Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

Background Patients' health related quality of life (HRQoL) has rarely been systematically monitored in general practice. Electronic tools and practice training might facilitate the routine application of HRQoL questionnaires. Thorough piloting of innovative procedures is strongly recommended before the conduction of large-scale studies. Therefore, we aimed to assess i) the feasibility and acceptance of HRQoL assessment using tablet computers in general practice, ii) the perceived practical utility of HRQoL results and iii) to identify possible barriers hindering wider application of this approach. Methods Two HRQoL questionnaires (St. George's Respiratory Questionnaire SGRQ and EORTC QLQ-C30) were electronically presented on portable tablet computers. Wireless network (WLAN) integration into practice computer systems of 14 German general practices with varying infrastructure allowed automatic data exchange and the generation of a printout or a PDF file. General practitioners (GPs) and practice assistants were trained in a 1-hour course, after which they could invite patients with chronic diseases to fill in the electronic questionnaire during their waiting time. We surveyed patients, practice assistants and GPs regarding their acceptance of this tool in semi-structured telephone interviews. The number of assessments, HRQoL results and interview responses were analysed using quantitative and qualitative methods. Results Over the course of 1 year, 523 patients filled in the electronic questionnaires (1–5 times; 664 total assessments). On average, results showed specific HRQoL impairments, e.g. with respect to fatigue, pain and sleep disturbances. The number of electronic assessments varied substantially between practices. A total of 280 patients, 27 practice assistants and 17 GPs participated in the telephone interviews. Almost all GPs (16/17 = 94%; 95% CI = 73–99%), most practice assistants (19/27 = 70%; 95% CI = 50–86%) and the majority of patients (240/280 = 86%; 95% CI = 82–91%) indicated that they would welcome the use of electronic HRQoL questionnaires in the future. GPs mentioned availability of local health services (e.g. supportive, physiotherapy) (mean: 9.4 ± 1.0 SD; scale: 1 – 10), sufficient extra time (8.9 ± 1.5) and easy interpretation of HRQoL results (8.6 ± 1.6) as the most important prerequisites for their use. They believed HRQoL assessment facilitated both communication and follow up of patients' conditions. Practice assistants emphasised that this process demonstrated an extra commitment to patient centred care; patients viewed it as a tool, which contributed to the physicians' understanding of their personal condition and circumstances. Conclusion This pilot study indicates that electronic HRQoL assessment is technically feasible in general practices. It can provide clinically significant information, which can either be used in the consultation for routine care, or for research purposes. While GPs, practice assistants and patients were generally positive about the electronic procedure, several barriers (e.g. practices' lack of time and routine in HRQoL assessment) need to be overcome to enable broader application of electronic questionnaires in every day medical practice.

Comparison of cost and outcome of care in patients with low back pain who are managed by physicians or physical therapists in private practice

The purpose of this study was to determine if there were differences in the cost and outcome of care in patients with low back pain who were managed by physicians or physical therapists in private practice in the state of Arizona. A secondary purpose was to describe the current status of private practice physical therapy clinicians who treat patients with low back pain.^ A Survey on Practice was mailed to 194 physical therapists who were listed by the American Physical Therapy Association as being in private practice in Arizona. Eighty-three percent of the surveys were returned after three attempts. Of those which were returned, 72 were complete and included in the analysis.^ The 72 practices were screened to determine those eligible for the second phase of the study. Those eligible for the second phase numbered 52 clinics. Twenty-six practices agreed to participate; however, only 21 did participate. Clinics which participated were sent packets of information which were to be kept on each patient seen with a complaint of low back pain during a three month period. Packets contained a patient-oriented survey on functional activity to be completed before and after the physical therapy course of treatment, as well as a log which was completed by the physical therapist on the type of care given to the patient and an assessment of the outcome of treatment. The patient was asked to fill out a satisfaction survey relative to the care received from the physical therapist and physician, if applicable.^ Although 259 patients were entered into the study, 210 patient logs were available for analysis. Results indicated that generally, there was no difference in cost or outcome as measured by the final functional score, change between the initial and final functional scores, or the therapist-rated outcome between the patients who were managed by physicians or physical therapists when controlling for age and length of time the patient was experiencing pain. Patients were more satisfied with care received from physical therapists as compared to physicians. Age and length of pain were good predictors of the type of referral patients received according to a logistic regression procedure. The initial disability score (IRS) and the time spent in the facility predicted therapist-rated outcome, a good or poor final disability score (FRS), and a good or poor change score. In addition, age predicted FRS and change scores. The time that the therapist spent in direct contact with the patient also predicted the change score.^ These findings of no difference in the cost and outcome of care were discussed as they relate to the practice of medicine and physical therapy. ^

A practice-based culminating experience with Texas Children's Hospital: A hospital's journey to baby-friendly status

Breastfeeding and the use of human milk are widely accepted as the most complete form of nutrition for infants. Breastfeeding is shown to be associated with many positive health outcomes for both infants and mothers. Healthy People 2000 goals to increase breastfeeding rates in the early postpartum period to 75% fell short, with only 64% of mothers meeting this objective. Lack of support from healthcare providers, and unsupportive hospital policies and practices are noted as barriers to the initiation and duration of breastfeeding. The purpose of this study was to evaluate implementation of the BFHI Ten Steps to Successful Breastfeeding at Texas Children's Hospital. ^ The Baby-Friendly Hospital Initiative (BFHI) was developed in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF) to ensure that healthcare facilities offering maternity services adhere to the Ten Steps of Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, and create legislation to protect the rights of breastfeeding women. The instrument used in this study was the BFHI 100 Assessment Tool created by Dr. Laura Haiek, Director of Public Health in Monteregie, Quebec, and her staff at Health and Social Services Agency of Quebec. The BFHI 100 tool utilizes 100 different indicators of compliance with BFHI through questionnaires administered to staff and administrators, pregnant and postpartum mothers, and an observer. ^ The study concluded that although there is much room for improvement in educating breastfeeding mothers, overall, the mothers interviewed were satisfied with their level of care in regards to breastfeeding support. Areas of improvement include staff training, as some nursing staff admitted to relying on the lactation consultants to provide most of the breastfeeding education for mothers. Only a small percentage of mothers interviewed reported that their baby “roomed-in” on average of 22 hours per day during their hospital stay. Staff encouragement of the rooming-in practice will help to increase the proportion of mothers who allow their babies to room-in. The current breastfeeding policy will also need to be revised and strengthened to be compliant with the Ten Steps. Ideally, Baby-Friendly practices will become the norm after staff are trained and policy revisions are made. Staff training and acceptance of breastfeeding as optimal nutrition for infants are the most critical factors that will ultimately drive change for the organization. ^

Screening for hypercholesterolemia in family practice

The purpose of this study was twofold: (1) To see if there was any difference in screening for hypercholesterolemia in a Family Practice setting after two national recommendations of 1985 and 1988. (2) To see if presence of coronary heart disease (CHD) risk factors e.g. smoking, hypertension, family history of heart disease, diabetes mellitus, and obesity influenced screening for hypercholesterolemia.^ A retrospective chart auditing was done at the Baylor College of Medicine, Family Practice Center, Houston for the years of 1985, 1986 and 1989. Statistically significant improvement in screening was observed in 1989 (after the second NCEP recommendations of 1988) compared to 1986 data (after the first national recommendations of 1985). But the proportion of target population screened (about 35%) was still far below the NCEP recommendations. Probably due to the small number of patients with CHD risk factors, no significant statistical differences were found in screening for hypercholesterolemia in 1985, 1986 and 1989 in patients with any CHD risk factor. ^

Dealing in practice with hot-spots

The hot-spot phenomenon is a relatively frequent problem in current photovoltaic generators. It entails both a risk for the photovoltaic module's lifetime and a decrease in its operational efficiency. Nevertheless, there is still a lack of widely accepted procedures for dealing with them in practice. This paper presents the IES UPM observations on 200 affected modules. Visual and infrared inspection, electroluminescence, peak power and operating voltage tests have been accomplished. Hot-spot observation procedures and well defined acceptance and rejection criteria are proposed, addressing both the lifetime and the operational efficiency of the modules. The operating voltage has come out as the best parameter to control effective efficiency losses for the affected modules. This procedure is oriented to its possible application in contractual frameworks.

Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors

Objective: To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom.

Análise de métodos de avaliação de eco eficiência.

Para que a sustentabilidade seja gerenciada e praticada de maneira efetiva, ela deve ser mensurada, utilizando-se de métodos de avaliação da sustentabilidade. Estão disponíveis diferentes métodos de avaliação, que geralmente reduzem o resultado desse levantamento à indicadores de desempenho ambiental, econômico e social (POPEA; ANNANDALE; MORISON-SAUNDERSB, 2004). Uma das denominações mais bem aceitas e difundidas para a conjunção da dimensão ambiental e econômica é conhecida por avaliação de eco eficiência (AEE). Eco eficiência é o \"aspecto da sustentabilidade que relaciona o desempenho ambiental de um sistema de produto ao valor do sistema de produto\" (ISO, 2012). Estão disponíveis diferentes métodos de AEE, porém sem evidência das suas semelhanças e particularidades e como essas características influenciam na escolha do método mais adequado de AEE em relação às potenciais aplicações O objetivo desta pesquisa é, portanto, analisar e indicar os tipos de métodos de avaliação de eco eficiência (AEE) mais adequados para ações gerenciais nas quais caibam tais abordagens. Foram selecionados onze métodos de AEE, a partir do estabelecimento de critérios de caracterização desses métodos, a saber: BASF, Bayer, EcoWater, Hahn et al., Kuosmanen e Kortelainen, MIPS, NRTEE, UN ESCAP, UN, TU Delft, e WBCSD. Identificaram-se, ainda, quatro potenciais aplicações: (i) Monitoramento de processo com vistas à melhoria contínua; (ii) Selecção e classificação de produtos; (iii) Atendimento a requisitos legais e outros requisitos; e, (iv) Marketing, rotulagem de produtos e comunicação ambiental. A partir dos elementos metodológicos estabelecidos pela norma ISSO 14045 (2012) e do conhecimento obtido dos métodos de AEE, determinaram-se quatro requisitos pelos quais os métodos e os potenciais aplicações foram avaliados: (i) Tipo de indicador de desempenho ambiental; (ii) Tipo de indicador de valor de sistema de produto; (iii) Abrangência de aplicação; e, (iv) Tipo de indicador de eco eficiência. Aplicando-se estes requisitos nos métodos de AEE e nos potenciais usos, concluiu-se que quanto à aplicações em termos de monitoramento de processos com vistas à melhoria continua os métodos de AEE recomendados foram Bayer, NRTEE, WBCSD e UN. Para situações de seleção e classificação de produtos os métodos BASF, EcoWater, Kuosmanen e Kortelainen, MIPS, Hahn et al., TU Delft, UN ESCAP e UN demonstraram ter boa aderência. No que se refere a usos voltados ao atendimento de requisitos legais e/ou de outras naturezas, os métodos NRTEE, WBCSD e UN são os mais indicados. Em aplicações de marketing, rotulagem e comunicação foram indicados os métodos BASF, EcoWater e MIPS. Finalmente, concluiu-se que, para a escolha adequada da metodologia para uma AEE, conhecimento prévio das características de cada abordagem é necessário.

The autonomy of the EU legal order and the law-making activities of international organizations. Some examples regarding the Council most recent practice. Research Papers in Law 03/2012

[Introduction.] It is generally believed that while the principle of the autonomy of the EU legal order, in the sense of constitutional and institutional autonomy that is to say what concerns the autonomous decision-making of the EU, has been clearly strengthened by the most recent jurisprudence of the Court of Justice (eg. Moxplant3, Intertanko or the Kadi/Al Baraakat judgements or the Opinion 1/2009 of the CJEU etc.) as well as, in my opinion, in many aspects by the Treaty of Lisbon, it is still valid to add that the principle of a favourable approach, stemming from the Court jurisprudence, for the enhanced openness of the EU legal order to international law has remained equally important for the EU4. On the other hand, it should be also seen that in a globalized world, and following the increased role of the EU as an international actor, its indispensable and crucial role concerning the creation of world (legal) order in many policy fields ( for example let's think about the G20 issues, the global economic and financial crisis, the role of the EU in promoting and protecting human rights worldwide, the implementation of the multilateral or regional conventional law, developed in the framework the UN (e.g. in the field of agriculture or environment etc) or what concerns the Kyoto process on climate change or the conservation of marine biological resources at international level etc), it seems reasonable and justified to submit that the influence, for example, of the law-making activities of the main stakeholder international organizations in the mentioned policy-areas on the EU (especially on the development of its constantly evolving legal order) or vice-versa the influence of the EU law-making practice on these international organizations is significant, in many aspects mutually interdependent and more and more remarkable. This tendency of the 21st century doesn't mean, however, in my view, that the notion of the autonomy of the EU legal order would have been weakened by this increasing interaction between international law and EU law over the passed years. This contribution is going to demonstrate and prove these departuring points by giving some concrete examples from the most recent practice of the Council (all occuring either in the second half of 2009 or after the entry into force of the Lisbon Treaty), and which relate to two very important policy areas in the EU, namely the protection of human rights and the Common Fishery Policy.

The machinist dictionary; the authoritative handbook of terms, definitions, and accepted standards of the machinist craft and industry.

Mode of access: Internet.

New technologies and journalism practice in Nigeria and Ghana

New technologies are generally perceived as the basic tool for survival in modern society. But the extent of their availability and use, as well as their impact on newspaper journalism practice in West Africa is unknown. This paper presents the results of a study that investigated the impact of new technologies on newspaper journalism practice in two West African countries — Nigeria and Ghana. The study, conducted in five newspapers in the two countries, found that, although a majority of the journalists believed the new technologies have improved the quality of their newspapers, fewer than half of the journalists were unimpressed with the level of the technologies available to them in the performance of their duties.

Primary personality trait correlates of religious practice and orientation

The aim of the study was to examine the relationships between Eysenck's primary personality factors and various aspects of religious orientation and practice. Some 400 UK undergraduates completed questionnaires constructed from the Batson and Schoenrade Religious Life Inventory (Batson & Schoenrade, 1991) and the Eysenck Personality Profiler (Eysenck, Barrett, Wilson, & Jackson, 1992). As is generally found, all the religious variables correlated negatively with the higher order personality factor of psychoticism. In contrast, among the primary factors, those associated with neuroticism appeared to be the strongest indicators of religiosity. In particular, all the primary traits classically linked to neuroticism correlate positively with the quest orientation. However, fewer primary traits predict religious behaviour in regression and of these, a sense of guilt is the greatest and a common predictor of extrinsic, intrinsic and quest religiosities. Upon factor analysis of the significant personality predictors together with the three religious orientations, the orientations formed a single discrete factor, which implies that extrinsic, intrinsic and quest religiosities have more in common with one another than with any of the personality traits included in the study. This suggests that religious awareness may itself be an important individual difference that is distinct from those generally associated with models of personality. (C) 2003 Elsevier Ltd. All rights reserved.

Hegemony, Institutionalism and US Foreign Policy: theory and practice in comparative historical perspective

This paper explores the theoretical and policy implications of contemporary American hegemony. A key argument is that the development of US hegemony generally, and the distinctive turn in US foreign policy that has occurred in the wake of 11 September in particular, can best be understood by placing recent events in a comparative and historical framework. The immediate post-World War II order laid the foundations of a highly institutionalised multilateral system that provided key benefits for a number of countries while simultaneously constraining and enhancing US power. An historical reading of US hegemony suggests that its recent unilateralism is undermining the foundations of its power and influence.

Family violence: Walking the tight rope between maternal alienation and child safety

Mothers are often alienated from their children when child abuse is suspected or confirmed, whether she is the primary abuser of the child or not. An abusive or violent partner often initiates the process of maternal alienation from children as a control mechanism. When the co-occurrence of maternal and child abuse is not recognised, nurses and health professionals risk further alienating a mother from her children, which can have detrimental effects in both the short and long term. Evidence shows that when mothers are supported and have the necessary resources there is a reduction in the violence and abuse she and her children experience; this occurs even in situations where the mother is the primary abuser of her children. The family-centred care philosophy, which is widely accepted as the best approach to nursing care for children and their families, creates tension for nurses caring for children who are the victims of abuse as this care generally occurs away from the context of the family. This fragmented approach to caring for abused children can inadvertently undermine the mother-child relationship and further contribute to maternal alienation. This paper discusses the complexity of family violence for nurses negotiating the 'tight rope' between the prime concern for the safety of children and further contributing to maternal alienation, within a New Zealand context. The premise that restoration of the mother-child relationship is paramount for the long-term wellbeing of both the children and the mother provides the basis for discussing implications for nursing practice.

Is corrections correcting? An examination of prisoner rehabilitation policy and practice in Queensland

This article provides an analysis of the policy and practice of prisoner rehabilitation in Queensland, and the extent to which they accord with international best practice. Actual practice was identified through interviews and written submissions from 20 ex-prisoners and 18 prisoner service providers (including two past staff members from Queensland prisons), as well as through an examination of reported judicial review decisions and Department of Corrective Services statistics. The results demonstrate that although the legislation and procedures suggest that a best practice system of prisoner rehabilitation exists in Queensland, there is a significant gulf between policy and practice. Far from being sufficiently prepared for release, Queensland prisoners are generally released directly from high security facilities into a community which they have great difficulty reintegrating into. The results suggest that the corrective services system in Queensland is not succeeding in fulfilling its primary purpose, 'correction', or in meeting its well-publicised goal of ensuring community safety.

Directions for a troubled discipline:strategy research, teaching and practice introduction to the dialog

This Dialog responds to a growing debate about the relevance of business schools generally and the value of strategy theory and research for strategic management practice. The authors propose that academic theory and management practice can be better connected through management education. The academy researches practice, derives theory, and returns it to practice through the development of teaching materials and the teaching of current and future practitioners. The three articles in this Dialog examine how different approaches to strategy research inform strategy teaching and its application to practice. Joseph Bower explains the rise of business policy and the process research approach that informed that teaching tradition at Harvard Business School. Robert Grant responds by emphasizing the economic theory underpinnings of strategic management research and its impact on teaching. Paula Jarzabkowski and Richard Whittington conclude by proposing a strategyas-practice perspective and suggesting ways to better incorporate strategy-as-practice research into strategy teaching.