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Reminders
Selected AbstractsPerceived need for emergency medicine training in Pakistan: A survey of medical education leadershipEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009Junaid A Razzak Abstract Objective: To assess the perception of leaders of the academic medical institutions regarding the need for specialty training in emergency medicine. Methods: A cross-sectional survey was conducted in all medical colleges of Pakistan in September 2005. Our sample included all academic leaders of recognized medical colleges in Pakistan. A questionnaire was designed and sent (mailed and faxed) to vice chancellors, deans, principals or medical directors of the institutions. Reminders were sent through faxes and emails wherever available, followed by phone calls if responses were not available after several attempts. Results: At the time of study, there were 39 medical colleges recognized by Pakistan Medical and Dental Council. Of these, responses were received from 26 teaching institutions in the country. A majority of the respondents (85%) were not satisfied with the care provided in the ED of their primary teaching hospital, and three-fourth (74%) thought that doctors specialized in other disciplines, like internal medicine and family medicine, cannot adequately manage all emergencies. When asked if Pakistan should have a separate residency training programme in emergency medicine, 96% responded in affirmative, and many (85%) thought that they will start a residency programme in emergency medicine if it was approved as a separate specialty. Conclusion: This survey shows significant support for a separate local training programme for emergency medicine in the country. [source] Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelinesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009L. LAINE Summary Background, Protective co-therapy is recommended in NSAID users with GI risk factors, but adherence is poor. Aim, To assess the proportion of NSAID users receiving co-therapy and strategies to improve adherence. Methods, Arthritis patients ,50 years of age received etoricoxib or diclofenac in a double-blind randomized trial. Reminders that high-risk patients (age , 65; previous ulcer/haemorrhage; corticosteroid, anticoagulant, aspirin use) should receive co-therapy were given at study initiation. Free PPI was provided. An intervention midway through the study included a written reminder and required written response regarding co-therapy. Results, 16 244/23 504 (69%) patients had GI risk factors. Pre-intervention, co-therapy was most common with previous ulcer/haemorrhage [706/1107 (64%)] and 3,4 risk factors [331/519 (64%)]. In the 10 026 patients enrolled pre-intervention and remaining in the study ,6 months after, co-therapy in high-risk patients increased from 2958/6843 (43%) to 4177/6843 (61%) (difference = 18%; 95% CI 16%,19%). The increase was greater outside the US (22%; 19%,24%) than in the US (15%; 13%,17%). Conclusions, Less than 50% of NSAID users with GI risk factors are given protective co-therapy , even if prescribers are given reminders and cost is not an issue. Direct communication requiring written response significantly increased adherence to guidelines, but achieving higher levels of adherence will require additional strategies. [source] Ethnography as Commentary: Writing from the Virtual Archive by Johannes Fabian Memory against Culture: Arguments and Reminders by Johannes FabianAMERICAN ANTHROPOLOGIST, Issue 4 2009CHRISTOPHER KELTY No abstract is available for this article. [source] Memory against Culture: Arguments and Reminders by Johannes FabianAMERICAN ETHNOLOGIST, Issue 2 2010DANIEL A. SEGAL No abstract is available for this article. [source] Don't Forget to Vote: Text Message Reminders as a Mobilization ToolAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 4 2009Allison Dale Current explanations of effective voter mobilization strategies maintain that turnout increases only when a potential voter is persuaded to participate through increased social connectedness. The connectedness explanation does not take into account, however, that registered voters, by registering, have already signaled their interest in voting. The theory presented in this article predicts that impersonal, noticeable,messages can succeed in increasing the likelihood that a registered voter will turn out by reminding the recipient that Election Day is approaching. Text messaging is examined as an example of an impersonal, noticeable communication to potential voters. A nationwide field experiment (n = 8,053) in the 2006 election finds that text message reminders produce a statistically significant 3.0 percentage point increase in the likelihood of voting. While increasing social connectedness has been shown to positively affect voter turnout, the results of this study, in combination with empirical evidence from prior studies, suggest that connectedness is not a necessary condition for a successful mobilization campaign. For certain voters, a noticeable reminder is sufficient to drive them to the polls. [source] Self-Regulation: Reminders and Suggestions from Personality ScienceAPPLIED PSYCHOLOGY, Issue 3 2006Daniel Cervone La littérature sur l'autorégulation est couramment accusée de faiblesse théorique. Il est possible que les avancées dans les recherches sur la personnalité puissent ouvrir des horizons dans ce secteur. Notre objectif est double. Nous rappelons d'abord des distinctions conceptuelles qui, bien que parfois négligées, sont essentielles dans les études contemporaines sur la personnalité et incontournables pour accéder au niveau théorique dans la littérature sur l'autorégulation. Nous disons ensuite que ceux qui font des études fondamentales et appliquées sur l'autorégulation auraient intérêt à assimiler les progrès récents concernant la dynamique et la structure de la personnalité intra-individuelle. Nous passons en revue la théorie de base et les recherches sur l'architecture des systèmes de la personnalité intra-individuelle, ainsi que les retombées de ce travail dans trois domaines d'application: la psychologie du travail/industrielle/organisationnelle, la psychologie clinique et la santé. The self-regulation literature commonly is said to lack theoretical order. This paper explores the possibility that advances in personality science may foster clarity in this literature. Our goals are two-fold. We remind readers of conceptual distinctions that are central to contemporary personality science, that are necessary to the attainment of theoretical order in the self-regulation literature, yet that sometimes are overlooked. Secondly, we suggest that basic and applied students of self-regulation would profit by capitalising on recent advances in personality science that explore intra-individual personality structure and dynamics. We review theory and research on the architecture of intra-individual personality systems and applications of this work to three domains: health, clinical, and work/industrial/organisation psychology. [source] Antenatal screening and intrapartum management of Group B Streptococcus in the UKBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2004Sara Kenyon Objective To determine whether there has been any change in UK policy for the screening and intrapartum management of Group B Streptococcus in pregnancy over a two year period. Design Two national survey's of practice carried out in 1999 and 2001. Setting All obstetric units in the UK. Population Clinical directors of maternity services. Methods A questionnaire was sent to all clinical directors of maternity services in the UK requesting information about their policy and practice with respect to antenatal screening for Group B Streptococcus colonisation. Reminders were sent after one month. Main outcome measures Number of maternity units in the UK screening and offering intrapartum antibiotic prophylaxis for Group B Streptococcus colonisation in pregnancy. Results The response rates were 84% in 1999 and 82% in 2001. Of the responding units, six (3%) in 1999 and four (2%) in 2001 used vaginal swab based screening for Group B Streptococcus colonisation in the antenatal period. In 1999, intrapartum antibiotic prophylaxis was offered to women with a previous baby affected by Group B Streptococcus in 85% (176/207) of maternity units and in 2001 this had risen to 95% (193/203). Similarly, in 1999 intrapartum antibiotic prophylaxis was offered to women who were known carriers of Group B Streptococcus in 87% (179/207) of maternity units and in 2001 this had risen to 95% (193/203). Appropriate dosage of a recommended antibiotic was prescribed in 7% (9/123) units in 1999 and in 20% (35/178) units in 2001. Conclusions Although intrapartum antibiotic prophylaxis for women at high risk of giving birth to babies with Group B Streptococcus is widely practiced in the UK, a programme of antenatal screening for Group B Streptococcus colonisation has not been adopted along the lines advocated in the USA. There therefore remains an opportunity to evaluate such a screening programme in a randomised trial. [source] Review article: medication non-adherence in ulcerative colitis , strategies to improve adherence with mesalazine and other maintenance therapiesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2008A. B. HAWTHORNE Summary Background, Significant number of patients with ulcerative colitis (UC) fail to comply with treatment. Aims, To review issues surrounding medication non-adherence in inflammatory bowel disease (IBD), including the clinical and health service implications in the UK, and discuss strategies for optimizing medication adherence. Methods, Articles cited were identified via a PubMed search, utilizing the words IBD, adherence, compliance, medication and UC. Results, Medication non-adherence is multifactorial involving factors other than dosing frequency. Male gender (OR: 2.06), new patient status (OR: 2.14), work and travel pressures (OR: 4.9) and shorter disease duration (OR: 2.1), among others are proven predictors of non-adherence in UC. These indicators can identify ,at-risk' patients and allow an individually tailored treatment approach to be introduced that optimizes medication adherence. A collaborative relationship between physician and patient is important; several strategies for improving adherence have been proven effective including open dialogue that takes into consideration the patient's health beliefs and concerns, providing educational (e.g. verbal/written information, self-management programmes) and behavioural interventions (e.g. calendar blister packs, cues/reminders). Conclusions, Educational and behavioural interventions tailored to individual patients can optimize medication adherence. Additional studies combining educational and behavioural interventions may provide further strategies for improving medication adherence rates in UC. [source] "I Am Not Alone": The Feasibility and Acceptability of Interactive Voice Response-Facilitated Telephone Peer Support Among Older Adults With Heart FailureCONGESTIVE HEART FAILURE, Issue 3 2007Michele Heisler MD Patient self-management is a critical determinant of heart failure (HF) outcomes, yet patients with HF are often frail and socially isolated, factors that may limit their ability to manage self-care and access clinic-based services. Mobilizing peer support among HF patients is a promising strategy to improve self-management support. In this pilot, the authors evaluated the feasibility and acceptability of an interactive voice response (IVR)-based platform to facilitate telephone peer support among older adults with HF. Participants completed a baseline survey, were offered a 3-hour training session in peer communication skills, and were paired with another patient who had HF. Participants were asked to contact their partner weekly using a toll-free IVR phone system that protected their anonymity and provided automated reminders if contacts were not made. Times and duration of participants' telephone contacts were monitored and recorded. After the 7-week intervention, participants completed surveys and brief face-to-face interviews. The authors found high levels of use and satisfaction and improvements in depressive symptoms among the 20 pilot study participants. An IVR peer-support intervention is feasible, is acceptable to patients, and may have positive effects on patients' HF social support and health outcomes, in conjunction with structured health system support, that warrant more rigorous evaluation in a randomized trial. [source] FS02.5 Nickel allergy and hand eczema , a twenty-year follow-upCONTACT DERMATITIS, Issue 3 2004Anna Josefson Aim:, To investigate the occurrence of hand eczema after 20 years in schoolgirls previously patch-tested to nickel. Methods:, In 1982,83, 960 schoolgirls, aged 8, 11 and 15 years, were investigated for the occurrence of nickel allergy (Larson-Stymne B and Widström L, Contact Dermatitis 1985:13:289,293). The girls were patch-tested and the prevalence of nickel allergy was 9%. Twenty years later, the same individuals have received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. After two reminders, the response rate was 81%. Results:, In total 17.5% of the girls reported hand eczema after the age of 15. The 1-year prevalence of hand eczema was 12.6%. Of the previously patch-tested schoolgirls who answered the questionnaire, 63 were sensitive to nickel. In this study, the prevalence of hand eczema among those 63 was 16%, compared to 17% in the non-sensitive group (NS). Excluding persons with atopic dermatitis, the prevalence of hand eczema was 12.5% in the nickel-sensitive group, and 10% among the others (NS). 32% of the persons who had had atopic dermatitis reported hand eczema after 15 years of age, compared to 10% of those with no history of atopic dermatitis (p < 0.001). Conclusion:, Contact allergy to nickel in early childhood (8,15 years) did not seem to increase the prevalence of hand eczema later in life. The prevalence of hand eczema was increased by a factor of three among those with a history of atopic dermatitis, which is in accordance with earlier reports. [source] Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysisDIABETIC MEDICINE, Issue 2 2006R. F. Dijkstra Abstract Aims Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. Patients and methods In a clustered-randomized controlled trial design, 13 Dutch general hospitals were randomly assigned to a control group, a professional-directed or a patient-centred implementation programme. Professionals received feedback on baseline data, education and reminders. Patients in the patient-centred group received education and diabetes passports. A validated probabilistic Dutch diabetes model and the UKPDS risk engine are used to compute lifetime disease outcomes and cost in the three groups, including uncertainties. Results Glycated haemoglobin (HbA1c) at 1 year (the measure used to predict diabetes outcome changes over a lifetime) decreased by 0.2% in the professional-change group and by 0.3% in the patient-centred group, while it increased by 0.2% in the control group. Costs of primary implementation were < 5 Euro per head in both groups, but average lifetime costs of improved care and longer life expectancy rose by 9389 Euro and 9620 Euro, respectively. Life expectancy improved by 0.34 and 0.63 years, and quality-adjusted life years (QALY) by 0.29 and 0.59. Accordingly, the incremental cost per QALY was 32 218 Euro for professional-change care and 16 353 for patient-centred care compared with control, and 881 Euro for patient-centred vs. professional-change care. Uncertainties are presented in acceptability curves: above 65 Euro per annum the patient-directed strategy is most likely the optimum choice. Conclusion Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings. [source] Revaccination of bone marrow transplant recipients: a review of current practices in AustraliaINTERNAL MEDICINE JOURNAL, Issue 4 2009Adrienne Torda Abstract Background: Vaccination following bone marrow transplant (BMT) is an important part of ongoing care and disease prevention. The aim of the study was to investigate vaccination procedures in BMT recipients and identify what systems are in place throughout Australia to remind and alert patients concerning their need for vaccination. Methods: Questionnaires were sent to haematologists managing BMT recipients in Australia to examine post-BMT vaccination practices in hospitals and outpatient clinics. Questionnaires were also sent to BMT recipients in New South Wales, who had their transplants (either allogeneic or autologous) in the past 5 years to determine what vaccinations they had received and what vaccination reminder systems had been used. Results: Vaccine recommendations and practices by BMT physicians showed little consensus. They also differed greatly between autologous and allogeneic transplant recipients. Only just more than half of the physicians had an effective reminder system in place and only 12 of 34 patients had received vaccination reminders. One-third of all patients were not aware of any need for revaccination. Conclusion: The disparity in physician practice regarding revaccination is significant and may reflect the lack of data available regarding efficacy of revaccination in this setting and/or a lack of knowledge about recommendations. Because of this, a national immunization schedule for post-BMT patients founded on evidence-based studies is required to provide optimal patient care. The lack of effective follow up and reminder systems ensuring patient completion of vaccination schedules is also an area needing improvement. [source] Pharmacy support staff involvement in, and attitudes towards, pharmacy-based services for drug misusersINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 6 2009Jenny Scott Abstract Objective This study aimed to examine involvement of pharmacy support staff in delivering services to drug misusers; to quantify their participation in related training; and to examine relationships between attitudes, practice experience and training. Methods The setting was a random sample of 10% of UK community pharmacies (n = 1218) using a postal questionnaire with two reminders. Pharmacy managers were used as gate-keepers to access pharmacy support staff, which included dispensary technicians and medicines counter assistants. Key findings Six hundred and ninety (56.7%) pharmacies responded, and 1976 completed questionnaires were returned from 610 (50.1%) pharmacies. A further 80 (6.6%) opted out. Three-fifths of staff had no input into decisions about whether their pharmacy provided services for drug misusers. One-third working in pharmacies that provide services were uncertain or negative about whether their pharmacy should do so. Staff were more involved in needle exchange (91%) and decisions to sell needles (95%) than supervising consumption of therapies (64%) or handing out dispensed medicines to drug misusers (73%), suggesting managers perceive needle exchange and sales as appropriate roles. Three-quarters of those working in pharmacies that provide services had not received any training to do so. Those who had undertaken training and who worked in pharmacies that provided services had significantly more positive attitudes compared to those had not undertaken training but also worked in pharmacies that provided services, or those who had undertaken training but did not provide services. Conclusions Pharmacy support staff were involved extensively in drug-misuse services but the majority had not been trained to do so. Attitudes were more positive in those who were involved in service provision and had undertaken training. The findings suggest a need for more extensive training and for further exploration of the views of managers on appropriate roles, particularly the clinical versus supply nature of needle exchange. This is timely given the recent publication of guidelines by the National Institute of Health and Clinical Excellence (NICE) on needle exchange. [source] Community pharmacy services to drug misusers in the south west of England: results of the 2003,2004 postal surveyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 4 2006Rachel M Britton research pharmacist Objectives To quantify current levels of methadone dispensing and supervised consumption for the treatment of drug misuse in community pharmacies in the south west of England. To compare 2003,2004 data to estimates made in 1995. Setting All community pharmacies in the strategic health authority areas of Avon, Gloucestershire and Wiltshire; Dorset and Somerset; and South West Peninsula (n = 903). Method A self-completion postal questionnaire was addressed to the ,pharmacist in charge', with up to three reminders. Descriptive data were collected on demography and drug misuse services provided by the pharmacist. Key findings An overall response rate of 78.3% (707/903) was achieved. Of all respondents, 69.2% (n = 489) dispensed methadone for the treatment of drug misuse, and 70.1% of these pharmacies (n = 343) reported providing a supervised methadone consumption service. The total number of clients receiving methadone through pharmacies in the south west was 3427, with a mean number of 7.0 clients per pharmacy; 49.5% of all clients receiving methadone had their daily doses supervised by the pharmacist. The majority of prescriptions issued for methadone (72.9%, n = 2503) were from general practice. Conclusions The majority of pharmacies (69.2%) in south west England dispense methadone and other drugs to drug misusers with just under half of the clients (49.5%) receiving their methadone by supervised consumption. [source] The Practical Approach to Lung Health in South Africa (PALSA) intervention: respiratory guideline implementation for nurse trainersINTERNATIONAL NURSING REVIEW, Issue 4 2006A. Bheekie d.pharm Aim:, This paper describes the design, facilitation and preliminary assessment of a 1-week cascade training programme for nurse trainers in preparation for implementation of the Practical Approach to Lung Health in South Africa (PALSA) intervention, tested within the context of a pragmatic cluster randomized controlled trial in the Free State province. PALSA combines evidence-based syndromic guidelines on the management of respiratory disease in adults with group educational outreach to nurse practitioners. Background:, Evidence-based strategies to facilitate the implementation of primary care guidelines in low- to middle-income countries are limited. In South Africa, where the burden of respiratory diseases is high and growing, documentation and evaluation of training programmes in chronic conditions for health professionals is limited. Method:, The PALSA training design aimed for coherence between the content of the guidelines and the facilitation process that underpins adult learning. Content facilitation involved the use of key management principles (key messages) highlighted in nurse-centred guidelines manual and supplemented by illustrated material and reminders. Process facilitation entailed reflective and experiential learning, role-playing and non-judgemental feedback. Discussion and results:, Preliminary feedback showed an increase in trainers' self-awareness and self-confidence. Process and content facilitators agreed that the integrated training approach was balanced. All participants found that the training was motivational, minimally prescriptive, highly nurse-centred and offered personal growth. Conclusion:, In addition to tailored guideline recommendations, training programmes should consider individual learning styles and adult learning processes. [source] Acute Pain Teams in England: current provision and their role in postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 3 2003Ann Mcdonnell BSc Summary ,,This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. ,,Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. ,,After written and telephone reminders, the response rate was 86% (n = 226). ,,Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P,0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. ,,Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a ,token' service only. Recent policy recommendations may have little impact on the current situation. [source] Cognitive,behavior therapy for PTSD in rape survivorsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2002Lisa H. Jaycox In recent years, new data have appeared, further suggesting the utility of cognitive,behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive,behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment. © 2002 Wiley Periodicals, Inc. J Clin Psychol/In Session 58: 891,906, 2002. [source] Meeting the advocacy needs of people who have been abused by health and social care practitionersJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2001Jennie Williams Abstract The Prevention of Professional Abuse Network (POPAN) is the first national organization within the UK to address the problem of the abuse of clients and patients by health and social care providers. POPAN has a small staff group of eight people and a larger network of advisers, supporters and allies; its activities include campaigning, training, consultancy, and the provision of information, advice and advocacy. Jennie Williams is a clinical psychologist and trustee of POPAN, she has supported the development of the organization since the early 1990s; Jo Nash was the main person involved in the development and provision of the advocacy service between September 1997 to January 2000. This is the edited version of a taped and transcribed interview that took place in 1999. Jo Nash is uniquely placed to provide information of significance to anyone using or providing health and social care services. Her work as an advocate has given her a very particular insight into the challenges faced by those seeking redress for professional abuse, and she has first hand experience of providing advocacy to people who are vulnerable and reluctant to trust anyone offering help. In this interview Jo Nash directs attention to the considerable limitations in current complaints systems, practices and procedures, and offers comment on the implications for change. Her work with POPAN provides continual reminders of the importance of prevention, and she identifies a number of ways in which action can be taken to prevent health and social care practitioners abusing their patients and clients. Copyright © 2001 John Wiley & Sons, Ltd. [source] Current issues challenging the professionJOURNAL OF CORPORATE ACCOUNTING & FINANCE, Issue 4 2010Jack T. Ciesielski The American Institute of Certified Public Accountants held its annual Current Securities and Exchange Commission and Public Company Accounting Oversight Board Conference on December 7,9, 2009. As auditors deal with various client accounting issues, and serve as gatekeepers in the whole financial reporting process, the topics presented at the conference serve as reminders for smart auditors,who incorporate them into their audit plans. The authors provide an overview of the issues and challenges discussed at the conference. © 2010 Wiley Periodicals, Inc. [source] Maintaining gender sensitivity in the family practice: facilitators and barriersJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2009Halime Celik MSc LLB Abstract Objective, This study aims to identify the facilitators and barriers perceived by General Practitioners (GPs) to maintain a gender perspective in family practice. Methods, Nine semi-structured interviews were conducted among nine pairs of GPs. The data were analysed by means of deductive content analysis using theory-based methods to generate facilitators and barriers to gender sensitivity. Results, Gender sensitivity in family practice can be influenced by several factors which ultimately determine the extent to which a gender sensitive approach is satisfactorily practiced by GPs in the doctor,patient relationship. Gender awareness, repetition and reminders, motivation triggers and professional guidelines were found to facilitate gender sensitivity. On the other hand, lacking skills and routines, scepticism, heavy workload and the timing of implementation were found to be barriers to gender sensitivity. Conclusion, While the potential effect of each factor affecting gender sensitivity in family practice has been elucidated, the effects of the interplay between these factors still need to be determined. [source] The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelinesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2007Fiona 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] Thromboprophylaxis for hospitalized medical patients: A Multicenter Qualitative study,,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2009Deborah Cook MD Abstract BACKGROUND: Observational studies have documented that medical patients infrequently receive venous thromboembolism (VTE) prevention. OBJECTIVE: To understand the barriers to, and facilitators of, optimal thromboprophylaxis. PATIENTS: Hospitalized medical patients. DESIGN: We conducted in-depth interviews with 15 nurses, 6 pharmacists, 12 physicians with both clinical and managerial experience, and 3 hospital administrators. SETTING: One university-affiliated and 2 community hospitals. INTERVENTION: Interviews were audiotaped and transcribed verbatim. Transcripts were reviewed and interpreted independently in duplicate. MEASUREMENT: Analysis was conducted using grounded theory. RESULTS: Physicians and pharmacists affirmed that evidence supporting heparin is strong and understood. Clinicians, particularly nurses, reported that mobilization was important, but were uncertain about how much mobilization was enough. Participants believed that depending on individual physicians for VTE prevention is insufficient. The central finding was that multidisciplinary care was also perceived as a barrier to effective VTE prevention because it can lead to unclear accountability by role confusion. Participants believed that a comprehensive, systems approach was necessary. Suggestions included screening and risk-stratifying all patients, preprinted orders at hospital admission that are regularly reevaluated, and audit and feedback programs. Patient or family-mediated reminders, and administrative interventions, such as hiring more physiotherapists and profiling thromboprophylaxis in hospital accreditation, were also endorsed. CONCLUSIONS: Universal consideration of thromboprophylaxis finds common ground in multidisciplinary care. However, results of this qualitative study challenge the conviction that either individual physician efforts or multidisciplinary care are sufficient for optimal prevention. To ensure exemplary medical thromboprophylaxis, clinicians regarded coordinated, systemwide processes, aimed at patients, providers, and administrators as essential. Journal of Hospital Medicine 2009;4:269,275. © 2009 Society of Hospital Medicine. [source] Oral Cancer Knowledge and Opinions Among Maryland Nurse PractitionersJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2001Piya Siriphant DDS Abstract Objectives: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. Methods: Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. Results: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. Conclusions: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection. [source] Strategies for Implementing School-Located Influenza Vaccination of Children: A Systematic Literature ReviewJOURNAL OF SCHOOL HEALTH, Issue 4 2010John Cawley PhD BACKGROUND: The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccinations for all children 6 months to 18 years of age, which includes school-aged children. Influenza immunization programs may benefit schools by reducing absenteeism. METHODS: A systematic literature review of PubMed, PsychLit, and Dissertation Abstracts available as of January 7, 2008, was conducted for school-located vaccinations, using search words "School Health Services" and "Immunization Programs"; limited to "Child" (6-12 years) and "Adolescent" (13-18 years) for PubMed and "mass or universal" and (immuniz* or immunis* or vaccin*) and (school or Child or Adolescen*) for PsychLit and Dissertation Abstracts. Fifty-nine studies met the criteria for review. RESULTS: Strategies such as incentives, education, the design of the consent form, and follow-up can increase parental consent and number of returned forms. Minimizing out-of-pocket cost, offering both the intramuscular (shot) and intranasal (nasal spray) vaccination, and using reminders can increase vaccination coverage among those whose parents consented. Finally, organization, communication, and planning can minimize the logistical challenges. CONCLUSIONS: Schools-based vaccination programs are a promising option for achieving the expanded ACIP recommendation; school-located vaccination programs are feasible and effective. Adhering to lessons from the peer-reviewed scientific literature may help public health officials and schools implement the expanded recommendation to provide the greatest benefit for the lowest cost. Given the potential benefits of the expanded recommendation, both directly to the vaccinated children and indirectly to the community, prospective, well-controlled trials to establish the cost-effectiveness of specific vaccination strategies should be high priorities for future research. [source] Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelinesALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009L. LAINE Summary Background, Protective co-therapy is recommended in NSAID users with GI risk factors, but adherence is poor. Aim, To assess the proportion of NSAID users receiving co-therapy and strategies to improve adherence. Methods, Arthritis patients ,50 years of age received etoricoxib or diclofenac in a double-blind randomized trial. Reminders that high-risk patients (age , 65; previous ulcer/haemorrhage; corticosteroid, anticoagulant, aspirin use) should receive co-therapy were given at study initiation. Free PPI was provided. An intervention midway through the study included a written reminder and required written response regarding co-therapy. Results, 16 244/23 504 (69%) patients had GI risk factors. Pre-intervention, co-therapy was most common with previous ulcer/haemorrhage [706/1107 (64%)] and 3,4 risk factors [331/519 (64%)]. In the 10 026 patients enrolled pre-intervention and remaining in the study ,6 months after, co-therapy in high-risk patients increased from 2958/6843 (43%) to 4177/6843 (61%) (difference = 18%; 95% CI 16%,19%). The increase was greater outside the US (22%; 19%,24%) than in the US (15%; 13%,17%). Conclusions, Less than 50% of NSAID users with GI risk factors are given protective co-therapy , even if prescribers are given reminders and cost is not an issue. Direct communication requiring written response significantly increased adherence to guidelines, but achieving higher levels of adherence will require additional strategies. [source] Resources Used by General Practitioners for Advising Travelers from New ZealandJOURNAL OF TRAVEL MEDICINE, Issue 2 2000Peter A. Leggat Background: The risks of the destination and any specific requirements for travel health advice may be obtained from a variety of resources. This study was designed to investigate the usefulness of various resources available in New Zealand for providing travel health advice and the extent to which GPs used these resources in providing travel health advice. Methods: Four hundred GPs (400/2830) were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. Results: Three hundred and thirty-two (332/400, 83%) GPs responded. The usefulness of various resources was reported, including Health Advice for Overseas Travellers (277/289, 96%), New Ethicals (256/278, 92%), New Zealand Public Health Report (79/164, 48%), International Travel and Health (41/144, 28%), computerized databases (6/122, 5%), journals (14/130, 11%), and other resources (44/139, 32%). Health Advice for Overseas Travellers was regarded as significantly more useful than International Travel and Health (x2= 4,68, df = 1, p < .05). Only 23% (70/309) of respondents indicated that they always used these resources in their practice of travel medicine. Fifty percent (154/309) of respondents indicated that they usually used these resources, while 27% (83/309) of respondents indicated that they used these resources sometimes. Only 1% (2/309) of GPs did not use resources at all for their practice of travel medicine. Conclusion: The most useful resource was Health Advice for Overseas Travellers, which outlines the New Zealand recommendations for medical practitioners providing travel health advice. It may be useful for GPs to gain access to and training in association with a greater range of specialist resources to use in conjunction with the provision of travel health advice. These might include international guidelines, journals, and access to computerized databases and the internet. With the recent introduction of a widely accessible computerized database in New Zealand, follow-up studies could be instituted to determine if GPs' use of computerized databases becomes more widespread and whether access to and use of these computerized databases influences the provision of travel health advice by GPs. Further studies are needed to examine the appropriateness of the advice provided by the various resources used by GPs in New Zealand. [source] Perceived barriers to adherence among adolescent renal transplant candidatesPEDIATRIC TRANSPLANTATION, Issue 3 2008Nataliya Zelikovsky Abstract:, Non-adherence to medical regimens is a ubiquitous hindrance to quality health care among adolescent transplant recipients. Identification of potentially modifiable barriers to adherence when patients are listed for organ transplant would help with early intervention efforts to prepare adolescents for the stringent medication regimen post-transplant. Fifty-six adolescents listed for a kidney transplant, mean age 14.27 (s.d. = 2.2; range 11,18 yr), 73.2% male, 62.5% Caucasian participated in a semi-structured interview, the Medical Adherence Measure, to assesses the patient's knowledge of the prescribed regimen, reported adherence (missed and late doses), the system used to organized medications, and who holds the primary responsibility over medication management. Better knowledge of the medication regimen was associated with fewer missed doses (r = ,0.48, p < 0.001). Patients who perceived more barriers had more missed (r = 0.38, p = 0.004) and late (r = 0.47, p < 0.001) doses. Patients who endorsed "just forget," the most common barrier (56.4%), reported significantly more missed (z = ,4.25, p < 0.001) and late (z = ,2.2, p = 0.02) doses. Only one-third of the transplant candidates used a pillbox to organize medications but these patients had significantly better adherence, z = ,2.2, p = 0.03. With regard to responsibility over managing the regimens, adolescents missed fewer doses when their parents were in charge than when they were solely responsible, z = ,2.1, p = 0.04. Interventions developed to prepare transplant candidates for a stringent post-transplant regimen need to focus on ensuring accurate knowledge of as simple a regimen as possible. Use of an organized system such as a pillbox to establish a routine and facilitate tracking of medications is recommended with integration of reminders that may be appealing for this age group. Although individuation is developmentally normative at this age, parent involvement seems critical until the adolescent is able to manage the responsibility more independently. [source] Group Threat, Collective Angst, and Ingroup Forgiveness for the War in IraqPOLITICAL PSYCHOLOGY, Issue 2 2009Michael J. A. Wohl We examine the consequences of threat to the ingroup for emotional reactions to ingroup harm doing. It was hypothesized that reminders of a past threat to the ingroup would induce collective angst, and this emotional reaction would increase forgiveness of the ingroup for its harmful actions toward another group. In Experiment 1, Americans read an article about the war in Iraq that implied Americans would soon experience another attack or one where such implied future threat to the ingroup was absent. When the ingroup's future was threatened, forgiveness for the harm Americans have committed in Iraq was increased, to the extent that collective angst was induced. In Experiment 2, Americans experienced more collective angst and were more willing to forgive their ingroup for their group's present harm doing in Iraq following reminders of either the terrorist attacks on September 11, 2001, or the 1941 Japanese attack on Pearl Harbor compared to when the victimization reminder was irrelevant to the ingroup. We discuss why ingroup threat encourages ingroup forgiveness for current harm doing. [source] Don't Forget to Vote: Text Message Reminders as a Mobilization ToolAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 4 2009Allison Dale Current explanations of effective voter mobilization strategies maintain that turnout increases only when a potential voter is persuaded to participate through increased social connectedness. The connectedness explanation does not take into account, however, that registered voters, by registering, have already signaled their interest in voting. The theory presented in this article predicts that impersonal, noticeable,messages can succeed in increasing the likelihood that a registered voter will turn out by reminding the recipient that Election Day is approaching. Text messaging is examined as an example of an impersonal, noticeable communication to potential voters. A nationwide field experiment (n = 8,053) in the 2006 election finds that text message reminders produce a statistically significant 3.0 percentage point increase in the likelihood of voting. While increasing social connectedness has been shown to positively affect voter turnout, the results of this study, in combination with empirical evidence from prior studies, suggest that connectedness is not a necessary condition for a successful mobilization campaign. For certain voters, a noticeable reminder is sufficient to drive them to the polls. [source] Practitioner Review: The Assessment and Treatment of Post-traumatic Stress Disorder in Children and AdolescentsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 3 2000Sean Perrin Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re- experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents. [source] | ||||||||||||||||||||||||||||||||||