Influences on doctors' prescribing: Is geographical remoteness a factor?

Objective: To identify factors influencing the prescribing of medicines by general practitioners in rural and remote Australia. Design: A qualitative study using a questionnaire to determine attitudes about prescribing, specific prescribing habits and comments on prescribing in ‘rural practice’. Setting: General practice in rural and remote Queensland. Subjects: General practitioners practising in rural and remote settings in Queensland (n = 258). Main outcome measures: The factors perceived to influence the prescribing of medicines by medical practitioners in rural environments. Results: A 58% response rate (n = 142) was achieved. Most respondents agreed that they prescribe differently in rural compared with city practice. The majority of respondents agreed that their prescribing was influenced by practice location, isolation of patient home location, limited diagnostic testing and increased drug monitoring. Location issues and other issues were more likely to be identified as ‘influential’ by the more isolated practitioners. Factors such as access to continuing medical education and specialists were confirmed as having an influence on prescribing. The prescribing of recently marketed drugs was more likely by doctors practising in less remote rural areas. Conclusion: Practising in rural and remote locations is perceived to have an effect on prescribing. These influences need to be considered when developing quality use of medicines policies and initiatives for these locations. What is already known: Anecdotal and audit based studies have shown that rural general practice differs to urban-based practice in Australia, including some limited data showing some variations in prescribing patterns. No substantiated explanations for these variations have been offered. It is known that interventions to change prescribing behaviour are more likely to be effective if they are perceived as relevant and hence increasing our knowledge of rural doctors’ perceptions of differences in rural practice prescribing is required. What this study adds: Rural doctors believed that they prescribe differently in rural compared with city practice and they described a range of influences. The more remotely located doctors were more likely to report the ‘rural’ influences on prescribing, however, most results failed to reach statistical significance when compared to the less remotely located doctors. These perceptions should be considered when developing medicines policy and education for rural medical practitioners to ensure it is perceived rurally relevant.

Product warranty logistics: Issues and challenges

Warranty is an important element of marketing new products. The servicing of warranty results in additional costs to the manufacturer. Warranty logistics deals with various issues relating to the servicing of warranty. Proper management of warranty logistics is needed not only to reduce the warranty servicing cost but also to ensure customer satisfaction as customer dissatisfaction has a negative impact on sales and revenue. Unfortunately, warranty logistics has received very little attention. The paper links the literature on warranty and on logistics and then discusses the different issues in warranty logistics. It highlights the challenges and identifies some research topics of potential interest to operational researchers. (C) 2003 Elsevier B.V. All rights reserved.

Ethical issues in using a cocaine vaccine to treat and prevent cocaine abuse and dependence

A cocaine vaccine'' is a promising immunotherapeutic approach to treating cocaine dependence which induces the immune system to form antibodies that prevent cocaine from crossing the blood brain barrier to act on receptor sites in the brain. Studies in rats show that cocaine antibodies block cocaine from reaching the brain and prevent the reinstatement of cocaine self administration. A successful phase 1 trial of a human cocaine vaccine has been reported. The most promising application of a cocaine vaccine is to prevent relapse to dependence in abstinent users who voluntarily enter treatment. Any use of a vaccine to treat cocaine addicts under legal coercion raises major ethical issues. If this is done at all, it should be carefully trialled first, and only after considerable clinical experience has been obtained in using the vaccine to treat voluntary patients. There will need to be an informed community debate about what role, if any, a cocaine vaccine may have as a way of preventing cocaine addiction in children and adolescents.

Attracting, recruiting and retaining male teachers: policy issues in the male teacher debate

Frequent calls for more male teachers are being made in English-speaking countries. Many of these calls are based upon the fact that the teaching profession has become (even more) 'feminized' and the presumption that this has had negative effects for the education of boys. The employment of more male teachers is sometimes suggested as a way to re-masculinize schools so they become more 'boy-friendly' and thus contribute to improving boys' school performance. The focus of this paper is on an Australian education policy document in the state of Queensland that is concerned with the attraction, recruitment and retention of male teachers in the government education system. It considers the failure of this document, as with many of the calls for more male teachers, to take into account complex matters of gender raised by feminism and the sociology of masculinities. The paper then critiques the primary argument given for the need for more male teachers: that is, that male teachers provide boys with much needed role models.

Issues in boys' education: A question of teacher threshold knowledges?

This paper explores the effects of specific teacher threshold knowledges about boys and gender on the implementation of a so-called 'boy friendly' curriculum at one junior secondary high school in Australia. Through semi-structured inter-views with selected staff at the school, it examines the normalizing assumptions and 'truth claims' about boys, as gendered subjects, which drive the pedagogical impetus for such a curriculum initiative. This research raises crucial questions about the need for the formulation of both school and governmental policy grounded in sound research-based knowledge about the social construction of gender and its impact on the lives of both boys and girls and their experiences of schooling. This is crucial, we argue, in light of the recent parliamentary report on boys' education in Australia which rejects gender theorizing and given the failure of key staff in the research school to interrogate the binary ways in which masculinity and femininity are socially constructed and institutionalized in schools through a particular 'gender regime'. While some good things are happening in the research school, the failure to acknowledge the social construction of gender means that ultimately the school's programs cannot be successful.

Addressing internet training issues for people with Parkinson's disease

The Internet enables access to information, services, support and participation in leisure opportunities. Some populations, including people with disabilities, lack access to these opportunities through the Internet. Barriers may include finances, physical access, lack of resources and inaccessible websites. Limited access to Internet training is an additional barrier for people with communication impairments. People with Parkinson's disease (PD) may have difficulty accessing usual Internet training due to high-level language, cognitive and physical limitations. Aphasia-friendly Internet training materials were trialed with this population to investigate if participants could learn to use the Internet and would benefit from Internet training. The tutors' experience was also investigated using qualitative measures. Seven people with PD were matched with volunteer tutors. These pairs met for six Internet training lessons using training materials available as a free download from: http://dexter.shrs.uq.edu.au/cdaru/aphasiagroups/. Pre and post-test Internet skills assessments and attitudinal questionnaires were conducted. Significant differences between pre and post-test scores were found. Participants reached varying levels of independence on Internet tasks. Favorable outcomes were reported by participants, and tutors reported a positive experience. Further investigation is recommended to determine the efficacy of this approach compared with other training avenues and with other communication-impaired populations. Practical and theoretical implications for speech pathology practice are discussed.

Whistleblower protection: Is Africa ready?

The article critically examines propositions driving the exportation of western whistleblower concepts into the developing world.(1) Specifically it attacks the prevailing view that public interest disclosure is somehow a culture-free, or at least a culture-muted phenomenon, governed by a set of rules and conventions detached from local histories and practices. The article concludes that this exportation is in the spirit of neo-colonialism and issues a note of warning about the dangers of dispersing western conceived forms of corruption reporting to Africa. Copyright (c) 2005 John Wiley & Sons, Ltd.

Reflecting on ethical and legal issues in wildlife disease

Disease in wildlife raises a number of issues that have not been widely considered in the bioethical literature. However, wildlife disease has major implications for human welfare. The majority of emerging human infectious diseases are zoonotic: that is, they occur in humans by cross-species transmission from animal hosts. Managing these diseases often involves balancing concerns with human health against animal welfare and conservation concerns. Many infectious diseases of domestic animals are shared with wild animals, although it is often unclear whether the infection spills over from wild animals to domestic animals or vice versa. Culling is the standard means of managing such diseases, bringing economic considerations, animal welfare and conservation into conflict. Infectious diseases are also major threatening processes in conservation biology and their appropriate management by culling, vaccination or treatment raises substantial animal ethics issues. One particular issue of great significance in Australia is an ongoing research program to develop genetically modified pathogens to control vertebrate pests including rabbits, foxes and house mice. Release of any self-replicating GMO vertebrate pathogen gives rise to a whole series of ethical questions. We briefly review current Australian legal responses to these problems. Finally, we present two unresolved problems of general importance that are exemplified by wildlife disease. First, to what extent can or should 'bioethics' be broadened beyond direct concerns with human welfare to animal welfare and environmental welfare? Second, how should the irreducible uncertainty of ecological systems be accounted for in ethical decision making?

Probing expert anticipation with the temporal occlusion paradigm: Experimental investigations of some methodological issues

Two experiments were conducted to examine whether the conclusions drawn regarding the timing of anticipatory information pick-up from temporal occlusion studies are influenced by whether (a) the viewing period is of variable or fixed duration and (b) the task is a laboratory-based one with simple responses or a natural one requiring a coupled, interceptive movement response. Skilled and novice tennis players either made pencil-and-paper predictions of service direction (Experiment 1) or attempted to hit return strokes (Experiment 2) to tennis serves while their vision was temporally occluded in either a traditional progressive mode (where more information was revealed in each subsequent occlusion condition) or a moving window mode (where the visual display was only available for a fixed duration with this window shifted to different phases of the service action). Conclusions regarding the timing of information pick-up were generally consistent across display mode and across task setting lending support to the veracity and generalisability of findings regarding perceptual expertise in existing laboratory-based progressive temporal occlusion studies.