A qualitative study of Australian GPs' attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD)

Background. The importance of general practice involvement in the care of attention-deficit/hyperactivity disorder (ADHD) is increasing due to the rising numbers of patients who present with the disorder. It has been suggested by consensus bodies that GPs should be identifying and referring patients at the severe end of the ADHD spectrum and managing those with less severe symptoms. However, GPs' views of their role in ADHD care are unknown. Objective. Our aim was to explore the attitudes and practices of Australian GPs towards the diagnosis and management of ADHD. Methods. We conducted a series of focus groups to explore GPs' beliefs regarding the causes of ADHD, their perceived role in ADHD diagnosis and management and their views on the role of behaviour therapies and pharmacotherapies in ADHD management. The subjects were 28 GPs in six focus groups. Results. GPs in this study did not want to be the primary providers of care for patients with ADHD. Participants indicated a preference to refer the patient to medical specialists for diagnosis and treatment of ADHD, and expressed low levels of interest in becoming highly involved in ADHD care. Concerns about overdiagnosis and misdiagnosis of the disorder, diagnostic complexity, time constraints, insufficient education and training about the disorder, and concerns regarding misuse and diversion of stimulant medications were the reasons cited for their lack of willingness. Conclusions. The Australian GPs in this study identify a role for themselves in ADHD care which is largely supportive in nature, and involves close liaison with specialist services.

Special issue: Selected papers from the sixth IFIP 2.6 working conference on visual database systems: Guest editors' introduction

While multimedia data, image data in particular, is an integral part of most websites and web documents, our quest for information so far is still restricted to text based search. To explore the World Wide Web more effectively, especially its rich repository of truly multimedia information, we are facing a number of challenging problems. Firstly, we face the ambiguous and highly subjective nature of defining image semantics and similarity. Secondly, multimedia data could come from highly diversified sources, as a result of automatic image capturing and generation processes. Finally, multimedia information exists in decentralised sources over the Web, making it difficult to use conventional content-based image retrieval (CBIR) techniques for effective and efficient search. In this special issue, we present a collection of five papers on visual and multimedia information management and retrieval topics, addressing some aspects of these challenges. These papers have been selected from the conference proceedings (Kluwer Academic Publishers, ISBN: 1-4020- 7060-8) of the Sixth IFIP 2.6 Working Conference on Visual Database Systems (VDB6), held in Brisbane, Australia, on 29–31 May 2002.

Palliative care at home: general practitioners working with palliative care teams

Home care is the preferred option for most people with a terminal illness. Providing home care relies on good community-based services, and a general practice workforce competent in palliative care practice and willing to accommodate patients' needs. Structured palliative care training of general practitioners is needed at undergraduate and postgraduate level, with attention to barriers to teamwork and communication. Good palliative care-can be delivered to patients at home by GPs (supported by specialist palliative care teams) and community nurses, with access to an inpatient facility when required. To optimise patient care, careful planning and good communication between all members of the healthcare team is crucial.

The ambivalent practices of reflexivity

Reflexivity involves turning one's reflexive gaze oil discourse-turning language back on itself to see the Work it does in constituting the world. The subject/researcher sees simultaneously the object of her or his gaze and the means by which the object (which may include oneself as subject) is being constituted. The consciousness of self that reflexive writing sometimes entails may be seen to slip inadvertently into constituting the very (real) self that seems to contradict a focus on the constitutive power of discourse. This article explores this site of slippage and of ambivalence. In a collective biography oil the topic of reflexivity, the authors tell and write stories about reflexivity and in a doubled reflexive arc, examine themselves at work during the workshop. Examining their own memories and reflexive practices, they explore this place of slippage and provide theoretical and practical insight into what is going on in reflexive research and writing.

Globalizing policy sociology in education: Working with Bourdieu

This paper uses Bourdieu to develop theorizing about policy processes in education and to extend the policy cycle approach in a time of globalization. Use is made of Bourdieu's concept of social field and the argument is sustained that in the context of globalization the field of educational policy has reduced autonomy, with enhanced cross-field effects in educational policy production, particularly from the fields of the economy and journalism. Given the social rather than geographical character of Bourdieu's concept of social fields, it is also argued that the concept can be, and indeed has to be, stretched beyond the nation to take account of the emergent global policy field in education. Utilizing Bourdieu's late work on the globalization of the economy through neo-liberal politics, we argue that a non-reified account of the emergent global educational policy field can be provided.

An archaeobotanical perspective on Holocene plant-use practices in lowland northern New Guinea

Existing archaeobotanical and palynological records of plant use in the northern New Guinea lowlands are reviewed in light of recent work at Kuk and theoretical refocusing on plant use practice. A practice-based approach is supported as the most useful way of investigating the highly problematical area of tropical plant food production. The existing direct record of past plant use in lowland New Guinea is considered woefully inadequate to achieve this task, as is that in Near Oceania and Island Southeast Asia. Archaeobotanical methods exist to fill the void, but full implementation requires a change in general archaeological and palaeoecological practice.

Can we start to think about consensus-oriented clinical practices?

Pulmonary Vascular Research Institute

Investigation on Brazilian Clinical Practices in Rheumatoid Arthritis The Brazilian Rheumatoid Arthritis Clinical Practices Investigation-BRACTICE

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease causing significant social, medical, and economic impact. Several therapeutic regimens are available within the medical arsenal. The rational and reasoned use of various medications approved for their treatment is imperative. This study aimed to evaluate how Brazilian rheumatologists use the drugs available to combat the disease. For this, 128 Brazilian rheumatologists from public and private health services responded to an 18-item questionnaire, sent over the Internet, about different situations of drug treatment of RA. The answers helped to confirm the trends among Brazilian rheumatologists in the drug treatment of RA. The study results have shown that most Brazilian rheumatologists follow the guidelines and consensus established by the Brazilian Society of Rheumatology for the treatment of RA. A small proportion, however, start the biologic therapy in early stages of the disease, including the very early stage, as the first treatment option. Most experts use corticosteroids in low doses early in the treatment. Conclusions: This study confirms that the majority but not all Brazilian rheumatologists follow, in their daily practice, established guidelines and consensus for the treatment of RA. However, it also shows that some few rheumatologists start with anti-tumor necrosis factor therapy in very early arthritis independently of disease severity or prognostic factors.