Obesity management: Australian general practitioners' attitudes and practices

Objectives: To document general practitioners’ (GPs) attitudes and practices regarding the prevention and management of overweight and obesity.

Research Methods and Procedures: A cross-sectional survey of a randomly selected sample of 1500 Australian GPs was conducted, of which 752 questionnaires were returned. The measures included views on weight management, definitions of success, views regarding the usefulness of drugs, approaches to and strategies recommended for weight management, and problems and frustrations in managing overweight and obesity.

Results: GPs view weight management as important and feel they have an important role to play. Although they consider themselves to be well prepared to treat overweight patients, they believe that they have limited efficacy in weight management and find it professionally unrewarding. GPs view the assessment of a patient's dietary and physical activity habits and the provision of dietary and physical activity advice as very important. The approaches least likely to be considered important and/or least likely to be practiced were those that would support the patient in achieving and maintaining lifestyle change.

Discussion: There remains considerable opportunity to improve the practice of GPs in their management of overweight and obesity. Although education is fundamental, it is important to acknowledge the constraints of the GPs’ existing working environment.

Assessment rubrics: towards clearer and more replicable design, research and practice

‘Rubric’ is a term with a variety of meanings. As the use of rubrics has increased both in research and practice, the term has come to represent divergent practices. These range from secret scoring sheets held by teachers to holistic student-developed articulations of quality. Rubrics are evaluated, mandated, embraced and resisted based on often imprecise and inconsistent understandings of the term. This paper provides a synthesis of the diversity of rubrics, and a framework for researchers and practitioners to be clearer about what they mean when they say ‘rubric’. Fourteen design elements or decision points are identified that make one rubric different from another. This framework subsumes previous attempts to categorise rubrics, and should provide more precision to rubric discussions and debate, as well as supporting more replicable research and practice.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Trajectory of sedation assessment and sedative use in intubated and ventilated patients in intensive care: a clinical audit

Background: Sedation is crucial for the recovery of patients in intensive care units (ICUs). Maintaining comfort and safety promotes optimal care for critically ill patients. Purpose: To examine sedation assessment and management undertaken by health professionals for mechanically ventilated patients in one Australian ICU. Methods: A retrospective clinical audit was undertaken of medical records of all eligible, mechanically ventilated patients admitted to an ICU of an Australian metropolitan, teaching hospital over a 12-month period. A Sedation Audit Tool was used to collect data from the day of intubation to 5 days after intubation. Findings: Data were extracted from medical records of 150 patients. The Riker Sedation-Agitation Scale (SAS) was the scoring system used. Patients were unarousable or very sedated between 57% and 81% at some point during the study period, while between 5% and 11% were agitated, very agitated or extremely agitated across this time. Patients' sedation scores were not documented in between 3.3% and 23.3% of patients. Medications commonly used were propofol, midazolam, morphine, and fentanyl. There were 135 situations of adverse events, which related to patients pulling endotracheal tubes leading to malpositioning, patients biting endotracheal tubes causing desaturation, patient experiencing excessive agitation requiring restraint use, patients experiencing increased intracranial pressure above desired limits, patients self-extubating, and patients experiencing over-drowsiness leading to delays in extubation. Conclusions: Many patients were either very sedated or agitated at some point during the study period, and some patients experienced adverse outcomes associated with sedation practices. The findings inform future quality initiatives to improve sedation practices.

Asset identification in information security risk assessment: A business practice approach

Organizations apply information security risk assessment (ISRA) methodologies to systematically and comprehensively identify information assets and related security risks. We review the ISRA literature and identify three key deficiencies in current methodologies that stem from their traditional accountancy-based perspective and a limited view of organizational "assets". In response, we propose a novel rich description method (RDM) that adopts a less formal and more holistic view of information and knowledge assets that exist in modern work environments. We report on an in-depth case study to explore the potential for improved asset identification enabled by the RDM compared to traditional ISRAs. The comparison shows how the RDM addresses the three key deficiencies of current ISRAs by providing: 1) a finer level of granularity for identifying assets, 2) a broader coverage of assets that reflects the informal aspects of business practices, and 3) the identification of critical knowledge assets.

Assessment of credit arrangements towards engineering programs/courses

Credit Transfer (CT), Advanced Standing (AS), Credit for Prior Learning (CPL), Recognition of PriorLearning (RPL), Prior Learning Assessment and Recognition (PLAR), Accreditation of PriorExperiential Learning (APEL), Validation of Prior Learning (VPL), Prior Learning Assessment (PLA),Credit Transfer and Recognition (CTR), Recognition of Current Competency (RCC) and Credit forConcurrent Formal Learning (CCFL) are the terms used by academic institutions and engineeringschools to describe several types of credit arrangements depending upon a student’s current state ofqualification, experience, skills and knowledge towards the requirement of his/her formal professionalengineering qualification. The objectives of such credit arrangements are to make sure that thelearning is not duplicated, to reduce the duration and cost of the engineering studies, to encourageworking engineering associates and technologists return to engineering schools for professionalengineering qualification and to help upgrade the skills and knowledge of the junior engineeringpractitioners, to name a few. Formal, informal, non-formal or a combination of prior learning are usedfor such credit arrangements. Engineering schools offer block credit, specified credit, unspecifiedcredit and a combination of these forms of credits when recognising prior learning of any form.However, anecdotal and literature evidence suggests that the assessment of credit arrangementslacks established universal framework for assessment, lacks harmonisation, compatibility,transparency and comparability and is complex and inconsistent resulting a significant variations in theassessment for recognising prior learning across engineering schools in spite of being based onsimilar fundamental principles. There is a clear need of a consolidated framework in order to assesscredit arrangements systematically and consistently.PURPOSEThe purpose of this study is to develop a consolidated framework for assessing credit arrangementstowards a partial requirements of a professional engineering course, program, degree or qualification.The developed framework is expected to help manage the assessment of credit arrangement process.APPROACHThis study first critically reviews existing frameworks and literature evidences regarding the principlesof credit arrangements towards a partial requirements of a professional engineering course, program,degree or qualification. This study then uses evidence-based literature knowledge (principles,processes and practices) to devise a consolidated framework for assessing credit arrangements. Theframework is then expanded in order to elaborate its several components.RESULTSThe existing frameworks and literature review suggest that for better assessment of creditarrangements, attentions are to be given on the forms of prior learning, types of credit arrangements,forms of credit recognition, required documents, characteristics of the prior learning, alignment of priorlearning with professional engineering qualification and additional aspects.CONCLUSIONSAs the assessment of credit arrangements has been a major challenge for engineering schools, theframework developed in this study is expected to help engineering schools to manage the assessmentprocess systematically and consistently. For further study, the framework needs to be continuouslyimplemented, monitored and evaluated.