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PubMed2004

Developing observational measures of performance in surgical teams.

Team performance is increasingly recognised as an essential foundation of good surgical care and a determinant of good surgical outcome. To understand team performance and to develop team training, reliable and valid measures of team performance are necessary. Currently there is no firm consensus on how to measure teamwork, partly because of a lack of empirical data to validate measures. The input-process-output model provides a framework for surgical team studies. Objective observational measures are needed in surgery as a basis for interdisciplinary team assessment and training. The "observational teamwork assessment for surgery" (OTAS) tool assesses two facets of the surgical process. Observer 1 monitors specific tasks carried out by team members, under the categories patient, environment, equipment, provisions, and communications. Observer 2 uses a behavioural observation scale to rate behaviour for the three surgical phases (pre-operative, operative, and post-operative) with components of teamwork: cooperation, leadership, coordination, awareness, and communication. Illustrative data from an initial series of 50 cases is presented here. The OTAS tool enables two independent observers, a surgeon and psychologist, to record detailed information both on what the theatre team does and how they do it, and has the potential to identify constraints on performance that might relate to surgical outcome.

Humans↗

PubMed2003

The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital.

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. METHODS: Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003. RESULTS: In a 4-week period, 19 individuals developed SARS, including 11 health care workers. The hospital's response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients. INTERPRETATION: The hospital's response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.

Anti-Inflammatory Agents↗

PubMed1989

Randomized controlled trial of an educational booklet for patients presenting with back pain in general practice.

A randomized controlled trial was used to evaluate an educational booklet on back pain for patients presenting to five group practices during one calendar year. The booklet had no immediate effect on consultations for back pain, but in the period from two weeks to one year after presentation significantly fewer patients in the group receiving the booklet consulted with back pain (35.6%) than in the control group (42.2%) (P less than 0.05). There were no significant differences between the booklet and control groups in certified absence from work owing to back pain. Referral to hospital, referral to physiotherapy, admissions to hospital and laminectomies were all less common in the booklet group. The reduction in the combined referral rate to physiotherapy and hospital, and the reduction in laminectomy rate almost reached statistical significance at the 5% level. In replying to a questionnaire sent one year after entry to the study 94.1% of respondents in the booklet group said that they had read the book, 84.0% said that they found it useful, and 68.0% said that they still had a copy. Scores on a 15-item test of knowledge about back pain were significantly higher in the group of patients who had received the booklet than in the control group. The results suggest that the booklet had some effect in altering both the knowledge and behaviour of patients with back pain. The provision of an educational booklet was a method of giving information which was appreciated by both patients and doctors.

Adult↗

PubMed1987

[Normalized living--an accident? A study of the Task Force on Normalized Living on nursing homes and group care departments of nursing homes].

This article describes a research project in 17 long-stay geriatric wards (13 psychogeriatric nursing homes and 4 special wards in old people's homes), designed to establish the proportion of residents which could be capable of living in experimental, normalized nursing homes. We used an existing group of residents, living in normalized care provisions, that belong to a nursing home in the Netherlands as a reference group. In two ways we tried to answer the research question. First we applied the criteria for selection of the normalized care provisions to our random sample. In the nursing homes, 8.6% of the residents conformed to all requirements. In the old people's homes, this percentage was 10.7%. These requirements are very strict, regarded the fact that in the experimental homes six months after admission only 65% of the inhabitants met all criteria. Second, we tried to establish the overlap between the long-stay geriatric wards and the normalized, experimental care provisions. For this purpose we used the behaviour observation scale 'Observation Psychogeriatrics' (OPG). With regard to their level of impairment, 11.6% of the nursing home residents were comparable to the experimental residents. In the special wards of the old people's homes this percentage was 14.6%. The result of both methods are the same. This study proves, that the experimental homes are a serious alternative, and that the traditional psychogeriatric long-stay wards all contain a number of residents for whom alternative ways of care are possible.

Activities of Daily Living↗

PubMed1997

Providing nursing care for a patient with borderline personality disorder on an acute inpatient unit: a phenomenological study.

This paper presents the findings of a study that used a phenomenological framework to examine the experience of six nurses who had provided inpatient care to a patient with borderline personality disorder, exhibiting active self-harming behaviours. The nurses' experiences of providing care were considered as being unsure, being in conflict, struggling to make sense of the patient's experience, and being traumatized. Difficulties were related to both the patient's behaviour and the organizational demands of care provision. The study highlighted the need for: education about the disorder and its treatment; comprehensive models of care; guidelines for nursing interventions; and supervision of staff.

Adult↗

PubMed1998

Protection against solar ultraviolet radiation.

Interest in protection against solar ultraviolet radiation (UVR) among the general public in Australia has been increasing steadily as a result of the 'SunSmart' campaigns run by the various state cancer councils. This increasing awareness is due in part to the requirements for occupational protection of outdoor workers and to provision of UVR protection for the recreational market. Behaviour outdoors can significantly affect exposure to solar UVR and use of items of personal protection can provide a substantial reduction in the UVR dose received. The protective properties of sunscreens, sunglasses, hats and clothing against UVR have been the subject of considerable research for some time, and over the last few years interest has extended to the provision of shade structures and the UVR protection provided by various commonly used materials. These materials include shadecloth, plastics, glass, windscreens and applicable tints. Australia has rigorous standards covering protection and UVR, in particular for sunscreens [Standards Australia/Standards New Zealand, Sunscreen products-evaluation and classification, Report No. AS 2604, Sydney/Wellington, 1993.], sunglasses [Standards Australia, Sunglasses and fashion spectacles-nonprescription types, Report No. AS 1067.1, Sydney, 1990.], protective eyewear [Standards Australia/Standards New Zealand, Eye protectors for industrial applications, Report No. AS/NZS 1337, Sydney/Wellington, 1992.] and shadecloth [Standards Australia, Synthetic shadecloth, Report No. AS 4174, Sydney, 1994.]. Compliance with the sunglass standard became mandatory in 1988 and UVR protection provided by sunglasses has increased substantially since then. In July 1996 a standard on 'sun protective textiles' [Standards Australia/Standards New Zealand, Sun protective clothing-evaluation and classification, Report No. AS/NZS 4399, Sydney, 1996.] incorporating ultraviolet protection factors (UPFs) and a rating scheme with protection categories, was introduced; this was the first of its kind in the world. Australian Radiation Laboratory (ARL) UPF swing tags with UVR protection advice from the Australian Cancer Society on the reverse side are used to denote the amount of protection against solar UVR provided by clothing. To date in excess of 5 million ARL swing tags have been issued. Work on the various standards is continuing. The maximum allowed 'sun protection factor' (SPF) limit for sunscreens may be increased to SPF 30 + in the near future, and additions to the sun protective textiles standard are also planned. This paper discusses measurement methods, results, the rationale used in formulating the Australian Standards and the current state of UVR protection in Australia.

Australia↗

PubMed1997

The response of group-housed baboons to three enrichment toys.

The behaviour of group-housed baboons was compared before and after the provision of durable cage toys. One adult male hamadryas baboon and 13 adult female olive baboons living in a large enclosure were observed after they were given seven nylon bones, seven Kong toys and seven Plaque Attackers. Observations were conducted four times per week on each subject over a 6-week period. Abnormal, cage-directed, inactive and self-directed behaviours all significantly decreased after the provision of the toys, while enrichment-directed activities significantly increased. Aggression did not differ between the no toy and toy conditions. Approximately 26% of the baboons were using the toys at any one time, and use of the Kong toys and the bones was higher than that of the Plaque Attackers. Individuals who used enrichment structures already present were also those who used the new toys the most.

Aggression↗

PubMed1984

An environmental model for sows: materializing physical and behavioural needs.

Animals experience welfare when their behavioural and physical needs are fulfilled. To enable an animal to show all kinds of behavioural patterns, the environment has to meet certain requirements. Satisfying physical needs generally results in good health. This also implies certain environmental characteristics. Behavioural and physical needs can therefore be translated into environmental characteristics, which constitute an environmental model. When it can be decided to what extent certain needs are essential for the animals, the necessity that certain environmental provisions are available within the animals environment can be derived. Essential needs correspond with provisions. These provisions should, from an animal welfare point of view, be available and together constitute a minimum environmental model. In this paper an attempt is made to draw up an environmental model for sows. Provisions are such that the occurrence of aberrations in behaviour and health should, to a large extent, be prevented. Therefore a lying area, space to walk, a feeding place, food, a dunging area, and stimuli for exploration are included in the model. Climatic conditions are favourable, and social behaviour, comfort behaviour and exploratory behaviour can be carried out. By comparing existing housing systems with this model, it is easy to find out whether minimal welfare requirements are met, and if improvements are thought to be necessary and in what direction these should be sought.

Animal Feed↗

PubMed1998

International nurse education: implications for providers.

This exploratory study conducted in 1996 described the profiles, roles and preparation of twelve South Australian registered nurses in relation to their provision of education programs for nurses from South East Asia. The research showed respondents were well qualified and highly experienced educators whose roles were complex. Their preparation for providing education programs for nurse from South East Asia had been haphazard and inadequate. Consequently respondents considered they were not fully prepared for the providing this specialised education. Career planning and a more strategic approach to the development of specific expertise are essential to support an international approach to nurse education. Nurse education that values intercultural awareness, and is multicultural and global would benefit both local and international students. Development of germane knowledge, skill, attitudes and behaviours is recommended to ensure excellence in the provision of international nurse education. An action research model is proposed as an alternative to traditional professional development to prepare providers of international education.

Asia, Southeastern↗

PubMed2001

The cost effectiveness of specialised facilities for service users with persistent challenging behaviours.

Little systematic research relates specifically to the last people to leave a psychiatric hospital at the end of a closure programme. The long-running evaluation of the reprovision of services from Friern Hospital in North London allowed a special study to be made of such a group (67 people in all), whose range of problem behaviours made placement in community settings most difficult. The patients were relatively young, with a shorter length of stay than the remainder of the former long-stay hospital population. They were assessed three times: before leaving Friern, and one and 5 years after relocation. The social and clinical characteristics of each person were measured, and the full costs of their care calculated. The "difficult-to-place" patients moved to four highly staffed rehabilitation facilities, where the total cost of their care was, on average, 1230 UK pounds per week. There was no overall change in their psychiatric state over the 5 years after they left Friern Hospital although, in the longer-term, they gained skills in several areas of daily functioning. Most importantly, there was a fall of almost 50% in the number of challenging behaviours exhibited by the study group. At the five-year follow-up point, the cost of care had fallen, on average, by 170 UK pounds per week, and 24 people had been able to move to more independent accommodation arrangements. Study participants had gained a new network of community service contacts, and used services provided by a greater variety of agencies. The indicators suggest that high expenditure on alternative care was justified retrospectively by overall long-term outcomes. An important policy lesson from the Friern Hospital reprovision study is that adequate funds should be reserved until the end of the closure programme to allow the investment of resources in provision for patients with the most severe problem behaviours.

Adult↗

PubMed2003

Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy.

The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

Antihypertensive Agents↗

PubMed2002

The feasibility of integrated STI prevalence and behaviour surveys in developing countries.

BACKGROUND: In countries where STI/HIV prevalence data and behavioural data are scarce UNAIDS second generation HIV surveillance guidelines recommend measuring STI/HIV prevalence and risk behaviours in vulnerable populations but do not recommend conducting these surveys concurrently because of concerns about participation rates, cost, and provision of services. OBJECTIVES: To assess the feasibility of conducting a national combined STD prevalence and behaviour survey in Mali among vulnerable populations with the intention of institutionalisation. METHODS: From March to June 2000 an integrated STI prevalence and behaviour survey was conducted using cluster sampling among five risk groups in four sites in Mali, west Africa. 2229 individuals in non-traditional settings such as taxi/bus stations, market areas, households, and brothels participated in any one or all components of the study: (1) behavioural questionnaire, (2) urine sample for Neisseria gonorrhoeae (GC)/Chlamydia trachomatis (CT) testing, (3) a fingerstick drop of blood for syphilis, and/or (4) HIV testing. RESULTS: High participation rates of 84%-100% were achieved despite specimen collection and HIV testing. Rates fell only slightly when participants were asked to provide biological samples and participants were more likely to provide urine than blood. Rates among the different groups for HIV and syphilis testing are similar and suggest that refusal was most probably because of a reluctance to give blood rather than because of HIV testing. The cost of the biological component added approximately $30 per participant. Included in the $30 are the costs of training, participant services, laboratory personnel and supplies, STI drugs, and STI testing costs. The total cost of the survey was $154,905. Biomarkers aided in validation of answers to behavioural questions. Consenting individuals received HIV pretest and post-test counselling and referral to a trained health provider for treatment of STI and the provision of services provided the framework for interventions in the groups following the survey. CONCLUSION: This represents an effective methodology for collecting risk behaviour and STI/HIV prevalence information concurrently and should be considered by countries expanding STI/HIV surveillance as part of UNAIDS second generation HIV surveillance.

Automobile Driving↗

PubMed2006

Issues of choice and control in the behaviour of a pair of captive polar bears (Ursus maritimus).

Stereotyped behaviour occurs in a wide variety of captive animals including ursids. The provision of animal control over aspects of their environment by providing choices is a critical element for improving welfare. The behaviour of two sibling polar bears at a metropolitan zoo was examined to investigate the effect of providing access to their indoor, off-exhibit holding space. Both bears demonstrated behavioural changes when given the choice to access their indoor dens including decreased stereotyped behaviours and increased social play. These results, although based on just two bears, provide additional support for the assertion that choice and control are closely tied to issues of well-being for captive animals.

Animals↗

PubMed2000

Tuberculosis in Pakistan: socio-cultural constraints and opportunities in treatment.

This study explores the extent to which factors related to individuals, the care provision process, and the cultural context influence the behaviour of tuberculosis patients attending TB clinics in rural Pakistan, and examines the effects of disease on their personal lives. Thirty-six patients attending three TB treatment clinics were interviewed in depth. These patients were stratified by stage of treatment (treatment proceeding, treatment completed, default), sex and by rural/urban status. Results indicate that the majority of patients were very poor, but nonetheless initially chose to attend private practitioners. Normally their disease was correctly diagnosed as tuberculosis only after repeated visits to a succession of health care providers. Patients' knowledge about their disease was limited, and doctors gave incorrect or only very limited health education. Most patients reported dissatisfaction with care provided. Almost all patients reported problems with access to treatment, both in terms of time and money; this was particularly true of women, whose freedom to travel in Pakistan is limited. Potential causes of default appeared to be more closely linked to deficiencies in treatment provision rather than patients' unwillingness to comply. Largely because of a perception that TB was incurable, respondents were generally unwilling to disclose that they were undergoing or had undergone TB treatment. For reasons related to confidential access to treatment, this could lead to default, perpetuating the perception of incurability, and hence causing a vicious circle. For TB programmes to be successful in Pakistan, it is essential that this circle is broken; and this can only be done through provision of good quality TB care and education to improve the population's understanding that TB can be cured. In addition, patients' unwillingness to disclose to health care providers that they had already received previous treatment meant that many patients were prescribed incorrect treatment regimes, potentially leading to the emergence of drug-resistant TB. In common with other researchers' findings, no clear differences were found between those who had completed treatment and those who had defaulted from treatment. This study was performed to provide information to assist the researchers to design potential TB treatment delivery strategies, and has proved invaluable for this purpose. Strategies based on findings from the study are currently being assessed using a randomised controlled trial.

Adolescent↗

PubMed2004

Long-term effects of husbandry procedures on stress-related parameters in male mice of two strains.

In socially unstable groups of male laboratory mice, individuals may experience a chronic stress situation. Previous experiments have shown that the transfer of specific olfactory cues during cage cleaning, and the provision of nesting material decrease aggression and stress in group-housed male mice. In this study, the combined effect of these husbandry procedures were tested for their long-term effect on stress in groups of moderately aggressive (BALB/c) and severely aggressive (CD-1) male mice. The physiological and behavioural stress-related parameters used were body weight, food and water intake, spleen and thymus weight, adrenal tyrosine hydroxylase activity, urine corticosterone levels and behaviour in a cage emergence test. Long-term provision of nesting material and its transfer during cage cleaning was found to influence several stress-related physiological parameters. Mice housed in cages enriched with nesting material had lower urine corticosterone levels and heavier thymuses, and they consumed less food and water than standard-housed mice. Furthermore, marked differences were found between strains. CD-1 mice were less anxious in the cage emergence test, weighed more, ate and drank more, and had heavier thymuses but lighter spleens and lower corticosterone levels than BALB/c mice. We conclude that the long-term provision of nesting material, including the transfer of nesting material during cage cleaning, reduces stress and thereby enhances the welfare of laboratory mice.

Agonistic Behavior↗

PubMed1986

School-based programmes for the prevention of drinking and driving: issues and results.

In an effort to decrease alcohol-related driving accidents and fatalities among youth, many school-based programmes to prevent drinking and driving have been developed. These programmes would seem to have many important advantages, including being able to foster appropriate attitudes and behaviours at critical times before and during the formation of driving behaviours and drinking behaviours. The didactic assumptions of these programmes are examined in this paper, and evaluations are reviewed. Programmes based on accurate provision of information and non-threatening attempts to change attitudes, and on behavioural peer intervention techniques, consistently demonstrate knowledge gains, and in some cases appropriate changes in attitudes and self-reported behaviours, immediately following programme exposure. These effects often tend to dissipate with time. Since the impact of these programmes on traffic safety measures has not been examined, their development should be carefully monitored and evaluated until traffic safety benefits can be documented.

Accident Prevention↗

PubMedDate not supplied

Educational provision for children with specific speech and language difficulties: perspectives of speech and language therapy service managers.

BACKGROUND: Children with specific speech and language difficulties (SSLD) pose a challenge to the education system, and to speech and language therapists who support them, as a result of their language needs and associated educational and social-behavioural difficulties. The development of inclusion raises questions regarding appropriate provision, whether the tradition of language units or full inclusion into mainstream schools. AIMS: To gather the views of speech and language therapy service managers in England and Wales regarding approaches to service delivery, terminology and decision-making for educational provision, and the use of direct and indirect (consultancy) models of intervention. METHOD AND PROCEDURES: The study reports on a national survey of speech and language therapy (SLT) services in England and Wales (129 respondents, 72.1% response rate) and interviews with 39 SLT service managers. OUTCOMES AND RESULTS: Provision varied by age group with support to children in the mainstream common from pre-school to the end of Key Stage 2 (up to 11 years), and to those in designated specialist provision, common at Key Stages 1/2 (ages 5-11 years), but less prevalent at Key Stages 3/4 (11-16 years). Decision-making regarding provision was influenced by the lack of common terminology, with SSLD and specific language impairment (SLI) the most common, and criteria, including the use of the discrepancy model for defining SSLD. Practice was influenced by the difficulties in distinguishing children with SSLD from those with autistic spectrum disorder, and difficulties translating policies into practice. CONCLUSIONS: The implications of the study are discussed with reference to SLT practice, including consultancy models, and the increasingly prevalent policy in local education authorities of inclusion of children with special educational needs.

Attitude of Health Personnel↗

PubMed2004

Challenges and opportunities for promoting physical activity in the workplace.

Although there would appear to be considerable potential for improving the health, productivity and quality of life of the Australian workforce through workplace physical activity (PA) promotion programs, the scientific evidence that such programs are effective is limited. This review appraises the quality of intervention studies conducted since 1997. Most studies included volunteer participants, who were either sufficiently motivated to change their behaviour or already active. Interventions that focused on corporate-fitness type programs and the provision of generic health education programs were not effective in terms of adequate participation rates and sustained behaviour change. The more successful individually-based programs were those which tailored materials to individual needs. The greatest potential for influencing the overall workforce appeared to be programs that included less 'organised' approaches and promoted incidental PA within and around the workplace. Future programs should; incorporate contemporary theories of behaviour and organisational change; emphasise linkages between the workplace and external settings; expand the profile of programs to address workplace culture; and encourage management support for behavioural adjustments to the organisation. There is a need for greater understanding and evaluation of desirable employer-related outcomes, such as reduced absenteeism, job stress and turnover and improved productivity and job satisfaction, coupled with the exploration of how these factors may relate to PA promotion and adoption. Finally, more in-depth evaluation strategies and complete descriptions of intervention programs are required, in order to identify the most effective strategies.

Exercise↗