the study start date, the entire library was reviewed to select resources for the BCT kickoff retreat. The expert presentation was created exclusively from and reviewed these resources. Specific resources from each of the 6 categories of materials were selected for the afternoon portion of the kickoff retreat. The selected tools were then divided into 5 stations, and BCT participants spent 15 minutes reviewing the resources at each station. The SMS library webpage was displayed at one station to give participants familiarity with the website navigation and to show participants all available resources. Furthermore, a complete list of the resources with links to the materials was provided to all BCT participants. A research team member was located at each station to record feedback from all BCT participants.
12 Read more
quality of life speciﬁc to diabetes (3). After completion of this trial, DAFNE has been adapted as part of routine clinical practice in .60 centers in the U.K. and the Republic of Ireland. The roll- out of the program has occurred gradu- ally, with seven centers starting DAFNE in 2002 and more centers joining each year since. Expansion has been accompanied by a quality assurance program, including collection of participant data on various biomedical and psychological parameters in a central audit database prior to course enrollment and at annual follow-up visits. To determine whether the beneﬁts of DAFNE training observed in the trial setting translate into routine clinical prac- tice, we have conducted a retrospective audit of biomedical and psychological outcomes at baseline (enrollment in the program) and at 1 year posttraining, in- cluding all participants who attended DAFNE courses in one 12-month period. The primary purpose of the study was to test the hypothesis that DAFNE education delivered in routine care would be asso- ciated with similar improvements in bio- medical and psychological outcomes to those seen in the RCT.
Given the current international and national data on chronic disease prevalence, future projections, and the associated health sequelae and healthcare costs [1-3], which clearly demonstrate an exponential escalation that is economically unsustainable, optimisation of healthcare delivery in this area is a health policy and whole-of- government imperative [4-6]. Three specific challenges are faced by policymakers in trying to optimise healthcare de- livery, including (i) identifying effective evidence-based interventions to address health problems; (ii) identifying how to best integrate these into health systems; and (iii) identifying how to best drive these changes across health systems . Although there is a significant body of high- level evidence demonstrating ‘what works’ in clinical prac- tice, for example through clinical trials, clinical practice guidelines, and Cochrane systematic reviews, far less evi- dence is available to guide how to successfully translate such evidence into policy and widespread practice . While the uptake of evidence to inform policy in some cir- cumstances may be rapid; for example, the removal of government subsidies for vertebroplasty procedures for osteoporotic vertebral fractures in Australia in response to two recent randomised controlled trials [8,9] and a meta- analysis  which demonstrated no clinical benefit for the procedure; this policy response is reactive and less pre- ferable than a standardised, incremental approach to evi- dence translation into policy. Notwithstanding the knowledge gap in effectively translating evidence into pol- icy, the literature on the effectiveness of various strategies for achieving evidence integration and translation is grow- ing. The Cochrane Effective Practice and Organisation of Care (EPOC) Group has completed 92 systematic reviews of interventions designed to improve the delivery, practice, and organisation of health care services, and protocols for a further 49 systematic reviews in this field . Further, the Health Systems Evidence database contains over 4000 systematic reviews, evidence briefs and other syntheses of research evidence on governance, financial and delivery arrangements within health systems, and interventions designed to support change in health systems .
12 Read more
Positive and negative symptoms, psychosocial problems and cardiovascular risk factors still occur relatively often in this population suffering from psychotic disorders. Our findings are in line with many other studies indicat- ing that a high proportion of patients with psychotic dis- orders have little or no social contact or friends and experience difficulties getting involved in social activities or work . Also, the prevalence of modifiable cardio- vascular disease risk factors in our study is comparable with other studies in psychotic disorders [7, 12, 25]. Interestingly, whereas obesity was present in 66 % of pa- tients, related problems such as diabetes mellitus and hypertension only occurred in a small subset of the sam- ple. These low prevalences may indicate that these prob- lems are already detected and treated relatively well, although these results should be replicated in a larger sample. Taken together, our ROM-system is sensitive for the detection of relevant problems in patients with a psychotic disorder.
Background: Reassuring information is recommended in clinical guidelines for the treatment of low back pain (LBP), but has not been clearly defined. The Consultation-based Reassurance Questionnaire (CRQ) was developed as a tool for measuring to what extent reassurance is present in back pain consultations and may provide important information about the clinical encounter. Until now the CRQ has only been tested in general practice patients in the UK although many patients with LBP are seen outside of this setting. The objectives of this study were to translate the CRQ into Danish, test its feasibility in chiropractic practice, and determine if CRQ scores were associated with satisfaction with care and perceived pain control.
The GET is a clinical educational instrument that has been developed by a team at UNSW Medicine, Australia. It is structured to facilitate a two stage process of engagement. Each stage (requiring approx. 30–45 mins) is designed to fit within existing workshop style GP training sessions. The two stages are based on two in- struments (A&B) that have been designed to guide clini- cians’ engagement with hypertension guidelines and the key decision points in managing hypertension. The GET will be supplemented by a final panel discussion with experts (experienced general practitioners and a car- diologist) which will enable participants to discuss any concerns and clarify any issues that arises out of their engagement with the GET. This discussion, drawing on participant experiences of the usefulness of the guide- lines, also aims to develop recommendations to enhance the usability of the existing guidelines.
It is now accepted that nursing research has reached a level of sophistication when it can be implemented and used for practice. In a much quoted article  gave rea- sons why nurses do not use research findings that are relevant to their practice. She suggested that it is because they do not hear about them. In an attempt to find out the extent at which these nurses read journals in this study, findings revealed that 44% of the nurses read journals while 56% do not read journals. The argument being made here is that how can nurses in this study hear about research if they do not read journals. Although nursing research are disseminated through publication in books and nursing journals, the problem as noted by  is that much of it is not being read by nurses in general and par- ticularly those in clinical practice. The reasons given by participants include: journals are not readily accessible, they are expensive and don’t know how to utilize re- search findings in journal. The major reason for not reading journals (research findings in journal are not applicable in my practice 28%) as seen in Table 3 below call for concern. In the word of one participant;
at each station. A variety of skills are examined at the sta- tions, including physical examination and clinical reasoning, communication, history-taking, teaching, procedural skills, resuscitation, and interpretation of laboratory results. Real patients and caregivers are used in stations for history-taking and demonstration of clinical signs. In order to reduce fatigue, more than one patient or caregiver with similar history or physical signs are used for each station. For the history- taking, caretakers are asked to adhere to a particular story line. Manikins are used for the resuscitation stations. Nurses or other health workers are asked to “act” or role-play at the communication and teaching stations. These “actors” are briefed to behave and maintain a consistent behavior at these stations. Usually eight to ten of the stations are manned by a faculty member who observes and scores the performance of the candidate and the rest are designed as unmanned stations. The unmanned stations mainly assess reading and interpreta- tion of investigation results relevant in patient management, and at these stations the trainees write down their answers. Written instructions are provided for the trainees to perform particular tasks at each of the stations. Predesigned checklists are used to score the stations. The examiners discuss the checklists and how to score prior to the examination.
treated with the WEB-DL, and in the French Observatory, 31/63 aneurysms were treated with the WEB-DL, with the remaining aneurysms treated with the WEB-SL or -SLS (most without the EV materials). Of note, the feasibility rate is not higher in WEB- CAST 2 than in WEBCAST, given that the WEB-SL and SLS were thought to be easier to navigate and deploy. In fact, the selection of patients and aneurysms for WEB treatment was different in WEBCAST and WEBCAST 2 as illustrated by the higher percent- age of anterior communicating artery aneurysms treated in WEB- CAST 2 (29.1%) compared with WEBCAST (7.8%). A similar differ- ence in patient/aneurysm selection when treating with the WEB-DL and WEB-SL and SLS was also observed in the French Observatory study. 15,16
First, this case study involved one unit and the results are therefore specific to this group of participants, in this particular context; however, participants provided contextual descriptions (i.e., culture, resources) that support the transferability of the results by allowing others to compare the congruence of this setting with their own . Second, there was the potential for social desirability  to influence participants’ accounts of their experience with the AI intervention based on professional expectations around evidence-based practice, a context attentive to excellence in pain management, and possible inclinations to report on a positively focused intervention in a positive way. Efforts were made to minimize the effects of this
40 Read more
Minimal previous research investigating the influence of the referral process on subsequent clinical treatment was found. Anecdotally, it is obvious (and empirically, it has been demonstrated; Levine, 1987) that assumptions made by the referral source can affect the treatment of the client. When information about a client comes, not from the client, nor from direct observation of the client, but from a more removed source such as the referring agency, then there is an important potential influence upon a clinician’s judgement of that client If someone offers a professional opinion, then what is known and thought of that person has a direct impact upon whether the opinion/information is accepted or n o t This principle is illustrated by the fact that most people will believe gossip told by a respected friend far more than that if told by a disliked acquaintance. This issue falls within the brief of social psychology,
111 Read more
The United Nations Convention on the Rights of the Child (UNCRC) came into force in 1989. 23 The UNCRC provides the foundation and framework required to support a rights-based approach to policies, systems, and practice related to the delivery of HPV vaccine to youth (Table 1). Fulfilling children’s rights, as delineated in the 38 substantive articles of the UNCRC, ensures the prerequisites are established for achieving optimal health and well-being (health equity) and eliminating health disparities (social justice) across the life course of children and adults. Using the articles of the UNCRC, a rights-based approach to expand youth access to the HPV vaccine is framed by the child’s right to (a) health and health care (Article 24), (b) an opinion that is respected and valued when deciding about receiving vaccines (Article 12), (c) access to vaccine related information to ensure their decisions are informed (Article 17), and (d) a place to share their views about vaccines (Article 13).
21 Read more
We thank Ann Grifasi, Ethel Sharp, Denise McGuigan, and Karen Devlin for their administrative assistance. We also thank all directors of family medi- cine residency and internal medicine programs who contributed to this study. Research for Health in Erie County, Inc., the Graduate Medical Edu- cation of the University at Buffalo, and the Society of General Internal Med- icine (through a Founders Award to EAA) funded this study. HJS is funded by a European Commission: The human factor, mobility and Marie Curie Actions. Scientist Reintegration Grant (IGR 42192). The sponsors had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. All authors read and approved the final manuscript.
Results: In HIT development, video observation is beneficial for 1) informing and improving system design 2) studying changes in work practice 3) identifying new potentials and 4) documenting current work practices. Conclusions: The video observation technique used within healthcare settings is superior to other ethnographic research methods when it comes to disclosing the complexity in clinical work practice. The insights gained are far more realistic compared to traditional ethnographic studies or usability studies and studies in clinical set ups. Besides, the data generated through video recordings provide a solid basis for dialog between the health care professionals involved. The most important lessons learned are that a well considered methodology and clear formulated objectives are imperative, in order to stay focused during the data rich analysis phase. Additionally, the video observation technique is primarily recommended for studies of specific clinical work practices within delimited clinical settings. Overall, the video observation technique has proven to be capable of improving our understanding of the interwoven relation between clinical work practice and HIT and to inform us about user requirements and needs for HIT, which is a precondition for the development of more successful HIT systems in the future.
13 Read more
synchrotrons such as the European Synchrotron Radiation Facility (ESRF) in Grenoble, France. The current ultimate source of brilliant x-rays are 3 rd generation synchrotrons. However, these synchrotrons are large, expensive facilities measuring hundreds of metres across which are often impractical to facilitate a wide-spread application of hard x-rays in science or medi- cine. In particular MRT and phase contrast imaging have not been established in clinical prac- tice due to the lack of compact high-brilliance x-ray sources (Bech et al 2010).
16 Read more
30 soggetti con uso di cannabinoidi nel mese precedente la valutazione e il secondo di 37 soggetti che non ave- vano mai utilizzato la sostanza. I soggetti che avevano utilizzato cannabis nel mese precedente la valutazione presentano punteggi medi significativamente più elevati alle dimensioni della SCL-90 “Aggressività” e “Psicotici- smo” e una maggiore gravità del disturbo valutato attra- verso la Clinical Global Impression-Severity (CGI-S). Non erano presenti differenze tra gli utilizzatori di cannabis e i non utilizzatori nelle valutazioni sul funzionamento globale. La dimensione “psicoticismo” della SCL-90 e un punteggio maggiore alla CGI-S, inoltre, discriminavano il gruppo degli utilizzatori di cannabis. I risultati dello studio suggeriscono che, in soggetti con esordio di un disturbo psicotico o con SMR, la valutazione dell’uso di cannabis potrebbe aggiungere informazioni cliniche alla descrizione psicopatologica e diagnostica, distinguendo un sottogruppo di soggetti all’esordio 96 .
16 Read more
Knowledge of dietary recommendations section was the most accurately completed (86% accurate answers) compared to other sections (food groups – 71%, food choice – 70%). When sample was split into good and poor nutritional knowledge groups, the trend remained the same. Consistent with the findings of another study , this suggests that the national health promotion campaigns, such as 5-a-day fruit and vegetables, salt re- duction, and increased wholegrain intake, are successful educational public health nutrition programmes, in terms of raising public awareness and increasing nutritional knowledge. In fact, all of the participants completed the question on recommended servings of daily fruit and veg- etables intake correctly.
that clinical leaders are not predefined roles. They emerge from the complex clinical setting by having an acquired expertise, appropriate knowledge, and respect of their peers and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders need to be both affective and effective; affective is about making a difference; effective is associated with bringing about results through facili- tating innovation and change through improvements within the clinical area. This is achieved by recognizing, influencing, and empowering individuals through effective communications in order to share and learn from and with each other in practice.
Given these refinements and remaining questions about conducting the AI intervention in different con- texts, especially those that may seem less conducive to AI and the implementation of pain management evi- dence in practice than that in this study, it is vital that a process evaluation be included in a larger multisite effectiveness study. Research questions on process should focus on the feasibility of finding interested and qualified facilitators in other contexts; the impact of variably qualified facilitators on the fidelity of the inter- vention; the acceptability and feasibility of identifying and training local champions to ultimately assume sus- tained facilitator roles; the dose of the AI intervention required to produce the expected effects if variable levels of participation are allowed; the impact of decreasing monetary compensation on issues like recruitment and levels of participation; and the accept- ability and feasibility of opening participation to the interprofessional team, given the potential challenges associated with engaging group members with different professional demands, priorities, and interests.
13 Read more
Authors of this study are not aware of any studies that captured an overall knowledge score on net care and repair; however, the three most common net care approaches mentioned in this study were also identi- fied in studies elsewhere [19, 20, 25]. Careful handling of net and keeping nets out of children’s reach is a com- mon technique used . Repairing small holes quickly is likely the least cited technique in many places, as was found in this study . While information regard- ing net care and repair would ideally be given out, this study found very few to have received any information. Results of this study suggest that increasing the amount and quality of information on net care and repair may increase positive perceptions, further reinforcing the idea that BCC could be an important tool; other studies have drawn similar conclusions .