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PubMed2001

Reflective practice and clinical outcomes: practitioners' views on how reflective practice has influenced their clinical practice.

There has been a recent increasing interest in reflective practice in nursing. There is a wealth of literature about its apparent advantages and benefits, but very little empirical research into clinical outcomes consequent to reflective practice. This study attempts an initial exploration into this area. A retrospective, three-phase, multi-method study in a single department of nursing was conducted. The research sample comprised students and former students of the department who had previously participated in an assessed reflective practice course or module. Years of experience, speciality or academic level did not have a significant influence, but the effectiveness of the facilitator was an important factor. The results suggest that reflective practice is regarded highly and that most respondents could identify significant, long-term changes to clinical practice resulting from it.

Attitude of Health Personnel↗

PubMed1985

Practice variability and children's motor behavior.

This research investigated Schmidt's variability-of-practice prediction and the breadth-of-a-movement class. Schmidt's hypothesis was tested by varying the parameters of ball and distance in overarm throwing. Breadth-of-a-movement class was tested by employing two novel tasks not previously used in variability-of-practice designs. 203 kindergarten and first-grade subjects were randomly assigned to one of four conditions, three experimental and one control. Experimental subjects performed 45 trials in their respective training conditions, weight, distance, weight/distance, in one session. Two novel striking tasks were administered to all subjects pre- and posttest to assess the variability-of-practice hypothesis, and the generalizability of overarm throwing and striking. Variability-of-practice in the overarm throw appeared to strengthen the striking schemas of the kindergarten boys. Results suggest some support for the inclusion of throwing and striking in a single-movement class. The concept, breadth of movement class, however, requires further study.

Child↗

PubMed2006

The impact of formal education and training on urodynamic practice in the United Kingdom: a survey.

AIM: A previous survey of personnel performing urodynamics had shown that half of the respondents thought that their training had been inadequate. In order to address this the outcome of a 4-day practical course for teaching urodynamics, which has been running since 1995 at the Bristol Urological Institute, was reviewed. We were not aware of any published studies that have assessed the impact of formal urodynamic training on clinical practice. With this in mind we set out to determine whether the education and training we had given had changed urodynamic practice in the UK. METHODS: Postal questionnaires were sent out to 84 delegates who had attended the course over a 2-year period (2001-2003). Paired questionnaires were used to assess urodynamic practice before and after the course and also to establish whether their practice had changed as a direct result of attending the certificate course. RESULTS: The results suggested that 79% of those responders had changed their practice since completing the course. Significant changes to practice were observed in checking calibration, confidence in setting-up equipment, interpretation of urodynamic traces and ability to check the accuracy of the results. CONCLUSIONS: The results of this survey suggest that attendance at a recognised urodynamic training course has had an impact on clinical practice in the UK. Training and education raises the level of confidence and ability to perform and interpret urodynamic investigations, which has wide implications for the accuracy, reliability and consistency of urodynamic investigations performed by those without formal training.

Clinical Competence↗

PubMed2003

Perceptions and experiences of motherhood, health and the husband's role among Thai women in Australia.

OBJECTIVE: to discuss the perceptions and experiences of motherhood among Thai immigrant women in Australia. DESIGN: ethnographic interviews and participant observation were used to elicit information. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Australia. FINDINGS: becoming a mother meant different things to these women. Motherhood had both positive and negative aspects. Women believed that their health became worse as a result of becoming a mother. The contributing causes of their health status were multi-faceted, including their age, the demanding tasks of motherhood, the depletion of their strength and energy from childbirth, and in not following Thai traditional confinement practices. The findings in this paper support previous literature that motherhood has a profound effect on the life of many women. We, however, found that cultural beliefs and practices have an effect on women's perceptions and experience of motherhood. We also found that the 'presence' of the husband when a woman becomes a mother is important. The ethnicity of their husbands also played a significant role in their motherhood role and the ways in which they mothered their children. IMPLICATIONS FOR PRACTICE: understanding the social and cultural environment in which immigrant women try to be a mother is important if we are to provide culturally sensitive assistance and care to women who choose to become a mother in their new homeland.

Adult↗

PubMed1988

[Legal fundamentals and practical accomplishments of abattoir and meat research in mammalian game animals].

Meat regulations also involve game inspection. The previous publication mainly dealt with the regulations and their practice concerning game intended for slaughter. The following publication deals with game hunted for food (deer: red deer, sika deer, fallow deer, roe deer; horned ungulates: european mufflon, chamois; wild boar; european hare; european rabbit) and also game such as the badger and the raccoon.

Animals↗

PubMed1995

Recommended childhood immunization schedule United States--1995. American Academy of Pediatrics and the Advisory Committee on Immunization Practices.

The need for a single childhood immunization schedule prompted the unification of previous vaccine recommendations made by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP). In addition to presenting the newly recommended schedule for the administration of childhood vaccines, this article addresses the previous differences between the AAP and ACIP schedules, and provides the rationale for changing previous recommendations.

Age Factors↗

PubMed2005

The use of skull X-rays in head injury in the emergency department--a changing practice.

INTRODUCTION: This is a consequential study of a previous audit, evaluating the role of skull X-rays in the emergency department in patients with head injuries, to see if the changes recommended, (implementation of The Royal College of Surgeons of England guidelines) have been adopted successfully and had the desired result. PATIENTS & METHODS: All patients who attended the accident and emergency department at the Royal Berkshire Hospital from 1-30 November 2003 with a diagnosis of head injury had their notes analysed for indications for skull X-ray, presence of fracture and outcome. RESULTS: 278 patients were identified as having a head injury and had notes available, 19% (54/278) of these patients had a skull X-ray, of whom 31% (17/54) had a clearly documented indication. This shows a marked improvement from the previous audit when 50% (193/385) had a skull X-ray with only 7% (14/193) having a clearly documented indication. DISCUSSION: Following the introduction of new guidelines, a clear improvement in the practice of evidence-based medicine has been achieved; however, there is still room for further improvement and on-going education of staff and auditing of performance will help to ensure this continues.

Adolescent↗

PubMed2002

Attributes of clinical recommendations that influence change in practice following audit and feedback.

The object of this study was to determine which attributes of clinical practice recommendations influence changes in clinical practice following audit and feedback. This was an observational study using multilevel modeling to examine the relationship between attributes of clinical practice recommendations and compliance with the recommendations before and after audit and feedback. Sixteen hospital gynecology units in Scotland participated in a national audit project. Clinical practice recommendations covering selected gynecological topics were developed and data collected to assess baseline (preintervention) compliance. Summaries of performance were fed back to consultant gynecologists in each hospital and follow-up (postintervention) data were collected. Trained audit assistants used standardized forms to abstract data from case notes. Compliance data were available at baseline and follow-up for a total of 42 clinical practice recommendations. Altogether, 4,664 case notes contributed to baseline data and 4,382 to follow-up data. Thirteen attributes describing clinical practice recommendations were developed, based upon previous work, and pretested. A panel of seven consultant gynecologists rated the extent to which each of the 42 recommendations possessed each of the 13 attributes. The main outcome measures were the association of each attribute with compliance and with changes in clinical practice. Recommendations compatible with clinician values and not requiring changes to fixed routines were independently associated with greater compliance at baseline and follow-up. However, recommendations incompatible with clinician values were independently associated with greater change in practice following audit and feedback. Attributes of recommendations may influence the effectiveness of audit and feedback in secondary care. Recommendations seen as incompatible with clinician values are associated with lower compliance but greater behavioral change following audit and feedback.

Attitude of Health Personnel↗

PubMed2006

The independent effect of age of general practitioner on clinical practice.

OBJECTIVE: To establish the extent to which general practitioner age alone explains variations in patient morbidity and treatment patterns. SETTING: An on-going, national survey of general practice activity in Australia. PARTICIPANTS: A random sample of 5013 GPs with a minimum of 375 general practice Medicare items claimed in the previous 3 months. Each GP contributed details of 100 consecutive encounters, with about 1000 GPs sampled each year between 1998 and 2003. MAIN OUTCOME MEASURES: Effect of practitioner age on GP activity after removing the influence of measured confounding factors: doctor, patient and practice characteristics; number of problems; and morbidity managed at encounters. RESULTS: GP age played a significant role in practice style. In comparison with young GPs (< 35 years), older GPs provided more home visits (P < 0.001) and attendances at residential aged-care facilities (P = 0.044); were more likely to manage chronic problems (P < 0.001); had higher prescribing rates (P < 0.001), and lower rates of pathology ordering (P < 0.001) and non-pharmacological treatments (P < 0.001). Individual body system management rates also differed significantly between younger and older GPs. CONCLUSION: A GP's age plays a significant role in determining practice style. Our results have implications in terms of the ageing GP population and in the wider context of the ageing medical labour force.

Adult↗

PubMed1975

Nutritional knowledge, attitudes, and practices of high school graduates.

A mail survey was conducted to investigate the relationship between previous nutrition education in high school home economics classes and the present nutritional knowledge, attitudes, and practices of Ohio high school graduates. Findings revealed that young women previously enrolled in home economics courses with a unit in food, nutrition, and health did not achieve significantly higher scores in tests of nutritional knowledge, attitudes, and practices than did those who had not been exposed to such nutritional education. Attitudes toward food and nutrition were found to mediate the nutritional knowledge and practices of these high school graduates.

Adolescent↗

PubMedDate not supplied

Implementation of advanced laparoscopy into daily gynecologic practice: difficulties and solutions.

BACKGROUND: The implementation of laparoscopy into Dutch gynecologic practice is slow. This study was conducted to assess the current state of laparoscopy, to identify factors influencing the implementation and to find solutions toward a better implementation. METHODS: In 2003 a questionnaire was sent to all 151 gynecologists who finished residency within the previous 5 years. The questionnaire addressed practice demographics, performance of laparoscopy, factors influencing use of laparoscopy in practice and means of obtaining laparoscopic skills after residency. RESULTS: Of 151 gynecologists, 124 (82%) responded, 46 (37%) male and 78 (63%) female. Mean age was 39 years (range 32-47 years). Respondents (73%) believed they were adequately trained during residency for basic laparoscopic procedures, but not for the more advanced procedures (82%). Lack of caseload, lack of being a primary surgeon, and lack of simulator training caused the deficiency of laparoscopic skills at the end of the residency. Causes of the slow implementation were long operating time, lack of attention for laparoscopy during residency, and budgetary problems, but not the financial compensation for gynecologists. In current practice, only 9% believed they reached their preferred level of competence. Hiring an advanced laparoscopic gynecologist was believed to be the best opportunity to reach the preferred level of competence. A minority of respondents supported a referral system or fellowship program. CONCLUSIONS: Basic laparoscopy is sufficiently mastered during residency training; however, advanced laparoscopy is not. More emphasis should be placed on laparoscopic training of advanced procedures during residency and for gynecologists in practice. Hiring a gynecologist with advanced laparoscopic skills is expected to be the solution for this problem. However, a referral system or fellowship program is not.

Adult↗

PubMed2004

Do students from rural backgrounds engage in rural family practice more than their urban-raised peers?

INTRODUCTION: In a previous prospective study, students from rural backgrounds were found to be significantly more likely to consider rural practice than their urban-raised peers. The purpose of this study was to determine whether the students with rural backgrounds who participated in the original investigation were more likely than their urban-raised peers to be currently engaged in rural family practice. METHOD: In Canada, family doctors have the greatest opportunity to practise in rural communities. Consequently, rural and urban background students from the original study who entered the discipline of family medicine as a career were identified for practice location follow-up. Participants were categorised as either rural (population less than 10 000) or urban practitioners according to the population of the community in which they practised. The proportion of rural and urban background students engaged in rural or urban practice was analysed using chi-square and relative risk probability. RESULTS: A total of 78 students from the original cohort were found to be practising family medicine; 22 of them had been rurally raised. Seven (32%) of the rural background students were practising in a rural community, compared to 7 (13%) of the 56 urban background students (RR = 2.55; P < 0.05). CONCLUSIONS: Rural background students who went on to complete family medicine residency training were approximately 2.5 times more likely to be engaged in rural practice than their urban-raised peers. Altering medical school admission policy to recruit more rural background applicants should be part of a multi-dimensional approach to increasing the number of rural practitioners.

Canada↗

PubMed1991

Profiles of antibacterial drug use in Australia and trends from 1987 to 1989. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee.

OBJECTIVE: To survey the use by Australian pensioners of orally administered antimicrobial agents supplied through the Pharmaceutical Benefits Scheme over the years 1987-1989. DATA SOURCES: Australian Pharmaceutical Benefits Scheme pensioner data for 1987-1989 and market research data from a private company. DATA EXTRACTION: The data were initially available as the number of prescriptions dispensed and were aggregated on a quarter year basis. These were converted to defined daily doses (DDDs) per 1000 pensioners per day (DDD/1000 per day). This conversion of the data allows comparisons across drug groups, and with prescribing patterns in other countries. The DDD/1000 per day also gives an indication of the proportion of individuals in the community receiving a drug at a particular time. DATA SYNTHESIS: There was a 26% increase in antibacterial drug use over this period. Comparison of prescribing profiles for particular indications with peer consensus guidelines revealed marked discrepancies, particularly for upper respiratory tract infections, urinary tract infections, otitis media and sinusitis. Upper respiratory tract infections accounted for 31% of instances of antibiotic prescribing. Dispensing of amoxycillin/potassium clavulanate relative to amoxycillin as a single agent, showed a marked increase in 1989 to the point where it represented 25% of all amoxycillin used. This could be considered excessive given the lack of evidence that amoxycillin resistance has substantially increased in infections presenting to general practice. The data presented here confirm previous suggestions that Australian antibiotic prescribing is heavily concentrated on the use of broad spectrum agents. By comparison with Norway or Sweden, there is a greater relative use of broad spectrum penicillins and tetracyclines and a lower relative use of phenoxymethylpenicillin and trimethoprim. CONCLUSIONS: Antibiotic prescribing practices in Australia continue to be often inappropriate and expensive, being directed too heavily towards the use of broad spectrum agents and newer more expensive drugs. Correction of such antibacterial drug use will require coordination of educational and regulatory activities that are sensitive to the context of general practice.

Anti-Bacterial Agents↗

PubMed1984

alpha-Hydroxylation of nitrogen-15 labelled N-nitrosamines by isolated hepatocytes.

The principal pathway of nitrosamine metabolism has long been considered to be alpha-hydroxylation. For N-nitrosodialkylamines, this hypothesis requires that a molecule of molecular nitrogen be released for every molecule of nitrosamine that is alpha-hydroxylated. Thus, the quantitative determination of nitrogen formation should provide a measure of the importance of this pathway. This method was applied earlier to the doubly-labelled nitrogen-15 compounds, N-nitrosodimethylamine (NDMA), N-nitrosomethylphenylamine (NMPhA) and N-methyl-N-nitrosourea (MNU), using both a 9 000 X g supernatant fraction of liver and the intact animal as metabolic systems. The in-vitro results were quite different from those obtained in vivo. The majority of the NDMA (67%) and the MNU (88%) were converted to nitrogen in vivo, while NMPhA gave considerably less nitrogen (52%). These results differed by a factor of approximately two from those obtained in vitro (NDMA, 33%; NMPhA, 18.8% and MNU, 96%). Since such differences may be a result of the loss of cellular architecture, we have extended the work to include isolated hepatocytes. It had been shown previously that isolated hepatocytes constitute a practical alternative to in-vivo systems, even though the correlation with in-vivo metabolism appears to depend on the substrate analysed. The values obtained using this system (NDMA, 47%; NMPhA, 23%; and MNU 105%) reconfirm that metabolism may be substrate dependent. As in our previous studies, no mixed nitrogen (15N14N) or labelled nitrogen oxides were found. The data are all consistent with the hypothesis that at least one demethylase for each of the nitrosamine substrates is associated with a cell membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Factors influencing theoretical knowledge and practical skill acquisition in student nurses: an empirical experiment.

A previous qualitative study [Nurse Education Today 20 (2000) 499] investigated perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap said to exist within nursing. One theme was views of how the theory-practice gap could be closed. A subsequent quantitative study is reported here, in which this theme was translated into three factors. A full factorial experimental design was used to study the effect of these factors on theoretical knowledge and practical skill acquisition in a sample of first year undergraduate student nurses from one institution of higher education (n=19). The effect of whether a nurse teacher or preceptor taught students theoretical elements relating to a clinical specialty, whether the nurse teacher and preceptor collaborated on the content of what was taught to students and whether students went straight to, or delayed the clinical specialty following theoretical input, was examined. The results demonstrated preceptors were more effective than nurse teachers in promoting theoretical knowledge relating to their clinical specialty. Collaboration between the preceptors and nurse teachers on teaching content was ineffective at increasing theoretical knowledge. Delay between theoretical input and clinical experience was not detrimental for medical placements and for rehabilitation placements, resulted in an improved theoretical knowledge.

Analysis of Variance↗

PubMed1987

Determinants of non-compliance with short term antibiotic regimens.

The contribution of doctor, patient, and consultation interaction patterns to compliance with antibiotic treatment was examined in 233 adult patients seen in general practice. Twelve variables were shown to discriminate between compliers and non-compliers. Discriminating variables relating to patients included health state, employment state, knowledge of tablet, and perception of anxiety level, difficulty in complying, and their observed anger, distance, and assertiveness in the consultation. Discriminating variables relating to doctors included provision of advice on duration of treatment, complexity of dosage schedule, age of doctor, and number of years in practice. For the most part these results confirmed previous research. It is concluded that the doctor should consider both the dosage schedule and the patient's daily routine when prescribing antibiotic tablets. Advice on how to take the tablets should be given in specific rather than in general terms. The significant effect of the age of the doctor and the years spent in practice has not been found in previous work. This finding may reflect differences in behavior between younger doctors and their patients. This difference was not detected in the observation of consultation events.

Adult↗

PubMed2003

Practice standards for optometry and optometric practice accreditation.

BACKGROUND: To assist optometrists to deliver care more efficiently and effectively, in 1995 Optometrists Association Australia decided to develop standards that would assist optometrists in better managing their practices. Existing practice management standards for health professionals were thought to be either not specific enough for optometric practice or to have shortcomings in the context of optometric practice in Australia. METHODS: Following a literature search, material previously developed by Optometrists Association Australia to assist practitioners with management of their practices and standards from other professions were used to assist with the development of a draft set of standards for optometric practices in Australia. Successive drafts were circulated for comment to optometrists in practice, non-optometrists with experience in the development of practice standards for other health professions and to Australian General Practice Accreditation Limited. The comments were used to refine the standards and the accreditation guidelines to their final form. RESULTS: Optometric Practice Standards suitable for use in a practice accreditation program were developed. The standards comprise seven sections--Practice administration, Quality assurance, Rights and needs of the patient, Practice services, Practice facilities, Communication and Patient records. These sections are divided into criteria that provide the detail of the requirements of the standard. Indicators describing how criteria can be assessed accompany the criteria.

Accreditation↗

PubMed1989

[Deregistration of barbiturates. A follow-up study after 1 year].

On January 1st 1986, all hypnotics and sedatives containing barbiturates were removed from the Danish Drug Register. After one year, a follow-up investigation of previous barbiturate users was undertaken with the object of investigating the significance of various factors for cessation or continuation of use of psychotropic drugs in connection with the removal of barbiturates from the Danish Drug Register. The investigation was carried out of a questionnaire investigation in general practice with participation of 82 practices. Information was obtained concerning 141 previous barbiturate users. Twenty-four of these had stopped (17%, 95% confidence limits 11-23) having psychotropic drugs prescribed during the course of the year in question. In particular, patients without or with slight mental conditions ceased using drugs (p = 0.02). An age and sex stratified analysis revealed that more patients who had obtained the preparation by direct doctor-patient contact stopped the habit (odds ratio 3.00, 95% confidence limits 1.04-8.61). Other factors were without significant significance for continued use or cessation, respectively. In 75% of the patients, adjustment was, in the opinion of the general practitioner, easy. Out of 105 patients who continued to have psychotropic drugs prescribed and where the preparation employed was known, 90 (86%) were prescribed benzodiazepines.

Adult↗