Knowledge-in-practice in the caring professions : multidisciplinary perspectives

Contents:  Ideas of knowledge in practice / Struan Jacobs -- Information, knowledge, and wisdom in medical practice / P. B. Greenberg -- The practice of the psychiatrist / Alex Holmes -- Social work knowledge-in-practice / Heather D'Cruz -- Disability : a personal approach / Lisa Chaffey -- Knowledge in the making : an analytical psychology perspective / Joy Norton -- Knowledge to action in the practice of nursing / Alison Hutchinson, Tracey Bucknall -- The risky business of birth / Frances Sheean and Jennifer M. Cameron -- Skills for person-centred care : health professionals supporting chronic condition prevention and self-management / Sharon Lawn and Malcolm Battersby -- Knowledge and reasoning in practice : an example from physiotherapy and occupational therapy / Megan Smith ... [et al.] -- Using knowledge in the practice of dealing with addiction : an ideal worth aiming for / Peter Miller.

An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications.
Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke.
Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke.
Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions.
Results. There was significant improvement in triage decisions (21Æ4% increase in triage category 2, p = 0Æ009; 15Æ6% decrease in triage category 4, p = 0Æ048). Frequency of assessments of respiratory rate (p = 0Æ009), heart rate (p = 0Æ022), blood pressure (p = 0Æ032) and oxygen saturation (p = 0Æ001) increased. In terms of risk management, documentation of pressure area
interventions increased by 28Æ8% (p = 0Æ006), documentation of nil orally status increased by 13Æ8% (ns), swallow assessment prior to oral intake increased by 41Æ3% (p = 0Æ003), speech pathology assessment in Emergency Department increased by 6Æ1% (ns) and there was 93Æ5 minute decrease in time to speech pathology assessment for admitted patients (ns).
Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

A validity-driven approach to the understanding of the personal and societal burden of low back pain : development of a conceptual and measurement model

Introduction: While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person’s life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual’s perspective using a validity-driven approach.
Methods: To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants’ ideas into clusters of ideas that then informed the conceptual model.
Results: One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed - Psychosocial, Physical, Treatment and Employment - each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others.
Conclusions: Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.

Disease mapping and regression with count data in the presence of overdispersion and spatial autocorrelation: a Bayesian model averaging approach

This paper applies the generalised linear model for modelling geographical variation to esophageal cancer incidence data in the Caspian region of Iran. The data have a complex and hierarchical structure that makes them suitable for hierarchical analysis using Bayesian techniques, but with care required to deal with problems arising from counts of events observed in small geographical areas when overdispersion and residual spatial autocorrelation are present. These considerations lead to nine regression models derived from using three probability distributions for count data: Poisson, generalised Poisson and negative binomial, and three different autocorrelation structures. We employ the framework of Bayesian variable selection and a Gibbs sampling based technique to identify significant cancer risk factors. The framework deals with situations where the number of possible models based on different combinations of candidate explanatory variables is large enough such that calculation of posterior probabilities for all models is difficult or infeasible. The evidence from applying the modelling methodology suggests that modelling strategies based on the use of generalised Poisson and negative binomial with spatial autocorrelation work well and provide a robust basis for inference.

A systematic approach to chronic heart failure care : a consensus statement

The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidencebased, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identifi cation of people with CHF prevents effi cient patient monitoring, limiting information to improve or optimise care. This leads to ineff ectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high quality evidence into practice.

Camera trapping: a contemporary approach to monitoring invasive rodents in high conservation priority ecosystems

Invasive rodent species have established on 80% of the world's islands causing significant damage to island environments. Insular ecosystems support proportionally more biodiversity than comparative mainland areas, highlighting them as critical for global biodiversity conservation. Few techniques currently exist to adequately detect, with high confidence, species that are trap-adverse such as the black rat, Rattus rattus, in high conservation priority areas where multiple non-target species persist. This study investigates the effectiveness of camera trapping for monitoring invasive rodents in high conservation areas, and the influence of habitat features and density of colonial-nesting seabirds on rodent relative activity levels to provide insights into their potential impacts. A total of 276 camera sites were established and left in situ for 8 days. Identified species were recorded in discrete 15 min intervals, referred to as 'events'. In total, 19 804 events were recorded. From these, 31 species were identified comprising 25 native species and six introduced. Two introduced rodent species were detected: the black rat (90% of sites), and house mouse Mus musculus (56% of sites). Rodent activity of both black rats and house mice were positively associated with the structural density of habitats. Density of seabird burrows was not strongly associated with relative activity levels of rodents, yet rodents were still present in these areas. Camera trapping enabled a large number of rodents to be detected with confidence in site-specific absences and high resolution to quantify relative activity levels. This method enables detection of multiple species simultaneously with low impact (for both target and non-target individuals); an ideal strategy for monitoring trap-adverse invasive rodents in high conservation areas.

Depression and suicidal behavior in adolescents : a multi-informant and multi-methods approach to diagnostic classification

Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification.

Carbon nanotube based elastomer composites-an approach towards multifunctional materials

The current study focuses on giving a basic understanding of tubular graphene sheets or carbon nanotubes (CNTs) and points towards their role in fabricating elastomer composites. Since the properties and the performance of CNT reinforced elastomer composites predominantly depend on the rate of dispersion of fillers in the matrix, the physical and chemical interaction of polymer chains with the nanotubes, crosslinking chemistry of rubbers and the orientation of the tubes within the matrix, here, a thorough study of these topics is carried out. For this, various techniques of composite manufacturing such as pulverization, heterocoagulation, freeze drying, etc. are discussed by emphasizing the dispersion and alignment of CNTs in elastomers. The importance of the functionalization technique as well as the confinement effect of nanotubes in elastomer media is derived. In a word, this article is aimed exclusively at addressing the prevailing problems related to the CNT dispersion in various rubber matrices, the solutions to produce advanced high-performance elastomeric composites and various fields of applications of such composites, especially electronics. Special attention has also been given to the non-linear viscoelasticity effects of elastomers such as the Payne effect, Mullin's effect and hysteresis in regulating the composite properties. Moreover, the current challenges and opportunities for efficiently translating the extraordinary electrical properties of CNTs to rubbery matrices are also dealt with.

Enhancing critical analysis and problem-solving skills in undergraduate psychology: An evaluation of a collaborative learning and problem-based learning approach

Critical analysis and problem-solving skills are two graduate attributes that are important in ensuring that graduates are well equipped in working across research and practice settings within the discipline of psychology. Despite the importance of these skills, few psychology undergraduate programmes have undertaken any systematic development, implementation, and evaluation of curriculum activities to foster these graduate skills. The current study reports on the development and implementation of a tutorial programme designed to enhance the critical analysis and problem-solving skills of undergraduate psychology students. Underpinned by collaborative learning and problem-based learning, the tutorial programme was administered to 273 third year undergraduate students in psychology. Latent Growth Curve Modelling revealed that students demonstrated a significant linear increase in self-reported critical analysis and problem-solving skills across the tutorial programme. The findings suggest that the development of inquiry-based curriculum offers important opportunities for psychology undergraduates to develop critical analysis and problem-solving skills. © 2013 The Australian Psychological Society.

Identifying the African wintering grounds of hybrid flycatchers using a multi-isotope (δ2H, δ13C, δ15N) assignment approach

Migratory routes and wintering grounds can have important fitness consequences, which can lead to divergent selection on populations or taxa differing in their migratory itinerary. Collared (Ficedula albicollis) and pied (F. hypoleuca) flycatchers breeding in Europe and wintering in different sub-Saharan regions have distinct migratory routes on the eastern and western sides of the Sahara desert, respectively. In an earlier paper, we showed that hybrids of the two species did not incur reduced winter survival, which would be expected if their migration strategy had been a mix of the parent species' strategies potentially resulting in an intermediate route crossing the Sahara desert to different wintering grounds. Previously, we compared isotope ratios and found no significant difference in stable-nitrogen isotope ratios (δ15N) in winter-grown feathers between the parental species and hybrids, but stable-carbon isotope ratios (δ13C) in hybrids significantly clustered only with those of pied flycatchers. We followed up on these findings and additionally analyzed the same feathers for stable-hydrogen isotope ratios (δ2H) and conducted spatially explicit multi-isotope assignment analyses. The assignment results overlapped with presumed wintering ranges of the two species, highlighting the efficacy of the method. In contrast to earlier findings, hybrids clustered with both parental species, though most strongly with pied flycatcher.

Mid- to late Holocene landscape change and anthropogenic transformations on Mo‘orea, Society Islands: a multi-proxy approach

Archaeology’s ability to generate long-term datasets of natural and human landscape change positions the discipline as an inter-disciplinary bridge between the social and natural sciences. Using a multi-proxy approach combining archaeological data with palaeoenvironmental indicators embedded in coastal sediments, we outline millennial timescales of lowland landscape evolution in the Society Islands. Geomorphic and cultural histories for four coastal zones on Mo‘orea are reconstructed based on stratigraphic records, sedimentology, pollen analysis, and radiocarbon determinations from mid- to late Holocene contexts. Prehuman records of the island’s flora and fauna are described utilizing landsnail, insect, and botanical data, providing a palaeo-backdrop for later anthropogenic change. Several environmental processes, including sea level change, island subsidence, and anthropogenic alterations, leading to changes in sedimentary budget have operated on Mo‘orea coastlines from c. 4600 to 200 BP. We document significant transformation of littoral and lowland zones which obscured earlier human activities and created significant changes in vegetation and other biota. Beginning as early as 440 BP (1416–1490 cal. ad), a major phase of sedimentary deposition commenced which can only be attributed to anthropogenic effects. At several sites, between 1.8 and 3.0 m of terrigenous sediments accumulated within a span of two to three centuries due to active slope erosion and deposition on the coastal flats. This phase correlates with the period of major inland expansion of Polynesian occupation and intensive agriculture on the island, indicated by the presence of charcoal throughout the sediments, including wood charcoal from several economically important tree species.

Aesthetic Approach in Single Immediate Implant-Supported Restoration

The aim of this study was to analyze the main aspects that influence the aesthetics of single immediate implant-supported restorations through a literature review on the MEDLINE database. It was observed that immediate implant-supported restorations present clinical success with aesthetic predictability demonstrated by the literature. Proper patient selection and diagnostic and multidisciplinary planning are essential and should be associated to technical ability of professional and knowledge concerning the biology of peri-implant tissues. It is suggested that provisional restoration should be immediately inserted after implant fixation to guide healing of gingival tissues with a proper emergence profile besides psychologic comfort for a patient due to immediate aesthetic reestablishment.

A complex networks approach for data clustering

This work proposes a method for data clustering based on complex networks theory. A data set is represented as a network by considering different metrics to establish the connection between each pair of objects. The clusters are obtained by taking into account five community detection algorithms. The network-based clustering approach is applied in two real-world databases and two sets of artificially generated data. The obtained results suggest that the exponential of the Minkowski distance is the most suitable metric to quantify the similarities between pairs of objects. In addition, the community identification method based on the greedy optimization provides the best cluster solution. We compare the network-based clustering approach with some traditional clustering algorithms and verify that it provides the lowest classification error rate. (C) 2012 Elsevier B.V. All rights reserved.

Petrographic approach to the study of organic microfossils from the Irati Subgroup (Permian, Parana Basin, Brazil)

Early diagenetic chert, infrequently exploited in Phanerozoic micropaleontology, was examined for organic-walled microfossils in petrographic thin sections of silicified dolostones from diverse levels and localities of the Assistencia Formation (Permian, Parana Basin) in the state of Sao Paulo, Brazil. In contrast to previous palynological studies of this formation, the use of thin sections allowed direct observation in three dimensions of common palynomorphs, as well as benthic microbial mats preserved in situ in various stages of their life cycles and degradation. As in palynological residues from the more wellknown shale of this formation, the chert contains wind-dispersed pollen grains and phytoclasts derived from terrestrial sources and planktonic cryptarchs (unornamented coccoidal unicellular or colonial palynomorphs). However, only in the chert is it possible to see much more delicate microfossils, such as abundant cyanobacteria of the in situ benthic microbiota as well as chlorophycean microalgae of the microphytoplankton. Post-depositional processes affecting the formation have destroyed all but the most resistant organic remains in the other lithologies, such that only rare, degraded pollen grains are seen in the unsilicified dolostone of the formation, and in the shale the vast majority of microfossils have been compacted to flattened disks. On the other hand, early silicification not only preserved organic remains at an incipient stage of decomposition but also impeded significant further degradation due to compaction, recrystallization, and oxidation. Thus, the petrographic study of such chert can complement traditional palynological investigations in Phanerozoic rocks by furnishing hitherto unavailable information, especially with regard to benthic organic microfossils and fragile organic-walled phytoplankton normally absent from organic residues. (C) 2011 Elsevier Ltd. All rights reserved.