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Local Practices (local + practice)
Selected AbstractsO-11 Proposal for extending the role Of ABMSPS in reporting cervical loopsCYTOPATHOLOGY, Issue 2007K. Ellis Introduction:, The advanced biomedical scientist practitioner (ABMSP) in Cervical Cytology was established in the NHS cervical screening programme (NHSCCSP) in 2001 and there are approximately 60 ABMSPs in post. The aim of this study was to explore the potential for further expansion of their role in the NHSCSP by reporting the histology of loop excision biopsies of the cervical transformation zone (LLETZ). Methods:, The initial study included LLETZ specimens from 55 sequential patients, which, according to standard local practice had the diagnosis of CIN confirmed by cervical punch biopsy prior to the procedure. All the cases were independently examined by an ABMSP and a consultant histopathologist and reports complying with the Royal College of pathologists (RCPath) minimum data sets were assembled. The cases were reviewed at the discussion microscope and ABMSP reports were compared to the final reports issued by the histopathologist. Results:, In the preliminary findings, total agreement between ABMSP and consultant histopathologist was reached on just under 90% of cases. Of those cases that did not reach total agreement, none varied by more than one grade. There was agreement on other parameters from the RCPath minimum data sets. Discussion:, Based on our preliminary findings, it appears there may be scope for extending the role of ABMSPs to report LLETZ samples under the supervision of a histopathologist. We plan to increase the number of cases both in our department and through collaboration with other UK centres and to present evidence to the RCPath, with a view to adoption of this role by ABMSPs and development of an appropriate training scheme. [source] Observations and recommendations for assessing patient satisfaction in a primary care setting using a previously validated questionnaireHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2000Anné-Lise McDonald BA MSc Abstract Within the rapidly changing climate of primary care, there is an increasing need to evaluate the reactions of patients to real and proposed changes in practice. There are a number of methodologies, both qualitative and quantitative which have been employed to do this. This article presents the methodological problems which may be encountered in evaluating patients' opinions and attitudes in a primary care setting. We begin by discussing the issues which need evaluation, then describe the research process of a recent case study which aimed to evaluate patient satisfaction using a previously validated survey instrument, including the modifications which had to be made to overcome the problems of research in a real life practice setting. We then discuss the strengths and weaknesses of applying different methodological instruments within a primary care setting, and propose a mixed methodological framework as a template for future research which combines the strengths of both large scale survey and small scale qualitative methods to give more insight into the concerns and beliefs of patients as changes occur within their local practice. [source] Caterers' experiences and perceptions of implementing the 2006 school meal standardsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2008C.J. Weir Background:, School meal standards were introduced in 2006 (Department for Education and Skills) and caterers are expected to comply with these standards. No research has been conducted looking at the caterer's experiences and perceptions of implementing these standards. This area has 32 school meal provider organisations for 103 schools. Half the schools are with one provider and the others are, mostly, single-handed in-house operations, often managed by a local community member. The aim of the current study was to explore caterers' understanding of the school meal standards, the barriers to implementation, and proposed solutions, to inform local practice. Methods:, A combined quantitative and qualitative design was used. A questionnaire was used to assess understanding and implementation of the standards and distributed to all the catering provider organisations (n = 32), with a good response rate of 78% (n = 25). For each question about achievement of the ten food-based standards the responses were scored 0,4 where: 0 = ,Do not intend to achieve this standard'; to 4 = ,Fully achieved'. This gave a total standards achievement score for each catering provider organisation, where the minimum score that could be achieved was zero which indicated the minimum level of achievement and the maximum score which could be achieved was forty which indicated all ten standards fully achieved. Four focus group were undertaken involving 40 people who considered themselves to be in a management role within a catering provider organisation. Semi structured interviews were undertaken with 11 people (until saturation), using purposive sampling, to explore barriers and solutions to implementation of the standards in detail. Descriptive and appropriate inferential statistics (Fisher's Exact tests and independent samples t- tests) were performedon the datausingStatistical Package for Social Sciences (SPSS). The process undertaken for the qualitative analysis was thematic analysis, and used analytic hierarchy (Richie & Lewis, 2003). Approval for this study was obtained from Leeds Metropolitan University ethics committee. Results:, The qualitative discussions led to caterers' identifying two main themes. These were: support from various groups, and the roles and responsibilities caterers believed these groups had and should be performing in order to achieve successful implementation of the standards ,Think it's good someone's shaken up school meals but who is doing the actually work , it's us isn't it'.(Semi structured interview respondent medium primary provider) ,I've found it really difficult as I'm on my own at the school, totally on my own without anyone to help'. (Focus group participant primary school group). The groups that caterers identified as those who had roles and responsibilities and who should be providing support were the ,whole school'; catering provider organisations; parents; the local authority; and, the broader environment/whole population. Caterers felt the standards had ,gone too far too soon' and did not allow choice. Caterers felt finances were a barrier, and that training was required across all sectors to achieve success. The standards implementation achievement score were statistically higher for caterers who had received formal training compared with those with only food and hygiene (P = 0.001); and, between caterers who provided to a secondary school as opposed to a primary school only (P = 0.034). There was a statistically significant relationship between providers and qualifications with those providing to secondary schools more likely to have had formal qualifications (P = 0.015). Discussion:, Caterers felt all those involved in schools and school meals needed to undertake their roles and responsibilities, to provide support, and, to implement the ethos of a whole school approach. The caterers in this study identified many barriers and practical obstacles either experienced or perceived to implementing the new school meals standards. Conclusions:, The results will be used to inform the Local Authority and Primary Care Trust to ensure the effective implementation of the school meal standards. There may be opportunity to transfer these results to other school caterers, and to develop support and training to assist implementation. [source] Immediate and associated complications of hysterectomy for benign diseaseAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2002O Tamizian ABSTRACT Abdominal and vaginal hysterectomy are common operations for benign gynaecological conditions. Though safe operations, they are not without complications. Good medical practice requires that patients be fully counselled regarding risks involved in undergoing medical interventions. This can only be done by regular review of local practice and comparison with national and international standards. We have reviewed 502 case notes of patients who have undergone a hysterectomy for benign conditions over an 18-month period. [source] Decreasing Lab Turnaround Time Improves Emergency Department Throughput and Decreases Emergency Medical Services Diversion: A Simulation ModelACADEMIC EMERGENCY MEDICINE, Issue 11 2008Alan B. Storrow MD Abstract Background:, The effect of decreasing lab turnaround times on emergency department (ED) efficiency can be estimated through system-level simulation models and help identify important outcome measures to study prospectively. Furthermore, such models may suggest the advantage of bedside or point-of-care testing and how they might affect efficiency measures. Objectives:, The authors used a sophisticated simulation model in place at an adult urban ED with an annual census of 55,000 patient visits. The effect of decreasing turnaround times on emergency medical services (EMS) diversion, ED patient throughput, and total ED length of stay (LOS) was determined. Methods:, Data were generated by using system dynamics analytic modeling and simulation approach on 90 separate days from December 2, 2007, through February 29, 2008. The model was a continuous simulation of ED flow, driven by real-time actual patient data, and had intrinsic error checking to assume reasonable goodness-of-fit. A return of complete laboratory results incrementally at 120, 100, 80, 60, 40, 20, and 10 minutes was compared. Diversion calculation assumed EMS closure when more than 10 patients were in the waiting room and 100% ED bed occupancy had been reached for longer than 30 minutes, as per local practice. LOS was generated from data insertion into the patient flow stream and calculation of time to specific predefined gates. The average accuracy of four separate measurement channels (waiting room volume, ED census, inpatient admit stream, and ED discharge stream), all across 24 hours, was measured by comparing the area under the simulated curve against the area under the measured curve. Each channel's accuracy was summed and averaged for an overall accuracy rating. Results:, As lab turnaround time decreased from 120 to 10 minutes, the total number of diversion days (maximum 57 at 120 minutes, minimum 29 at 10 minutes), average diversion hours per day (10.8 hours vs. 6.0 hours), percentage of days with diversion (63% vs. 32%), and average ED LOS (2.77 hours vs. 2.17 hours) incrementally decreased, while average daily throughput (104 patients vs. 120 patients) increased. All runs were at least 85% accurate. Conclusions:, This simulation model suggests compelling improvement in ED efficiency with decreasing lab turnaround time. Outcomes such as time on EMS diversion, ED LOS, and ED throughput represent important but understudied areas that should be evaluated prospectively. EDs should consider processes that will improve turnaround time, such as point-of-care testing, to obtain these goals. [source] Variation in GH and IGF-I assays limits the applicability of international consensus criteria to local practiceCLINICAL ENDOCRINOLOGY, Issue 1 2007A. Pokrajac Summary Background, There is increasing reliance on consensus criteria for decision making. Recent criteria state that acromegaly is excluded by a nadir GH during an oral glucose tolerance test (OGTT) of < 1 µg/l and a normal level of IGF-I. Objective, To study GH and IGF-I assay performance close to cut-off values for active acromegaly. Design and methods, Two serum samples known to give borderline results were sent to all centres participating in the UK National External Quality Assessment Service (NEQAS). Sample A was assigned to be a nadir during an OGTT and sent for GH assessment to 104 centres. Sample B, with a clinical scenario, was sent to 23 centres that measure IGF-I, and these centres were asked to measure IGF-I, interpret the result and provide the source of their reference ranges (RRs). Results, For sample A, the median GH was 2·6 mU/l (range 1·04,3·5 mU/l). Applying a conversion factor (CF) of 2·0 (1 µg/l = 2 mU/l), the most negatively biased method classified 10% of the values consistent with acromegaly, while the most positively biased method classified all values as consistent with the diagnosis. Applying a CF of 3·0 (1 µg/l = 3 mU/l), only 11% of results were consistent with acromegaly. For sample B, the median IGF-I was 50·8 nmol/l (range 24·3,60·9 nmol/l). All centres used age-related RRs. There was a 50% variation in the upper limit of the RRs between centres. Overall, 30% of the IGF-I results were against the diagnosis. There was little agreement in the RRs quoted by centres using the same method. Conclusion, Variability in assay performance, coupled with use of inappropriate CFs and RRs, undermines the applicability of international consensus criteria to local practice. [source] A Strategic Approach to Rights: Lessons from Clientelism in Rural PeruDEVELOPMENT POLICY REVIEW, Issue 5 2005Aaron Schneider International norms of social, economic and political rights are presented as a means of transforming social relations in developing countries. Yet, when rights norms are introduced into domestic practice, they do not always produce liberal, democratic results. Instead, rights and local practices of clientelism mix. This article examines this political process in rural Peru. Alternatives to clientelism emerge when NGOs and international development agencies forge strategic and selective coalitions between urban middle-class sectors and the rural poor. This calls for an explicit politics of advancing rights by any means necessary: accepting hybrid forms when inevitable, incorporating excluded groups when possible, and striking alliances that displace traditional elites. [source] Review article: Inotrope and vasopressor use in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2009Ainslie Senz Abstract Shock is a common presentation to the ED, with the incidence of septic shock increasing in Australasia over the last decade. The choice of inotropic agent is likely dependent on previous experience and local practices of the emergency and other critical care departments. The relatively short duration of stay in the ED before transfer leaves little room for evaluating the appropriateness of and response to the agent chosen. Delays in transfer to inpatient facilities means that patients receive advanced critical care within the ED for longer, requiring initiation and titration of vasoactive agents in the ED. This article discusses the general concepts of shock and the indicators for inotrope and vasopressor use, revises the various agents available and reviews the current evidence for their use. [source] The multiplicity of citizenship: transnational and local practices and identifications of middle-class migrantsGLOBAL NETWORKS, Issue 3 2010MARIANNE VAN BOCHOVE Abstract In this article we focus on local and transnational forms of active citizenship, understood as the sum of all political practices and processes of identification. Our study, conducted among middle-class immigrants in Rotterdam, the Netherlands, indicates that the importance of active transnational citizenship should not be overstated. Among these immigrants, political practices are primarily focused on the local level; political practices directed to the home country appear to be quite rare. However, although transnational activities in the public sphere are rather exceptional, many immigrants do participate in homeland-directed activities in the private sphere. If we look at processes of identification, we see that a majority of the middle-class immigrants have a strong local identity. Many of them combine this local identification with feelings of belonging to people in their home country. [source] Inside the Sending State: The Politics of Mexican Emigration Control1INTERNATIONAL MIGRATION REVIEW, Issue 2 2006David Fitzgerald The social science of international migration has generally ignored labor emigration control policies. In the critical case of Mexico, however, the central government consistently tried to control the volume, duration, skills, and geographic origin of emigrants from 1900 to the early 1970s. A neopluralist approach to policy development and implementation shows that the failure of emigration control and the current abandonment of serious emigration restrictions are explained by a combination of external constraints, imposed by a highly asymmetrical interdependence with the United States, and internal constraints, imposed by actors within the balkanized Mexican state who recurrently undermined federal emigration policy through contradictory local practices. [source] In other words: Language mixing, identity representations, and third space1JOURNAL OF SOCIOLINGUISTICS, Issue 2 2008Rakesh M. Bhatt This paper analyzes the use of Hindi in English newspapers in India to argue that code-switching creates a discursive space , a third space (Bhabha 1994) , where two systems of identity representation converge in response to global-local tensions on the one hand, and dialogically constituted identities, formed through resistance and appropriation, on the other. The results of the analysis of data show that code-switching: (1) reflects a new socio-ideological consciousness; (2) yields a new way to negotiate and navigate between a global identity and local practices; and (3) offers a new linguistic diacritic for class-based expressions of cultural identity. Based on these results, I conclude that code-switching, as linguistic hybridity, is a third space where social actors (re-)position themselves with regard to new community-practices of speaking, reading, and writing. It is in this space that actors are presumed to have the capacity to synthesize, to transform: code-switching serves as a visible marker of this transformation. [source] Socialist psychotherapy and its dissidentsJOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES, Issue 3 2001Christine Leuenberger Ph.D. research associate/lecturerArticle first published online: 17 JUL 200 This article focuses on the history of psychotherapeutic theory and practice in socialist East Germany before the fall of the Berlin Wall in 1989. The "official" pre-1989 socialist history of East German psychology is juxtaposed to psychotherapists' post-1989 oral history of the development of Socialist psychological theory and practice. These reconstructive histories draw on embryonic therapeutic practices that diverged from the dominant socialist paradigm. Their existence exemplifies how a state-driven high modernist scheme for remaking society can fail as it does not account for the complex relationship between a state's abstract knowledge and local practices. Moreover, the emphasis therapists put on the prevalence of these alternative practices also reveals how the present post-socialist context becomes an interpretative resource for reconstructing their past. By emphasizing these practices they try to bridge the gap between their past and current practices so as to minimize the transformation that has taken place. © 2001 John Wiley & Sons, Inc. [source] Talking Heads: Capturing Dayak Deathways on FilmAMERICAN ETHNOLOGIST, Issue 1 2001Anne Schiller In 1996, an elite group of Ngaju Dayak religious activists invited National Geographic Television to film their rites of secondary treatment of the dead in the village ofPetak Putih, Central Kalimantan, Indonesian Borneo. In this article; I explore activists' efforts to engage the National Geographic Society and their attempts to exert a high degree of control over the manner in which local traditions were portrayed to the filmmakers. I focus in particular on how representations of specific local practices figure in the recasting of a contemporary Dayak face, and on questions concerning religious authenticity and authority. I argue that the activists' interest in making a film, and their decisions during its shooting were part of their larger organizational strategies, with potentially far-reaching political and economic consequences. [Indonesia, Dayaks, religion, identity, tourism, filmmaking] [source] Urban water supply and local neoliberalism in Tagbilaran City, the PhilippinesASIA PACIFIC VIEWPOINT, Issue 2 2009Karen T. Fisher Abstract The aim of this paper is to explore the processes and outcomes of neoliberalism in relation to urban water supply in the city of Tagbilaran, the Philippines, in order to provide a nuanced account of (an) actually existing hybrid neoliberal space. Using Bakker's typology of market environmentalist reforms in resource management as a guiding frame to link this case to a bigger ,neoliberal' conversation, I distinguish how reforms to resource governance at the national level, coupled with changes in the ways in which resource management institutions and resource management organisations function at the local level have acted to constitute local practices of neoliberal governance. Local articulations of (national and supranational) neoliberal and development discourses are revealed as a means for reconceptualising the role of the state and the emergence of new forms of hybrid governance in Tagbilaran. Analysis of the operation of BWUI, a public/private water utility, and the politics of privatisation/private sector participation enables a closer inspection of how water and water services are politicised and resisted by local publics. [source] Environmental management of transnational corporations in India,are TNCs creating islands of environmental excellence in a sea of dirt?BUSINESS STRATEGY AND THE ENVIRONMENT, Issue 2 2002Audun Ruud This paper discusses how and to what extent local environmental practices at affiliated units of transnational corporations (TNCs) are influenced by TNC headquarters (HQ). The study focuses on intra-firm dynamics of what is termed ,cross-border environmental management' of TNCs. The study documents that the environmental management of TNC-affiliated units in India are strongly influenced by HQ's environmental policies and standards. However, it is found that there are deviations in local practices from intentions and policy commitments stated at HQ. This can be particularly attributed to local economic and political factors. Cross-border environmental management is making a difference. However it is limited to affiliated TNC units and few additional external environmental impacts are documented. Copyright © 2002 John Wiley & Sons, Ltd. and ERP Environment [source] | |||||||||||||