Assessing feasibility and acceptability of study procedures : getting ready for implementation of national stroke guidelines in out-patient health care

BACKGROUND: Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings. METHODS: The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records. RESULTS: To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting. CONCLUSION: In this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context.

Mixed-initiative decision support for care planning based on clinical practice guidelines

Care Plan On-Line (CPOL) is an intranet based system that supports a “Coordinated Care” model for chronic/complex disease management. CPOL combines provision of solicited and unsolicited advice features based on integration of the electronic medical record (EMR) with its decision support logic. The objective is to support General Practitioners (GPs) in formulating a 12-month care plan of services such that: (a) the plan is proactive and patient-centered; (b) the GP is kept in awareness of project- and diseasespecific clinical practice guidelines; and (c) the support integrates with GP workflow in a natural fashion. A key feature of our approach is to blur the distinction of EMR and decision support by presenting guidelines in layers with the top-most being a problem-oriented presentation of patient status, progressing on through to patient-independent supporting evidence. In conjunction with a degree of automated inclusion of care planning services, the system demonstrates mixed user and software initiative. We describe the CPOL deployment setting, the challenges of guideline-based clinical decision support, our approach to guideline delivery, and the CPOL architecture.

Guidelines for interviewing children during child custody evaluations

This paper offers a brief review of the current literature related to the interviewing of children during child custody evaluations. In particular, the paper highlights several key issues and concerns, and provides a series of recommendations for professionals working in this area. These recommendations (which apply to children aged 3 to 12 years) are organised under the following headings: (a) establish rapport using broad open-ended questions, (b) make the purpose and ground rules of the interview clear to the child, (c) allow the child's perspective be heard without expecting an outright custody preference, (d) demonstrate a willingness to consider all reasonable perspectives or hypotheses about what has occurred, (e) try not to exacerbate the child's stress or guilt, (f) pursue all possible explanations for a child's report, irrespective of whether there are clear signs of “coaching” or contamination, (g) obtain appropriate training in the use of forensic interviewing techniques, and (h) engage in research on the impact of children's participation in custody cases.

Poets in dialogue, dialogues in poets

Is there something noticeably peculiar about dialogues with poets when transformed into writing, be it in electronic or printed form? The pauses and hesitations, the thrust and parry, the slurrings and overlappings of ordinary speech by and large disappear. In their place is an artifice, a deliberate creation of a script, with questions and responses clearly marked for our attention. Might we be approaching a tidied duologue which, some might also cynically remark, largely reproduces a dual monologue? Moreover, when poets are in dialogue, with whom or what does the poet converse?

How well do Australian women comply with dietary guidelines?

Objective: To investigate the proportion of middle-aged Australian women meeting national dietary recommendations and its variation according to selected sociodemographic and behavioural characteristics.

Design: This cross-sectional population-based study used a food-frequency questionnaire to investigate dietary patterns and compliance with 13 commonly promoted dietary guidelines among a cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health.

Setting: Nation-wide community-based survey.

Subjects: A total of 10 561 women aged 50–55 years at the time of the survey in 2001.

Results: Only about one-third of women complied with more than half of the guidelines, and only two women in the entire sample met all 13 guidelines examined. While guidelines for meat/fish/poultry/eggs/nuts/legumes and ‘extra’ foods (e.g. ice cream, chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large percentages of women (68–88%) did not meet guidelines relating to the consumption of breads, cereal-based foods and dairy products, and intakes of total and saturated fat and iron. Women working in lower socio-economic status occupations, and women living alone or with people other than a partner and/or children, were at significantly increased risk of not meeting guidelines.

Conclusions: The present results indicate that a large proportion of middle-aged Australian women are not meeting dietary guidelines. Without substantial changes in their diets, and help in making these changes, current national guidelines appear unachievable for many women.

Rationale and design of the national benchmarking and evidence-based national clinical guidelines for chronic heart failure management programs study

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

Developing national physical activity guidelines for Australians

The process and outcome of developing National Physical Activity Guidelines for Australians is described. The guidelines provide a means of incorporating new data on physical activity into public health education.

An investigation of the development of navigation design guidelines for online educational applications delivery to a primary school audience

Despite growing interest in educational websites for children, there has been surprisingly little research conducted into the design of websites intended for a younger audience. This research aims to determine how the design principles identified in the extant body of literature, might be fused with the development practices currently employed within a focus organisation (case study organisation), to synthesise and partially validate a set of website navigation design guidelines for use when developing website navigation for primary school students, between the ages of nine and twelve years.