42 resultados para quality use of medicines


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This article presents findings from a recent cross-sectional study that was designed to evaluate both the impact of erectile dysfunction (ED) on the lives of Australian men, and explore whether the use of PDE5 inhibitors was able to alter this impact. The sample comprised 410 men with ED, and 242 men who did not have ED. All men were primarily recruited over the internet via men's health web sites. Participants completed a questionnaire to assess their self-esteem, masculinity, quality of life, sexual satisfaction, relationship satisfaction and usage of oral ED medication. The results demonstrated that men with ED experienced deficits on all of the psychosocial areas when compared to men without ED. Moreover, treatment with ED medication did not alleviate this deficit. Implications of these findings for the treatment of men with ED are discussed in the context of the biopsychosocial model of health and the need for a multidisciplinary approach to ED management is highlighted.

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An international movement promoting the reduced use of physical restraint and other coercive practices has brought into focus the ways in which those who are responsible for the care of children and young people respond to problematic behaviour. The topic generates emotive discussion, with proponents advancing the argument that the use of coercive measures enhances the quality of care and protects young people from harm, and civil libertarians who argue that restraint is never an appropriate way of managing behaviour. Despite such debates there is an absence of good research and scholarly activity on restraint practices, leading to uncertainty about the immediate and long-term effects of particular practices on both staff and young people. Consequently, it has been difficult for agencies to develop clear, consistent, and definitive policies. Drawing on international perspectives, the aim of this article is to discuss issues relevant to the practice of restraint in residential care facilities for children and young people in Australia, highlighting a number of issues that require resolution prior to the development of practice guidelines.

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Global and Asian aquaculture have witnessed a ten-fold increase in production from 1980 to 2004. However, the relative percent contribution to production of each of the major commodities has remained almost unchanged. For example, the contribution of freshwater finfish has declined from 71 to 66 percent in Asia but has remained unchanged globally over the last 20 to 30 years. This fact has dictated trends in the use of fish as a feed for cultured stocks. The growth in the sector has gone hand in hand with an increasing dependence on fish as feed, either directly or indirectly. In a number of countries in the Asia-Pacific region, the aquaculture sector has surpassed the capture fisheries sector in its respective contributions to the gross domestic product (GDP). Aquaculture’s increased contribution to national GDPs can be taken as a clear indication of the contribution of the sector to food security and poverty alleviation. The use of finfish and other aquatic organisms as a feed source can be through direct utilization of whole or chopped raw fish in wet form, through fishmeal and fish oil in formulated feeds, and/or as live fish, although the latter is uncommon and the overall amounts used are relatively small. In the first two categories, the fish used are often termed “trash fish/low-value fish”. Although attempts have been made to define this term, all definitions have a certain degree of ambiguity and/or subjectivity. In this regional review, the amount of fish used as feed sources based on the above categories was estimated primarily from the production data, supported by assumptions on the inclusion levels of fishmeal in formulated feeds and observed feed conversion efficiencies for both formulated feeds and for stock fed trash fish/low-value fish directly. A scenario for the use of fish as feed was developed by starting from the levels of aquaculture production recorded in 2004 and assuming increases in production volumes of 10, 15 and 20 percent by 2010, respectively, for the three trajectories. In parallel, the pattern of wild fish use as feed was projected to change as fish and shrimp farmers increasingly replace farmmade feeds by incorporating trash fish/low-value fish with manufactured feeds that include fishmeal. Also, the fishmeal inclusion rates in manufactured feeds are falling slowly, and this has been incorporated into the projections. The regional review also deals with the production of fishmeal using trash fish/low-value fish in the Asia-Pacific region. Regional fishmeal production as a whole is relatively low when compared with that of major fishmeal-producing countries such as Chile, Iceland and Norway, amounting to approximately 1 million tonnes per year. However, there is a trend towards increasing the use of fish industry waste, such as from the tuna canning industry in Thailand. The fishmeal produced in the region is priced considerably lower than globally traded fishmeal, but its quality is poorer. Total fishmeal use in Asian aquaculture in 2004 was estimated as 2 388 million tonnes, the highest proportion of this being used for crustacean aquaculture (1 418 million tonnes). Based on growth predictions (to year 2010) in the sector and improvements to feed quality and management, it is expected that the quantity of fishmeal used in Asian aquaculture will be slightly less than at present. An estimated 240 000 tonnes of fish oil is used in Asian aquaculture, principally in shrimp feeds. Based on production estimates of commodities in 2004 that rely on trash fish/low-value fish as the main feed source, this regional review suggests that Asian aquaculture currently uses between 2 465 and 3 882 million tonnes, an amount that is predicted to decrease to between 1.890 and 2 795 million tonnes by 2010. The use of trash fish/low-value fish and fishmeal by the aquaculture sector has been repeatedly adjudicated as a non-sustainable practice, and globally the sector is seeking to reduce its dependence on fish as feed through improved feed management practices and development of better quality feeds and feed formulations using alternative ingredients. Over the next few years, decreases in the use of trash fish/low-value fish are also expected to be achieved through better conversion of raw materials into fishmeal and fish oil during the reduction processes. The “way forward” in addressing the issue of the use of fish as feed in aquaculture in the Asia-Pacific region includes the need for a concerted regional research thrust to reduce the use of fish as feed sources in aquaculture, as has been achieved in the animal husbandry sector. Secondly, there is a need to increase farmer awareness on the use of trash fish as feed. This is achievable, considering the similar progress that has been made by the region’s shrimp farming sector, which almost exclusively involves small-scale practitioners who are often clustered in a given locality. The analysis also suggests that the use of trash fish/low-value fish in aquaculture may be compatible with improving food security and alleviating poverty. In Asia, trash fish/low-value fish is mostly landed in areas where there are other suitable fish commodities for human consumption. To make the trash fish/low-value fish suitable and available for human consumption would involve some degree of value-adding and transportation costs, which are likely to increase the price to beyond the means of the consumer, particularly in remote rural areas. Under such a scenario, the direct or indirect use of this perishable resource as a feed source to produce a consumable commodity appears to make economic sense and appears to be the most logical use for overall human benefit. In this manner, trash fish/low-value fish contributes to food security by increasing income generation opportunities and hence contributes to poverty alleviation. Another factor that needs to be taken into account is the large numbers of artisanal fishers who harvest this raw material. The continued use of trash fish/low-value fish, therefore, allows these fishers to maintain their livelihoods1. Admittedly, this is an area that warrants more detailed investigation, from resource use, livelihoods and economic viewpoints.

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The Australian housing industry is beset with quality issues with repeated building defects causing problems with customer satisfaction and housing performance. These defects are caused by a combination of initial poor workmanship and poor quality materials and subsequently by poorly executed or inadequate maintenance. These poor work practices increase the cost and maintenance of housing. The waste and rectification work generated by such practices means that the housing industry generally is not engaged with sustainability. Building Control is part of achieving quality of building output. Whilst the Australian Building Code has regulations for initial-build material quality and workmanship, there is no continuing control and effective enforcement over a house over its life span. Sustainability is not dealt with as a topic at all in the Building Code with only energy efficiency concerns regulated. Inadequate knowledge transfer, to the mainly small builders who produce the majority of Australia’s housing, is seen to be a key issue. Mechanisms to make the transfer of knowledge to those who need to use it need to be improved. Building regulations, for example, could be more visual and accessible in their content and small builders should be encouraged to update their knowledge and skills. This comparative research will guide industry service providers in improving their performance and suggest how overall housing quality can be improved (thereby reducing wasteful practices), by considering more appropriate mechanisms for knowledge transfer among industry service providers in the Australian housing industry.

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This thesis represents one of the first research papers to examine individual factors and their association with best-practice investigative interviewing. Findings indicate that adherence to open-ended questioning (arguably one of the most important skills in child abuse interviewing) is largely the by-product of good training rather than personal attributes or job experience per se. maximising interviewer performance is crucial if the quality of evidence obtained from child witnesses is to improve on a global level.

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Purpose – Since the 1990s, there has been a growing interest in style of information usage. However, most studies on style of information usage are conducted in developed countries. There is limited research on style of information usage in developing countries. The purpose of this paper is to fill the gap in the existing literature by examining relationships between style of information usage and use of financial and non-financial information in Malaysia.

Design/methodology/approach – The authors adopted a survey method, for which a written questionnaire was prepared and mailed out to companies in Kuala Lumpur, Selangor, Terengganu and Pulau Pinang.

Findings – Findings of the study show that diagnostic style of information usage is positively associated with use of financial information, while interactive style of information usage is positively associated with use of non-financial information. Further analysis on types of non-financial information used by managers who adopt interactive style of information usage reveals that customer-related non-financial information such as quality, customer satisfaction and flexibility play a more important role in their decision-making processes.

Originality/value –
The paper provides insights into relationships between style of information usage on and use of accounting information in developing countries. Findings of the study can be applied to assist management accountants in meeting managers’ information requirements.

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The size and growth of seabird populations are believed to be regulated, in part, by the availability and quality of suitable breeding habitat. Global climate change is predicted to affect coastal habitats and may, therefore, have important consequences for the terrestrial breeding habitat of seabirds and hence seabird populations. The present study assessed use of breeding habitat in the four most abundant species of seabird breeding in south-eastern Australia using a generalised additive mixed-modelling approach. Habitat characteristics were measured on 13 islands in winter and summer, 2008-11. Burrows of the four species were associated with one or more habitat parameters, potentially explained by predator avoidance, physical requirements and possibly by interspecific competition. Whereas the habitat characteristics used by each species showed broad interspecific overlap, there was strong divergence, and the four species typically occupied different nesting sites within breeding areas. Information on the proportion of available habitat used and the influence of breeding habitat on reproductive success would enhance current understanding of what constitutes optimal breeding habitat as well as the role of interspecific competition in this assemblage of seabirds.

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Computerized clinical guidelines are frequently used to translate research into evidence-based behavioral practices and to improve patient outcomes. The purpose of this integrative review is to summarize the factors influencing nurses' use of computerized clinical guidelines and the effects of nurses' use of computerized clinical guidelines on patient safety improvements in hospitals. The Embase, Medline Complete, and Cochrane databases were searched for relevant literature published from 2000 to January 2013. The matrix method was used, and a total of 16 papers were included in the final review. The studies were assessed for quality with the Critical Appraisal Skills Program. The studies focused on nurses' adherence to guidelines and on improved patient care and patient outcomes as benefits of using computerized clinical guidelines. The nurses' use of computerized clinical guidelines demonstrated improvements in care processes; however, the evidence for an effect of computerized clinical guidelines on patient safety remains limited.

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Some migratory birds refuel at stopover sites that they by-pass on the return trip. In theory, this skipping behaviour is only expected in time-selected migrants when the overflown site is of a lower quality than the departure site. We provide empirical evidence that quality differences in stopover sites are the cause for skipping in Bewick's Swans Cygnus bewickii tracked by satellite telemetry. Two and five complete tracks were recorded in spring and autunm, respectively, showing that the White Sea was visited for c. 2 weeks in spring, but by-passed (or visited for a few days at the most) in autumn. Skipping of the White Sea in autumn was predicted by a dynamic programming model which was based on calculated gain rates during stopover in the Pechora Delta and the White Sea. This prediction was not sensitive to plausible variations in gain rates. Relative to the Pechora Delta the White Sea is a poor site because a large tidal amplitude precludes foraging on the beds of the submerged macrophyte Fennel Pondweed Potamogeton pectinatus during high tide. The dynamic programming model predicted a fast autunm migration. However, the phenology of autunm arrival dates of Bewick's Swans on the wintering grounds revealed that only in three out of ten years a significant number of birds was able to reach the wintering grounds without refuelling. In the other years, unfavourable wind conditions along the Russian/Baltic part of the route prevented such non-stop migration.

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Researchers and decision makers in healthcare are taking great interest in clinical practices where there is a high potential to improve healthcare outcomes and reduce costs by incorporating a myriad of technology solutions. However, to date very few, if any of these IS/IT (information systems/information technology) solutions have realised the expected improvements to quality care with the expected cost reductions. This makes the need to evaluate the impact of IT on overall performance of clinical practices i.e. business value of IT a key strategic imperative in healthcare. To address this key need, we propose a comprehensive framework that conceptualises business value of IT in healthcare in different layers. To illustrate the proposed framework, a case study is used, which serves to examine the proposed conceptual model. The exemplar case study is an Australian-made nursing documentation system; an enterprise system that caters for multiple clinical users in acute healthcare contexts and hence provides appropriate richness to validate the proposed model.

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UNLABELLED: Regular physical activity and limiting extended periods of sitting are two behaviours critical for the prevention of obesity in young people. The purpose of the systematic review was to synthesize the psychometric evidence for self-report use-of-time tools that assess these behaviours. Articles were retrieved that reported reliability and/or validity for use-of-time tools in participants aged 18 years or under. Outcome variables were physical activity, sedentary behaviour and energy expenditure. Study quality was appraised, and the results summarized narratively. Sixteen studies and six different tools were identified. The tools were the Previous Day Physical Activity Recall, the Three-Day Physical Activity Recall, the Physical Activity Interview, the Computerized Activity Recall, the Activitygram, and the Multimedia Activity Recall for Children and Adolescents. Overall, tools indicated moderate validity compared with objective and criterion comparison methods. Generally, validity correlation coefficients were in the range of 0.30-0.40. Correlation coefficients for test-retest reliability ranged widely from 0.24 to 0.98. CONCLUSION: Use-of-time tools have indicated moderate reliability and validity for the assessment of physical activity and energy expenditure. Future research should focus on using criterion methods and on validating specifically for sedentary behaviour outcomes. Implementation of these tools for population surveillance should be considered.

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Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.