Patient anxiety and IV sedation in Northern Ireland

Background In recent years there has been an increase in the provision of conscious sedation, which is said to be a safe and effective means of managing the anxious patient. However, there are no guidelines to aid the dental practitioner in assessing the patient's need for sedation based on their level of anxiety.

Aims and methods The present study investigated the importance of patient anxiety as an indicator for IV sedation, using focus groups to inform the development of narrative vignettes. Ninety-nine practitioners responded to a series of scenarios to determine whether the level of patient anxiety and the patient's demand for IV sedation influenced their decision making.

Results Level of dental anxiety had a stronger influence on the clinician's decision making than patient demand, with increasing levels of dental anxiety being positively associated with the likelihood of clinicians indicating a need for IV patient sedation and also, the likelihood of clinicians providing IV sedation to these patients. Only 14% (n = 14) of respondents reported formally assessing dental anxiety.

Conclusions While dental anxiety is considered to be a key factor in determining the need for IV sedation, there is a lack of guidance regarding the assessment of anxiety among patients.

Rewarding Merit in Judicial Appointments?: A research project undertaken by the School of Law, Queen’s University Belfast for the Northern Ireland Judicial Appointments Commission

This research involved carrying out an online survey using a number of vignettes/scenarios to explore understandings and attitudes to judicial appointments. This sort of survey is relatively novel in this context and provided a useful way of understanding how a range of factors such as merit and seniority, career paths and connections, as well as gender and visibility, are perceived as operating within the appointments system. The research also involved a series of focus group interviews with a number of individuals with various professional backgrounds and at different levels of seniority. These, and a limited number of individual interviews, afforded an opportunity to explore more closely some of the themes arising from the scenarios as well as a chance to look in some depth at some of the views and concerns of a range of members of the legal professions.

Building upon the previous research project, this work was less concerned with revisiting earlier themes and more interested in exploring how the idea of “merit” as a governing factor in judicial appointment is seen as working in practice, and whether it is perceived as being most likely to be found within particular career profiles. We also investigated issues such as the possible development of formal and informal pathways to a judicial career and practical problems such as how an applicant might become known to the senior judiciary, and the importance of this. Overall our interest was primarily in developing an understanding of how gender is perceived to operate in the appointments process and how any barriers to recruiting women, particularly to the senior judiciary, could be further broken down.

Where would you turn for help?:Older adults' awareness of community support services

Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.

Social determinants of older adults' awareness of community support services in Hamilton, Ontario

Community support services (CSSs) have been developed in Canada and other Western nations to enable persons coping with health or social issues to continue to live in the community. This study addresses the extent to which awareness of CSSs is structured by the social determinants of health. In a telephone interview conducted in February-March 2006, 1152 community-dwelling older adults (response rate 12.4%) from Hamilton, Ontario, Canada were made to read a series of four vignettes and were asked whether they were able to identify a CSS they may turn to in that situation. Across the four vignettes, 40% of participants did name a CSS as a possible source of assistance. Logistic regression was used to determine factors related to awareness of CSSs. Respondents most likely to have awareness of CSS include the middle-aged and higher-income groups. Being knowledgeable about where to look for information about CSSs, having social support and being a member of a club or voluntary organisations are also significant predictors of awareness of CSSs. Study results suggest that efforts be made to improve the level of awareness and access to CSSs among older adults by targeting their social networks as well as their health and social care providers. © 2011 Blackwell Publishing Ltd.

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

Objective
This study aimed to evaluate the extent to which patient-related factors and physicians' country of practice (Northern Ireland [NI] and the Republic of Ireland [RoI]) influenced decision making regarding medication use in patients with end-stage dementia.

Methods
The study utilised a factorial survey design comprising four vignettes to evaluate initiating/withholding or continuing/discontinuing specific medications in patients with dementia nearing death. Questionnaires and vignettes were mailed to all hospital physicians in geriatric medicine and to all general practitioners (GPs) in NI (November 2010) and RoI (December 2010), with a second copy provided 3 weeks after the first mailing. Logistic regression models were constructed to examine the impact of patient-related factors and physicians' country of practice on decision making. Significance was set a priori at p ≤ 0.05. Free text responses to open questions were analysed qualitatively using content analysis.

Results
The response rate was 20.6% (N = 662) [21.1% (N = 245) for GPs and 52.1% (N = 38) for hospital physicians in NI, 18.3% (N = 348) for GPs and 36.0% (N = 31) for hospital physicians in RoI]. There was considerable variability in decision making about initiating/withholding antibiotics and continuing/discontinuing the acetylcholinesterase inhibitor and memantine hydrochloride, and less variability in decision making regarding statins and antipsychotics. Patient place of residence and physician's country of practice had the strongest and most consistent effects on decision making although effect sizes were small.

Conclusions
Further research is required into other factors that may impact upon physicians' prescribing decisions for these vulnerable patients and to clarify how the factors examined in this study influence prescribing decisions.

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

OBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

DESIGN: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

RESULTS: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

CONCLUSIONS: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

Comparing Social Work Students' Perceptions of Risk Using Online Discussion Fora: Lessons Learned from a European Pilot Project

Comparisons of international child welfare systems have identified two basic orientations to practice; a ‘child protection’ orientation and a ‘child welfare’ orientation, which are founded upon fundamentally different values and assumptions regarding the family, the origins of child care problems, and the proper role of the state in relation to the family. This paper describes a project which sought to compare how undergraduate social work students from three European Universities perceive risk in referrals about the welfare of children and to explore the impact of different cultural, ideological and educational contexts on the way in which risk is constructed by students. Students from Northern Ireland, Germany and Poland examined three vignettes via ten online discussion fora each of which provided a narrative summary of their discussion. The paper presents some findings from the analysis of the qualitative data emerging from the student discussions and draws out the lessons learned in terms of how the project was designed and implemented using online discussion fora.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

Introduction
Standard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.

Methods
The Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.

Discussion
This trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

Quête transpersonnelle et trajectoire identitaire dans la tension des paradigmes éducatifs : autoethnographie d'une éducatrice de la génération des baby-boomers

Cette thèse s'inscrit dans un paradigme compréhensif et herméneutique et dans une démarche de recherche qualitative. Elle utilise l'autoethnographie comme méthodologie. L'autoethnographie cherche à comprendre une histoire singulière sociohistoriquement inscrite dans des contextes culturels déterminés L'autoethnographie est à la fois une méthode de recherche, un style d'écriture, une oeuvre et une aventure transformatrice à travers laquelle la chercheure devient le sujet de son histoire. Ici, c'est la vie et l'expérience de la chercheure qui constitue le corpus des données. L'autoethnographie offr une invitation sensible à créer une relation dynamique entre la personne qui raconte son histoire et ses lecteurs. C'est une approche originale, qui fait appel à la vulnérabilité, à la sincérité et à l'authenticité de la chercheure. Le style d'écriture vise à décrire, à montrer et invite à pénétrer la réalité de l'expérience plutôt qu'à théoriser, expliquer ou défendre des certitudes. Cette thèse dévoile la quête transpersonnelle du sujet-chercheure qui traverse une vie d'élève, de mère, d'enseignante, d'étudiante, de formatrice d'adultes et, enfin, d'enseignante en formation initiale à l'enseignement. Une quête vécue dans la culture de l'éducation et qui s'est actualisée à travers des moments clés où se joue, dans et pour la chercheure, une tension entre des approches éducatives centrées sur la personne et son potentiel, et d'autres approches centrées sur les instruments, les contenus et l'évaluation. Cette autoethnographie est présentée sous forme de vignettes qui offrnt au lecteur l'accès à des moments significatifs de vie. La production des données s'est faite à l'aide d'outils variés tels le journal de recherche, le récit de vie, des récits phénoménologiques, des photographies, des poésies, des extraits de travaux d'étudiantes, des documents et des articles. Ces données ont été analysées et interprétées de manière qualitative et en mode écriture en vue de permettre une meilleure compréhension de l'autrice et de sa praxis.

Several Interruptions: Web commission for the relaunch of The Arts Council of England website

Several Interruptions, which collages together online videos in which people are seen holding their breath underwater, is both interruption (as its name suggests) as well as documentary, in which the seemingly mundane and numerous has been made back into something unique and original. Thomson & Craighead have personally chosen, from some 61,000 possible files on YouTube, videos which they have edited together into brief vignettes which interrupt each other sequentially (in time) and laterally (on-screen).

A aceitação de alunos com necessidades educativas especiais passados 6 anos da implementação do Decreto-Lei nº3/2008:opinião de educadores de infância e de professores do 1ºciclo

Objetivo: A compreensão da Educação Especial no paradigma da inclusão envolve vontade política e social e mobiliza necessariamente os profissionais de educação, sendo fundamental conhecer a sua opinião. Em Portugal, o Decreto-Lei n.º 3/2008 trouxe mudanças significativas no papel dos docentes do ensino regular, pelo que este estudo tem como objetivo, passados 6 anos da implementação, descrever a opinião de educadores e professores do 1º ciclo acerca da inclusão de alunos com Necessidades Educativas Especiais e conhecer os fatores que justificam as suas opiniões. Método: Foram inquiridos 244 docentes, 122 educadores de infância e 122 professores do 1º ciclo de escolas públicas e privadas, da Área Metropolitana do Porto, os instrumentos usados foram uma folha de caracterização individual e um questionário de vinhetas com descrições do funcionamento de crianças, onde os respondentes se posicionavam, para cada uma, quanto à sua aceitação nas salas. Resultados /Discussão: Os resultados apontam que as vinhetas que descreviam funcionamentos de crianças compatíveis com Perturbação de Espetro de Autismo e Paralisia Cerebral, foram as menos, sendo as justificações a falta de formação e a impossibilidade de despender o tempo necessário devido à exigência de bons resultados académicos. Aferimos que a formação em Educação Especial apenas estava associada à aceitação de alunos com Paralisia Cerebral. Aferimos que a função do docente-educador vs professor do 1ºciclo- apenas é influenciadora de aceitação no caso de alunos com Perturbação de Espetro de Autismo, Paralisia Cerebral e Atraso Global de Desenvolvimento/Dificuldades de Aprendizagem. O facto de se tratar de uma escola pública ou privada influencia a aceitação dos alunos, com os docentes do ensino privado a evidenciarem maior aceitação dos alunos do que os do ensino público.

Benchmarking therapeutic drug monitoring software: A review of available computer tools

Therapeutic drug monitoring (TDM) aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic and clinical capabilities. Bayesian calculations currently represent the gold standard TDM approach but require computation assistance. In recent decades computer programs have been developed to assist clinicians in this assignment. The aim of this survey was to assess and compare computer tools designed to support TDM clinical activities. The literature and the Internet were searched to identify software. All programs were tested on personal computers. Each program was scored against a standardized grid covering pharmacokinetic relevance, user friendliness, computing aspects, interfacing and storage. A weighting factor was applied to each criterion of the grid to account for its relative importance. To assess the robustness of the software, six representative clinical vignettes were processed through each of them. Altogether, 12 software tools were identified, tested and ranked, representing a comprehensive review of the available software. Numbers of drugs handled by the software vary widely (from two to 180), and eight programs offer users the possibility of adding new drug models based on population pharmacokinetic analyses. Bayesian computation to predict dosage adaptation from blood concentration (a posteriori adjustment) is performed by ten tools, while nine are also able to propose a priori dosage regimens, based only on individual patient covariates such as age, sex and bodyweight. Among those applying Bayesian calculation, MM-USC*PACK© uses the non-parametric approach. The top two programs emerging from this benchmark were MwPharm© and TCIWorks. Most other programs evaluated had good potential while being less sophisticated or less user friendly. Programs vary in complexity and might not fit all healthcare settings. Each software tool must therefore be regarded with respect to the individual needs of hospitals or clinicians. Programs should be easy and fast for routine activities, including for non-experienced users. Computer-assisted TDM is gaining growing interest and should further improve, especially in terms of information system interfacing, user friendliness, data storage capability and report generation.

Psychothérapies de groupe d'auteurs de violence sexuelle: intérêt d'un traitement de groupe combiné avec un suivi individuel

Parmi les traitements psychothérapeutiques destinés aux auteurs de violence sexuelle, les psychothérapies de groupe se sont avérées d'emblée une modalité thérapeutique pertinente. Sur un plan psychodynamique, les psychothérapies de groupe sont souvent proposées en parallèle à un suivi individuel. Toutefois, les effets de la combinaison d'un suivi de groupe à un suivi individuel n'ont été que peu étudiés. Au travers de vignettes cliniques extraites de séances individuelles et de groupe, cet article a pour but de présenter les effets sur le déroulement de suivis psychothérapeutiques psychodynamiques proposés à des auteurs de violences sexuelles. Enfin, au vu de l'effet positif constaté, la pertinence et l'indication d'un tel dispositif sont discutées.

« Le Livre de mendicité espirituelle, composé par maistre JEHAN JARSON ».

Commençant par : « Ma povre, ma malade, ma chartriere... » et finissant par : «... pardurablement adorer, qui vivis per infinita secula. Amen » .

Français 1989

Contient : 1° « La Dances aux aveugles », par « MICHAULT » ; 2° « L'Abusé en cour » [par RENE D'ANJOU]