Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies.

INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS AND ANALYSIS: A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two independent reviewers will conduct a structured review and meta-synthesis, and a third reviewer will arbitrate where there is disagreement. This protocol has been registered on PROSPERO 2014. ETHICS AND DISSEMINATION: Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically, in print and at conferences. Updates of the review will be conducted to inform and guide healthcare translation into practice. TRIAL REGISTRATION NUMBER: PROSPERO 2014:CRD42014012961. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014012961.

Gambling in a remote Aboriginal setting - the good, the bad and the ugly

The effort undertaken by the Ceduna Koonibba Aboriginal Health Service (CKAHS) and Statewide Gambling Therapy Service (SGRS) to investigate the impact of gambling on Aboriginal people living in the region is discussed. The different initiatives undertaken after obtaining additional funding to help stop gambling in the region are highlighted.

Valuation and reporting of native fauna in monetary terms: compatibility between a market-Based system and natural resources?

A change in community values and priorities has introduced ethical,
environmental and social issues into the way in which business conducts
its activities. There are an increasing number of managed investment funds focusing on socially responsible investment (SRI) by concentrating on firms that operate according to predetermined criteria for environmental, social and ethical issues. For investors in these funds environmental stewardship issues are integrated with concern over financial resources and performance. In this paper the accounting and reporting by business activities concerned with conservation of wildlife are examined. The world of accounting has functioned for many years with relatively few accounting standards devoted to specialised industry needs. In 1998 the Australian Accounting Standards Board and in 2001 the International Accounting Standards Board issued standards devoted to agriculture. Both standards deal with the reporting of managed biological assets and require application of essentially the same approaches despite the Australian standard requiring net market value while the International standard requires fair value. In this paper we analyse how one conservation firm Earth Sanctuaries Ltd. (ESL) has applied AASB 1037 and then we explore the implications for conservation firms operating in geographical locations outside Australia. It is suggested that AASB 1037 and indeed lAS 41 may not provide value appropriate information for investor decisions relating to accounting profits for such firms. Our examination shows that it is appropriate to reconsider accounting guidelines provided by these standards in order to link the information relating to economic and environmental performance. Transparency may be improved by a move closer to Elkington 's (1997) triple bottom line reporting. We therefore contend that the issues arising from the use ofAASB 1037 and lAS 41 need to be widely considered by all standard setters, particularly given the increasing attention to SRI.

Ethical performance evaluation (EPE) in business practices: framework and case illustrations

Purpose – A set of principal parameters (i.e. time, context, gap, outcome, and consequence) influences the ethical performance evaluation (EPE) of business practices in the marketplace and society. The purpose of this paper is to describe a managerial framework of EPE based upon these parameters.

Design/methodology/approach – Case illustrations are used to underpin the introduced managerial framework of EPE.

Findings – The EPE of business practices is not only dependent upon the ethical values and principles of today, but those principles of tomorrow may be equally, or even more, crucial. The EPE of business practices is also dependent upon the surrounding context and its specific ethical values and principles. Furthermore, it is dependent upon the gap between different perceptions of ethical values and principles and if the outcome of the corporation's ethical values and principles are proactive or reactive in relation to the reigning ethical values and principles in the marketplace and society. Finally, it is also dependent upon the potential and eventual consequences of ethical values and principles.

Research limitations/implications – The only way that we can “objectively” evaluate past ethical values and principles is through the use of ethical values and principles at the time and in respect to the context at hand. Research tends to fail when considering the longitudinal and evolutionary dimensions in the exploration of ethical values and principles in business practices. There is too much focus upon on-the-spot-accounts in the past and in current research efforts. An important area for further research is how to deal with the durability and variability of ethical values and principles in business practices in the marketplace and society. The key may be a stronger emphasis on longitudinal research efforts that may explore them over time and as contexts evolve. Ethical values and principles are connected and re-connected over time and across contexts in one way or another. They have a past, a current status and a future.

Practical implications – The decision as to whether business practices are ethical or unethical is – relatively speaking – easy to determine from a narrow perspective, however, the decision whether business practices are ethical or unethical becomes complicated as the perspective is widened and deepened. An introduced managerial framework of EPE provides a generic foundation and structure to examine the acceptability versus unacceptability of business practices.

Originality/value – The paper introduces a managerial framework of EPE, followed by case illustrations. It addresses the impact of time on ethical values and principles in any context on the potential and eventual gaps, outcomes and consequences in business practices. The managerial framework of EPE may also be used in non-business areas whenever found applicable and convenient to use.

Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

Accountability and dignity : ethical issues in forensic and correctional practice

Our aim in the special issue is to address some of the more abstract and fundamental ethical problems evident in the criminal justice system and to inquire into their significance for those individuals who assess and deliver rehabilitation programs to offenders. In order to provide an appropriate theoretical framework for an investigation of ethical concerns in the forensic and correctional practice domains, we first outline an ethical framework that is intended to help practitioners reflect systematically on their practice [Ward, T., & Syversen, K., (2009). Vulnerable agency and human dignity: An ethical framework for forensic practice. Aggression and Violent Behavior, 14, 94–105]. Second, we explicitly examine the relationship between two normative frameworks evident within the criminal justice system, punishment and rehabilitation, and inquire into their relationship. Finally, we briefly describe each of the papers comprising the special issue.

NFC, moral position, socialisation and ethical decision-making

Absolutism (deontology and teleology), moral relativism (individual moral position), and individual and environmental factors are at the crossroads of descriptive ethics research. For several decades, researchers have espoused teleological aspects, such as the punitive influence of codes of ethics, as managerial tools that enhance ethical conduct in organisations. The current study modelled the individual factors of need-for-cognition (NFC), individual moral position, and occupational socialisation as influences on the work-norms of marketers. The findings from a survey of marketers suggest that NFC influences the ethical idealism, professional socialisation, and work-norms of marketers positively. The research identifies that encouraging cognitive activities among marketers may be a useful alternative when developing appropriate deontological work-norms and decision-making under ethical conditions in marketing.

Ethical awareness, orientation and intentions of accounting students

This study investigates the ethical awareness and decision making of accounting students using three ethical decision making cases studies. Given the increased focus on ethics education by professional accounting bodies the study focuses on the differences in ethical decision making between students undertaking a final year ethics course with students who have not yet studied ethics in their accounting degree.

The study extends the work of Cohen et al. (1996) to incorporate individual background factors such as gender, residence and the study of ethics at university level in measuring ethical decision making.

The results show that there are significant differences between local and international students in ethical decision making possibly linked to cultural differences. The findings also lend strong support for the incorporation of ethics education in the curriculum given that the significant difference in the ethical decision making of students who had studied a compulsory ethics unit in their undergraduate degree program.

Lawyers and ethics in practice : the impact of clinical and ethics curricula on lawyers’ ethical decision-making

The authors have conducted a longitudinal study exploring the relationships between values and ethical behaviour for early-career legal practitioners. The study comprised a representative Australian cohort of final-year law students and tracked them through their first two years of employment or further study. It examined changes to ethical decision-making by presenting participants with hypothetical scenarios that provided ethical dilemmas. A questionnaire utilising hypothetical situations was presented in 11 scenarios. This chapter examines responses to the scenarios across the three years of the study, particularly exploring changes over time. Of particular interest were the effects of gender and prior ethics education on changing responses. Findings suggested significant differences between males and females in their ethical responses. They also suggested that involvement in clinical practice, in particular during the law degree, may have a positive impact on future willingness to assist access to justice (insofar as such lawyers were more inclined to participate in later pro bono activity).

Ethical issues in forensic and correctional research

It is surprising that while the literature on ethical issues associated with social science research is burgeoning and becoming increasingly sophisticated very few papers have been written on the ethics of forensic or correctional research. The literature that exists is disappointingly narrow and superficial, and relies on professional ethical codes to a considerable degree. In this paper we present an ethical framework developed by Ward and Syversen to help with ethical decision making in research contexts. We then discuss some of the specific ethical challenges for researchers working in forensic and correctional domains, and consider how best to deal with ethical problems drawing from this framework. Our aim will be to provide researchers with some general ideas of how to proceed in certain situations rather than come up with a final set of answers to every conceivable problem.

Patterns of alcohol use and associated physical and lifestyle characteristics according to new Australian guidelines

Objective: To describe the pattern of alcohol consumption and associated physical and lifestyle characteristics in a population-based sample of Australian men.
Method: A community-based age-stratifi ed random sample of 1420 men (median age 56 years, range 20 – 93) participating in the Geelong Osteoporosis Study, an epidemiological study set in south-eastern Australia. Daily alcohol intake was ascertained from a detailed food frequency questionnaire and categorized according to the Australian National Health and Medical Research Council 2009 guidelines (non-drinkers, greater than zero but ≤ 2 drinks per day, > 2 drinks per day), with a standard drink equivalent to 10 g of ethanol. Anthropometry was measured and lifestyle factors self-reported. Body composition was determined using dual energy absorptiometry. Socio-economic status was categorized according to the Australian Bureau of Statistics data. Results were age standardized to the Australian male population figures.
Results: The median daily ethanol consumption was 12 g (IQR 2 – 29) per day with a range of 0 – 117 g/day. The age-standardized proportion of non-drinkers was 8.7%, 51.5% consumed up to two drinks per day ( ≤ 20 g ethanol/day), and 39.9% exceeded 2 standard drinks per day ( > 20 g ethanol/day). Alcohol consumption was positively associated with cigarette smoking, weight, higher SES and inversely with age and physical activity.
Conclusions: Approximately, 40% of Australian men consume alcohol at levels in excess of current recommendations, which in combination with other risk factors may adversely impact upon health.

(Un)ethical practices and ethical dilemmas in universities : academic leaders’ perceptions

In this paper we report on the qualitative component of a study that explored middle-level academic leaders’ experiences of (un)ethical practices and ethical dilemmas in their daily work. An electronic survey was distributed to academic leaders from universities across three Australian states. There are three major findings in this study. First, the messy context of universities is providing a fertile ground for ethical dilemmas to flourish. Second, the two main categories of unethical practices identified by participants were academic dishonesty and inappropriate behaviour towards staff and students. Third, the ethical dilemmas that emerged focused on the academic leaders’ strong sense of professional ethics that were in conflict with an ethic of care, supervisors’ directives, and the rules and policies of the organisation.

Perceptions of fruit and vegetable dietary guidelines among Australian young adults

Aim:  Regular consumption of fruit and vegetables has been associated with a decreased risk of a number of chronic diseases. An appropriate level of knowledge is important to successfully adhere to the dietary guidelines for eating fruit and vegetables. However, there is little research about the level of knowledge that young adults have about fruit and vegetable consumption. The current study aimed to investigate the recall and understanding of Australian dietary guidelines, food product and serving size knowledge in a population of young adults. Methods:  One hundred and six undergraduate students completed online questionnaires regarding (1) knowledge of dietary recommendations; (2) knowledge of serving size information; and (3) foods that could be included as part of fruit and vegetable intake. Results:  The results showed that the sample had significant knowledge gaps in all three areas. Approximately half (54%) of participants correctly reported the recommended daily intake of fruit and vegetables, the majority were not able to correctly report serving sizes (correct responses were 30–61%) and were not able to identify all ingredients from a recipe that counted towards fruit and vegetable intake. Conclusions:  Past interventions have not tended to focus on the fruit and vegetable knowledge, or behaviours, of Australian young adults. On the basis of findings from this study, it appears that more work is needed to develop messages to effectively target this important group.