Physical activity promotion in primary care: Bridging the gap between research and practice

Background: Aflifle a growing literature supports the effectiveness of physical activity interventions delivered in the primary care setting, few studies have evaluated efforts to increase physician counseling on physical activity during routine practice (i.e., outside the context of controlled research). This paper reports the results of a dissemination trial of a primary care-based physical activity counseling intervention conducted within the context of a larger, multi-strategy, Australian community-based, physical activity intervention, the 10,000 Steps Rockhampton Project. Methods: All 23 general practices and 66 general practitioners (GPs, the Australian equivalent of family physicians) were invited to participate. Practice visits were made to consenting practices during which instruction in brief physical activity counseling was offered, along with physical activity promotion resources (print materials and pedometers). The evaluation, guided by the RE-AIM framework, included collection of process data, as well as pre-and post-inteivention data from a mailed GP survey, and data from the larger project's random-digit-dialed, community-based, cross-sectional telephone survey that was conducted in Rockhampton and a comparison community, Results: Ninety-one percent of practices were visited by 10,000 Steps staff and agreed to participate, with 58% of GPs present during the visits. General practitioner survey response rates were 67% (n =44/66 at baseline) and 71% (n =37/52, at 14-month follow-up). At follow-up, 62% had displayed the poster, 81% were using the brochures, and 70% had loaned pedometers to patients, although the number loaned was relatively small. No change was seen in GP self-report of the percentage of patients counseled on physical activity. However, data from the telephone surveys showed a 31% increase in the likelihood of recalling GP advice on physical activity in Rockhampton (95% confidence interval [CI]=1.11-1.54) compared to a 16% decrease (95% CI=0.68-1.04) in the comparison community. Conclusions: This dissemination study achieved high rates of GP uptake, reasonable levels of implementation, and a significant increase in the number of community residents counseled on physical activity. These results suggest that evidence-based primary care physical activity counseling protocols can be translated into routine practice, although the initial and ongoing investment of time to develop partnerships with relevant healthcare organizations, and the interest generated by the overall 10,000 Steps program should not be underestimated. ((C) 2004 American journal of Preventive Medicine.

Influence of socioeconomic deprivation on the primary care burden and treatment of patients with a diagnosis of heart failure in general practice in Scotland: population based study

Objectives To examine whether there are socioeconomic gradients in die incidence, prevalence, treatment, and follow up of patients with heart failure in primary care. Design Population based study. Setting 53 general practices (307741 patients) participating in the Scottish continuous morbidity recording project between 1 April 1999 and 31 March 2000. Participants 2186 adults with heart failure. Main outcome measures Comorbid diagnoses, frequency of visits to general practitioner, and prescribed drugs. Results 2186 patients with heart failure were seen (prevalence 7.1 per 1000 population, incidence 2.0 per 1000 population). The age and sex standardised incidence of heart failure increased with greater socioeconomic deprivation, from 1.8 per 1000 population in the most affluent stratum to 2.6 per 1000 population in the most deprived stratum (odds ratio 1.44, P=0.0003). On average, patients were seen 2.4 times yearly, but follow up rates were less frequent with increasing socioeconomic deprivation (from 2.6 yearly in the most affluent subgroup to 2.0 yearly in the most deprived subgroup, P=0.00009). Overall, 812 (80.6%) patients were prescribed diuretics, 396 (39.3%) angiotensin converting enzyme inhibitors, 216 (21.4%) beta blockers, 208 (20.7%) digoxin, and 86 (8.5%) spironolactone. The wide discrepancies in prescribing between different general practices disappeared after adjustment for patient age and sex. Prescribing patterns did not vary by deprivation categories on univariate or multivariate analyses. Conclusions Compared with affluent patients, socioeconomically deprived patients were 44% more likely to develop heart failure but 23% less likely to see their general practitioner on an ongoing basis. Prescribed treatment did not differ across socioeconomic gradients.

PRN Sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service

Objective: To identify utilisation rates of prn (pro re nata) sedation in children and adolescents receiving inpatient psychiatric treatment, and to compare correlates of prn prescribing and administration. Method A retrospective chart review examined 122 medical charts from a child and youth mental health inpatient service. Results 71.3% of patients were prescribed prn sedation and 50.8% were administered prn sedation. Patients received an average of 8.0 doses of prn sedation, with 9.8% receiving 10 or more doses. Chlorpromazine and diazepam were the most commonly utilised agents. Prescribing of prn sedation was only related to use of regular medications (p < 0.01), and non-parent carers (p < 0.01). In contrast, administration of prn sedation was associated with multiple diagnoses (p < 0.01), pervasive development disorder (p < 0.01), mental retardation (p < 0.01) ADHD (p < 0.01), longer hospital admission (p < 0.01), use of atypical antipsychotics (p < 0.01) and polypharmacy (p < 0.01). Conclusions Despite lack of data to inform practice, prn sedation is widely utilised, especially in complex patients. Future research in this area needs to incorporate nurses and examine whether patients benefit from prn sedation, which drugs and dosing patterns optimise safety and efficacy, and what is the role of prn sedation in the context of other medication.

Industrial networks of the future:review of research and practice

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? Firstly, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example in assembly operations. Secondly, the increased tendency towards specialization has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies to supply niche markets. Thirdly, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than previously was the case. Fourthly, there is a continuous move towards more loosely connected entities that comprise manufacturing networks. More traditional concepts, such as the “keiretsu” and “chaibol” networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these four fundamental challenges to prepare for the industrial networks of 2020 and beyond.

A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

Capturing strategy as an everyday practice:quantitative methodologies for analysing practice data

Few works address methodological issues of how to conduct strategy-as-practice research and even fewer focus on how to analyse the subsequent data in ways that illuminate strategy as an everyday, social practice. We address this gap by proposing a quantitative method for analysing observational data, which can complement more traditional qualitative methodologies. We propose that rigorous but context-sensitive coding of transcripts can render everyday practice analysable statistically. Such statistical analysis provides a means for analytically representing patterns and shifts within the mundane, repetitive elements through which practice is accomplished. We call this approach the Event Database (EDB) and it consists of five basic coding categories that help us capture the stream of practice. Indexing codes help to index or categorise the data, in order to give context and offer some basic information about the event under discussion. Indexing codes are descriptive codes, which allow us to catalogue and classify events according to their assigned characteristics. Content codes are to do with the qualitative nature of the event; this is the essence of the event. It is a description that helps to inform judgements about the phenomenon. Nature codes help us distinguish between discursive and tangible events. We include this code to acknowledge that some events differ qualitatively from other events. Type events are codes abstracted from the data in order to help us classify events based on their description or nature. This involves significantly more judgement than the index codes but consequently is also more meaningful. Dynamics codes help us capture some of the movement or fluidity of events. This category has been included to let us capture the flow of activity over time.

Flow patterns on sieve trays

Studies into gas-liquid flow patterns were carried out on commercial scale sieve trays where the ratio of froth depth to flow path length is typical of that found in practice. Experiments were conducted on a 2.44 m diameter air-water distillation simulator, in which flow patterns were investigated by direct observation, using directional flow pointers; by water cooling, to simulate mass transfer; and by height of clear liquid measurements across the tray. The flow rates used are typical of those found in practice. The approach adopted was to investigate the effect of the gas flow on the liquid flow by comparing water only flow patterns across an unperforated tray with air-water flow patterns on perforated trays. Initial gas-liquid contacting experiments on the 6.35 mm hole tray showed that, under certain conditions, the gas flow pattern beneath the test tray can have a significant effect on the tray liquid flow pattern such that gas-driven liquid circulation was produced. This was found to be a function of this particular air-water simulator design, and as far as is known this is the first time that this phenomenon has been observed. Consequently non-uniform gas flow effects were removed by modification of the gas distribution system. By eliminating gas circulation effects, the effect of the gas flow on the separation of liquid flow was similar to that obtained on the 1.0 mm hole tray (Hine, 1990). That is, flow separation occurred at the ends of the inlet downcomer which produced large circulating zones along the tray segments both on the non-perforated and perforated trays. The air when forced through the liquid, inhibited circulating flow such that it only occurred at high water inlet velocities. With the 6.35 mm hole tray, the growth and velocity of circulating flow was reduced at high superficial air velocities, and in the experiments to simulate distillation, liquid was in forward flow over most of the tray.

Toward a theory of coordinating:creating coordinating mechanisms in practice

This paper uses a practice perspective to study coordinating as dynamic activities that are continuously created and modified in order to enact organizational relationships and activities. It is based on the case of Servico, an organization undergoing a major restructuring of its value chain in response to a change in government regulation. In our case, the actors iterate between the abstract concept of a coordinating mechanism referred to as end-to-end management and its performance in practice. They do this via five performative–ostensive cycles: (1) enacting disruption, (2) orienting to absence, (3) creating elements, (4) forming new patterns, and (5) stabilizing new patterns. These cycles and the relationships between them constitute a process model of coordinating. This model highlights the importance of absence in the coordinating process and demonstrates how experiencing absence shapes subsequent coordinating activity.

Capturing strategy as an everyday practice:quantitative methodologies for analysing practice data

Few works address methodological issues of how to conduct strategy-as-practice research and even fewer focus on how to analyse the subsequent data in ways that illuminate strategy as an everyday, social practice. We address this gap by proposing a quantitative method for analysing observational data, which can complement more traditional qualitative methodologies. We propose that rigorous but context-sensitive coding of transcripts can render everyday practice analysable statistically. Such statistical analysis provides a means for analytically representing patterns and shifts within the mundane, repetitive elements through which practice is accomplished. We call this approach the Event Database (EDB) and it consists of five basic coding categories that help us capture the stream of practice. Indexing codes help to index or categorise the data, in order to give context and offer some basic information about the event under discussion. Indexing codes are descriptive codes, which allow us to catalogue and classify events according to their assigned characteristics. Content codes are to do with the qualitative nature of the event; this is the essence of the event. It is a description that helps to inform judgements about the phenomenon. Nature codes help us distinguish between discursive and tangible events. We include this code to acknowledge that some events differ qualitatively from other events. Type events are codes abstracted from the data in order to help us classify events based on their description or nature. This involves significantly more judgement than the index codes but consequently is also more meaningful. Dynamics codes help us capture some of the movement or fluidity of events. This category has been included to let us capture the flow of activity over time.

A review of research and practice for the industrial networks of the future

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? First, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example, in assembly operations. Second, the increased tendency towards specialisation has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies for niche markets. Third, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than was previously the case. Fourth, there is becoming a continuous move towards more loosely connected entities that comprise manufacturing networks. Finally, in these networks, concepts for supply chain management should address collaboration and information technology that supports decentralised decision-making, in particular to address sustainable and green supply chains. More traditional concepts, such as the keiretsu and chaibol networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these five fundamental challenges to prepare for the industrial networks of 2020 and beyond. © 2010 Springer-Verlag London.

Industrial networks of the future:a critical commentary on research and practice

Academia has followed the interest by companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? Firstly, it seems that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example in assembly operations. Secondly, the increased tendency to specialize forces other parts of industrial networks to introduce advanced manufacturing technologies for niche markets. Thirdly, the capital market for investments in capacity and the trade in manufacturing as a commodity dominates resource allocation to a larger extent. Fourthly, there will be a continuous move toward more loosely connected entities forming manufacturing networks. More traditional concepts, like keiretsu and chaibol networks, do not sufficiently support this transition. Research should address these fundamental challenges to prepare for the industrial networks of 2020 and beyond.

Patterns of refractive change in myopic subjects during the incipient phase of presbyopia:a preliminary study

Purpose: Changes in refractive error are well documented over the typical human lifespan. However, a relatively neglected period of investigation appears to be during the late fourth decade; this is at the incipient phase of presbyopia (IP), where the amplitude of accommodation is much reduced and approaches the level where a first reading addition is anticipated. Significantly, informal clinical observation has suggested a low incidence of an unexpected abrupt increase in myopia during IP. Methods: We investigated this alleged myopic shift retrospectively by mapping the longitudinal refraction histories of normally-sighted 35-44years old British White patients previously examined in routine optometric practice. The refractive trends in the right eyes of healthy myopic subjects (spherical equivalent refraction, SER =-0.50D: N=39) were analysed relative to that point at which a first near dioptric addition was considered to be clinically useful. Results: A refractive change was evident in some subjects during IP; viz, an abrupt increase in myopic SER of between -0.50 and -0.75D. These individuals (N=8) represented 20% of the study population of myopic incipient presbyopes. Beyond the pivotal point of the first near addition the longitudinal refraction stabilized in these subjects. In contrast, and as the extent of the available longitudinal data would permit, the remaining myopic eyes maintained an approximately stable refractive trend throughout IP and beyond. Conclusions: The anatomical or physiological basis of this specific late (non-developmental) abrupt myopic refractive change is an intriguing issue. Axial (vitreous chamber elongation), corneal (contour) and lenticular (profile and index) power bases, alone or in concert, might be considered candidates for this hitherto unexplored refractive phenomenon. Although necessarily obtained under conventional conditions of central (0deg) fixation, our data might also be a reflection of the recent recognition of the possible influence of the peripheral refraction upon the axial error. Consideration of this material provides an impetus for further research, including ocular biometry, a reappraisal of ciliary zonular functional anatomy, renewed investigation of the AC/A ratio, and the extent of a centripetal refractive influence on myopia development. © 2011 The College of Optometrists.

The Aston Medication Adherence Study:mapping the adherence patterns of an inner-city population

Background: The Aston Medication Adherence Study was designed to examine non-adherence to prescribed medicines within an inner-city population using general practice (GP) prescribing data. Objective: To examine non-adherence patterns to prescribed oralmedications within three chronic disease states and to compare differences in adherence levels between various patient groups to assist the routine identification of low adherence amongst patients within the Heart of Birmingham teaching Primary Care Trust (HoBtPCT). Setting: Patients within the area covered by HoBtPCT (England) prescribed medication for dyslipidaemia, type-2 diabetes and hypothyroidism, between 2000 and 2010 inclusively. HoBtPCT's population was disproportionately young,with seventy per cent of residents fromBlack and Minority Ethnic groups. Method: Systematic computational analysis of all medication issue data from 76 GP surgeries dichotomised patients into two groups (adherent and non-adherent) for each pharmacotherapeutic agent within the treatment groups. Dichotomised groupings were further analysed by recorded patient demographics to identify predictors of lower adherence levels. Results were compared to an analysis of a self-reportmeasure of adherence [using the Modified Morisky Scale© (MMAS-8)] and clinical value data (cholesterol values) from GP surgery records. Main outcome: Adherence levels for different patient demographics, for patients within specific longterm treatment groups. Results: Analysis within all three groups showed that for patients with the following characteristics, adherence levels were statistically lower than for others; patients: younger than 60 years of age; whose religion is coded as "Islam"; whose ethnicity is coded as one of the Asian groupings or as "Caribbean", "Other Black" and "African"; whose primary language is coded as "Urdu" or "Bengali"; and whose postcodes indicate that they live within the most socioeconomically deprived areas of HoBtPCT. Statistically significant correlations between adherence status and results from the selfreport measure of adherence and of clinical value data analysis were found. Conclusion: Using data fromGP prescribing systems, a computerised tool to calculate individual adherence levels for oral pharmacotherapy for the treatment of diabetes, dyslipidaemia and hypothyroidism has been developed.The tool has been used to establish nonadherence levels within the three treatment groups and the demographic characteristics indicative of lower adherence levels, which in turn will enable the targeting of interventional support within HoBtPCT. © Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013.

Dietary analysis and patterns of nutritional supplement use in normal and age-related macular disease affected subjects:a prospective cross-sectional study

Background: Poor diet is thought to be a risk factor for many diseases, including age-related macular disease (ARMD), which is the leading cause of blind registration in those aged over 60 years in the developed world. The aims of this study were 1) to evaluate the dietary food intake of three subject groups: participants under the age of 50 years without ARMD (U50), participants over the age of 50 years without ARMD (O50), and participants with ARMD (AMD), and 2) to obtain information on nutritional supplement usage. Methods: A prospective cross-sectional study designed in a clinical practice setting. Seventy-four participants were divided into three groups: U50; 20 participants aged < 50 years, from 21 to 40 (mean ± SD, 37.7 ± 10.1 years), O50; 27 participants aged > 50 years, from 52 to 77 (62.7 ± 6.8 years), and ARMD; 27 participants aged > 50 years with ARMD, from 55 to 79 (66.0 ± 5.8 years). Participants were issued with a three-day food diary, and were also asked to provide details of any daily nutritional supplements. The diaries were analysed using FoodBase 2000 software. Data were input by one investigator and statistically analysed using Microsoft Excel for Microsoft Windows XP software, employing unpaired t-tests. Results: Group O50 consumed significantly more vitamin C (t = 3.049, p = 0.005) and significantly more fibre (t = 2.107, p = 0.041) than group U50. Group ARMD consumed significantly more protein (t = 3.487, p = 0.001) and zinc (t = 2.252, p = 0.029) than group O50. The ARMD group consumed the highest percentage of specific ocular health supplements and the U50 group consumed the most multivitamins. Conclusions: We did not detect a deficiency of any specific nutrient in the diets of those with ARMD compared with age- and gender-matched controls. ARMD patients may be aware of research into use of nutritional supplementation to prevent progression of their condition.