			Home About us Contact

Practice Change (practice + change)

Distribution by Scientific Domains

Medical Sciences	88%
3 Other Domains	12%

Selected Abstracts

A Critical Time for Practice Change in the Pain Treatment Continuum: We Need to Reconsider the Role of Pumps in the Patient Care Algorithm

PAIN MEDICINE, Issue 7 2010
Timothy R. Deer MD
No abstract is available for this article. [source]

Implementing interdisciplinary practice change in an international health-care organization

INTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 4 2009
Anita C Reinhardt PhD RN
The current emphasis on adopting evidence-based practice often results in the need to change interdisciplinary practice. This article describes the successful system-wide change to evidence-based wound care practices in a large, Middle-Eastern health services organization using a multinational workforce. Elements within this change initiative are identified that stimulated experimentation and collaboration among members of this organization's workforce while also preserving culturally determined expectations for authority and decision-making. The result was a system-wide practice change accomplished through consensus-building and interdisciplinary learning while also utilizing the strengths to be found in an established organizational hierarchy. This description of practice change among the members of a multicultural, multinational workforce provides lessons for managing a diversity of perspectives, creating consensus and accomplishing change in an environment where multiple cultural values intersect. [source]

Implementing cognitive services in community pharmacy: a review of facilitators used in practice change

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2006
Alison S Roberts research fellow
Objective To investigate facilitators of change in community pharmacy and their use in the implementation of cognitive pharmaceutical services (CPS). Method Relevant literature published in English was identified through searches of online databases (no date limits), texts, conference proceedings, and bibliographies of identified literature. Literature that involved a discussion of facilitators of community pharmacy practice change in relation to the implementation and/or delivery of CPS was selected for review. Some of the identified studies were conceptual in nature, and although they were selected in the same way as the empirical research papers, were not able to be critically reviewed in an equivalent manner. A narrative, rather than systematic review, was considered more appropriate. Key findings The identified facilitators exist at two levels: the individual (e.g. knowledge) and the organisation (e.g. pharmacy layout). Few studies identified or measured facilitators drawn from experience, with many based on the views of researchers or participants in the studies, in reaction to identified barriers to CPS implementation. Purposive sampling was common in the reviewed studies, limiting the generalisability of the findings. Conclusion Although a number of facilitators have been identified in the literature, it appears that little consideration has been given to how they can best be used in practice to accelerate CPS implementation. Identifying facilitators at both individual and organisational levels is important, and future research should focus not only on their identification in representative populations, but on how they should be incorporated into programmes for CPS delivery. [source]

Using quality report cards for reshaping dentist practice patterns: a pre-play communication approach

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008
Chinho Lin PhD
Abstract Rationale, aims and objectives, Understanding how information disclosure influences dentists' patterns of practice change is important in developing quality-improvement policies and cost containment. Thus, using quality report cards is a promising strategy for investigating whether dentists will reshape their patterns of practice because of the influence of peer comparison. Methods, Based on the coordination game, a data warehouse decision support system (DWDSS) was used as a pre-play communication instrument, along with the disclosure of quality report cards, which allow dentists to search their own service rates of dental restoration and restoration replacement as well as compare those results with others. Results and conclusions, The group using the DWDSS had a greater decrease in two indicators (i.e. service rates of dental restoration and restoration replacement) than the dentists who did not use it, which implies that the DWDSS is a useful facility for helping dentists filter and evaluate information for establishing the maximum utility in their practice management. The disclosure of information makes significant contributions to solving managerial problems associated with dentists' deviation of practice patterns. [source]

The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2007
Fiona Simpson MND
Abstract Aims and objectives, Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). Design, A survey instrument delivered by mail with email follow-up reminders. Setting, Fourteen hospitals throughout Australia and New Zealand. Subjects, Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. Survey, Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. Results, A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as ,most common' and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. Conclusions, When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload. [source]

An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model

JOURNAL OF NURSING MANAGEMENT, Issue 3 2010
BETTYANNE GRANT RNBC
grant b., colello s., riehle m. & dende d. (2010) Journal of Nursing Management18, 326,331 An evaluation of the nursing practice environment and successful change management using the new generation Magnet Model Aim, To discuss the new Magnet Model as it relates to the successful implementation of a practice change. Background, There is growing international interest in the Magnet Recognition Programme. The latest generation of the Magnet Model has been designed not only as a road map for organizations seeking to achieve Magnet recognition but also as a framework for nursing practice and research in the future. Evaluation, The Magnet Model was used to identify success factors related to a practice change and to evaluate the nursing practice environment. Key issues, Even when proposed changes to practice are evidence based and thoughtfully considered, the nurses' work environment must be supportive and empowering in order to yield successful and sustainable implementation of new practice. Conclusion, Success factors for implementation of a practice change can be illuminated by aligning environmental characteristics to the components of the new Magnet Model. Implications for nursing management, The Magnet Model provides an exceptional framework for building an agile and dynamic work force. Thoughtful consideration of the components and inter-relationships represented in the new model can help to both predict and ensure organizational vitality. [source]

Challenges confronting clinicians in acute care

JOURNAL OF NURSING MANAGEMENT, Issue 6 2009
VICKI PARKER RN
Aim, To engage acute care clinicians in prioritizing professional issues of concern and to help them identify and design change projects. Background, In order to meet and respond to challenges and to ensure safety, efficiency and positive patient and staff outcomes, it is imperative to understand the nature of difficulties faced by health professionals and for clinicians to be included in decision making and change. Method, A three-phase mixed-method design utilizing descriptive and interpretive approaches. Data were collected via survey, focus groups and nominal group workshops. Results, Communication, skill mix and work environments were identified as issues of most concern. Participants were able to identify and prioritize a range of projects to help them better understand and alleviate workplace problems. Conclusion, This study highlights key directions for practice change and confirms previous findings identifying urgent need for research that aims to overcome poor communication and skill shortages. It differs from other studies by providing a platform for participants to design projects leading to solutions and participate in change. Implications for nursing management, Support must be provided for managers in rostering, staffing, and resource procurement and allocation. The results of the present study highlights a need to refocus management styles on staff empowerment, participation and team building. [source]

Public Safety Outcomes of Virginia's Detention Assessment Instrument

JUVENILE AND FAMILY COURT JOURNAL, Issue 3 2007
SCOTT REINER
ABSTRACT The placement of juveniles in secure detention has been the subject of considerable attention recently. For the past several years, Virginia has been engaged in efforts to improve detention practices at both the state and local levels. One important policy and practice change is the implementation of a standardized, structured decision-making instrument to guide detention decisions by intake officers of the Virginia Department of Juvenile Justice (DJJ). This report will present a brief background on the Detention Assessment Instrument (DAI); an analysis of the performance of the DAI on key public safety outcomes; and an overview of Virginia's participation in the Juvenile Detention Alternatives Initiative (JDAI). [source]

A review of evaluation outcomes of web-based continuing medical education

MEDICAL EDUCATION, Issue 6 2005
Vernon R Curran
Introduction, The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web-based CME. Various models for designing and facilitating web-based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web-based CME evaluative outcomes reported in the peer-reviewed literature. Methods, A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation. Results, The results of this analysis revealed that the majority of evaluative research on web-based CME is based on participant satisfaction data. There was limited research demonstrating performance change in clinical practices and there were no studies reported in the literature that demonstrated that web-based CME was effective in influencing patient or health outcomes. Discussion, The findings suggest an important need to examine in greater detail the nature and characteristics of those web-based learning technologies, environments and systems which are most effective in enhancing practice change and ultimately impacting patient and health outcomes. This is particularly important as the Internet grows in popularity as a medium for knowledge transfer. [source]

Teaching and evaluating point of care learning with an Internet-based clinical-question portfolio

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2009
MSc Associate Professor of Medicine, Michael L. Green MD
Abstract Introduction: Diplomates in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program satisfy the self-evaluation of medical knowledge requirement by completing open-book multiple-choice exams. However, this method remains unlikely to affect practice change and often covers content areas not relevant to diplomates' practices. We developed and evaluated an Internet-based point of care (POC) learning portfolio to serve as an alternative. Methods: Participants enter information about their clinical questions, including characteristics, information pursuit, application, and practice change. After documenting 20 questions, they reflect upon a summary report and write commitment-to-change statements about their learning strategies. They can link to help screens and medical information resources. We report on the beta test evaluation of the module, completed by 23 internists and 4 internal medicine residents. Results: Participants found the instructions clear and navigated the module without difficulty. The majority preferred the POC portfolio to multiple-choice examinations, citing greater relevance to their practice, guidance in expanding their palette of information resources, opportunity to reflect on their learning needs, and "credit" for self-directed learning related to their patients. Participants entered a total of 543 clinical questions, of which 250 (46%) resulted in a planned practice change. After completing the module, 14 of 27 (52%) participants committed to at least 1 change in their POC learning strategies. Discussion: Internists found the portfolio valuable, preferred it to multiple-choice examinations, often changed their practice after pursuing clinical questions, and productively reflected on their learning strategies. The ABIM will offer this portfolio as an elective option in MOC. [source]

Requesting a commitment to change: Conditions that produce behavioral or attitudinal commitment

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2008
Githa Kanisin Overton PhD
Abstract There is a lack of clarity in the conceptualization of commitment underlying the commitment to change (CTC) procedure used by organizers of continuing education in the health professions. This article highlights the two distinct conceptualizations of commitment that have emerged in the literature outside health care education and practice. The distinction is important because different antecedent conditions produce different types and dimensions of commitment. This article goes on to explore the antecedents of behavioral and attitudinal commitment and illustrates how different types of commitment may have been produced in previous CTC studies. As a result, the article also demonstrates the need for clarity in the conceptualization of commitment, especially to guide empirical research into the nature and strength of commitment produced by the variety of CTC strategies. Such research is relevant in increasing our understanding of how and why CTCs are able to influence practice change. [source]

Benchmarking epidemiological characteristics of cervical cancer in advance of change in screening practice and commencement of vaccination

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2007
Colin Luke
Abstract Objectives: To investigate trends in cervical cancer incidence, mortality and survival by histology for benchmarking purposes ahead of practice change and the introduction of Human Papilloma Virus (HPV) vaccine. Methods: Using data from the South Australian Cancer Registry, age-standardised rates are presented for four-year periods from 1977 to 2004. Socio-demographic and secular predictors of glandular as opposed to squamous cancers are investigated, using multivariable logistic regression. Disease-specific survivals are analysed using Kaplan-Meier product-limit estimates and Cox proportional hazards regression. Results: Incidence and mortality rates reduced by 55.1% and 59.3% respectively between 1977,80 and 2001,04, with larger reductions for squamous than glandular cancers. The ratio of squamous to glandular cancer incidence reduced from 5.4:1 in 1977,88 to 2.8:1 in 1993,2004, with a corresponding reduction from 5.2:1 to 3.0:1 for mortality. Compared with squamous cancers, glandular lesions were more common in patients from higher socio-economic areas, but less common in those over 70 years of age, Aboriginal patients, and those born in Southern Europe. Conclusion: The proportion of cancers comprising glandular lesions has increased, possibly reflecting prevention of squamous cancers through treatment of screen-detected preinvasive lesions. Additional mortality reductions from screening may be limited where the proportion of glandular lesions is high, with vaccination offering the best prospects for gains in the long term. Priority should be given to Aboriginal and Torres Strait Islander women in vaccination programs in view of their high death rate from cervical cancer. [source]

Qualitative Data Collection and Analysis Methods: The INSTINCT Trial

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
William J. Meurer MD
Patient care practices often lag behind current scientific evidence and professional guidelines. The failure of such knowledge translation (KT) efforts may reflect inadequate assessment and management of specific barriers confronting both physicians and patients at the point of treatment level. Effective KT in this setting may benefit from the use of qualitative methods to identify and overcome these barriers. Qualitative methodology allows in-depth exploration of the barriers involved in adopting practice change and has been infrequently used in emergency medicine research. The authors describe the methodology for qualitative analysis within the INcreasing Stroke Treatment through INteractive behavioral Change Tactics (INSTINCT) trial. This includes processes for valid data collection and reliable analysis of the textual data from focus group and interview transcripts. INSTINCT is a 24-hospital, randomized, controlled study that is designed to evaluate a system-based barrier assessment and interactive educational intervention to increase appropriate tissue plasminogen activator (tPA) use in ischemic stroke. Intervention hospitals undergo baseline barrier assessment using both qualitative as well as quantitative (survey) techniques. Investigators obtain data on local barriers to tPA use, as well as information on local attitudes, knowledge, and beliefs regarding acute stroke treatment. Targeted groups at each site include emergency physicians, emergency nurses, neurologists, radiologists, and hospital administrators. Transcript analysis using NVivo7 with a predefined barrier taxonomy is described. This will provide both qualitative insight on thrombolytic use and importance of specific barrier types for each site. The qualitative findings subsequently direct the form of professional education efforts and system interventions at treatment sites. [source]

Effect of Evidence-Based Acute Pain Management Practices on Inpatient Costs

HEALTH SERVICES RESEARCH, Issue 1 2009
John M. Brooks
Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based acute pain management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based acute pain management practices have on inpatient cost. Data Sources/Study Setting. Data from a randomized "translating research into practice" (TRIP) behavioral intervention designed to increase the use of evidence-based acute pain management practices for patients hospitalized with hip fractures. Study Design. Experimental design and observational "as-treated" and instrumental variable (IV) methods. Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts. Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. "As-treated" estimates of the effect of changes in evidence-based acute pain management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention. Conclusions. A hospital treating more that 12 patients with acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over "as-treated" methods to assess the direct effect of practice changes on cost. [source]

Patient Response to the Fast-Track Experience

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003
Jane Flanagan
PURPOSE To describe patients' functional health, symptom distress, and recovery at home across a fasttrack perioperative experience. METHODS A nonexperimental, descriptive, correlational design using pre/post test measures and openended questions captured the fast-tracking experience. A convenience sample included 77 patients entering the same-day surgery unit to undergo arthroscopy with general anesthesia and planned fast-track recovery. In the preadmission test area, patients were asked by a nurse to participate in the study. If they agreed and met selection criteria, a nurse completed a demographic sheet, the Foster and Jones Functional Health Pattern Assessment Screeing Tool (FHPAST), and the Symptom Distress Scale (SDS). On the evening of surgery, a nurse called the patient to review the SDS to be completed by phone. At 72 hours after surgery, the FHPAST, the SDS, and a 72-hour open-ended questionnaire were administered to understand the patient experience of fast-tracking. FINDINGS At 12 hours nurses reported patients were "euphoric" and it was difficult to imagine pain or other symptoms. Some patients complained of nausea and fatigue. Most patients had family present. At 72 hours patients described unmet expectations, fatigue, immobility, ineffective pain management, sleep disturbance, and nausea. Interventions included teaching, coaching, and reassurance. Some patients continued to have nursing problems at 72 hours and benefited from a telephone follow-up call. CONCLUSIONS Preliminary results suggest that nursing diagnoses, interventions, and outcomes can be used to describe patient responses to the fast-track experience. Results indicate a need for practice changes to include innovative models and further research to measure outcomes. Fast-tracking can be effective, but requires clinical reasoning by nurses to guide the individual's healing. A coaching intervention seems to enhance patient satisfaction and a sense of being cared for. [source]

The suitability of computer-based training for workers with limited formal education: a case study from the US agricultural sector

INTERNATIONAL JOURNAL OF TRAINING AND DEVELOPMENT, Issue 4 2006
W. Kent Anger
The suitability of computer-based instruction (CBI) for workers with limited education was evaluated in an Hispanic orchard workforce that reported little computer experience and 5.6 mean years of formal education. Ladder safety training was completed by employees who rated the training highly (effect size [d_gain] = 5.68), and their knowledge of ladder safety improved (d_gain = 1.45). There was a significant increase (p < 0.01) in safe work practices immediately after training (d_gain = 0.70), at 40 days post training (d_gain = 0.87) and at 60 days (d_gain = 1.40), indicating durability. As in mainstream populations, reaction or affective ratings correlated well with utility ratings, but not with behavior change. This demonstrates that an agricultural workforce with limited formal education can learn job safety from CBI and translate the knowledge to work practice changes, and those changes are durable. [source]

Development of a Clinical Practice Guideline for Testing Nasogastric Tube Placement

JOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 1 2009
Sue Peter
PURPOSE.,A Perth metropolitan hospital group standardized changes to nasogastric tube placement, including removal of the "whoosh test" and litmus paper, and introduction of pH testing. DESIGN AND METHODS.,,Two audits were conducted: bedside data collection at a pediatric hospital and a point-prevalence audit across seven hospitals. RESULTS.,,Aspirate was obtained for 97% of all tests and pH was , 5.5 for 84%, validating the practice changes. However, patients on continuous feeds and/or receiving acid-inhibiting medications had multiple pH testing fails. PRACTICE IMPLICATIONS.,Nasogastric tube placement continues to present a challenge for those high-risk patients on continuous feeds and/or receiving acid-inhibiting medications. [source]

Developing a theory-based taxonomy of methods for implementing change in practice

JOURNAL OF ADVANCED NURSING, Issue 2 2007
Jennifer Leeman
Abstract Title. Developing a theory-based taxonomy of methods for implementing change in practice Aim., In this paper we present a theory-based taxonomy of the methods used to implement change in practice. Background., Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods. Method., A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report. Findings., Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control. Conclusions., The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings. [source]

Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders

JOURNAL OF NURSING MANAGEMENT, Issue 6 2010
CHRISTINE A. BOOMER RGN, PG Cert.
boomer c.a.& mccormack b. (2010) Journal of Nursing Management 18, 633,644 Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim, To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background, The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods, Programme evaluation methodology to determine the ,worth' of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results, Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions, Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management, Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators. [source]

Utilizing audit to evaluate improvements in continuous veno-venous haemofiltration practices in intensive therapy unit

NURSING IN CRITICAL CARE, Issue 4 2006
Annette Richardson
Abstract Continuous veno-venous haemofiltration (CVVH) is used regularly in the management of acute renal failure in intensive therapy unit (ITU). A three-staged approach was undertaken involving two audits of practice to improve CVVH record keeping in a 15-bedded cardiac ITU. An initial baseline audit identified a number of areas for improvement in practice. The areas for improvement were implemented then a second audit was repeated. The improvements and practice changes included the dissemination of audit findings to the multidisciplinary team, redesigning the prescription chart to a more user-friendly format and the development of a competency-based CVVH workbook. This nurse-led project demonstrated how positive outcomes and improvements could be achieved with record keeping across the multidisciplinary ITU team. [source]

The Emergency Physician and Knowledge Transfer: Continuing Medical Education, Continuing Professional Development, and Self-improvement

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Barbara J. Kilian MD
A workshop session from the 2007 Academic Emergency Medicine Consensus Conference, Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake, focused on developing a research agenda for continuing medical education (CME) in knowledge transfer. Based on quasi-Delphi methodology at the conference session, and subsequent electronic discussion and refinement, the following recommendations are made: 1) Adaptable tools should be developed, validated, and psychometrically tested for needs assessment. 2) "Point of care" learning within a clinical context should be evaluated as a tool for practice changes and improved knowledge transfer. 3) The addition of a CME component to technological platforms, such as search engines and databases, simulation technology, and clinical decision-support systems, may help knowledge transfer for clinicians or increase utilization of these tools and should, therefore, be evaluated. 4) Further research should focus on identifying the appropriate outcomes for physician CME. Emergency medicine researchers should transition from previous media-comparison research agendas to a more rigorous qualitative focus that takes into account needs assessment, instructional design, implementation, provider change, and care change. 5) In the setting of continued physician learning, barriers to the subsequent implementation of knowledge transfer and behavioral changes of physicians should be elicited through research. [source]

Felt tip pens and school councils: children's participation rights in four English schools

CHILDREN & SOCIETY, Issue 4 2001
Dominic Wyse
The United Nation Convention on the Rights of the Child has created practical challenges for nation states and institutions particularly in relation to children's rights to participation. The limited research that is available has tended to use survey methodology; qualitative accounts of children's daily lives are rare. The present study investigated the nature of children's participation in their education in two primary and two secondary schools; in particular the right to express views freely in all matters affecting the child. The study found that children's opportunities to express their views were extremely limited even when school councils were in place. It is concluded that the goal of active citizenship espoused by recent national curriculum developments will remain illusive unless educational practice changes to a focus on school processes rather than products. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Changing GPs' prescription patterns through guidelines and feedback.

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007
Intervention study
Abstract Purpose To investigate whether and how a multi-dimensional intervention including clinical guidelines on the choice of medical treatment in the primary and the secondary health care sector, and individual feedback to general practices about their own and other practices' prescription patterns in five Anatomical Therapeutic Chemical classification system (ATC)-groups was followed by changes in the practices' prescription pattern. Methods Prospective historical registry study and a questionnaire study of GPs' self-reported use of guidelines and feedback. Results In every ATC-group the number of prescribed defined daily doses (DDDs) kept growing after the intervention, while potential savings by DDD decreased. Individual practices' changes in the prescription pattern differed by ATC-group and practices with high potential savings/DDD before the intervention showed the greatest relative reduction in potential savings/DDD. The county's average cost/DDD for the five ATC-groups declined from above the Danish average before the intervention to a level below the average cost/DDD after the intervention. In the questionnaire study (response rate: 79%), 69% of respondents had read the guidelines and 78% reported that the feedback influenced their prescription of drugs. Conclusions The observed changes in drug costs and potential savings were not due to volume effects but a combination of price effects, including generic substitution and choice of less expensive analogues, demonstrating that it is possible to change GPs' prescription patterns without interfering with patients' access to treatment or with GPs' clinical freedom.' Copyright © 2007 John Wiley & Sons, Ltd. [source]