mammography practice in the country. The study was coordinated by the National Centre of Radiobiology and Radiation Protection. All medical physics services were requested to fill in standardised forms with information about most important parameters routinely measured during QC. All QC service providers responded. Results demonstrated significant improvement of practice since the introduction of QC, with reduction of established deviations from 65 % during the first year to 7 % in the last year. The systems that do not meet the acceptability criteria were suspended from use. Performance of automatic exposure control and digital detectors are not regularly tested because of the absence of requirements in the legislation. The need of updated guidance and training of medical physicists to reflect the change in technology was demonstrated. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Current Status of Evidence-Based Practice for Students with Intellectual Disability and Autism Spectrum Disorders

ERIC Educational Resources Information Center

West, Elizabeth A.; McCollow, Meaghan; Umbarger, Gardner; Kidwell, James; Cote, Debra L.

2013-01-01

The purpose of this paper is to provide a current look at the status of evidence-based practice (EBP) for students with intellectual disability and autism spectrum disorders. Specifically, this paper will (1) provide an introduction to the history and evolution of the use of levels of evidence, (2) discuss the importance of EBPs, (3) identify…

Bone density loss on computed tomography at 3-year follow-up in current compared to former male smokers.

PubMed

Pompe, E; Bartstra, J; Verhaar, H J; de Koning, H J; van der Aalst, C M; Oudkerk, M; Vliegenthart, R; Lammers, J-W J; de Jong, P A; Mohamed Hoesein, F A A

2017-04-01

Cigarette smoking negatively affects bone quality and increases fracture risk. Little is known on the effect of smoking cessation and computed tomography (CT)-derived bone mineral density (BMD) decline in the spine. We evaluated the association of current and former smoking with BMD decline after 3-year follow-up. Male current and former smokers participating in a lung cancer screening trial who underwent baseline and 3-year follow-up CT were included. BMD was measured by manual placement of a region of interest in the first lumbar vertebra and expressed in Hounsfield Unit (HU). Multiple linear regression analysis was used to evaluate the association between pack years smoked and smoking status with BMD decline. 408 participants were included with median (25th-75th percentile) age of 59.4 (55.9-63.5) years. At the start of the study, 197 (48.3%) participants were current smokers and 211 (51.7%) were former smokers and had a similar amount of pack years. Current smokers had quit smoking for 6 (4-8) years prior to inclusion. There was no difference in BMD between current and former smokers at baseline (109±34 HU vs. 108±32 HU, p=0.96). At 3-year follow-up, current smokers had a mean BMD decline of -3±13 HU (p=0.001), while BMD in former smokers did not change as compared to baseline (1±13 HU, p=0.34). After adjustment for BMD at baseline and body mass index, current smoking was independently associated with BMD decline (-3.8 HU, p=0.003). Age, pack years, and the presence of a fracture at baseline did not associate with BMD decline. Current smokers showed a more rapid BMD decline over a 3-year period compared to former smokers. This information might be important to identify subjects at risk for osteoporosis and emphasizes the importance of smoking cessation in light of BMD decline. Copyright © 2017 Elsevier B.V. All rights reserved.

Flexibility of the elderly after one-year practice of yoga and calisthenics.

PubMed

Farinatti, Paulo T V; Rubini, Ercole C; Silva, Elirez B; Vanfraechem, Jacques H

Flexibility training responses to distinct stretching techniques are not well defined, especially in the elderly. This study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week. Sixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex). Results showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p < 0.01 for each) and a decrease in the control group (by 2.1 points) (p < 0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p <0.05). In conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.

Increased diagnostic activity in general practice during the year preceding colorectal cancer diagnosis.

PubMed

Hansen, Pernille Libach; Hjertholm, Peter; Vedsted, Peter

2015-08-01

Accurate diagnostic activity in general practice before colorectal cancer (CRC) diagnosis is crucial for an early detection of CRC. This study aimed to investigate the rates of daytime consultations, hemoglobin (Hb) measurements and medicine prescriptions for hemorrhoids in general practice in the year preceding CRC diagnosis. Using Danish registries, we conducted a population-based matched cohort study including CRC patients aged 40-80 years (n = 19,209) and matched references (n = 192,090). We calculated odds ratios (ORs) using a conditional logistical regression model and incidence rate ratios (IRRs) using a negative binomial regression model. The CRC patients had significantly more consultations from 9 months before diagnosis and significantly increased rates of Hb measurements from up to 17 months before diagnosis compared with references. Furthermore, up to 18 months before diagnosis, CRC patients had significantly higher rates of prescriptions for hemorrhoids; and 2 months before diagnosis, the IRR was 12.24 (95% confidence interval (CI): 10.29-14.55) for men. The positive predictive value (PPV) of CRC for having a first-time prescription for hemorrhoids was highest among men aged 70-80 years [PPV = 3.2% (95% CI: 2.8-3.7)]. High prescription rates were predominantly seen among rectal cancer patients, whereas colon cancer patients had higher rates of consultations and Hb measurements. This study revealed a significant increase in healthcare seeking and diagnostic activity in general practice in the year prior to CRC diagnosis, which indicates the presence of a "diagnostic time window" and a potential for earlier diagnosis of CRC based on clinical signs and symptoms. © 2015 UICC.

Current Practices in Lumbar Surgery Perioperative Rehabilitation: A Scoping Review.

PubMed

Marchand, Andrée-Anne; O'Shaughnessy, Julie; Châtillon, Claude-Édouard; Sorra, Karin; Descarreaux, Martin

The objective of this review was to identify current practices and relevant patient-reported and objective outcome measures with regard to rehabilitation protocols directed at the lumbar spine in perioperative procedure settings in order to inform clinical practice and future research. A literature search was performed in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Central Register of Controlled Trials, PEDro (Physiotherapy Evidence Database), and PubMed using terms relevant to surgical interventions, rehabilitation, and the lumbar spine. Twenty-nine studies met the inclusion criteria, and 28 investigated postoperative forms of rehabilitation. Patient-reported outcomes typically used were pain and disability, although a wide range of objective measures based on physical capacities were often reported. Rehabilitation programs, for the most part, included some form of strengthening exercises alone or in combination with stabilization exercises, aerobic conditioning, stretching, or education. Despite most studies reporting statistically significant results between intervention groups, considering clinically significant improvement within intervention groups yielded a different portrait. A wide range of objective and subjective outcomes is used to document changes after active rehabilitation. Program components include both active and assisted interventions combined with various means of education and discussion. Multimodal rehabilitation protocols after lumbar surgery may be used to improve patient-reported and objective outcome measures such as pain, disability, and physical function. Further research should be conducted on the effects of preoperative rehabilitation programs. Copyright © 2016. Published by Elsevier Inc.

Community-based child health nurses: an exploration of current practice.

PubMed

Borrow, Stephanie; Munns, Ailsa; Henderson, Saras

2011-12-01

The purpose of this research was to define, the practice domain of community-based child health nursing in light of widespread political, economic and social changes in Western Australia. The project was conducted by a group of nurse researchers with experience in child health nursing from the School of Nursing and Midwifery at Curtin University and the Child and Adolescent Community Health Division at the Department of Health, Western Australia. The overall aim of the project was to map the scope of nursing practice in the community child health setting in Western Australia and to identify the decision making framework that underpins this nursing specialty. Given the widespread social, economic and health service management changes, it was important for nurses involved with, or contemplating a career in, community-based child health to have the role accurately defined. In addition, consumer expectations of the service needed to be explored within the current climate. A descriptive qualitative study was used for this project. A purposive sample of 60 participants was drawn from the pool of child health nurses in the South Metropolitan Community Health Service, North Metropolitan Health Service and Western Australian Country Health Service. Following ethical approval data was collected via participants keeping a 2-week work diary. The data was coded and thematic analysis was applied. Several themes emerged from the analysis which were validated by follow up focus group interviews with participants. This clearly demonstrated common, recurring issues. The results identified that the community-based child health nurses are currently undertaking a more complex and expanded child health service role for an increasingly diverse client population, over their traditional practices which are still maintained. Excessive workloads and lack of human and non human resources also presented challenges. There are increasing requirements for child health nurses to engage in

A Focus Group Study of Child Nutrition Professionals' Attitudes about Food Allergies and Current Training Practices

ERIC Educational Resources Information Center

Lee, Yee Ming; Kwon, Junehee; Sauer, Kevin

2014-01-01

Purpose/Objectives: The purpose of this study was to explore child nutrition professionals' (CNPs) attitudes about food allergies, current practices of food allergy training, and operational issues related to food allergy training in school foodservice operations. Methods: Three focus groups were conducted with 21 CNPs with managerial…

Gardening practices in a rural village in South Africa 10 years after completion of a home garden project.

PubMed

Zimpita, Tisungeni; Biggs, Chara; Faber, Mieke

2015-03-01

Few studies have documented whether the behavior changes produced by home garden projects have been maintained after completion of the projects. To determine the benefits and challenges affecting production and consumption of β-carotene-rich vegetables and fruits in a rural South African village 10 years after completion of a home garden project. This cross-sectional survey assessed gardening practices and household consumption of β-carotene-rich vegetables and fruits using a questionnaire (n = 186). Benefits and challenges affecting production and consumption of β-carotene-rich vegetables and fruits were assessed through focus group discussions. Thirty-nine percent of the households currently planted β-carotene-rich vegetables and fruits. Major challenges included lack of fencing, animals eating crops, and lack or shortage of water. Planting materials for β-carotene-rich vegetables were sourced from the community nursery, while papaya was grown from its own seed. Shops were the most likely alternative sources of β-carotene-rich vegetables. The frequency of consumption of orange-fleshed sweet potato, butternut, spinach, and papaya when in season differed significantly, with households planting β-carotene-rich vegetables and fruits having more frequent consumption than households not planting these vegetables and fruits. Households planting β-carotene-rich vegetables and fruits were perceived as "well-to-do" and "healthy" households and as "givers". This study showed that 10 years after the endline evaluation of a home garden project, approximately one-third of the households in the village planted β-carotene-rich vegetables and fruits, which is very similar to the proportion at project completion and a postintervention study that was done 6 years later, despite various challenges, indicating that the practice of planting these vegetables and fruits was continued over the years.

Multiple indications for everolimus after liver transplantation in current clinical practice

PubMed Central

Bilbao, Itxarone; Dopazo, Cristina; Lazaro, Jose; Castells, Lluis; Caralt, Mireia; Sapisochin, Gonzalo; Charco, Ramon

2014-01-01

AIM: To assess our experience with the use and management of everolimus-based regimens post-liver transplantation and to redefine the potential role of this drug in current clinical practice. METHODS: From October 1988 to December 2012, 1023 liver transplantations were performed in 955 patients in our Unit. Seventy-four patients (7.74%) received immunosuppression with everolimus at some time post-transplantation. Demographic characteristics, everolimus indication, time elapsed from transplantation to the introduction of everolimus, doses and levels administered, efficacy, side effects, discontinuation and post-conversion survival were analyzed. RESULTS: Mean age at the time of conversion to everolimus was 57.7 ± 10 years. Indications for conversion were: refractory rejection 31.1%, extended hepatocellular carcinoma in explanted liver 19%, post-transplant hepatocellular carcinoma recurrence 8.1%, de novo tumour 17.6%, renal insufficiency 8.1%, severe neurotoxicity 10.8%, and others 5.4%. Median time from transplantation to introduction of everolimus was 6 mo (range: 0.10-192). Mean follow-up post-conversion was 22 ± 19 mo (range: 0.50-74). The event for which the drug was indicated was resolved in 60.8% of patients, with the best results in cases of refractory rejection, renal insufficiency and neurotoxicity. Results in patients with cancer were similar to those of a historical cohort treated with other immunosuppressants. The main side effects were dyslipidemia and infections. Post-conversion acute rejection occurred in 14.9% of cases. The drug was discontinued in 28.4% of patients. CONCLUSION: Everolimus at low doses in combination with tacrolimus is a safe immunosuppressant with multiple early and late indications post-liver transplantation. PMID:25032101

A Descriptive Study of First-Year College Students' Non-Academic Digital Literacy Practices with Implications for College Writing Education

ERIC Educational Resources Information Center

Amicucci, Ann N.

2013-01-01

In this qualitative research study, the author investigated first-year college students' non-academic digital literacy practices, the audiences for these practices, and students' preferences for enacting these practices in the first-year college writing classroom. Methods of data collection included surveying 177 students, conducting…

Current management practices and interventions prioritised as part of a nationwide mastitis control plan

PubMed Central

Bradley, A. J.; Breen, J. E.; Hudson, C. D.; Green, M. J.

2016-01-01

The objectives of this study were to report performance and management data taken from a sample of UK dairy farms that have participated in the Agriculture and Horticulture Development Board Dairy Mastitis Control Plan (DMCP) and to identify important mastitis prevention practices that are not currently widely implemented. A total of 234 UK dairy herds were included in the study from which farm management and udder health data were collected. Herds were grouped according to their mastitis epidemiology and could be classed as (i) environmental dry period (EDP) (i.e. environmental pathogen with majority of infections being acquired during the dry period), (ii) environmental lactation (EL), (iii) contagious dry period (CDP) or (iv) contagious lactation (CL). The results of this study showed that many mastitis-related management practices that are generally considered to be important were not widely performed. A better understanding of those practices not widely adopted by UK dairy farmers at present may aid practitioners in identifying and overcoming potential barriers to improved mastitis control. PMID:26966249

An assessment of the Bhutanese traditional medicine for its ethnopharmacology, ethnobotany and ethnoquality: Textual understanding and the current practices.

PubMed

Wangchuk, Phurpa; Pyne, Stephen G; Keller, Paul A

2013-06-21

: This study involves the assessment of the Bhutanese traditional medicine (BTM) which was integrated with the mainstream biomedicine in 1967 to provide primary health care services in the country. It caters to 20-30% of the daily out-patients within 49 traditional medicine units attached to 20 district modern hospitals and 29 Basic Health Units in the country. : This study presents the ethnopharmacological, ethnobotanical and the ethnoquality concepts in relation to mainstream Tibetan medicine and describes the current practices of BTM. : Experienced BTM practitioners (Drung-tshos and Smen-pas) were selected using a convenience sampling method and were interviewed using an open questionnaire followed by informal discussions. The corpus of BTM, Tibetan and scientific literature was obtained and the information on ethnopharmacological, ethnoquality and ethnobotanical concepts and current practices of BTM was extracted. : This study found that the BTM shares many similarities in terms of materia medica, pharmacopoeia and the principles and concepts of ethnopharmacology and ethnobotany with its mainstream Tibetan medicine. However, the resourceful Bhutanese Drung-tshos and Smen-pas have adapted this medical system based on the local language, culture, disease trend, health care needs and their familiarity with the locally available medicinal ingredients making it particular to the country. A number of notable distinctions observed in the current practices include a code of classification of diseases (only 79 of 404 types of disorders recognized), formulations (currently used only 103 of thousands formulation types), usage of medicinal plants (only 229 species of thousands described) and selected treatment procedures (golden needle and water therapy). This BTM was found to cater to 20-30% of daily out-patients visiting 49 modern hospitals and basic health units in the country. : The BTM has been evolved from the Tibetan medicine. While the pharmacopoeia

Typography and layout of technical reports - Survey of current practices

NASA Technical Reports Server (NTRS)

Pinelli, T. E.; Cordle, V. M.; Mccullough, R.

1985-01-01

As part of a review of the NASA Langley Research Center scientific and technical information program, 50 technical reports from industry, research institutions, and government agencies were systematically examined and analyzed to determine current usage and practice in regard to (1) typography, including composition method, type style, type size, and margin treatment; (2) graphic design, including layout and imposition of material on the page; and (3) physical media, including paper, ink, and binding methods. The results indicate that approximately 50 percent of the reports were typeset, 70 percent used Roman (serif) type, 80 percent used 10- or 11-point type for text, 60 percent used a ragged right-hand margin, slightly more than half used paragraph indentation, 75 percent used a single-column layout, 65 percent had one or more figures or tables placed perpendicular to (not aligned with) the text, and perfect binding was the most frequently used binding method.

Effective Practices to Support Year-Long Student Teachers by Cooperating Teachers and the School District

ERIC Educational Resources Information Center

Olson, Heather

2017-01-01

The purpose of the study was to determine what student teachers perceive as an effective practice used by their cooperating teacher and school district to enhance the success of the year-long student teaching experience. In addition, the study intended to determine the differences in what student teachers perceive as effective practice based on…

Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices.

PubMed

Michaud, Katarzyna; Mangin, Patrice; Elger, Bernice S

2011-05-01

Autopsy-negative sudden cardiac deaths (SCD) seen in forensic practice are most often thought to be the result of sudden arrhythmic death syndrome. Postmortem genetic analysis is recommended in such cases, but is currently performed in only a few academic centers. In order to determine actual current practice, an on-line questionnaire was sent by e-mail to members of various forensic medical associations. The questions addressed routine procedures employed in cases of sudden cardiac death (autopsy ordering, macroscopic and microscopic cardiac examination, conduction tissue examination, immunohistochemistry and electron microscopy, biochemical markers, sampling and storage of material for genetic analyses, toxicological analyses, and molecular autopsy). Some questions concerned the legal and ethical aspects of genetic analyses in postmortem examinations, as well as any existing multidisciplinary collaborations in SCD cases. There were 97 respondents, mostly from European countries. Genetic testing in cases of sudden cardiac death is rarely practiced in routine forensic investigation. Approximately 60% of respondents reported not having the means to perform genetic postmortem testing and 40% do not collect adequate material to perform these investigations at a later date, despite working at university hospitals. The survey demonstrated that many of the problems involved in the adequate investigation of SCD cases are often financial in origin, due to the fact that activities in forensic medicine are often paid by and dependent on the judicial authorities. Problems also exist concerning the contact with family members and/or the family doctor, as well as the often-nonexistent collaboration with others clinicians with special expertise beneficial in the investigation of SCD cases, such as cardiologists and geneticists. This study highlights the importance in establishing guidelines for molecular autopsies in forensic medicine.

Using vital signs to assess children with acute infections: a survey of current practice

PubMed Central

Thompson, Matthew; Mayon-White, Richard; Harnden, Anthony; Perera, Rafael; McLeod, Diane; Mant, David

2008-01-01

Background GPs are advised to measure vital signs in children presenting with acute infections. Current evidence supports the value of GPs' overall assessment in determining how unwell a child is, but the additional benefit of measuring vital signs is not known. Aim To describe the vital signs and clinical features that GPs use to assess children (aged <5 years) with acute infections. Design of study Questionnaire survey. Setting All 210 GP principals working within a 10 mile radius of Oxford, UK. Method Data were collected on reported frequency, methods, and utility of measuring vital signs. Description of clinical features was used to assess the overall severity of illness. Results One hundred and sixty-two (77%) GPs responded. Half (54%, 95% confidence interval [CI] = 47 to 62) measured temperature at least weekly, compared to pulse (21%, 95% CI = 15 to 27), and respiratory rates (17%, 95% CI = 11 to 23). Almost half of GPs (77, 48%) never measured capillary refill time. Temperature was measured most frequently using electronic aural thermometers (131/152; 86%); auscultation or counting were used for pulse and respiratory rates. A minority used pulse oximeters to assess respiratory status (30/151, 20%). GPs' thresholds for tachypnoea were similar to published values, but there was no consensus on the threshold of tachycardia. Observations of behaviour and activity were considered more useful than vital signs in assessing severity of illness. Conclusion Vital signs are uncommonly measured in children in general practice and are considered less useful than observation in assessing the severity of illness. If measurement of vital signs is to become part of standard practice, the issues of inaccurate measurement and diagnostic value need to be addressed urgently. PMID:18494174

78 FR 64425 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 16, 225, 500, 507, and 579 [Docket No. FDA-2011-N-0922] Current Good Manufacturing Practice and Hazard Analysis and Risk- Based Preventive Controls for Food for Animals; Public Meeting on Proposed Rule AGENCY: Food and...

Training the intern: The value of a pre-intern year in preparing students for practice.

PubMed

Dare, Anna; Fancourt, Nicholas; Robinson, Elizabeth; Wilkinson, Tim; Bagg, Warwick

2009-08-01

To evaluate the clinical and professional development that occurs during a New Zealand trainee intern year in preparation for the first house officer role. A quantitative questionnaire was distributed to all trainee interns (year 6) and year 5 medical students in New Zealand at the end of the 2007 academic year. This survey assessed self-reported competency and performance across clinical, professional and role development domains. Response rate was 65% (457/702). Compared to year 5 students, trainee interns reported significantly greater competence and performance levels across all three domains. The greatest improvement occurred in the independent performance of procedural skills (trainee interns: 77%, year 5: 35%, p < 0.001) and clinical tasks (trainee interns: 94%, year 5: 56%, p < 0.001) and in the level of clinical responsibility taken (p < 0.001). At the end of the trainee intern year, 92% of students felt prepared to be a junior doctor, versus only 53% at the end of their 5th year (p < 0.0001). The trainee intern year is important in preparing graduates for the intern role. The year affords increased responsibility and practical experience, whilst retaining an educational focus, facilitating the move from competence towards performance. Preparedness for practice was substantially higher following the New Zealand trainee intern year than has been reported with other pre-intern placements.

77 FR 9664 - Funds for Leadership Training in Pediatric Dentistry's Current Grantees; One-Year Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

... Leadership Training in Pediatric Dentistry's Current Grantees; One-Year Extension AGENCY: Health Resources... Funds for Leadership Training in Pediatric Dentistry's (T17) Current Grantees. SUMMARY: The Health... for the Leadership Training in Pediatric Dentistry awards to Columbia University, The Regents of the...

Views of practicing dentists regarding a mandatory fifth year of training.

PubMed

Lefever, Karen H; Atchison, Kathryn A; McCauley, Kevin R; Mito, Ronald D; Engelhardt, Rita

2003-03-01

As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years.

Physician and staff turnover in community primary care practice.

PubMed

Ruhe, Mary; Gotler, Robin S; Goodwin, Meredith A; Stange, Kurt C

2004-01-01

The effect of a rapidly changing healthcare system on personnel turnover in community family practices has not been analyzed. We describe physician and staff turnover and examine its association with practice characteristics and patient outcomes. A cross-sectional evaluation of length of employment of 150 physicians and 762 staff in 77 community family practices in northeast Ohio was conducted. Research nurses collected data using practice genograms, key informant interviews, staff lists, practice environment checklists, medical record reviews, and patient questionnaires. The association of physician and staff turnover with practice characteristics, patient satisfaction, and preventive service data was tested. During a 2-year period, practices averaged a 53% turnover rate of staff. The mean length of duration of work at the current practice location was 9.1 years for physicians and 4.1 years for staff. Longevity varied by position, with a mean of 3.4 years for business employees, 4.0 years for clinical employees, and 7.8 years for office managers. Network-affiliated practices experienced higher turnover than did independent practices. Physician longevity was associated with a practice focus on managing chronic illness, keeping on schedule, and responding to insurers' requests. No association was found between turnover and patient satisfaction or preventive service delivery rates. Personnel turnover is pervasive in community primary care practices and is associated with employee role, practice network affiliation, and practice focus. The potentially disruptive effect of personnel turnover on practice functioning, finances, and longitudinal relationships with patients deserves further study despite the reassuring lack of association with patient satisfaction and preventive service delivery rates.

Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways.

PubMed

Rath, Santosh; Yadav, Lalit; Tewari, Abha; Chantler, Tracey; Woodward, Mark; Kotwal, Prakash; Jain, Anil; Dey, Aparajit; Garg, Bhavuk; Malhotra, Rajesh; Goel, Ashish; Farooque, Kamran; Sharma, Vijay; Webster, Premila; Norton, Robyn

2017-12-01

Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework. A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip

Attitudes towards General Practice: a comparative cross-sectional survey of 1st and 5th year medical students

PubMed Central

Kruschinski, Carsten; Wiese, Birgitt; Hummers-Pradier, Eva

2012-01-01

Objective: Positive attitudes towards General Practice can be understood as a prerequisite for becoming a General Practitioner (GP) and for collaboration with GPs later on. This study aimed to assess attitudes of medical students at the beginning and the end of medical school. Methods: A total of 160 1st year students at Hannover Medical School were surveyed. Their attitudes were compared to those of 287 5th year students. Descriptive, bi- and multivariate analyses were performed to investigate influences of year of study and gender. Results: Year of study and gender both were associated with the attitudes towards General Practice. The interest in General Practice and patient-orientation (communication, care of older patients with chronic diseases) was higher in 1st year students compared to more advanced students. Female students valued such requirements more than male students, the differences in attitudes between the years of study being more pronounced in male students. Conclusion: Despite some limitations caused by the cross-sectional design, the attitudes towards General Practice competencies changed to their disadvantage during medical school. This suggests a formative influence of the strategies used in medical education. Educational strategies, however, could be used to bring about a change of attitudes in the other direction. PMID:23255966

Endophthalmitis Prophylaxis in Cataract Surgery: Overview of Current Practice Patterns Around the World.

PubMed

Grzybowski, Andrzej; Schwartz, Stephen G; Matsuura, Kazuki; Ong Tone, Stephan; Arshinoff, Steve; Ng, Jonathon Q; Meyer, Jay J; Liu, Wu; Jacob, Soosan; Packer, Mark; Lutfiamida, Rifna; Tahija, Sjakon; Roux, Paul; Malyugin, Boris; Urrets-Zavalia, Julio A; Crim, Nicolas; Esposito, Evangelina; Daponte, Pablo; Pellegrino, Fernando; Graue-Hernandez, Enrique O; Jimenez-Corona, Aida; Valdez-Garcia, Jorge E; Hernandez-Camarena, Julio C; Relhan, Nidhi; Flynn, Harry W; Ravindran, Ravilla D; Behnding, Anders

2017-01-01

Acute-onset postoperative endophthalmitis after cataract surgery remains a rare but important cause of visual loss. There is no global consensus regarding the optimal strategies for prophylaxis of endophthalmitis and practices vary substantially around the world, especially with respect to the use of intracameral antibiotics. The European Society of Cataract & Refractive Surgeons in a randomized clinical trial (2007) reported an approximately 5-fold reduction in endophthalmitis rates associated with the use of intracameral cefuroxime. Despite this report, the use of intracameral antibiotics has not been universally adopted. Various endophthalmitis prophylaxis patterns around the world (including the United States, Canada, Australia/New Zealand, Japan, China, India, Indonesia, South Africa, Argentina, Russia, Sweden and Mexico) are compared. Each contributing author was asked to provide similar information, including endophthalmitis rates based on published studies, current practice patterns, and in some cases original survey data. Various methods were used to obtain this information, including literature reviews, expert commentary, and some new survey data not previously published. Many different practice patterns were reported from around the world, specifically with respect to the use of intracameral antibiotics. There is no worldwide consensus regarding endophthalmitis prophylaxis with cataract surgery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

SUBSTANCE USE SCREENING AND INTERVENTIONS IN DENTAL CLINICS: SURVEY OF PRACTICE-BASED RESEARCH NETWORK DENTISTS ON CURRENT PRACTICES, POLICIES, AND BARRIERS

PubMed Central

Wright, Shana; Matthews, Abigail G.; Rotrosen, John; Shelley, Donna; Buchholz, Matthew P.; Curro, Frederick A.

2013-01-01

Background Dental visits represent an opportunity to identify and assist patients with substance use, but little is known about how dentists are addressing tobacco, alcohol and illicit drugs. We surveyed dentists to learn about the role their practices might play in providing substance use screening and interventions. Methods A 41-item, web-based survey was distributed to all 210 dentists active in the PEARL dental practice-based research network. The questionnaire assessed clinic policies and current practices, attitudes, and perceived barriers to providing services for tobacco, alcohol, and illicit drug use. Results 143 dentists completed the survey (68% response rate). While screening was common, fewer were providing follow-up counseling or referrals for substance use. Insufficient knowledge/training was the most frequently cited barrier to intervention. Many dentists said they would offer assistance for tobacco (67%) or alcohol or illicit drugs (52%) if reimbursed; an affirmative response was more likely among those who saw publicly insured patients. Conclusions Dentists recognize the importance of screening for substance use, but lack clinical training and systems that could facilitate intervention. Practice Implications If barriers were reduced through changes in reimbursement, education, and systems-level support, our findings indicate that dentists may be willing to address substance use, including use of alcohol and illicit drugs as well as tobacco. PMID:23729460

Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice.

PubMed

French, Simon D; Charity, Melanie J; Forsdike, Kirsty; Gunn, Jane M; Polus, Barbara I; Walker, Bruce F; Chondros, Patty; Britt, Helena C

2013-11-18

COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

21 CFR 4.4 - How can I comply with these current good manufacturing practice requirements for a co-packaged or...

Code of Federal Regulations, 2014 CFR

2014-04-01

... practice operating system in accordance with paragraph (b) of this section, the following requirements..., and the current good manufacturing practice operating system has been shown to comply with the drug... operating system has been shown to comply with the QS regulation, the following provisions of the drug CGMPs...

21 CFR 4.4 - How can I comply with these current good manufacturing practice requirements for a co-packaged or...

Code of Federal Regulations, 2013 CFR

2013-04-01

... practice operating system in accordance with paragraph (b) of this section, the following requirements..., and the current good manufacturing practice operating system has been shown to comply with the drug... operating system has been shown to comply with the QS regulation, the following provisions of the drug CGMPs...

Implementation of parental feeding practices: does parenting style matter?

PubMed

Kiefner-Burmeister, Allison; Hoffmann, Debra; Zbur, Samantha; Musher-Eizenman, Dara

2016-09-01

To combat childhood obesity, researchers have focused on parental feeding practices that promote child health. The current study investigated how parenting style relates to twelve parental feeding practices. Data on parenting style and parental feeding practices were obtained for a correlational study from users of Amazon's Mechanical Turk, an online survey system. USA. Mothers of children aged 7-11 years (n 193). Parenting style related differentially to eleven out of the twelve measured practices. Authoritative mothers displayed more feeding practices that promote child health and fewer practices that impede child health. Authoritarian and permissive mothers displayed more unhealthy practices than authoritative mothers, but differed from each other on the practices they employed. Parenting style may relate to more aspects of feeding than previously realized. The inclusion of numerous healthy feeding practices along with unhealthy practices in the current study provides suggestions for the application of healthy feeding behaviours. Instruction on feeding behaviours and parenting style should be a focus of future educational programmes.

Practice patterns of graduates of 2- and 3-year family medicine programs: in Ontario, 1996 to 2004.

PubMed

Green, Michael; Birtwhistle, Richard; Macdonald, Ken; Kane, John; Schmelzle, Jason

2009-09-01

To compare patterns of practice between graduates of core 2-year family medicine (FM) training programs and those completing an additional postgraduate year (PGY3) of training. Retrospective cohort study using administrative data from the Ontario Health Insurance Plan. Ontario. Graduates of Ontario FM residency programs from 1996 to 2002 who provided insured services in Ontario for 1 or more fiscal years between 1996 and 2004. Proportion of physician years of service in which a minimum number of services were provided in each of the following categories: anesthesia, emergency medicine (EM), home visits, hospital visits, nursing home visits, intrapartum obstetrics, palliative care, office-only practice, and rural locations, as well as deciles for proportion of billings for emergency department work and "quasi-specialty" designations based on billing patterns. Results are stratified by type of training and years in practice. Graduates of PGY3 programs are significantly more likely to practise in a range of nonoffice settings than their counterparts who completed core 2-year FM training programs. Differences were the most marked in areas in which additional training had been undertaken, but also extended to other categories. There was no effect on the proportion practising in rural locations, unless the training was undertaken in a rural setting or in anesthesia. Physicians including EM in their practices were more likely to practise mostly or almost all EM if they had undertaken either EM programs or self-directed programs at non-northern training sites. Very few graduates of any type were classified as belonging to a quasi-specialty group, other than those who completed care of the elderly or palliative care (hospitalist) and anesthesia programs. Completion of a PGY3 program is strongly associated with increased participation in practice outside the office, particularly in the area of the training provided.

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

Current practice of cervical disc arthroplasty: a survey among 383 AOSpine International members.

PubMed

Chin-See-Chong, Timothy C; Gadjradj, Pravesh S; Boelen, Robert J; Harhangi, Biswadjiet S

2017-02-01

OBJECTIVE The use of cervical disc arthroplasty (CDA) in spinal practice is controversial. This may be explained by the lack of studies with a large sample size and long-term outcomes. With this survey the authors aimed to evaluate the opinions of spine surgeons on the use of CDA in the current treatment of cervical disc herniation (CDH). METHODS A web-based survey was sent to all members of AOSpine International by email using SurveyMonkey on July 18, 2016. A single reminder was sent on August 18, 2016. Questions included geographic location; specialty; associated practice model; number of discectomies performed annually; the use of CDA, anterior cervical discectomy (ACD), and anterior cervical discectomy and fusion (ACDF); and the expectations for clinical outcomes of these procedures. RESULTS A total of 383 questionnaires were analyzed. Almost all practitioners (97.9%) were male, with a mean of 15.0 ± 9.7 years of clinical experience. The majority of responders were orthopedic surgeons (54.6%). 84.3% performed ACDF as the standard technique for CDH. 47.8% of the surgeons occasionally used CDA, whereas 7.3% used CDA as standard approach for CDH. The most common arthroplasty device used was the ProDisc-C. Low evidence for benefits and higher costs were the most important reasons for not offering CDA. The risk of adjacent-level disease was considered smaller for CDA as compared with ACDF. However, ACDF was expected to have the highest effectiveness on arm pain (87.5%), followed by CDA (77.9%), while ACD had the least (12.6%). CONCLUSIONS In this survey, CDA was not considered to be the routine procedure to treat CDH. Reported benefits included the reduced risk of adjacent-level disease and preservation of motion of the neck. Lack of enough evidence on its effectiveness as well as higher costs were considered to be disadvantages of CDA. More research should be conducted on the implementation impact of CDA and the cost-effectiveness from society's perspective.

The Book of Job: a 2,500-year-old current guide to the practice of oncology: the nexus of medicine and spirituality.

PubMed

Patterson, Stephen; Balducci, Lodovico; Meyer, Russell

2002-01-01

To establish the role of ancient literature and religious tradition to the modern practice of oncology; foster awareness of practicing in a historical context resulting from different traditions; and propose a spiritual context for the practice of oncology and explore methods to highlight this perspective in cancer education. Contextual and content analysis of a religious text shared by the most common religious traditions of the West (Christianity, Judaism, and Islam). The origin of suffering eludes all logical explanations. All religious traditions affirm that the sufferer should be heard, cared for, and kept part of the human consortium, and under no circumstances blamed for the disease. In terms of oncology practice this means that the treatment should be negotiated with the patient according to his or her need; that physicians' obligations for care continues after the treatment fails, and that patients' lifestyles or poor compliance should not be blamed for poor outcomes. The Book of Job supports a spiritual perspective in oncology practice, indicating that patient care is a holistic endeavor. This perspective is the key to dealing with common interactive problems, such as adversarial relations between patient and provider in face of death and suffering, and more important, may promote care beyond treatment of the disease.

[The practice of Dutch child and adolescent psychiatry - developments over the last fifteen years].

PubMed

Boer, F

2013-01-01

The child and adolescent psychiatry (cap) section of the Dutch Association for Psychiatry intends to keep track of the extent to which CAP is practised and to monitor the way in which it functions. The CAP has conducted three surveys since 1996. This paper reports on the 2012 survey. To investigate the composition (i.e. age and gender) of specialists working in child and adolescent psychiatry, to find out how much time these psychiatrists really spend on child and adolescent psychiatry and what type of work they actually do; furthermore, to make a list of specific questions such as 24-hour availability, and to note opinions regarding the planned transfer of child and adolescent mental health care facilities to town councils. A survey was conducted and an analysis was made of the data collected. The number of specialists practicing child and adolescent psychiatry in the Netherlands, expressed in full-time equivalents, has more than doubled since 1996 (from 183 in 1996 tot 389 in 2012). Compared to 1996, many more of these psychiatrists spend nearly all their time on CAP. The percentage of these specialists working only in private practice remains the same as in 1996 (19%) , although the percentage was lower in 2003 (135). Whereas in 1996 specialists in child and adolescent psychiatry worked mainly as psychotherapists, in 2012 they were working in a broader field, including assessment and pharmacotherapy. Dutch CAP has grown substantially over the past 15 years. Growth in psychiatry in general has been even more marked. Considering the current composition of the population, there is only a relatively limited amount of specialised psychiatric help available for people under the age of 20. The impending transfer of CAP mental health care facilities to town councils is a matter of deep concern to professionals and to psychiatrists in particular. Only if CAP investigations continue over the coming years will it become clear that this deep concern is entirely justified.

Multi-year Current Observations on the Shelf Slope off Cape Hatteras, NC

NASA Astrophysics Data System (ADS)

Muglia, M.

2017-12-01

As part of an observing and modeling effort by the North Carolina Renewable Ocean Energy Program to determine if the Gulf Stream is a viable marine hydrokinetic energy resource for the state, upper continental slope current measurements were made over a period of nearly four years off of Cape Hatteras, NC. Velocity profiles were measured by a near-bottom, upward-looking, 150-kHz Acoustic Doppler Current Profiler deployed at a depth of 230-260 m. The mooring was sited at the location where water from the Gulf Stream, Middle Atlantic Bight, South Atlantic Bight, and Slope Sea all converge. Measured tidal amplitudes here are 2 m. These observations are used to consider the temporal variability and vertical structure of the currents at this location at tidal to interannual periods at this complex location. Concurrent near-bottom water mass properties are considered.

Current practice patterns and knowledge among gynecologic surgeons of InterStim® programming after implantation.

PubMed

Hobson, Deslyn T G; Gaskins, Jeremy T; Frazier, LaTisha; Francis, Sean L; Kinman, Casey L; Meriwether, Kate V

2017-10-03

The objective of this study was to describe surgeons' current practices in InterStim® programming after initial implantation and their knowledge of programming parameters. We hypothesized that surgeons performing their own reprogramming would have increased knowledge. We administered a written survey to attendees at the Society of Gynecologic Surgeons Scientific Meeting and analyzed those on which surgeons indicated they offer InterStim® care. The survey queried surgeon characteristics, experience with InterStim® implantation and programming, and clinical opinions regarding reprogramming and tested six knowledge-based questions about programming parameters. Correct response to all six questions was the primary outcome. One hundred and thirty-five of 407 (33%) attendees returned the survey, of which 99 met inclusion criteria. Most respondents (88 of 99; 89%) were between 36 and 60 years, 27 (73%) were women, 76 (77%) practiced in a university setting, and 76 (77%) were trained in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Surgeons who had InterStim® programming training were more likely to perform their own programming [15/46 (32%) vs 6/47 (13%), p = 0.03]. Most answered all knowledge-based questions correctly (62/90, 69%); no surgeon characteristics were significantly associated with this outcome. Most surgeons cited patient comfort (71/80, 89%) and symptom relief (64/80, 80%) as important factors when reprogramming, but no prevalent themes emerged on how and why surgeons change certain programming parameters. Surgeons who had formal InterStim® programming training are more likely to perform programming themselves. No surgeon characteristic was associated with improved programming knowledge. We found that surgeons prioritize patient comfort and symptoms when deciding to reprogram.

Current Status and Issues in Basic Pharmaceutical Education.

PubMed

Yasuhara, Tomohisa

2017-01-01

Basic research in pharmaceutical sciences has a long and successful history. Researchers in this field have long given prime importance to the knowledge they have gained through their pharmaceutical education. The transition of pharmacy education to a 6-year course term has not only extended its duration but also placed more emphasis on practical clinical education. The School Education Act (in article 87, second paragraph) determines that "the term of the course, whose main purpose is to cultivate practical ability in clinical pharmacy, shall be six years" (excerpt). The 6-year pharmacy education is an exception to the general 4-year university term determined by the School Education Act. Therefore, the purpose of the 6-year course in pharmacy is clearly proscribed. This is true of the basic course in pharmaceutical education as well; hence, the basic course must be oriented toward developing "practical ability in clinical" education, too. The 6-year pharmacy course, starting from practice (Do), has evolved with the development of a syllabus that includes a model core curriculum (Plan). Furthermore, improvement in the course can be seen by the promoted development of faculty (Act). Now, evidence-based education research will be introduced (Check). This is how the Plan-Do-Check-Act cycle in pharmaceutical education is expected to work. Currently, pedagogy research in pharmacy education has just begun, so it is difficult to evaluate at this time whether basic pharmaceutical education does in fact contribute to enhancing the "practical clinical ability" component of pharmaceutical education.

Using Hybridization and Specialization to Enhance the First-Year Experience in Community Colleges: A National Picture of High-Impact Practices in First-Year Seminars

ERIC Educational Resources Information Center

Young, Dallin George; Keup, Jennifer R.

2016-01-01

This chapter draws from national data to explore unique attributes of first-year seminars in community college contexts as well as high-impact practices that are often connected to them. Findings point to areas of opportunity for practice and directions for future research to better understand how community colleges can be poised to meet the…

Pharmacovigilance in oncology: evaluation of current practice and future perspectives.

PubMed

Baldo, Paolo; De Paoli, Paolo

2014-10-01

Pharmacovigilance (PV), or drug safety monitoring, aims to improve patient safety through the detection and management of drug-related adverse reactions. It is implemented both by spontaneous reporting of adverse drug reactions (ADRs) and by careful detection of signals suggestive of drug toxicity. PV is an important clinical topic in clinical practice and pharmacotherapy, assuring the maintenance of a safe risk/benefit ratio throughout the commercial life cycle of a drug. We conducted a structured literature search on PubMed, Scopus, Cinahl and the Cochrane Library. We also performed manual searches in international databases of ADR individual reports to outline a structured profile on the topic. Our goal was to review key elements that affect safety monitoring of cancer drugs and their appropriate use, highlighting the strengths and weaknesses of PV in oncology. This paper provides an understanding of the methodologies used by PV in current clinical practice and particularly in cancer drug therapy; a focus upon reporting of ADRs by health professionals and patients; and a focus upon methods used by PV to detect new signals of risk/harm related to medicines utilization. To our knowledge, few articles focus upon the importance of PV and post-marketing surveillance of cancer drug therapies. Structured management of spontaneous reports of ADRs and data collection is essential to monitoring the safe use of drugs in this field in which pharmacotherapy is affected by high incidence of drug-related complications and by a narrow benefit/risk ratio. © 2014 John Wiley & Sons, Ltd.

Writing Placement and Proficiency Assessment Practices in Two Rural Two-Year Colleges

ERIC Educational Resources Information Center

Wise, Melody Anne

2013-01-01

This research is a dual-case study which specifically focuses on two rural two-year colleges in separate parts of the United States: one in the central Southern region, and the other in the Northeastern region. I wanted to focus on these colleges' writing placement and proficiency practices in relation to their respective missions and how they…

RECONCILING ON-SITE STORMWATER BEST MANAGEMENT PRACTICE (BMP) EFFECTIVENESS AND PERFORMANCE WITH CURRENT HYDROLOGIC AND ECONOMIC PERCEPTIONS

EPA Science Inventory

There is currently a dearth of data characterizing best management practice impacts on runoff production at the parcel-level. This data is of critical importance insofar as judging the effectiveness and reliability of on-site stormwater BMPs, with significant implications for bot...

What is the current practice of therapists in the measurement of somatosensation in children with cerebral palsy and other neurological disorders?

PubMed

Walmsley, Corrin; Taylor, Susan; Parkins, Timothy; Carey, Leeanne; Girdler, Sonya; Elliott, Catherine

2018-04-01

Somatosensation is the ability to detect and recognise body sensations such as touch, vibration, pressure, pain, temperature and proprioception. Cerebral palsy is a neurological disorder that is often accompanied by impairments in somatosensation. Current somatosensory assessments have limited psychometrics established for use with these children. The aim of this study was to identify therapists' current practice and perspectives related to the assessment of somatosensation in children with neurological disorders. A cross-sectional questionnaire was used to identify the somatosensory assessments currently used in clinical practice, time allocated to assessment, and therapists' satisfaction and confidence using the available assessments of somatosensation. The questionnaire was adapted from a previously utilised questionnaire that identified therapists' use of somatosensory assessments with adults post-stroke. A total of 135 therapists responded to the questionnaire. Seventy-nine (92%) occupational therapists and 44 (89.7%) physiotherapists indicated that they currently assessed or treated children with somatosensory deficits. Sixty-four (82.1%) occupational therapists and 38 (86.3%) physiotherapists regarded assessment of somatosensation in children with neurological disorders as important to very important. However, only seven (8.8%) occupational therapists and seven (15.9%) physiotherapists reported confidence in their ability to do so. The methods with which therapists detect and measure somatosensory impairment in children with neurological disorders are variable, with non-standardised and/or informal assessments most frequently used. Despite there being recommendations of best practice for the assessment of specific domains of somatosensation in children with cerebral palsy, current practice does not yet mirror these recommendations. Additionally, therapists have low satisfaction and confidence with what they are currently using, highlighting the need for a

The transition into veterinary practice: Opinions of recent graduates and final year students

PubMed Central

2011-01-01

Background The transition from veterinary student to member of the veterinary profession is known to be challenging. This study aimed to determine and compare the opinions of final year veterinary students and recent graduates on graduate attributes that ease this transition. Methods The study was carried out across 3 veterinary schools in the United Kingdom. Paper based or electronic surveys were used. Final year students in the 3 schools were surveyed either electronically (school A) or on paper (schools B and C). Student cohort sizes were 112, 227 and 102 respectively. Recent graduates were contacted either at a reunion event (school A) or electronically from database records (school B and school C). Cohort sizes of contacted graduates were 80, 175 and 91 respectively. Respondents were asked to rate 42 individual attributes on a 5 point Likert scale. Focus groups with final year students and recent graduates and telephone interviews with recent graduates were carried out. Data were analysed by two researchers through a combination of manual coding and thematic analysis. Data were grouped into broad themes then sorted into narrower themes. Data were then searched for counter examples. Results Response rates for final year students were 34% (school A), 36% (school B) and 40% (school C). Response rates for recent graduates were 56% (school A), 20% (school B) and 11% (school C). There was a high level of agreement between the cohorts with respect to communication skills, problem solving and decision making skills, recognition of own limitations and the ability to cope with pressure all rated unanimously important or very important. Business acumen, knowledge of veterinary practice management and research skills were the 3 attributes ranked at the bottom of the list. Nine attributes were identified with a significantly different (p < 0.05) ranking between the cohorts. Final year students ranked veterinary clinical knowledge, knowledge of veterinary public health and

The transition into veterinary practice: opinions of recent graduates and final year students.

PubMed

Rhind, Susan M; Baillie, Sarah; Kinnison, Tierney; Shaw, Darren J; Bell, Catriona E; Mellanby, Richard J; Hammond, Jenny; Hudson, Neil P H; Whittington, Rachel E; Donnelly, Ruth

2011-09-22

The transition from veterinary student to member of the veterinary profession is known to be challenging. This study aimed to determine and compare the opinions of final year veterinary students and recent graduates on graduate attributes that ease this transition. The study was carried out across 3 veterinary schools in the United Kingdom. Paper based or electronic surveys were used. Final year students in the 3 schools were surveyed either electronically (school A) or on paper (schools B and C). Student cohort sizes were 112, 227 and 102 respectively. Recent graduates were contacted either at a reunion event (school A) or electronically from database records (school B and school C). Cohort sizes of contacted graduates were 80, 175 and 91 respectively. Respondents were asked to rate 42 individual attributes on a 5 point Likert scale. Focus groups with final year students and recent graduates and telephone interviews with recent graduates were carried out. Data were analysed by two researchers through a combination of manual coding and thematic analysis. Data were grouped into broad themes then sorted into narrower themes. Data were then searched for counter examples. Response rates for final year students were 34% (school A), 36% (school B) and 40% (school C). Response rates for recent graduates were 56% (school A), 20% (school B) and 11% (school C). There was a high level of agreement between the cohorts with respect to communication skills, problem solving and decision making skills, recognition of own limitations and the ability to cope with pressure all rated unanimously important or very important. Business acumen, knowledge of veterinary practice management and research skills were the 3 attributes ranked at the bottom of the list. Nine attributes were identified with a significantly different (p < 0.05) ranking between the cohorts. Final year students ranked veterinary clinical knowledge, knowledge of veterinary public health and zoonotic issues, veterinary

Finding Ways to Effectively Use Year 12 Achievement Data to Inform Practice in Secondary Schools

ERIC Educational Resources Information Center

Italiano, Frank; Hine, Gregory

2014-01-01

This action research explored how Year 12 achievement data were used by school personnel to inform practice within seven Catholic secondary schools. Deputy Principals of Curriculum from participating schools were interviewed regarding their perceptions of the improvement of Year 12 student achievement outcomes, and their insights into how to…

Communication on Safety of Medicines in Europe: Current Practices and General Practitioners' Awareness and Preferences.

PubMed

de Vries, Sieta T; van der Sar, Maartje J M; Cupelli, Amelia; Baldelli, Ilaria; Coleman, Anna Marie; Montero, Dolores; Šipić, Ivana; Andrić, Adriana; Wennberg, Annika; Ahlqvist-Rastad, Jane; Denig, Petra; Mol, Peter G M

2017-08-01

National competent authorities (NCAs) for medicines coordinate communication relating to the safety of medicines in Europe. The effectiveness of current communication practices has been questioned, particularly with regard to reaching general practitioners (GPs). The aim of this study was to assess current European NCA safety communication practices and to investigate European GPs' awareness of and preferences for safety communications on medicines. Web-based surveys were distributed among European NCAs and healthcare professionals (HCPs). The survey among regulators was emailed to a representative of each of the 27 European countries participating in the Strengthening Collaboration for Operating Pharmacovigilance in Europe (SCOPE) Joint Action. HCPs from nine European countries (Denmark, Spain, Croatia, Ireland, Italy, The Netherlands, Norway, Sweden, and the UK) were asked about their preferences through a link to the survey on websites, in newsletters, and/or in a direct email. From this survey, data from GPs were used and descriptive analyses were conducted. Current NCA practices were reported for 26 countries. In 23 countries (88%), NCAs published direct healthcare professional communications (DHPCs, i.e. urgent communication letters for serious safety issues) on their website in addition to distribution to individual HCPs. Educational materials were available on the NCA's website in 10 countries (40%), and 21 NCAs (81%) indicated they had their own bulletin/newsletter, which is often presented on the NCA's website (15 countries; 60%). More than 90% of the 1766 GPs who completed the survey were aware of DHPCs. The most preferred senders of safety information were NCAs and professional bodies, while the preferred channels for keeping up to date with safety information were medicines reference books and clinical guidelines. GPs found the repetition of safety issues useful (range of 80% in the UK to 97% in Italy). Preference for an electronic copy rather than a

Coliform Bacteria Monitoring in Fish Systems: Current Practices in Public Aquaria.

PubMed

Culpepper, Erin E; Clayton, Leigh A; Hadfield, Catherine A; Arnold, Jill E; Bourbon, Holly M

2016-06-01

Public aquaria evaluate coliform indicator bacteria levels in fish systems, but the purpose of testing, testing methods, and management responses are not standardized, unlike with the coliform bacteria testing for marine mammal enclosures required by the U.S. Department of Agriculture. An online survey was sent to selected aquaria to document current testing and management practices in fish systems without marine mammals. The information collected included indicator bacteria species, the size and type of systems monitored, the primary purpose of testing, sampling frequency, test methods, the criteria for interpreting results, corrective actions, and management changes to limit human exposure. Of the 25 institutions to which surveys were sent, 19 (76%) responded. Fourteen reported testing for fecal indicator bacteria in fish systems. The most commonly tested indicator species were total (86%) and fecal (79%) coliform bacteria, which were detected by means of the membrane filtration method (64%). Multiple types and sizes of systems were tested, and the guidelines for testing and corrective actions were highly variable. Only three institutions performed additional tests to confirm the identification of indicator organisms. The results from this study can be used to compare bacterial monitoring practices and protocols in fish systems, as an aid to discussions relating to the accuracy and reliability of test results, and to help implement appropriate management responses. Received August 23, 2015; accepted December 29, 2015.

Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units.

PubMed

McCord, Helen; Fieldhouse, Elise; El-Naggar, Walid

2018-06-26

 This article assesses the degree of variability in the current practice of skin antiseptics used in Canadian neonatal intensive care units (NICUs) and different experiences related to each antiseptic used.  An anonymous survey was distributed to a clinical representative of each of the 124 Canadian level II and level III NICUs.  One hundred and two respondents (82.2%), representing all Canadian provinces, completed the survey. Chlorhexidine gluconate with/without alcohol was the antiseptic most used (96%) and the antiseptic with the highest reported adverse effects (68% reported skin burns/breakdown). Other antiseptics used include povidone-iodine (35%) and isopropyl alcohol (22%). Specific guidelines for antiseptic use were available in only 50% of the units with many NICUs lacking gestational and/or chronological age restrictions. Only 23% of responders believed that there was awareness among health care providers of the adverse effects of antiseptics used. Less than half (43%) were completely satisfied with the antiseptics used in their units.  Chlorhexidine gluconate is the most commonly used antiseptic in Canadian NICUs. The high number of associated adverse effects and the lack of guidelines regulating antiseptic use are of concern. Large clinical trials are urgently needed to guide practice and improve the safety of antiseptics. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Life cycle assessment part 2: current impact assessment practice.

PubMed

Pennington, D W; Potting, J; Finnveden, G; Lindeijer, E; Jolliet, O; Rydberg, T; Rebitzer, G

2004-07-01

Providing our society with goods and services contributes to a wide range of environmental impacts. Waste generation, emissions and the consumption of resources occur at many stages in a product's life cycle-from raw material extraction, energy acquisition, production and manufacturing, use, reuse, recycling, through to ultimate disposal. These all contribute to impacts such as climate change, stratospheric ozone depletion, photooxidant formation (smog), eutrophication, acidification, toxicological stress on human health and ecosystems, the depletion of resources and noise-among others. The need exists to address these product-related contributions more holistically and in an integrated manner, providing complimentary insights to those of regulatory/process-oriented methodologies. A previous article (Part 1, Rebitzer et al., 2004) outlined how to define and model a product's life cycle in current practice, as well as the methods and tools that are available for compiling the associated waste, emissions and resource consumption data into a life cycle inventory. This article highlights how practitioners and researchers from many domains have come together to provide indicators for the different impacts attributable to products in the life cycle impact assessment (LCIA) phase of life cycle assessment (LCA).

Current safety practices in nano-research laboratories in China.

PubMed

Zhang, Can; Zhang, Jing; Wang, Guoyu

2014-06-01

China has become a key player in the global nanotechnology field, however, no surveys have specifically examined safety practices in the Chinese nano-laboratories in depth. This study reports results of a survey of 300 professionals who work in research laboratories that handle nanomaterials in China. We recruited participants at three major nano-research laboratories (which carry out research in diverse fields such as chemistry, material science, and biology) and the nano-chemistry session of the national meeting of the Chinese Chemical Society. Results show that almost all nano-research laboratories surveyed had general safety regulations, whereas less than one third of respondents reported having nanospecific safety rules. General safety measures were in place in most surveyed nano-research laboratories, while nanospecific protective measures existed or were implemented less frequently. Several factors reported from the scientific literature including nanotoxicology knowledge gaps, technical limitations on estimating nano-exposure, and the lack of nano-occupational safety legislation may contribute to the current state of affairs. With these factors in mind and embracing the precautionary principle, we suggest strengthening or providing nanosafety training (including raising risk awareness) and establishing nanosafety guidelines in China, to better protect personnel in the nano-workplace.

Comparison of urban and rural general surgeons: motivations for practice location, practice patterns, and education requirements.

PubMed

Heneghan, Steven J; Bordley, James; Dietz, Patrick A; Gold, Michael S; Jenkins, Paul L; Zuckerman, Randall J

2005-11-01

The purpose of this study is to determine the differences between rural and urban surgeons with regard to practice patterns, factors in choosing a practice location, and educational needs. A list of surgeons obtained from the American Medical Association was examined using the Office of Management and Budget definition of rural. Seventeen hundred rural surgeons were mailed surveys; 421 responded. One hundred fourteen urban surgeons were contacted by telephone. Questions were designed to measure job and community satisfaction, factors influencing their decision to practice in their current location, spectrum and volume of cases, and their perceived educational needs. Age distribution did not differ markedly between urban and rural surgeons. Motivation to practice in their current location varied considerably between urban and rural surgeons. Both groups equally rated quality of life as the leading factor influencing their current practice location. Urban surgeons rated other factors, such as income, practice growth, hospital facilities, and proximity to family, higher than rural surgeons. Practice patterns and educational needs also varied between the two groups. Rural surgeons performed more procedures per year with more variety in procedure type. Both groups felt that additional training in advanced laparoscopic techniques would be helpful, and rural surgeons felt that additional training in the surgical subspecialty areas was important. Although rural and urban surgeons do not differ in age or the importance of lifestyle in deciding career location, different factors do impact their choice of location. Practice pattern and educational needs varied markedly between rural and urban general surgeons.

Current Trends in Malaysian Higher Education and the Effect on Education Policy and Practice: An Overview

ERIC Educational Resources Information Center

Grapragasem, Selvaraj; Krishnan, Anbalagan; Mansor, Azlin Norhaini

2014-01-01

Malaysia has evolved from a production-based to knowledge-based economy in order to stay relevant and compete in the global marketplace. Thus, the purpose of this article is to discuss current trends in Malaysian higher education and how these affect education policies and practices. Four main trends are discussed in this study: Globalization,…

Preschool Assessment. Principles and Practices

ERIC Educational Resources Information Center

Brassard, Marla R.; Boehm, Ann E.

2007-01-01

Comprehensive and user-friendly, this ideal graduate text and professional reference provides a developmentally informed framework for assessing 3- to 6-year-olds in accordance with current best practices and IDEA guidelines. The authors are leading clinician-researchers who take the reader step by step through selecting appropriate measures,…

The perceived benefits of a two-year period of extended specialty training in general practice: the trainees' perspective.

PubMed

Agius, Steven; Lewis, Barry; Kirk, Bob; Hayden, Jacky

2014-01-01

Evidence suggests that, in the UK, the current three-year specialty training period in general practice is inadequate for equipping newly qualified GPs with mastery in all the necessary clinical and generic skills that would allow them to respond with optimum effect to the complexities and uncertainties of the generalist workplace. The North Western Deanery initiated an innovative pilot programme of extended (by 24 months) specialty training in general practice (GPST4-5). Nine ST3 trainees who had just 'graduated' from GPST, holding nMRCGP, were recruited, thereby formally deferring their application for a Certificate of Completion of Training (CCT). The programme was evaluated using established qualitative research techniques. Semi-structured interviews were conducted at fixed points and data were analysed for recurring discourses and themes using a framework thematic analysis. We obtained evidence of the benefits of extended specialty training in encouraging the development of clinical mastery alongside additional specialist skills, generalist and leadership competencies. We also identified the enabling factors for beneficial extended training, including workplace-based training under educational mentorship, combined with a blended learning programme and sustained expert- and peer-support.

Minimally invasive surgery fellowship graduates: Their demographics, practice patterns, and contributions.

PubMed

Park, Adrian E; Sutton, Erica R H; Heniford, B Todd

2015-12-01

Fellowship opportunities in minimally invasive surgery, bariatric, gastrointestinal, and hepatobiliary arose to address unmet training needs. The large cohort of non-Accreditation Council for Graduate Medical Education -accredited fellowship graduates (NACGMEG) has been difficult to track. In this, the largest survey of graduates to date, our goal was to characterize this unique group's demographics and professional activities. A total of 580 NACGMEG were surveyed covering 150 data points: demographics, practice patterns, academics, lifestyle, leadership, and maintenance of certification. Of 580 previous fellows, 234 responded. Demographics included: average age 37 years, 84% male, 75% in urban settings, 49% in purely academic practice, and 58% in practice <5 years. They averaged 337 operating room cases/year (approximately 400/year for private practice vs 300/year for academic). NACGMEG averaged 100 flexible endoscopies/year (61 esophagogastroduodenoscopies, 39 colon). In the past 24 months, 60% had submitted abstracts to a national meeting, and 54% submitted manuscripts to peer-reviewed journals. Subset analyses revealed relevant relationships. There was high satisfaction (98%) that their fellowship experience met expectations; 78% termed their fellowships, versus 50% for residencies, highly pertinent to their current practices. 63% of previous fellows occupy local leadership roles, and most engage in maintenance of certification activities. Fellowship alumnae appear to be productive contributors to American surgery. They are clinically and academically active, believe endoscopy is important, have adopted continuous learning, and most assume work leadership roles. The majority acknowledge their fellowship training as having met expectations and uniquely equipping them for their current practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving Your Reflective Practice through Stories of Practitioner Research. Pen Green Books for Early Years Educators

ERIC Educational Resources Information Center

Arnold, Cath, Ed.

2012-01-01

"Improving Your Reflective Practice through Stories of Practitioner Research" shows how research has informed and created effective and valuable reflective practice in early years education, and offers depth to the arguments for a research-orientated stance to this vital field of study. This thought-provoking text explores and documents a variety…

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.

PubMed

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

2013-02-01

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 CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.

Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey.

PubMed

Hough, Judith L; Shearman, Andrew D; Jardine, Luke A; Davies, Mark W

2012-02-01

Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are diverse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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.

Current issues in dental practice management. Part 1. The importance of shared values.

PubMed

Newsome, Philip R H

2003-04-01

There can be few who would argue with the notion that the nature of dental practice in the United Kingdom has changed dramatically over the last couple of decades. A variety of factors, including new clinical techniques, growing consumerism, a much greater awareness of health-related and well-being issues in the public at large, as well as a marked deregulation within the dental profession, the development of vocational training and recently mandatory lifelong learning, the growing number of females working in the profession, and an increasing reluctance of young dentists to finance dental practices have all combined to create an environment which has enabled and encouraged a move away from traditional forms of dental care delivery. Instead, there has been considerable growth in independently-funded practice and a commensurate growth in the number of practices operating under a corporate body umbrella of one form or another. Currently there are 27 corporate bodies registered with the General Dental Council (GDC) with the likelihood of more in the future given the proposed GDC review. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable. Although they still have only a small share of the dental market--with 4% of all dentists in the UK in 1999--they have expanded rapidly from a small base. The data available at the time the paper was written indicate that the global total of fees earned from dentistry in the UK in the financial year 2001/2002 was almost 3 billion Pounds, of which 1.9 billion Pounds (64%) came from NHS fees and 1.1 billion Pounds (36%) from private fees. Of this 1.9 billion Pounds received in NHS fees in 2001/2002, 0.55 billion Pounds were paid by patients who were not exempt from charges, bringing the total amount actually paid out of patients' pockets for dental treatment to 1.65 billion Pounds. Compare these figures with 1996

Adoption research, practice, and societal trends: Ten years of progress.

PubMed

Wiley, Mary O'Leary

2017-12-01

Adoption involves the legal transfer of parental rights and responsibilities from a child's birth parents to adults who will raise the child (Reitz & Watson, 1992). Research related to adoption has expanded over the past 10 years and has incorporated more focus on implications for practice and public policy. This expansion has reflected increased awareness of the lived experience of adopted individuals, in addition to that of adoptive families and birth or first parents and families, collectively known as the adoption kinship network (Grotevant & McRoy, 1998). Trends discussed included research and social trends or movements (2007-2017) since the publication of the final article in a series of articles in the psychological literature related to adoption in The Counseling Psychologist (Baden & Wiley, 2007; Lee, 2003; O'Brien & Zamostny, 2003; Wiley & Baden, 2005; Zamostny, O'Brien, Baden, & Wiley, 2003; Zamostny, Wiley, O'Brien, Lee, & Baden, 2003). This article summarizes the social trends and research related to adoption over the last 10 years, including longitudinal and meta-analytic studies, increased research and conceptualization of ethnic and racial identity development, research on microaggressions, and research on diverse adoptive families, including those with gay and lesbian parents. Social trends included increased knowledge related to Internet accessibility, genetic information, continued focus on openness, and viewing adoption through a more critical lens. Implications are discussed for the development of programs that enhance competence of mental health professionals and adoption professionals in adoption-competent practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Teacher Evaluation: Current Practices in OECD Countries and a Literature Review. OECD Education Working Papers, No. 23

ERIC Educational Resources Information Center

Isore, Marlene

2009-01-01

This paper discusses the most relevant issues concerning teacher evaluation in primary and secondary education by reviewing the recent literature and analysing current practices within the OECD countries. First, it provides a conceptual framework highlighting key features of teacher evaluation schemes. In particular, it emphasises the importance…

Current marketing practices in the nursing home sector.

PubMed

Calhoun, Judith G; Banaszak-Holl, Jane; Hearld, Larry R

2006-01-01

Marketing is widely recognized as an essential business function across all industries, including healthcare. While many long-term care facilities adopted basic healthcare marketing practices and hired marketing staff by the early 1990s, a paucity of research on nursing home marketing exists in the literature. This study examines the extent to which nursing homes have developed more formulated marketing and related communication and promotional strategies as market competition has increased in this sector during the past two decades. In addition, we explored managers' perceptions of their control over marketing decision making, the impact of competition on the use of marketing practices, and areas for enhanced competitive positioning. Administrators from 230 nursing homes in 18 Southeastern Michigan counties were surveyed regarding (1) the adoption level of approximately 40 literature-based, best-practice marketing strategies; (2) the types of staff involved with the marketing function; and (3) their perception of their level of control over marketing functions and of local competition. Results from 101 (44 percent) survey participants revealed that although respondents viewed their markets as highly competitive, their marketing practices remained focused on traditional and relatively constrained practices. In relation to the importance of customer relationship management, the majority of the administrators reported intensive efforts being focused on residents and their families, referrers, and staff, with minimal efforts being extended to insurers and other types of payers. A significant positive relation was found between the intensity of marketing initiatives and the size of the facility (number of beds), whereas significant negative correlations were revealed in relation to occupancy and the perceived level of control over the function.

Allied Health Occupations in New Mexico: A Survey of Current and Five-Year Projected Need, 1989-1994.

ERIC Educational Resources Information Center

McLaughlin, James L.; And Others

In 1989, the Health Occupations Advisory Committee surveyed health care agencies throughout New Mexico about their current and planned employment needs in nursing and allied health fields. The survey was mailed to approximately 500 hospitals, county health offices, outpatient and long-term care facilities, employment agencies, practice groups, and…

The Synergy of and Readiness for High-Impact Practices during the First Year of College

ERIC Educational Resources Information Center

Hansen, Michele JoAnn; Schmidt, Lauren

2017-01-01

Students often participate in a myriad of academic support programs offered during the first year of college. This study is an investigation of the effects of participation in multiple high-impact educational practices on academic success outcomes (cumulative GPAs and persistence rates) among 2,028 first-year students. Results suggest that the…

Improving Hospital Services Based on Patient Experience Data: Current Feedback Practices and Future Opportunities.

PubMed

Kaipio, Johanna; Stenhammar, Hanna; Immonen, Susanna; Litovuo, Lauri; Axelsson, Minja; Lantto, Minna; Lahdenne, Pekka

2018-01-01

Patient feedback is considered important for healthcare organizations. However, measurement and analysis of patient reported data is useful only if gathered insights are transformed into actions. This article focuses on gathering and utilization of patient experience data at hospitals with the aim of supporting the development of patient-centered services. The study was designed to explore both current practices of collecting and utilizing patient feedback at hospitals as well as future feedback-related opportunities. Nine people working at different hierarchical levels of three university hospitals in Finland participated in in-depth interviews. Findings indicate that current feedback processes are poorly planned and inflexible. Some feedback data are gathered, but not systematically utilized. Currently, it is difficult to obtain a comprehensive picture of the situation. One future hope was to increase the amount of patient feedback to be able to better generalize and utilize the data. Based on the findings the following recommendations are given: attention to both patients' and healthcare staff's perspectives when collecting feedback, employing a coordinated approach for collecting and utilizing patient feedback, and organizational transformation towards a patient-centric culture.

Projected cancer risks potentially related to past, current, and future practices in paediatric CT in the United Kingdom, 1990–2020

PubMed Central

Journy, Neige M Y; Lee, Choonsik; Harbron, Richard W; McHugh, Kieran; Pearce, Mark S; Berrington de González, Amy

2017-01-01

Background: To project risks of developing cancer and the number of cases potentially induced by past, current, and future computed tomography (CT) scans performed in the United Kingdom in individuals aged <20 years. Methods: Organ doses were estimated from surveys of individual scan parameters and CT protocols used in the United Kingdom. Frequencies of scans were estimated from the NHS Diagnostic Imaging Dataset. Excess lifetime risks (ELRs) of radiation-related cancer were calculated as cumulative lifetime risks, accounting for survival probabilities, using the RadRAT risk assessment tool. Results: In 2000–2008, ELRs ranged from 0.3 to 1 per 1000 head scans and 1 to 5 per 1000 non-head scans. ELRs per scan were reduced by 50–70% in 2000–2008 compared with 1990–1995, subsequent to dose reduction over time. The 130 750 scans performed in 2015 in the United Kingdom were projected to induce 64 (90% uncertainty interval (UI): 38–113) future cancers. Current practices would lead to about 300 (90% UI: 230–680) future cancers induced by scans performed in 2016–2020. Conclusions: Absolute excess risks from single exposures would be low compared with background risks, but even small increases in annual CT rates over the next years would substantially increase the number of potential subsequent cancers. PMID:27824812

Survey on current practices for neurological prognostication after cardiac arrest.

PubMed

Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro

2015-05-01

To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Current practice in coagulation and transfusion therapy in multiple trauma patients: A German nation-wide online survey].

PubMed

Wafaisade, A; Wyen, H; Mutschler, M; Lendemans, S; Bouillon, B; Flohe, S; Paffrath, T; Maegele, M; Tjardes, T; Probst, C

2015-12-01

In recent years, the treatment of trauma-associated coagulopathy and bleeding has advanced enormously. The aim of this study was to assess the current practice of coagulation and transfusion management in Germany. From October 2011 until January 2012 we conducted a survey via online-questionnaire that was sent per E-Mail to all members of the German Society for Trauma Surgery. It comprised 12 questions with respect to current treatment of coagulopathy and haemorrhage in trauma patients. The response rate was 145/3006 (5 %). The respondents had following specialties: 77.2 % trauma surgery 15.9 % anesthesiology, 6.9 % others. 64 % of respondents were employed by a Level 1 trauma centre, wheras 17 % worked in a local level 3 centre. The majority (94 %) claimed to treat hypothermia regularly. Only about half of the participants reported to follow a massive transfusion protocol in their institution. The potential components of these protocols were reported in varying rates, being it well-established components (e.g. FFP 78 %; Fibrinogen 75 %) or therapies with poor evidence in multiple trauma (Desmopressin 39 %, rFVIIa 47 %). Calcium was provided by only 48 % of respondents although generally recommended in all guidelines. The current study suggests that in Germany strategies and principles regarding management of trauma-associated coagulopathy are standardized only poorly. Level 1 centres appear to apply a more advanced approach, however to much variability exists with respect to the components of the transfusion protocols. The low response rate indicates that most German trauma surgeons consider coagulation and hemorrhage as "expert-topics" beyond their field of duty.

State of family medicine practice in Lebanon.

PubMed

Helou, Mariana; Rizk, Grace Abi

2016-01-01

Many difficulties are encountered in family medicine practice and were subject to multinational studies. To date, no study was conducted in Lebanon to assess the challenges that family physicians face. This study aims to evaluate the family medicine practice in Lebanon stressing on the difficulties encountered by Lebanese family physicians. A questionnaire was sent to all 96 family medicine physicians practicing in Lebanon. Participants answered questions about characteristics of family medicine practice, evaluation of the quality of work, identification of obstacles, and their effect on the medical practice. The response rate was 59%, and the average number of years of practice was 10.7 years. Physicians complain mainly of heavy load at work, too many bureaucratic tasks, demanding patients, and being undervalued by the specialists. Most physicians are able to adapt between their professional and private life. Despite all the obstacles encountered, Lebanese family physicians have a moderate satisfaction toward their practice. They remain positive and enthusiastic about their profession. Until the ministry of public health revises its current health system, the primary care profession in Lebanon will remain fragile as a profession.

NCAA strength and conditioning coach demographics, current practice trends and common injuries of athletes during strength and conditioning sessions.

PubMed

Waryasz, Gregory R; Daniels, Alan H; Gil, Joseph A; Suric, Vladimir; Eberson, Craig P

2016-10-01

NCAA strength and conditioning coaches are responsible for the day-to-day conditioning and strength training of collegiate athletes. NCAA regulations will likely require all strength and conditioning coaches to have a strength and conditioning certification. NCAA strength and conditioning coaches have varied philosophies on exercise programming based on educational background. The study aims to further evaluate the backgrounds and exercise philosophies of NCAA strength and conditioning coaches. A survey (Survey Monkey®, Palo Alto, CA, USA) was distributed to NCAA strength and conditioning professionals to evaluate their education background, current practice trends, use of specific equipment and footwear, and what injuries occurred during sessions. Of the 208 survey participants, 77.9% were male with an average age of 34.5±9.1 years old. An exercise-related bachelor's degree was held by 80.4% and an exercise-related master's degree by 72.4%. Over 89% had a strength and conditioning certification. Having a master's, bachelor's, or type strength and conditioning certification had no difference in 1-repetition maximal practice with athletes. Lower extremity injuries made up the highest percentage (58.9%) of injuries seen by NCAA Strength and Conditioning Coaches than lumbar spine injuries (16.7%). The five most common injuries reported during workouts were lumbar strain (N.=431, 14.7%), hamstring strain (N.=332, 11.3%), ankle sprain (N.=299, 10.2%), patellar tendonitis (N.=232, 7.9%), and shin splints (N.=226, 7.7%). Collegiate education and certifications have impact on practice patterns of strength and conditioning coaches in the NCAA.

Evaluation of Long-Life Concrete Pavement Practices for Use in Florida

DOT National Transportation Integrated Search

2012-11-01

Current Florida construction practices produce asphalt pavements with a service life of 12 to 20 years before needing rehabilitation; concrete pavements are typically designed for 20 years. However, pavements with much longer design lives are possibl...

Incentives for Research Participation: Policy and Practice From Canadian Corrections

PubMed Central

Forrester, Pamela; Brazil, Amanda; Doherty, Sherri; Affleck, Lindy

2012-01-01

We explored current policies and practices on the use of incentives in research involving adult offenders under correctional supervision in prison and in the community (probation and parole) in Canada. We contacted the correctional departments of each of the Canadian provinces and territories, as well as the federal government department responsible for offenders serving sentences of two years or more. Findings indicated that two departments had formal policy whereas others had unwritten practices, some prohibiting their use and others allowing incentives on a case-by-case basis. Given the differences across jurisdictions, it would be valuable to examine how current incentive policies and practices are implemented to inform national best practices on incentives for offender-based research. PMID:22698018

The effectiveness of a stratified care model for non-specific low back pain in Danish primary care compared to current practice: study protocol of a randomised controlled trial.

PubMed

Morso, Lars; Schiøttz-Christensen, Berit; Søndergaard, Jens; Andersen, Nils-Bo de Vos; Pedersen, Flemming; Olsen, Kim Rose; Jensen, Morten Sall; Hill, Jonathan; Christiansen, David Høyrup

2018-06-08

Prior studies indicate that stratified care for low back pain results in better clinical outcome and reduced costs in healthcare compared to current practice. Stratified care may be associated with clinical benefits for patients with low back pain at a lower cost, but evidence is sparse. Hence this study aims to evaluate the clinical effects and cost-effectiveness of stratified care in patients with non-specific low back pain compared to current practice. The study is a two-armed randomised controlled trial in primary care in the Regions of Southern and Central Denmark (2.5 million citizens). Patients with non-specific low back will be recruited by paticpating GPs. Patients are randomised to either (1) stratified care or (2) current practice at participating physiotherapy clinics. In the stratified care arm, the intervention is based on the patient's STarT Back Tool classification and trained accordingly, whereas physiotherapists in the current pratice arm are blinded to the STarT score. Primary outcomes in the trial will be group differences in time off work, improvement in LBP disability measured by the Roland Morris Disability Questionnaire (RMDQ) and patient-reported global change. Secondary measures will be pain intensity, patient satisfaction, data on patient healthcare resource utilisation and quality-adjusted life year based on the EQ-5D-5L. Stratified care that effectively targets treatment to relevant sub-groups of patients has potentially great impact on the treatment pathways of low back pain. Thus, if effective, this could result in better patient outcomes and at the same time reduce the costs for treatment of low back pain. ClinicalTrials.gov , NCT02612467 . Registered on 16 November 2015.

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

PubMed Central

Teoh, M; Clark, C H; Wood, K; Whitaker, S; Nisbet, A

2011-01-01

Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites. PMID:22011829

Exploring the Impact of WPAs' Leadership at Two-Year Colleges

ERIC Educational Resources Information Center

Loughman, Kyle Sean

2012-01-01

Currently, two-year colleges are teaching the lion's share of college composition classes, mainly consisting of developmental writing and first-year composition courses; however, those same two-year colleges have been slow in embracing the composition theory and practices that are studied and implemented at four-year colleges. One way to…

Are there financial savings associated with supplementing current diagnostic practice for preeclampsia with a novel test? Learnings from a modeling analysis from a German payer perspective.

PubMed

Hadker, Nandini; Garg, Suchita; Costanzo, Cory; van der Helm, Wim; Creeden, James

2013-05-01

To quantify the financial impact of adding a novel serum test to the current diagnostic toolkit for preeclampsia (PE) detection in Germany. A decision-analytic model was created to quantify the economic impact of adding a recently developed novel diagnostic test for PE (Roche Diagnostics, Rotkreuz, Switzerland) to current diagnostic practice in Germany. The model simulated a cohort of 1000 pregnant patients receiving obstetric care and quantified the budget impact of adding the novel test to current German PE detection and management practices. The model estimates that the costs associated with managing a typical pregnancy in Germany are €941 when the novel test is used versus €1579 with standard practice. This represents savings of €637 per pregnant woman, even when the test is used as a supplementary diagnostic tool. The savings are attributed to the novel test's ability to better classify patients relative to current practice, specifically, its ability to reduce false negatives by 67% and false positives by 71%. The novel PE test has the potential to provide substantial cost savings to German healthcare payers, even when used as an addition to standard practice. Better classification of patients at risk for developing PE and declassification of those that are not compared to current practice leads to economic savings for the healthcare system. Furthermore, by reducing the rates of false-positive and false-negative classification relative to current standard of care, the test helps better target healthcare spending and lowers overall costs associated with PE care.

[Description of current hypnosis practice in French university hospitals].

PubMed

Chabridon, G; Nekrouf, N; Bioy, A

2017-10-01

Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Teaching Intercultural Communication in a Basic Technical Writing Course: A Survey of Our Current Practices and Methods

ERIC Educational Resources Information Center

Matveeva, Natalia

2008-01-01

This research article reports the results of an online survey distributed among technical writing instructors in 2006. The survey aimed to examine how we teach intercultural communication in basic technical writing courses: our current practices and methods. The article discusses three major challenges that instructors may face when teaching about…

Cutaneous T cell lymphoma: Current practices in blood assessment and the utility of T-cell receptor Vβ chain restriction

PubMed Central

Gibson, Juliet F; Huang, Jing; Liu, Kristina J; Carlson, Kacie R; Foss, Francine; Choi, Jaehyuk; Edelson, Richard; Hussong, Jerry W.; Mohl, Ramsey; Hill, Sally; Girardi, Sally

2016-01-01

Background Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T cell lymphoma (CTCL) is important for early detection, prognosis, and monitoring disease burden. Objective Determine the spectrum of current clinical practices; critically evaluate elements of current ISCL B1 and B2 staging criteria; and assess the potential role of TCR-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, PPV, and NPV of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture five Yale cohort patients with immunophenotypic abnormalities who later progressed. TCR-Vβ testing was more specific than PCR and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of “modified B1 criteria”: CD4/CD8 ratio ≥5, %CD4+/CD26- ≥ 20%, %CD4+/CD7- ≥ 20%, with evidence of clonality. TCR-Vβ testing should be considered in future diagnostic and staging algorithms. PMID:26874819

Understanding the HighScope Approach: Early Years Education in Practice. Understanding the... Approach

ERIC Educational Resources Information Center

Wiltshire, Monica

2011-01-01

"Understanding the HighScope Approach" is a much needed source of information for those wishing to extend and consolidate their understanding of the HighScope Approach. It will enable the reader to analyse the essential elements of the HighScope Approach to early childhood and its relationship to quality early years practice. Exploring…

K Today: Teaching and Learning in the Kindergarten Year

ERIC Educational Resources Information Center

Gullo, Dominic F., Ed.

2006-01-01

The kindergarten year is quite unlike preschool and not like first grade, either. What should teaching practice look like for this critical year? This book offers a vivid picture of kindergarten children, perceptive discussion of the current kindergarten context and policy issues, and clear guidelines for teaching and assessing kindergartners.…

Black Truffle Harvesting in Spanish Forests: Trends, Current Policies and Practices, and Implications on its Sustainability

NASA Astrophysics Data System (ADS)

Garcia-Barreda, Sergi; Forcadell, Ricardo; Sánchez, Sergio; Martín-Santafé, María; Marco, Pedro; Camarero, J. Julio; Reyna, Santiago

2018-04-01

The European black truffle is a mycorrhizal fungus native to Spanish Mediterranean forests. In most Spanish regions it was originally commercially harvested in the second half of the 20th century. Experts agree that wild truffle yields suffered a sharp decline during the 1970s and 1980s. However, official statistics for Spanish harvest are scarce and seemingly conflicting, and little attention has been paid to the regime for the exploitation of truffle-producing forests and its implications on the sustainability of this resource. Trends in harvest from 1969 to 2013 and current harvesting practices were analyzed as a case study, taking into account that Spain is a major truffle producer worldwide, but at the same time truffles have only recently been exploited. The available statistical sources, which include an increasing proportion of cultivated truffles since the mid-1990s, were explored, with estimates from Truffle Harvesters Federation showing higher consistency. Statistical sources were then compared with proxies for wild harvest (rents from truffle leases in public forests) to corroborate time trends in wild harvesting. Results suggest that black truffle production is recovering in recent years thanks to plantations, whereas wild harvest is still declining. The implications of Spanish legal and institutional framework on sustainability of wild truffle use are reviewed. In the current scenario, the decline of wild harvest is likely to continue and eventually make commercial harvesting economically unattractive, thus aggravating sustainability issues. Strengthening of property rights, rationalization of harvesting pressure, forest planning and involvement of public stakeholders are proposed as corrective measures.

Current UK practices in the management of subacromial impingement.

PubMed

Bryceland, James K; Drury, Colin; Tait, Gavin R

2015-07-01

Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

Measuring Infant and Young Child Complementary Feeding Practices: Indicators, Current Practice, and Research Gaps.

PubMed

Ruel, Marie T

2017-01-01

The publication of the WHO Infant and Young Child Feeding (IYCF) indicators in 2008 equipped the nutrition and broader development community with an invaluable tool for measuring, documenting, and advocating for faster progress in improving these practices in low- and middle-income countries (LMICs). The indicators, with 5 of them focusing on complementary feeding (CF) practices, were originally designed for population level assessment, targeting, monitoring, and evaluation. This chapter takes stock of where we are with the existing CF indicators: it reviews how the indicators have been used, what we have learned, and what their strengths and limitations are, and it suggests a way forward. We find that the indicators have been used extensively for population level assessments and country comparisons, and to track progress. They have also been adopted by researchers in program impact evaluations and in research seeking to understand the determinants and consequences of poor CF practices for child growth and development outcomes. In addition to generating a wealth of knowledge and unveiling the severity of the global problem of poor CF practices in LMICs, the indicators have been an invaluable tool to raise awareness and call for urgent action on improving CF practices at scale. The indicators have strengths and limitations, which are summarized in this chapter. Although enormous progress has been achieved since the indicators were released in 2008, we feel it is time to reflect and revisit the CF indicators, improve them, develop new ones, and promote their appropriate use. Better indicators are critically important to stimulate action and investments in improving CF practices at scale. © 2017 Nestec Ltd., Vevey/S. Karger AG, Basel.

[Materials/Biomaterials in Clinical Practice - a Short Review and Current Trends].

PubMed

Bolle, T; Meyer, F; Walcher, F; Lohmann, C; Jockenhövel, S; Gries, T; Hoffmann, W

2017-04-01

Biomaterials play a major role in interventional medicine and surgery. However, the development of biomaterials is still in its early phases in spite of the huge progress made within the last decades. On the one hand, this is because our knowledge of the molecular and cellular processes associated with biomaterials is still increasing exponentially. On the other hand, a wide variety of advanced materials with highly interesting properties is being developed currently. This review provides a short introduction into the variety of materials in use as well as their application in interventional medicine and surgery. Also the importance of biomaterials for tissue engineering in the field of regenerative medicine and the functionalisation of biomaterials, including sterilisation methods are discussed. For the future, an even broader interdisciplinary scientific collaboration is necessary in order to develop novel biomaterials and facilitate their translation into clinical practice. Georg Thieme Verlag KG Stuttgart · New York.

Complexities Involved in Mentoring Towards a High-Leverage Practice in the Induction Years

ERIC Educational Resources Information Center

Stanulis, Randi N.; Brondyk, Susan K.

2013-01-01

Background/Context: For years mentoring has been promoted as an essential element of effective induction programs. Since research reports of the impact of mentoring have been uneven, it is critical to closely examine the complex aspects that could affect the ways teachers enact ideas into the practice of mentoring. This study is about mentor…

A 20-Year High-Resolution Wave Resource Assessment of Japan with Wave-Current Interactions

NASA Astrophysics Data System (ADS)

Webb, A.; Waseda, T.; Kiyomatsu, K.

2016-02-01

Energy harvested from surface ocean waves and tidal currents has the potential to be a significant source of green energy, particularly for countries with extensive coastlines such as Japan. As part of a larger marine renewable energy project*, The University of Tokyo (in cooperation with JAMSTEC) has conducted a state-of-the-art wave resource assessment (with uncertainty estimates) to assist with wave generator site identification and construction in Japan. This assessment will be publicly available and is based on a large-scale NOAA WAVEWATCH III (version 4.18) simulation using NCEP and JAMSTEC forcings. It includes several key components to improve model skill: a 20-year simulation to reduce aleatory uncertainty, a four-nested-layer approach to resolve a 1 km shoreline, and finite-depth and current effects included in all wave power density calculations. This latter component is particularly important for regions near strong currents such as the Kuroshio. Here, we will analyze the different wave power density equations, discuss the model setup, and present results from the 20-year assessment (with a focus on the role of wave-current interactions). Time permitting, a comparison will also be made with simulations using JMA MSM 5 km winds. *New Energy and Industrial Technology Development Organization (NEDO): "Research on the Framework and Infrastructure of Marine Renewable Energy; an Energy Potential Assessment"

Examining a conceptual model of parental nurturance, parenting practices and physical activity among 5-6 year olds.

PubMed

Sebire, Simon J; Jago, Russell; Wood, Lesley; Thompson, Janice L; Zahra, Jezmond; Lawlor, Deborah A

2016-01-01

Parenting is an often-studied correlate of children's physical activity, however there is little research examining the associations between parenting styles, practices and the physical activity of younger children. This study aimed to investigate whether physical activity-based parenting practices mediate the association between parenting styles and 5-6 year-old children's objectively-assessed physical activity. 770 parents self-reported parenting style (nurturance and control) and physical activity-based parenting practices (logistic and modeling support). Their 5-6 year old child wore an accelerometer for five days to measure moderate-to-vigorous physical activity (MVPA). Linear regression was used to examine direct and indirect (mediation) associations. Data were collected in the United Kingdom in 2012/13 and analyzed in 2014. Parent nurturance was positively associated with provision of modeling (adjusted unstandardized coefficient, β = 0.11; 95% CI = 0.02, 0.21) and logistic support (β = 0.14; 0.07, 0.21). Modeling support was associated with greater child MVPA (β = 2.41; 0.23, 4.60) and a small indirect path from parent nurturance to child's MVPA was identified (β = 0.27; 0.04, 0.70). Physical activity-based parenting practices are more strongly associated with 5-6 year old children's MVPA than parenting styles. Further research examining conceptual models of parenting is needed to understand in more depth the possible antecedents to adaptive parenting practices beyond parenting styles. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Towards an Understanding of Factors Influencing Early Years Professionals' Practice of Consultation with Young Children

ERIC Educational Resources Information Center

Davies, Sarah; Artaraz, Kepa

2009-01-01

Recent Government agendas in England highlight a need to involve children in policy and service design, provision and evaluation of services they use or which affect them. While consultation with older children has become more common, this is not the case for younger children. This article reports on a study exploring the current practice and…

An examination of current practices and gender differences in strength and conditioning in a sample of varsity high school athletic programs.

PubMed

Reynolds, Monica L; Ransdell, Lynda B; Lucas, Shelley M; Petlichkoff, Linda M; Gao, Yong

2012-01-01

Currently, little is known about strength and conditioning programs at the high school level. Therefore, the purpose of this research was to explore current practices in strength and conditioning for varsity high school athletes in selected sports. The following were specifically examined: who administers programs for these athletes, what kinds of training activities are done, and whether the responsible party or emphasis changes depending on the gender of the athletes. Coaches of varsity soccer, basketball, softball, and baseball in 3 large Idaho school districts were asked to complete an online survey. Sixty-seven percent (32/48) of the questionnaires were completed and used for the study. The majority of coaches (84%) provided strength and conditioning opportunities for their athletes, although only 37% required participation. Strength training programs were designed and implemented primarily by either physical education teachers or head coaches. Compared with coaches of male athletes, coaches of female athletes were less likely to know the credentials of their strength coaches, and they were less likely to use certified coaches to plan and implement their strength and conditioning programs. Most programs included dynamic warm-ups and cool-downs, plyometrics, agility training, speed training, and conditioning, and most programs were conducted 3 d·wk(-1) (76%) for sessions lasting between 30 and 59 minutes (63%). Compared with their female counterparts, male athletes were more likely to have required training, participate in strength training year round, and train using more sessions per week. This study provides additional information related to the practice of strength and conditioning in a sample of high school athletic teams.

Effectiveness of an Online Educational Module in Improving Evidence-Based Practice Skills of Practicing Registered Nurses.

PubMed

Moore, Lora

2017-10-01

Implementation of evidence-based practice (EBP) at the bedside has been difficult to achieve. Significant gaps between current research and actual practice have been identified and must be addressed in effort to increase utilization of EBP. The purpose of this study was to evaluate the efficacy of an online EBP educational intervention and to examine the relationship between educational preparation and years of nursing experience on nurses' practice, attitudes, and knowledge and skills of EBP. An experimental pretest-posttest design study with three randomized groups utilizing the EBPQ instrument was conducted. No significant differences were noted in EBPQ subscale scores of practice, attitude, or knowledge and skills from pre- to posttest. In addition, no statistical difference in EBPQ subscale scores regarding educational preparation or years of experience were noted. While nurses report positive attitudes toward EBP, their perceptions of practice and knowledge and skills score much lower. Educational interventions are needed for practicing nurses to overcome this knowledge deficit to successfully implement EBP. However, the use of online, independent, computer-based learning modules, while cost-efficient and offer several benefits when educating nurses, may not necessarily be the most effective method for teaching EBP knowledge and skills to practicing nurses. © 2017 Sigma Theta Tau International.

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

PubMed Central

Borrell-Carrió, Francesc; Suchman, Anthony L.; Epstein, Ronald M.

2004-01-01

The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientific clinical method, while suggesting 3 clarifications: (1) the relationship between mental and physical aspects of health is complex—subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician-patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientific laws, as the term “new paradigm” would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient. PMID:15576544

Paediatric dental chair sedation: An audit of current practice in Gauteng, South Africa.

PubMed

Bham, F; Perrie, H; Scribante, J; Lee, C-A

2015-06-01

Procedural sedation and analgesia (PSA) is often required to perform dental procedures in children. Serious adverse outcomes, while rare, are usually preventable. To determine the proportion of dental practitioners making use of paediatric dental chair PSA in Gauteng Province, South Africa, describe their PSA practice, and determine compliance with recommended safety standards. A prospective, contextual, descriptive study design was used, with 222 randomly selected dental practitioners contacted to determine whether they offered paediatric dental chair PSA. Practitioners offering PSA were then asked to complete a web-based questionnaire assessing their practice. Of the 213 dental practitioners contacted, 94 (44.1%; 95% confidence interval 37 - 51) provided PSA to children. Most patients were 1 - 5 years old, although there were practices that offered PSA to infants. While most procedures were performed under minimal to moderate sedation, deep sedation and general anaesthesia were also administered in dental rooms. Midazolam was the most frequently used sedative agent, often in conjunction with inhaled nitrous oxide; 28.1% of PSA providers administered a combination of three or more agents. Presedation patient assessment was documented in 83.0% of cases, and informed consent for sedation was obtained in 75.6%. The survey raised several areas of concern regarding patient safety: 41.3% of dental practices did not use any monitoring equipment during sedation; the operator was responsible for the sedation and monitoring of the patient in 41.3%; 43.2% did not keep any recommended emergency drugs; and 19.6% did not have any emergency or resuscitation equipment available. Most respondents (81.8%) indicated an interest in sedation training. Paediatric dental chair PSA was offered by 44.1% of dental practitioners interviewed in Gauteng. Modalities of PSA provided varied between practices, with a number of safety concerns being raised.

Renal biopsies in children: current practice and audit of outcomes.

PubMed

Hussain, Farida; Mallik, Meeta; Marks, Stephen D; Watson, Alan R

2010-02-01

There is considerable variation in the way that children are prepared for and the techniques employed in a renal biopsy. There was national agreement between UK paediatric renal centres to review current practice and audit outcomes An initial questionnaire survey was undertaken and a 12-month prospective audit performed of renal biopsies against agreed standards for the number of needle passes, adequacy of biopsy material and complication rates. Eleven of 13 centres participated. Information leaflets are sent pre-biopsy in five centres with only one using play preparation. Six of 11 routinely perform biopsies as day-case (DC) procedures and 6 use general anaesthesia (GA). Real-time ultrasound is the favoured method in eight centres. Biopsies are performed by nephrologists only in four centres, nephrologists with radiologists in five and radiology alone in two. Of 531 biopsies (352 native), 31% were performed as a DC with 49% being done under GA. The standard for the number of passes of native kidneys (95%). The major complication rate was higher than the standard of practice with limited use of preparation materials and DC procedures. The results have stimulated constructive debate about preparation and indications for biopsy and training issues. The audit enables centres and individuals to monitor performance.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice.

PubMed

Franks, Peter J; Barker, Judith; Collier, Mark; Gethin, Georgina; Haesler, Emily; Jawien, Arkadiusz; Laeuchli, Severin; Mosti, Giovanni; Probst, Sebastian; Weller, Carolina

2016-06-01

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic

Current Status and Future Suggestions for Improving the Pharm. D Curriculum towards Clinical Pharmacy Practice in Pakistan

PubMed Central

Malhi, Saima Mahmood; Ajmal, Kiran; Shamim, Sumbul; Ata, Saniya; Farooq, Salman; Sharib, Syed Muhammad; Muntaha, Sidrat-ul

2017-01-01

Objectives & Background: Good curriculum is reflected as the backbone for standard universities to develop competitive professionals having great potential. Pharmacy education in Pakistan has gone through the same developmental stages as in other countries, but is still striving for improvement. In the present study, we want (i) to know the opinion on whether the current pharmacy curriculum requires any improvement in order to meet the training needs of pharmacy professionals regarding clinical knowledge and pharmacy practice; and (ii) to present some humble suggestions to decision-making authorities in order to improve it with respect to patient-focused programs (PFP). Methods: The study was conducted in two sessions. In first session, a questionnaire was distributed to pharmacy students of eight public/private sector universities of Karachi (N = 354) offering Pharm. D degrees. The second session dealt with the pharmacy teachers, deans, and practicing pharmacists in health care facilities (who are in any ways also related to academia), in order to take their opinions on and suggestions for the development of a better Pharm. D curriculum (N = 135). Results: Our results showed that 75.2% of respondents agree that the Pharm. D curriculum does not meet the international standards of practice, and 88.4% of respondents support the addition of more clinical aspects than industrial ones, as Pharm. D could be both clinically and industrially oriented, according to the needs of the Pakistani people. Furthermore, 80.2% of respondents are of the view that an apprenticeship should be included in last two years, while 88.4% demand a ‘paid residency program’ to facilitate the hospital, clinical and compounding areas of pharmacy. In addition, we also received a number of verbal suggestions for improving the Pharm. D curriculum being followed in Pakistan. Discussion & Conclusions: We conclude that our Pharm. D curriculum needs additions in terms of clinical practice by

General practice--reflection on five years of multidisciplinary training at Medical Centre Gütersloh.

PubMed

van den Heuvel, H G J

2011-12-01

Medical Centre Gütersloh is a primary care setting which provides the full range of general practice care for British Forces Germany Health Service (BFG HS). The aim of this article is to evaluate the multidisciplinary training organised by the author there, to exchange information and to provide suggestions for improvement and development. Description of the training scheme and analysis of routinely collected management data. The training scheme is based on adult education principles with a focus on interactive learning. Over the period November 2005-July 2010 a total of 1201 members of staff from various disciplines participated in 86 documented training sessions. The majority of the attending staff considered the training to be relevant, interesting and well presented. A substantial proportion indicated that they would change their practice as a result of the training. These views remained stable over time. The majority of facilitators consisted of medical centre employees. This article provides an overview onfive years of multidisciplinary training in a general practice setting. Overall feedback from staff suggests that the training has been highly valued over those years. However, it is recognised that this evaluation has its limitations and suggestions are made regarding how these types of training schemes can be improved and developed further.

Cultivar and Year Rather than Agricultural Practices Affect Primary and Secondary Metabolites in Apple Fruit

PubMed Central

Renard, Catherine M. G. C.; Plenet, Daniel; Gautier, Hélène; Touloumet, Line; Girard, Thierry; Simon, Sylvaine

2015-01-01

Many biotic and abiotic parameters affect the metabolites involved in the organoleptic and health value of fruits. It is therefore important to understand how the growers' decisions for cultivar and orchard management can affect the fruit composition. Practices, cultivars and/or year all might participate to determine fruit composition. To hierarchize these factors, fruit weight, dry matter, soluble solids contents, titratable acidity, individual sugars and organics acids, and phenolics were measured in three apple cultivars (‘Ariane’, ‘Melrose’ and ‘Smoothee’) managed under organic, low-input and conventional management. Apples were harvested at commercial maturity in the orchards of the cropping system experiment BioREco at INRA Gotheron (Drôme, 26) over the course of three years (2011, 2012 and 2013). The main factors affecting primary and secondary metabolites, in both apple skin and flesh, were by far the cultivar and the yearly conditions, while the management system had a very limited effect. When considering the three cultivars and the year 2011 to investigate the effect of the management system per se, only few compounds differed significantly between the three systems and in particular the total phenolic content did not differ significantly between systems. Finally, when considering orchards grown in the same pedoclimatic conditions and of the same age, instead of the usual organic vs. conventional comparison, the effect of the management system on the apple fruit quality (Fruit weight, dry matter, soluble solids content, titratable acidity, individual sugars, organic acids, and phenolics) was very limited to non-significant. The main factors of variation were the cultivar and the year of cropping rather than the cropping system. More generally, as each management system (e.g. conventional, organic…) encompasses a great variability of practices, this highlights the importance of accurately documenting orchard practices and design beside the

Sixty years of fear appeal research: current state of the evidence.

PubMed

Ruiter, Robert A C; Kessels, Loes T E; Peters, Gjalt-Jorn Y; Kok, Gerjo

2014-04-01

Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered. © 2014 The Authors. International Journal of Psychology published by John Wiley © Sons Ltd on behalf of International Union of Psychological Science.

Evaluation of Long-Life Concrete Pavement Practices for Use in Florida : [Summary

DOT National Transportation Integrated Search

2012-01-01

Current Florida construction practices produce asphalt pavements with a service life of 12 to 20 years before needing rehabilitation; concrete pavements are typically designed for 20 years. However, pavements with much longer design lives are possibl...

Evaluation of a 3year intervention to increase adoption of safer nursery crop production practices.

PubMed

Chapman, Larry J; Newenhouse, Astrid C; Karsh, Ben-Tzion