850 resultados para Clinical experience


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Mindfulness is a concept which has been widely used in studies on consciousness, but has recently been applied to the understanding of behaviours in other areas, including clinical psychology, meditation, physical activity, education and business. It has been suggested that mindfulness can also be applied to road safety, though this has not yet been researched. A standard definition of mindfulness is “paying attention in a particular way, on purpose in the present moment and non-judgemental to the unfolding of experience moment by moment” [1]. Scales have been developed to measure mindfulness; however, there are different views in the literature on the nature of the mindfulness construct. This paper reviews the issues raised in the literature and arrives at an operational definition of mindfulness considered relevant to road safety. It is further proposed that mindfulness is best construed as operating together with other psychosocial factors to influence road safety behaviours. The specific case of speeding behaviour is outlined, where the psychosocial variables in the Theory of Planned Behaviour (TPB) have been demonstrated to predict both intention to speed and actual speeding behaviour. A role is proposed for mindfulness in enhancing the explanatory and predictive powers of the TPB concerning speeding. The implications of mindfulness for speeding countermeasures are discussed and a program of future research is outlined.

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Schizophrenia is a mental disorder affecting 1-2% of the population and it is estimated 12-16% of hospital beds in Australia are occupied by patients with psychosis. The suicide rate for patients with this diagnosis is higher than that of the general population. Any technique which enhances training and treatment of this disorder will have a significant societal and economic impact. A significant research project using Virtual Reality (VR), in which both visual and auditory hallucinations are simulated, is currently being undertaken at the University of Queensland. The virtual environments created by the new software are expected to enhance the experiential learning outcomes of medical students by enabling them to experience the inner world of a patient with psychosis. In addition the Virtual Environment has the potential to provide a technologically advanced therapeutic setting where behavioral, exposure therapies can be conducted with exactly controlled exposure stimuli with an expected reduction in risk of harm. This paper reports on the current work of the project, previous stages of software development and future educational and clinical applications of the Virtual Environments. (C) 2004 Elsevier Ltd. All rights reserved.

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Undernutrition is common in patients admitted for surgery and is often unrecognised, untreated and worsens in hospital. The complex synergistic relationship between nutritional status and the physiological responses to surgery puts patients at high nutritional risk. There are clear prospective associations between inadequate nutritional status and the risk of poorer outcomes for surgical patients, including infection, complications and length of stay. However, practically and ethically evidence that nutritional interventions can significantly reduce these poor outcomes is difficult to obtain. Nevertheless health professionals have a duty of care to ensure our patients are properly fed, by whatever means, to meet their physiological requirements.

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Structural health monitoring has been accepted as a justified effort for long-span bridges, which are critical to a region's economic vitality. As the most heavily instrumented bridge project in the world, WASHMS - Wind And Structural Health Monitoring System has been developed and installed on the cable-supported bridges in Hong Kong (Wong and Ni 2009a). This chapter aims to share some of the experience gained through the operations and studies on the application of WASHMS. It is concluded that Structural Health Monitoring should be composed of two main components: Structural Performance Monitoring (SPM) and Structural Safety Evaluation (SSE). As an example to illustrate how the WASHMS could be used for structural performance monitoring, the layout of the sensory system installed on the Tsing Ma Bridge is briefly described. To demonstrate the two broad approaches of structural safety evaluation - Structural Health Assessment and Damage Detection, three examples in the application of SHM information are presented. These three examples can be considered as pioneer works for the research and development of the structural diagnosis and prognosis tools required by the structural health monitoring for monitoring and evaluation applications.

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The aim of this study was to explore the experience of mental health nurses undertaking doctoral studies. The study was conducted in Victoria, Australia. A descriptive exploratory approach to inquiry was used for this study. Participants were mental health nurses who had successfully completed a doctoral qualification. Eligibility for inclusion required participants to be residing in Victoria (irrespective of where their doctoral studies were undertaken) and to have conducted their research within the domain of mental health and/or currently employed in the field of mental health nursing. Of the 20 potential participants invited, 16 accepted the invitation. Five emergent themes were explicated from narrative analyses. These themes were being a trail blazer, positioning for professional advancement, achieving a balance between competing priorities, maintaining a commitment to the development of the profession, and a point of affirmation. An understanding of the experience of undertaking doctoral studies can be used to influence the development of strategies to encourage more mental health nurses to consider undertaking a doctoral degree.

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Background: Early pregnancy loss has been linked to enduring psychological morbidity. Aims: This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method: Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures: K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results: A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions: The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage.

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Background: The “Curriculum renewal in legal education” project has been funded by the Australian Learning and Teaching Council with the core objectives being the articulation of a set of final year curriculum design principles, and the development of a model of a transferable final year program. Through these principles and the development of the model, it is anticipated that the final year experience for law students will provide greater opportunity for them to understand the relevance of their learning, and will enhance their capacity to make decisions regarding their career path. Discussion / Argument: This paper reports on the project’s progress to date, and presents an argument for the inclusion of work integrated learning (WIL) as a component of the final year experience in undergraduate law programs. The project has identified that the two principal objectives of capstone experiences are to provide closure and to facilitate transition to post-university life. Reflective practice and Bruner’s spiral curriculum model are the central theoretical foundations by which these objectives can be achieved. Experiential learning is also increasingly seen as an essential element of a capstone experience. WIL is consistent with the objectives of capstones in focusing on the transition to professional practice and providing opportunities for reflection. However, the ability of WIL to meet all of the objectives of capstones, particularly closure and integration, may be limited. Conclusions / Implications: The paper posits that while WIL should be considered as a potential component of a capstone experience, educators should ensure that WIL is not equated with a capstone experience unless it is carefully designed to ensure that all of the objectives of capstones are met. Keywords: Work-integrated learning, capstone, final year experience, law

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This paper reports on the study of passenger experiences and how passengers interact with services, technology and processes at an airport. As part of our research, we have followed people through the airport from check-in to security and from security to boarding. Data was collected by approaching passengers in the departures concourse of the airport and asking for their consent to be videotaped. Data was collected and coded and the analysis focused on both discretionary and process related passenger activities. Our findings show the interdependence between activities and passenger experiences. Within all activities, passengers interact with processes, domain dependent technology, services, personnel and artifacts. These levels of interaction impact on passenger experiences and are interdependent. The emerging taxonomy of activities consists of (i) ownership related activities, (ii) group activities, (iii) individual activities (such as activities at the domain interfaces) and (iv) concurrent activities. This classification is contributing to the development of descriptive models of passenger experiences and how these activities affect the facilitation and design of future airports.

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The learning experiences of student nurses undertaking clinical placement are reported widely, however little is known about the learning experiences of health professionals undertaking continuing professional development (CPD) in a clinical setting, especially in palliative care. The aim of this study, which was conducted as part of the national evaluation of a professional development program involving clinical attachments with palliative care services (The Program of Experience in the Palliative Approach [PEPA]), was to explore factors influencing the learning experiences of participants over time. Thirteen semi-structured, one-to-one telephone interviews were conducted with five participants throughout their PEPA experience. The analysis was informed by the traditions of adult, social and psychological learning theories and relevant literature. The participants' learning was enhanced by engaging interactively with host site staff and patients, and by the validation of their personal and professional life experiences together with the reciprocation of their knowledge with host site staff. Self-directed learning strategies maximised the participants' learning outcomes. Inclusion in team activities aided the participants to feel accepted within the host site. Personal interactions with host site staff and patients shaped this social/cultural environment of the host site. Optimal learning was promoted when participants were actively engaged, felt accepted and supported by, and experienced positive interpersonal interactions with, the host site staff.

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Prospective clinical case series of 100 patients receiving thoracoscopic anterior scoliosis correction surgery. The objective was to evaluate the relationship between clinical outcomes of thoracoscopic anterior scoliosis surgery and deformity correction using the Scoliosis Research Society (SRS) outcomes instrument questionnaire. The surgical treatment of scoliosis is quantitatively assessed in the clinic using radiographic measures of deformity correction, as well as the rib hump, but it is important to understand the extent to which these quantitative measures correlate with self-reported improvements in patients’ quality of life following surgery. A series of 100 consecutive adolescent idiopathic scoliosis patients received a single anterior rod via a thoracoscopic approach at the Mater Children’s Hospital, Brisbane, Australia. Patients completed SRS outcomes questionnaires pre-operatively and at 24 months post-operatively. There were 94 females and 6 males with a mean age of 16.1 years. The mean Cobb angle improved from 52º pre-operatively to 25º post-operatively (52%) and the mean rib hump improved from 16º to 8º (51%). The mean total SRS score for the cohort was 99.4/120. None of the deformity related parameters in the multiple regression were significant. However, patients with the lowest post-operative major Cobb angles reported significantly higher SRS scores than those with the highest post-operative Cobb angles, but there was no difference on the basis of rib hump correction. There were no significant differences between patients with either rod fractures or screw-related complications compared to those without complications.

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To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic? The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add? The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners? Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.

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The Paediatric Spine Research group was formed in 2002 to perform high quality research into the prevention and management of spinal deformity, with an emphasis on scoliosis. The group has successfully built collaborative bridges between the scientific and research expertise at QUT, and the clinical skills and experience of the spinal orthopaedic surgeons at the Mater Children’s Hospital in Brisbane. Clinical and biomechanical research is now possible as a result of the development of detailed databases of patients who have innovative and unique surgical interventions for spinal deformity such as thoracoscopic scoliosis correction, thoracoscopic staple insertion for juvenile idiopathic scoliosis and minimally invasive growing rods. The Mater in Brisbane provides these unique datasets of spinal deformity surgery patients, whose procedures are not being performed anywhere else in the Southern Hemisphere. The most detailed is a database of thoracoscopic scoliosis correction surgery which now contains 180 patients with electronic collections of X-Rays, photographs and patient questionnaires. With ethics approval, a subset of these patients has had CT scans, and a further subset have had MRI scans with and without a compressive load to simulate the erect standing position. This database has to date contributed to 17 international refereed journal papers, a further 7 journal papers either under review or in final preparation, 53 national conference presentations and 35 international conference presentations. Major findings from selected journal publications will be presented. It is anticipated that as the surgical databases grow they will continue to provide invaluable clinical data which will feed into clinically relevant projects driven by both medical and engineering researchers whose findings will benefit spinal deformity patients and scientific knowledge worldwide.

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For some time we have jokingly referred to our network jamming research with jam2jam as ‘Switched on Orff’ (Brown, Sorensen and Dillon 2002; Dillon 2003; Dillon 2006; Dillon 2006; Brown and Dillon 2007). The connection with electronic music and Wendy Carlos’ classic work ‘Switched on Bach’ was obvious; we were using electronic music in schools and with children. The deeper connection with Orff however was about recognising that electronic music and instruments could have cultural values and knowledge embedded in their design and practice in same way as what has come to be known as the Orff method (Orff and Keetman 1958-66). However whilst the Orff method focuses upon Western art music perceptual framework electronic instruments have the potential to have more fluid musical environments and even to move to interdisciplinary study by including visual media. Whilst the Orff method focused on making sense of Western art music through experience electronic environments potentially can make sense of the world of multi media that pervades our lives.